Falls and Injury Prevention

Falls and Injury Prevention Assessment & Management

Advice for Health Professionals:

Falls and fall-related injuries are common among the older adults. Every year 30% of all adults over 65 years old will fall¹. Falls may result in functional dependence, poorer quality of life, and have been correlated with increased psychological distress, morbidity, hospitalisation, mortality, and health related costs for the individual and society².

Many falls can be prevented. All clinicians should routinely ask about falls in their interactions with older adults³. All older adults should be advised on falls prevention and physical activity. A specific note should be made on those who report concerns about their balance and/or had at least one fall within the last 12 months. In addition, older adults should be asked if they experience dizziness and/or problems with their hearing ability and cognitive function.

Engaging older adults is necessary for falls and injury prevention. Falls assessments should include understanding people’ s medical history, beliefs, attitudes, lifestyle, and priorities related to falls³. Validated subjective and objective balance tools should be implemented in the assessments. In addition, screening the ability to dual task is essential as many everyday activities and tasks involve dual tasking⁴. Research shows that even healthy older adults show a significant decline in the ability to dual task compared to healthy younger adults. Poor dual task performance has been associated with increased falls risk⁵.

Also, due to recently known age-related decline in the vestibular function and its association to increased falls, especially in adults over 80 years old⁶ as well as increased risk for Benign Paroxysmal Positional Vertigo (BPPV) in those over 65 years old⁷. Current global falls guidelines recommend asking about dizziness and screening inner ear at least for BPPV as part of balance and falls risk assessment where indicated³. A comprehensive assessment of falls and balance in older adults will require training appropriately the clinicians with simple resources.

Managing many of the risk factors for falls including gait and balance problems, have wider benefits beyond falls prevention such as improved physical and mental health, functional capacity, and quality of life. As a result of falls assessment, older adults who are at low risk for falls should be offered education about falls prevention and exercise for general health and/or falls prevention if interested by an appropriately trained physiotherapist³.

Older adults at increased falls risk as an addition to the above, must be offered a home exercise programme customised to the individual’s needs by an appropriately trained physiotherapist to improve their balance, subjective balance confidence, general muscle strength and reduce their falls risk. The programme should include strategies to train cognitive function performance⁸, dual task performance, especially, including static and dynamic balance tasks⁹ and vestibular rehabilitation¹⁰ to target greater treatment outcome.

Reference list:

1. Ganz DA, Latham NK. Prevention of Falls in Community-Dwelling Older Adults. N Engl J Med. 2020;382(8):734-743. doi:10.1056/NEJMcp1903252
2. James SL, Lucchesi LR, Bisignano C, et al. The global burden of falls: global, regional and national estimates of morbidity and mortality from the Global Burden of Disease Study 2017. Inj Prev. 2020;26(Supp 1):i3-i11. doi:10.1136/injuryprev-2019-043286
3. Montero-Odasso M, van der Velde N, Martin FC, et al. World guidelines for falls prevention and management for older adults: a global initiative. Age Ageing. 2022;51(9):afac205. doi:10.1093/ageing/afac205
4. Woollacott M, Shumway-Cook A. Attention and the control of posture and gait: a review of an emerging area of research. Gait Posture. 2002;16(1):1-14. doi:10.1016/s0966-6362(01)00156-4
5. Asai T, Oshima K, Fukumoto Y, Yonezawa Y, Matsuo A, Misu S. Does dual-tasking provide additional value in timed “up and go” test for predicting the occurrence of falls? A longitudinal observation study by age group (young-older or old-older adults). Aging Clin Exp Res. 2021;33(1):77-84. doi:10.1007/s40520-020-01510-6
6. Liston MB, Bamiou DE, Martin F, et al. Peripheral vestibular dysfunction is prevalent in older adults experiencing multiple non-syncopal falls versus age-matched non-fallers: a pilot study. Age Ageing. 2014;43(1):38-43. doi:10.1093/ageing/aft129
7. Lindell E, Kollén L, Johansson M, et al. Benign paroxysmal positional vertigo, dizziness, and health-related quality of life among older adults in a population-based setting. Eur Arch Otorhinolaryngol. 2021;278(5):1637-1644. doi:10.1007/s00405-020-06357-1
8. Silsupadol P, Shumway-Cook A, Lugade V, et al. Effects of single-task versus dual-task training on balance performance in older adults: a double-blind, randomized controlled trial. Arch Phys Med Rehabil. 2009;90(3):381-387. doi:10.1016/j.apmr.2008.09.559
9. Wollesen B, Mattes K, Schulz S, et al. Effects of Dual-Task Management and Resistance Training on Gait Performance in Older Individuals: A Randomized Controlled Trial. Front Aging Neurosci. 2017;9:415. Published 2017 Dec 13. doi:10.3389/fnagi.2017.00415
10. Rossi-Izquierdo M, Gayoso-Diz P, Santos-Pérez S, et al. Vestibular rehabilitation in elderly patients with postural instability: reducing the number of falls-a randomized clinical trial. Aging Clin Exp Res. 2018;30(11):1353-1361. doi:10.1007/s40520-018-1003-0