As one of the leading causes of hospitalisation among older people, fall-related injuries are a threat to the functional independence that is vital for healthy ageing. According to the World Health Organization, adults older than 60 years of age suffer the greatest number of fatal falls. The physical and cognitive changes that occur with advancing age and frailty increase the risk of a fall-related injury. Fast becoming a major global public health problem, with over 80% of fall-related fatalities occurring in low-and middle-income countries, there is an urgent need to implement prevention strategies and institute policies that minimise risk and create safe communities that enhance quality of life.
In the ageing population, falls have multifactorial causes ranging from pharmacologic, behavioural, environmental, and activity-related actions. Effective prevention programs and strategies are most often based on modifiable risk factors such as vitamin D insufficiency, gait and balance problems, vision impairment, medications linked to falls or home hazards such as improper use of an assistive device, poor lighting, lack of bathroom grab bars, or slippery surfaces.
Preventing falls requires not just a comprehensive assessment of all the factors involved, but also a multidisciplinary approach that draws on the expertise and skill set of each team member.
The National Council on Aging’s Center for Healthy Aging for Professionals publishes expert content on evidence-based programs for professionals. In a recent article, the Center highlighted the work of CAPABLE programs. CAPABLE (Community Aging in Place – Advancing Better Living for Elders) is a program developed at the Johns Hopkins School of Nursing for low-income older people to safely age in place. The approach teams a registered nurse, an occupational therapist, and a handy worker to address both the environmental factors in homes as well as the strengths of older people themselves to improve safety and independence. The in-person at home program studied over a period of five months resulted in improved health outcomes resulting in better function, lower hospitalisation rates, decreased nursing home admissions, lower disability, and decreased depression.
Effective prevention strategies first and foremost should address not only the reduction of falls but also the reduction of injuries and other consequences of falls. “A fall” is the product of a sequence of risks, including the probability of falling, learned protective responses, environmental surfaces, and the strength and resiliency of bones, tissues, and organs1. Designing an integrated care pathway for fall prevention that addresses the entire sequence is of vital importance. The National Institute for Health and Care Excellence (NICE) guidelines to identify, assess, and treat those at risk for falls cover the areas of identification and assessment of older people at risk; exercise; podiatry; vision; home assessment; medical review; and pharmacological review.
The UN Decade of Healthy Ageing focuses on changing how we think, feel and act towards age and ageing, developing communities that foster the abilities of older people, delivering integrated care, and providing older people with access to long-term care. Policies that take into consideration a cross-sectoral approach towards fall prevention services and implement them at-country level, with connections to community-based services, including physiotherapy and occupational therapy; as well as closer collaboration between governments, academia, industry, and civil society will go a long way towards reducing the rate and severity of falls and fall-related injuries.
To learn more about preventing falls to ensure healthy ageing, please contact Prof. Jean Woo, Emeritus Professor of Medicine and Director, CUHK Jockey Club Institute of Ageing | University of Hong Kong, at the IFA Expert Centre, which is a unique resource for those interested or involved in the areas of ageing, vision health, human rights, vaccination and more. To learn more about how to contribute to the critical dialogue on vision health, healthy ageing, and fall prevention, join the DR Barometer community, and connect with Dr. Supriya Venigalla (firstname.lastname@example.org).
1 Institute of Medicine (US) Division of Health Promotion and Disease Prevention; Berg RL, Cassells JS, editors. The Second Fifty Years: Promoting Health and Preventing Disability. Washington (DC): National Academies Press (US); 1992. 15, Falls in Older Persons: Risk Factors and Prevention. Available from: https://www.ncbi.nlm.nih.gov/books/NBK235613/
Prof. Jean Woo Emeritus Professor of Medicine and Director, CUHK Jockey Club Institute of Ageing
Professor Woo's research interests include chronic diseases affecting elderly people, health services research, nutrition epidemiology