Written by: Catharine Paddock, PhD
Taking up Tai Chi and cutting back on medication could form part of a multiple intervention approach to helping elderly people reduce their risk of falling, according to recently updated guidelines from the American Geriatrics Society and the British Geriatric Society, summarized this month in the Journal of the American Geriatrics Society.
In their first update since 2001, the guidelines for preventing falls in the elderly now recommend that interventions be "multifactorial" and include an exercise component and assess feet, footwear, fear of falling, ability to go about daily living, and other factors.
The guidelines also say that fall screening and prevention should be a routine part of healthcare for the elderly.
The new panel that updated the guidelines included members from previous panels and new members with considerable expertise, both in practical and published work, in preventing falls and caring for older people.
Dr Mary Tinetti of Yale University School of Medicine in New Haven, Connecticut in the US, was one of the panel co-chairs. She told the press that:
"Falls are one of the most common health problems experienced by older adults and are a common cause of losing functional independence."
"Given their frequency and consequences, falls are as serious a health problem for older persons as heart attacks and strokes," she added.
They also reviewed randomized controlled trials published between April 2008 and July 2009 and found no reason to change their conclusions and recommendations.
The new guidelines say that doctors should decide whether to assess risk of falling by first asking patients if they have fallen recently or are unsteady when walking.
If patients say they have not experienced a fall recently and are not unsteady when walking then they do not need a risk assessment.
But if they answer yes, then doctors should go ahead with a risk assessment and look for other known problem areas like muscle weakness, poor balance or blood pressure that drops too much on standing.
If this risk assessment shows these problems, patients should then receive interventions as advised in the guidelines.
Tinetti said that they found the most effective fall prevention trials were those involving multiple interventions instead of only one.
She said while previous studies had suggested it is more effective to focus on single interventions, they are confident a multiple intervention approach is better because they looked not only at what was recommended but also what was actually carried out.
The new guidelines suggest not only that doctors should design "multifactorial" interventions, but these also:
- Include exercise for balance, gait and strength training. A good example is Tai chi or physical therapy.
- Include "environmental adaptation" to reduce factors that increase risk of falling in the home and when carrying out daily activities.
- Include cataract surgery where needed, but not as an individual approach.
- Aim to reduce medication regardless of number of drugs prescribed: this is a departure from the 2001 guideline which said this need only apply to patients on four or more drugs.
- Pay particular attention to drugs that affect the brain, for instance sleeping pills and antidepressants.
- Focus on raising low blood pressure and managing heart rate and rhythm abnormalities.
"There is emerging evidence that the rate of serious fall injuries, such as hip fractures, is decreasing modestly in areas in which fall prevention is integrated into clinical practice."
"By making fall prevention part of the clinical care of older adults this trend can continue," she added.
"Summary of the Updated American Geriatrics Society/British Geriatrics Society Clinical Practice Guideline for Prevention of Falls in Older Persons."
Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society.
Journal of the American Geriatrics Society, Volume 59, Issue 1, pages 148-157, published online 13 January 2011.
Additional source: Wiley-Blackwell (press release, 13 Jan 2011).