Strategies for Preventing Falls in Elderly Patients in Emergency Department

Introduction:

Injuries due to falls in older adults are one reason to get admitted to the senior emergency departments. A fall can cause serious health issues in older adults, resulting in long-term disability. About 30 percent of fall cases result in loss of independence, decreased mobility, and serious injuries. Treating falls in elderly patients involves a multidisciplinary team of occupational therapists, physical therapists, social workers, case managers, geriatrics consultants, and pharmacists. Falls in elderly persons can be prevented by checking their vision, managing medications, exercising, and making a safe home. Researchers have found a substantial rise in falls in middle-aged women, suggesting that falls are not exclusively an issue of senior age.

What Is a Fall?

A fall is an accidental or unplanned event that results in the rest of the body on the ground level. It has three phases. The first phase includes the displacement of the body's center of mass. The second phase includes the failure of the body to maintain an upright posture. The final or third phase includes the impact on the body due to environmental surfaces, injuring the organs and tissues.

What Are the Causes of Falls in Elderly Patients?

The cause can be intrinsic factors such as muscle weakness, joint problems, and unreliable postural reflexes or extrinsic factors such as surrounding hazards. The causes of falls in elderly patients are:

• Decreased eyesight and hearing impairment due to the increasing age.

• Certain diseases such as heart disease, arthritis (tenderness and swelling of the joint), Parkinson's disease (a brain condition that causes uncontrollable movements), diabetes (a metabolic disorder that causes increased blood sugar levels), thyroid disorders, and problems with the foot, nerves, and blood vessels affect the balance which can result in falls.

• Conditions such as urinary incontinence, which can result in rushing to the bathroom, can increase the risk of falls.

• Adults with dementia or mild cognitive impairment also have a high risk of falls.

• Sarcopenia (age-related decreased muscle mass), problems in the blood pressure called postural hypotension (decrease in blood pressure due to standing from a lying position), and problems in balance and gait.

• Pain in the foot and unsafe footwear can also increase the risk of falls.

• Some medications with side effects such as confusion or dizziness can also increase the chance of falls.

• Being weak.

• Vitamin D deficiency.

• Use of psychotropic drugs (drugs that affect the brain and cause changes in behavior, feelings, mood, and thoughts), sedatives, tranquilizers, and antidepressants.

• Home hazards such as uneven steps, broken steps, and rugs can cause tripping.

• Reduced physical activities.

What Are the Injuries That Can Occur Due to Falls?

The injuries that can occur due to falls are:

• Soft tissue injury.

• Fractures most commonly include the wrist, hip, pelvis, and humorous areas.

• Contusion (a region in the body where the blood vessels are ruptured).

• Laceration.

• Chipped tooth.

• Brain injury.

• Hematoma.

• Joint dislocation.

• Sprain.

• Becoming inactive because of the fear of falling.

What Are the Strategies for Preventing Falls in Elderly Patients in Emergency Departments?

Here are some fall safety tips:

Being Physically Active:

• Staying physically active by being involved in the right exercise program. These exercises help in improving muscles and also making them strong. Exercises such as climbing stairs, walking, or mild weight-bearing activities can help slow down the process of osteoporosis (a bone disorder that results in decreased bone mass and density and an increased risk of fractures). Doing regular exercises can also help in improving joint flexibility.

• Balancing and strengthening exercises such as pilates, yoga, and tai chi can help improve balance. These exercises increase flexibility, endurance, balance, and coordination and decrease the chance of falls.

• Balance and Gait Training, such as habituation exercises (reduce the giddiness by repeated exposure to visual stimuli or movements) in case of hearing problems.

Luminize the Living Area:

• Fall-proofing home.

• Maintain good lighting around the home to prevent trips over dimly lit areas.

• Install night lights in the corridors, bathroom, and bedroom.

• If one needs to get out of bed in the middle of the night, keep a lamp handy.

• Provide easy access to light switches not located near room entrances. Think about switching to lit or glow-in-the-dark switches in place of standard switches.

• Before ascending or descending stairs, switch on the lights.

• Keep flashlights in locations that are simple to locate in case of power disruptions.

• Restricting access to dangerous areas.

Maintain Good Overall Health:

• Having eyes and hearing tested can decrease the risks of falls.

• Getting enough sleep.

• Limiting the use of alcohol and quitting smoking. Alcohol can cause problems in balance and commonly result in hip or arm fractures. Tobacco can decrease muscle mass and can increase the risk of fractures.

• Standing up slowly.

• Getting tested for blood pressure in case of postural hypertension.

• Staying indoors in case of bad weather.

• Including vitamin D and calcium in the diet can help increase the bones' strength.

• Getting proper treatment for osteoporosis.

• Reduction of psychotropic drugs.

• Use of drugs that have the shortest duration and of low effective doses.

Apply Assistive Aids:

• Use assistive devices such as walkers or canes in case of difficulty walking.

• Nonslip treads for steps made of raw wood.

• Armrest-equipped or elevated toilet seats.

• A solid plastic seat for the bathtub and a mobile shower head so one may take a bath while seated.

• Take extra caution in case of slippery surfaces.

• Keeping hands-free and avoiding the use of a backpack or handbag.

• Use of hip protectors.

Put on Appropriate Footwear:

• Using the proper footwear which provides full support to the foot.

• Shoes with slick soles, high heels, and floppy slippers can cause people to trip, fall, and slip. Wear solid and flat shoes that fit correctly instead.

• Wearing sensible shoes can help lessen joint pain.

Education programs for elderly patients should include:

• Understanding the risk factors, such as avoiding darkened stairways.

• Understanding the effects of injuries and how they can affect the quality of life.

• Distinguishing between safe and risky behaviors.

• Understanding the use of medications.

What Is the Management of the Fall of an Elderly Patient?

The management should include the treatment of injury and identify the cause of the fall. Emergency department-based physical therapy is effective in reducing fall visits. The management includes:

• The history of the fall includes the identification of the cause of the fall, medical conditions, drug history, and identifying environmental risk factors.

• Physical examination should include assessing the injury and function.

• Lab tests should include an X-ray, CT (computed tomography), and MRI ( Magnetic Resonance Imaging) scan.

• Physical therapy to improve the movements.

• Medications or regional blocks to control pain.

• Use of splint in case of fractures.

• In the case of soft tissue wounds, sutures are placed.

• Hip fractures are corrected by internal fixation or joint replacement.

• Surgical evacuation is required in case of brain injury.

Conclusion:

An unintentional fall can increase the risk of health problems in elderly persons and have a higher risk of mortality, which increases with age. Awareness programs should be conducted and include how injuries can result in a high mortality rate. Education should be provided to recognize potential hazards and to distinguish the risk and safe behaviors.