Fall Prevention Community Dwelling Older People

Question: Discuss about the Fall Preventionfor Community Dwelling Older People. Answer: Falls Education to Prevent Falls in Community-Dwelling Older People: A Systematic Review Introduction Falls are a devastating problem in patients who are older and are recognized to be a major health issue. Fall can be defined as coming to rest on the ground or other lower level inadvertently which does excludes the change in the position mediated with an intention to rest on furniture or another object (1). In a community, older people above 65 years of age are susceptible to fall once per year, and 50% of these people have recurrent falls (2, 3). Older people above 65 years are highly represented in 80% of the hospital admissions due to fall-induced injury (2). The susceptibility of older people towards fall and injury increases and is attributed to age-related psychological changes. Other factors include high prevalence of comorbidities and delayed functional recovery increasing the further risk of falls (4). Fall-induced injuries in community dwelling elderly patients includes functional impairment, longstanding pain, disability and death (2). Fall and its associated consequences are responsible for increasing health care costs, a significant part of which is preventable. In the year 2008, the cost due to falling induced injuries among older adults was reported to be $1.6 billion in the United Kingdom and $23.3 billion in the United States (4). The healthcare expenditure due to fall and their consequences is estimated to reach $55 billion by the year 2020 (3). The psychological consequences due to fall are many and mainly includes fear of recurrent falls, reduction in social interactions, loss of confidence, and decrease in physical function due to a self restriction of daily activities (5). Fall prevention is not an easy task. The injuries induced by fall together with disabilities and impairments complicate the whole event which may or may not increase the opportunities to fall (2). The commonly recommended interventions for fall prevention and its associated injuries are exercise programs, systemic assessments of fall risk, targeted interventions, inspection of environmental hazards, and programs for hazard reduction (6). Education programs, environmental modification, and medication optimization are other interventions for preventing falls and adverse consequences associated with it (6). Some studies have evaluated single interventions while others have used more than one component. Based on the individual risk assessment a patient can be delivered with multiple component interventions also called as multifactorial intervention or all the patients can be provided with same components also known as multiple interventions" (5). Fall prevention interventions aim at redu cing the risk of fall by minimizing the exposure to risk factor. The interventions aim for correcting the behavioral, environmental and other putative factors for risk of falls in the older community. The multifactorial intervention programs include exercises for improving balance and strength, patient education on risk factors of fall to increase awareness, modification of environment to increase patient safety and optimization of health by clinical management (7). References World Health Organization. WHO Global Report on Falls Prevention in Older Age 2007. Available from: https://www.who.int/ageing/publications/Falls_prevention7March.pdf. Kannus P, Sievnen H, Palvanen M, Jrvinen T, Parkkari J. Prevention of falls and consequent injuries in older adults. The Lancet. 2005;366(9500):1885-93. Jeon MY, Jeong H, Petrofsky J, Lee H, Yim J. Effects of a randomized controlled recurrent fall prevention program on risk factors for falls in frail elderly living at home in rural communities. Medical Science Monitor. 2014;20:2283-91. Ambrose AF, Paul G, Hausdorff JM. Risk factors for falls among older adults: a review of the literature. Maturitas. 2013;75(1):51-61. Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2012;9(11). Lee H-C, Chang K-C, Tsauo J-Y, Hung J-W, Huang Y-C, Lin S-I. Effects of a multifactorial fall prevention program on fall incidence and physical function in community-dwelling older adults with risk of falls. Archives of physical medicine and rehabilitation. 2013;94(4):606-15. e1. Steinberg M, Cartwright C, Peel N, Williams G. A sustainable programme to prevent falls and near falls in community dwelling older people: results of a randomised trial. Journal of Epidemiology Community Health. 2000;54(3):227-32.