Introduction
Fall prevention is health promotion. In the United States, they are the leading cause of death from accidents and the seventh leading cause of death in ≥ 65 years of age (NSC, 2021). In 2017, there were 31,190 deaths from falls in persons ≥ 65 years of age versus 5,148 cases in younger persons; thus, 85% of deaths due to falls in 13% of the population ≥ 65 years (NSC, 2021). In addition, the falls have resulted in more than 3 million visits by the elderly from the Department of Emergency Situations. Public health insurance Medicare spending on fall-related injuries alone was $ 31 billion in 2015 and will undoubtedly increase in the future (CDC, 2020). For falls, more than 40% of patients are reported to require home health care. (Florence et al., 2018) Falls, particularly multiple falls, increase the risk of injury, hospitalization, and mortality, especially in frail older adults with underlying medical conditions (such as osteoporosis) and a decrease in vital signs in daily life (e.g., urinary incontinence). Delayed complications can include decreased motor function, fear of falls, and institutionalization.
Function and quality of life may deteriorate dramatically after a fall; at least 50% of older people who were seen on an outpatient basis before a hip fracture cannot regain their previous level of mobility. After falling, older people may fear falling again, as mobility is sometimes reduced because confidence is lost. Because of this fear, some people may even avoid certain activities (e.g., shopping, cleaning). Decreased activity can increase the combination of ossification and weakness, further reducing mobility (Ganz & Latham, 2020). Isolation of the main modifiable risk factors allows one to create a fall prevention program in outpatient settings and in-home healthcare more specifically. Thus, the paper presents a structured literature review of existing evidence supporting this claim. First, it outlines risk factors that can be tackled and modified. Then, it suggests some evidence-based steps for the prevention program development. It concludes with the argument reinstatement and summary.
Modifiable Risk Factors
The following are considered modifiable risk factors for falls: low or high body mass index (BMI), physical inactivity, smoking, alcohol abuse, sleep disturbances, fear of falls, defects in shoes and clothing, environmental factors (for example, uneven or slippery surfaces), and use of unsuitable walking aids (Cuevas-Trisan, 2019). Another factor associated with the risk of falls is low vitamin D levels. Vitamin D deficiency is widespread in the U.S. and around the world. Thus, according to various researchers, it was detected in 53–97% of the population (Basatemur et al., 2017). Vitamin D deficiency is known to lead to proximal muscle weakness, which is believed to be due to secondary hyperparathyroidism and induced hypophosphatemia. Most studies provide conflicting information regarding the minimum threshold for vitamin D at which the risk of falls begins to increase. Race and ethnicity, age, and gender significantly impact the formation of the optimal level of vitamin D (Basatemur et al., 2017). Changes in movement speed, abnormal gait patterns (e.g., steppe, spastic, propulsive) increase the risk of falls. Partially modifiable RFs include depression, visual impairment, chronic pain syndrome, taking many drugs and drugs that increase the risk of falls.
Analysis of the literature showed that all activities aimed at preventing falls could be divided into five main categories: multivariate assessment of the risk of falls, impact on modifiable and partially modifiable risk factors, educational programs, changes in the home environment, and physical exercise (Cheng et al., 2018). Correcting risk factors is a fundamental goal in the prevention of falls at home. For this purpose, adequate intake of vitamin D, vision correction, use of hip protectors, intake of food supplements, drug therapy of concomitant chronic diseases are recommended (Moncada & Mire, 2017). The physician evaluates these methods in conjunction with the patient, and education and lifestyle adjustments are provided.
Patient education is an essential component of fall risk reduction interventions, both during counseling sessions and in specialized schools. Training in Fall Prevention Schools should be aimed at increasing patient awareness of diseases and factors that increase the risk of falls, forming an active attitude of patients to their disease, skills, and self-control abilities over the state of health (Chidume, 2021). Only with the active participation of patients capable of learning in their physical and mental state can effectively improve their quality of life, prevent the progression of diseases and contribute to the prolongation of active longevity. The main goals of educational programs are to educate patients in practical actions based on the information received, increase the detection of diseases that increase the risk of falls by passing diagnostic tests, increase motivation to perform therapeutic and prophylactic measures, and clarify the need for repeated training. In addition to training, patients who received recommendations from a general practitioner, a district therapist, a doctor – a specialist in the prevention of diseases leading to falls, are more motivated for examination and treatment (Chidume, 2021). The main task of training is to influence the modifiable RF with the help of the educational program.
Also, an essential condition for prevention is the modification of the home and outside environment. Changing the home environment (anti-slip tapes on carpets, handrails, good lighting in rooms, and minimal furniture) can reduce falls by up to 41% (Moncada & Mire, 2017). In addition, the use of anti-slip devices for shoes in icy conditions reduces the risk of falls in winter. Eliminating unfavorable environmental factors (improving the condition of sidewalks on streets, repairing uneven surfaces, removing garbage, installing ramps at intersections) reduces the risk of falls, thereby improving the quality of life of older people (Moncada & Mire, 2017). Their lack of knowledge of safe (ergonomic) movement increases the risk of future falls. Therefore, it is necessary to train people over 65 years of age in ergonomic rules. Patient schools should be taught how to maintain an ergonomic posture while standing, sitting, cleaning the apartment, lifting and carrying weights (such as bags), getting out of bed, and shoeing).
Older adults who exercise are less prone to falls. Therefore, a complex of physical exercises is also an integral component of measures aimed at preventing falls (Thomas et al., 2019). For patients at high risk of falls, exercise is most effective. For people, 65 years and older, physical activity includes recreational or leisure activities (such as cycling or walking) and professional activities (if the person continues to work).
Conclusion
Fall prevention programs can help decrease the number and frequency of falls. The most promising are targeted strategies aimed at changing behaviors and modifying risk factors among those living in the home. The most effective prevention of falls can be achieved by addressing multiple risk factors in individual patients. Thus, the most compelling evidence for the effectiveness of interventions to prevent falls comes from those prevention programs that reached specific groups of people at high risk and used complex interventions combined with an individualized approach. A multivariate assessment of the risk of falls in the elderly should be carried out in order to eliminate the adverse factors that increase the risk of falls.
References
Basatemur, E., Horsfall, L., Marston, L., Rait, G., & Sutcliffe, A. (2017). Trends in the diagnosis of vitamin D deficiency. Pediatrics, 139(3), e20162748.
CDC. (2020). Older Adult Falls Data. Centers for Disease Control and Prevention.
Cheng, P., Tan, L., Ning, P., Li, L., Gao, Y., Wu, Y.,… & Hu, G. (2018). Comparative effectiveness of published interventions for elderly fall prevention: a systematic review and network meta-analysis. International journal of environmental research and public health, 15(3), 498-539.
Florence, C. S., Bergen, G., Atherly, A., Burns, E., Stevens, J., & Drake, C. (2018). Medical costs of fatal and nonfatal falls in older adults. Journal of the American Geriatrics Society, 66(4), 693-698.
NSC. (2021). Older Adult Falls. Injury Facts.
Thomas, E., Battaglia, G., Patti, A., Brusa, J., Leonardi, V., Palma, A., & Bellafiore, M. (2019). Physical activity programs for balance and fall prevention in elderly: A systematic review. Medicine, 98(27), e16218.