Aging Well is No Accident

For seniors to live a full and natural life, it is crucial that they prevent falls and avoid accidents by making the home as safe as possible. It is important to be aware that falls, fires and car accidents are the three leading causes of accidental injury and death among seniors. The good news is that most of these accidents are easily preventable through awareness of safety measures, or through simple home improvements that make little or no impact on quality of life.

The myth of "accidental" falls

Each year more than one third of adults 65 and older suffer a serious fall. What makes this especially sobering is the fact that falls and fall-related injuries are a leading cause of death in older people—for seniors 85 and older, it's estimated that one in five falls results in death. According to research conducted by the Public Health Agency of Canada, 20 percent of injury-related deaths among seniors can be traced back to a fall.

In 2008, about 1.8 million seniors in the United States alone were treated in emergency departments for nonfatal injuries from falls, and more than 433,000 of these patients were hospitalized. Many of those who fall develop a fear of falling—even if they are not injured. This fear alone can cause seniors to modify their gait, limit their mobility and reduce their physical fitness—thereby actually increasing their risk of falling.

Until recently, most falls have been blamed on a single cause precipitated by either a medical event or an "accident" related to the environment. Today, researchers know that falls are rarely the result of an isolated event. Rather, falls are complex events caused by the interaction of both internal and external factors.

Most falls represent the end result of a series of independent and often small risks. Individually, such risks pose no harm. Young people avoid many daily mishaps so naturally that they never even realize it. Eventually however, age, disability or compromised health can make it difficult to deal with even the simplest environmental risks. Often, a fall is ready to happen long before the victim encounters the event. So it is important to recognize and correct risky fall factors—both physiological and environmental and break the chain of risk before a fall occurs.

Internal risk factors

A number of physiological and medical factors play a role in causing falls. Understanding them can help you reduce the risks they pose. Here are a few major ones.

  • Changes in muscles and bones. As we get older, changes in muscles and joints not only make movement more difficult, but also make it harder to correct for a sudden loss of balance. Similarly, loss of strength in the legs or upper arms limites the ability to transfer in and out of bed or chair - increasing the risk of falling.
  • Vision changes. As we get older it becomes harder for our eyes to adjust to varying levels of lightness and darkness. We also become more sensitive to glare. Decreased depth perception also makes it hard to distinguish high-contrast patterns from actual elevation changes. All of this means that it's much easier for us to trip and fall as we get older.
  • Balance problems. Aging naturally diminishes the body's reflexes that enable people to properly interpret and re-orient their center of gravity as they move or walk. Changes in gait (such as walking with a narrower or wider stance than usual) increase the risk of catching a foot on an obstruction.
  • Cardiovascular difficulties. Numbness in the limbs affects the ability to sense the ground; cardiovascular problems can also cause sudden loss of blood to the brain, resulting in fainting.
  • Neuropathy. As much as 8 percent of the overall population and 20 percent of the senior population suffer from some form of neuropathy. Numbness of the feet and loss of balance are part and parcel of this disease. It is especially easy for seniors with neuropathy of the feet to slip on wet or icy surfaces.
  • Medications. Many drugs (and their interactions) affect judgment and coordination. Tranquilizers can slow reflexes while other drugs increase the risk of fainting.
  • Chronic or acute diseases. Falls may often be the initial symptom of a disease. Degenerative disorders only compound the risk of falls.
  • Depression, stress or lack of sleep. Such issues can make seniors preoccupied and less alert to the dangers around them.

External risk factors

The environment (either indoors or outdoors) plays a major role in exposing seniors to falls. Falls in the bedroom, bathroom and dining areas are the most common, reflecting the amount of time spent in those areas. Relocation—such as moving between a home and a nursing facility, hospital or even a relative's home—can greatly increase the risk of falls, particularly by frail seniors. Lack of familiarity with floor surfaces and distance is only aggravated by a lack of expected visual clues for depth perception. Within these areas, here are some major items to consider and things you can do to limit the risk these environmental factors play.

  • Lighting. Is there plenty of light in every room and along hallways and in stairways? Is there emergency lighting or a flashlight within easy reach?
  • Bathroom and kitchen. Are there grab bars in the tub or shower and by the toilet? Are there non-slip bath strips or mats in the tub or shower? A bath bench and a raised toilet seat are valuable additions. In kitchens, countertops should be glare-free. Often-used items should be kept within easy reach.
  • Flooring. Are all rugs (including bathroom rugs) tacked down or secured with nonskid pads? All carpeting should be low pile. Only no-wax cleaners should be used on floors and shine should be eliminated as much as possible to reduce glare.
  • Stairways. Hand rails are a necessity on both sides of stairways and outside steps. Care must be taken to ensure these hand rails are secure, so they do not wobble and induce a loss of balance. Steps should also have non-skid treads. Marking the edge of the first and the last step with a color strip provides a helpful visual clue.
  • Furniture and living areas. Arrange furniture so that walking paths are clear. Make sure all electrical cords are out of the way. Special care should be taken to ensure that the floor is kept free of all clutter.

What you can do to lessen the risks

While specific internal and external factors seldom cause falls all by themselves, the management, reduction or elimination of each risk will help prevent these factors from overlapping and causing a fall. Research results published in the British Medical Journal in January 2008 suggest that falls can be reduced by 50 percent when an individual's risks of falling are assessed and action taken to reduce them. Here are just a few ways you can reduce the risk of falling.

  • Engage in regular physical activity. Helping seniors to remain physically active improves their balance, flexibility and strength, alleviates stress and depression, increases alertness and strengthens the heart and circulatory system. Even simple exercises such as stretching while in bed can improve the ability to stand, walk and even improve the reflexes needed to arrest impending falls. Seniors should be reminded to exercise regularly.
  • Have eyes checked by an eye doctor at least once a year. Vision changes, as well as eye diseases like glaucoma and macular degeneration, can progress rapidly as people age, making it difficult for seniors to notice hazards when walking.
  • Manage a healthy diet. While seniors tend to eat less than younger people, it's important not to skip meals. It's best to eat a wide variety of healthy foods. Limit alcohol consumption, too, since it can adversely affect alertness and coordination.
  • Monitor medications. Use a log to keep track of all current medications. Learn their side effects, especially if they affect alertness or balance, as tranquilizers do. It's best to limit or avoid physical activities when under the effects of such medications.
  • Schedule regular checkups. Even if a senior is feeling fine, it's important to have regular physical, vision and hearing exams. Eyeglasses and hearing aids should be worn as instructed and have the most up-to-date prescription.
  • Dress for success. Safety starts with sturdy shoes. Nonskid soles, flat bottoms and good support are essential. Walking around in socks or smooth soled slippers can be dangerous. Sunglasses and a broad-brimmed hat are also helpful for reducing glare.
  • Use proper equipment. A doctor, physical therapist or a medical equipment supplier can help you choose the best cane, walker or wheelchair. A power assisted seat-lift chair may be a wise furniture investment. You may also want to consider a personal emergency response device that can be self-activated, or hire a monitoring service that will call often and send help if no one responds.
  • Get the help you need to monitor safety. An in-home caregiver can greatly help reduce the risk of falls. This is especially true for older people who have Alzheimer's disease or other dementia that makes them prone to wandering.

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