The First 48 Hours: Preventing a Fall

Lila de Tantillo Health Guide
  • The risk of a fall is one of the greatest dangers facing older people. According to the National Institutes of Health, more than 1.6 million older adults in the United States go to the emergency room for fall-related injuries each year. A bad fall can result in severe cuts and bruises, eye injury, dislocated joints, damage to the spleen or liver, head trauma or even death - and more than one in three people age 65 or older fall each year.

    But falls pose an additional threat to individuals with osteoporosis, whose fragile bones are especially vulnerable to fracture. If you have been diagnosed with osteoporosis, taking measures to prevent falls should be a top priority within the first 48 hours after learning about your condition. In fact, one study after another has demonstrated that taking proactive actions to reduce the risk of a fall can have a major cumulative effect.
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    "The way to prevent falls in an older person is to take the list of factors that contribute to falls and go through them systematically to correct the ones you can," says Dr. Susan Nayfield, chief of the Geriatrics Branch at the National Institute on Aging in Bethesda, Md. and an expert on falls in older people. "Correcting a few contributing factors can have a big effect on correcting the total risk of a fall."

    In contrast to younger persons, who can often pinpoint a specific explanation for a fall - such as ice or an ill-fitting shoe - falls in older people tend to result from a combination of causes. "As people get older, people tend to fall not for a single reason - there are often a number of contributing factors," says Dr. Nayfield.

    Several of these factors can include natural aspects of aging such as decreases in vision, muscle mass and strength, and sensation in hands and feet. Older individuals are also more prone to diseases that can affect gait and balance, and often take medications that can make them sleepy or dizzy.

    For these reasons, safeguarding the overall health and well-being of a person with osteoporosis is crucial to helping prevent a fall. "The first way to prevent falls is to make sure the older person is as healthy as possible, and that any medical problems that could contribute to falling are adequately treated," Dr. Nayfield says.

    Taking care of your health may require complete medical checkup to screen for and treat underlying conditions, such as a heart arrhythmia, that could contribute to a spill. Patients may also discuss with their doctors reducing, eliminating or switching from sedating medications such as sleep aids or antihistamines, which could also increase the chances of a fall. Of course, don't ever stop taking prescribed medicine without discussing it with your doctor first. And another critical part of one's health is vision, and making sure your eyeglass prescription is up-to-date is key.

    In addition, individuals with osteoporosis have long been told to ensure an adequate daily calcium intake, generally 1200 mg per day. In recent years Vitamin D has also been touted as necessary for the proper absorption of calcium, and the National Osteoporosis Foundation now recommends people over 50 to consume 800-1000 international units of Vitamin D daily to help make their bones stronger. But increasing evidence has demonstrated that Vitamin D can also have some effect in actually preventing a fall.

  • The recent research indicates that Vitamin D aids in protein synthesis, helping build and repair muscle cells. This enhances muscle strength and muscle contraction, which can help you keep your feet on the ground.
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    "You're less likely to fall and therefore less likely to fracture," says Dr. Denise Houston, a nutrition epidemiologist at the Wake Forest University Baptist Medical Center. She was the lead researcher on a recent study demonstrating the connection between Vitamin D deficiency and insufficiency and poor physical performance in the medical journal Gerontology. "The Vitamin D helps muscle strength and balance, and its effects on the bone make it less likely to fracture if someone does fall."

    If you are taking a multivitamin, you may want to check to see if it includes the recommended quantities of Vitamin D, or perhaps consider taking an additional supplement.

    The next critical aspect of fall prevention is taking into account one's living environment, and making changes where necessary. While it would be unrealistic to find and correct every conceivable hazard, Dr. Nayfield advocates making a person's home as "fall-safe" as possible. A crucial aspect of this is adequate lighting, with functioning light bulbs and appropriate night lights for after dark. Rugs should be non-slip and secured. Grab bars can be installed in places where a person changes position, such as near the toilet and tub. Railings should be sturdy and clutter should be banned.

    Consider where things are stored in your home. Frequently used items should be easily accessible, not stuck in the back of a closet or in a high cabinet requiring a footstool to be reached. In some cases, a "grabber" - a long instrument with a claw that can be controlled from a handle at the other end - might be helpful.

    The final major aspect of fall prevention - although in some cases the most challenging - is the continuous use of caution and common sense. For example, individuals with osteoporosis would be well advised to avoid floppy slippers and shoes with high heels. In fact, a 2004 study in the Journal of the American Geriatric Society found that the types of footwear least associated with falls were canvas and athletic shoes. Most correlated with falls were going barefoot or in stocking feet, which can be particularly slippery and therefore dangerous. And of course, before wearing any type of shoe, ensuring the correct fit is vital.

    If the doctor has recommended an older person to use a cane or a walker, the patient should follow through on the advice rather than risk trying to walk in an unstable fashion. "If someone could benefit from an assistive device, they need to get it and use it appropriately and not be embarrassed by it," Dr. Nayfield says.

    Falls in older people result in billions of dollars spent on health care costs, and substantially reduced independence and quality of life. For the sake of your well-being, take the time to reduce your risk of a fall. By doing so, you can substantially reduce your risk of an osteoporosis-related fracture.
Published On: June 18, 2007