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    Prevention of Falls

    Having a fall can be a grave threat to older people and reduce their ability to remain independent.  Falls can result in fractures, hospitalization, and sometimes even death. However, falls are not an inevitable part of the aging process. We can identify the risk factors which increase the chance of falling. There are proven ways to reduce the incidence and prevent falls.

    How do falls affect us?

    It is noteworthy to understand that falls are not a normal part of aging. Injuries due to falls can lead to increased morbidity, reduced mobility, and increased patient dependence on others. Falling can be a terrifying experience, which can not only shatters confidence but may also result in grave injuries. The wrist, hip, and spine are more prone to injury. This can cause the person to become bedridden. Injuries to the head can lead to disorientation and balance problems. A person who has fallen once is more at risk of having a repeat episode. Thus this is a significant public health hazard. Fall-related injuries have substantial and often intimidating costs.

    Who is at a higher risk of falls?

    People with difficulty walking, patients suffering from vertigo, dizziness and balance disorders, impaired memory and cognition problems, or those with conditions of mental health like depression are more susceptible to falls. Older people with hearing problems have a higher risk of falls.

    Older people with the fear of falling often restrict their activities which has a detrimental effect on their physical and mental health. Most falls are due to the combination of several risk factors.

    Which conditions increase the risk of falls?

    Many factors affect the stability of a person. Some risk factors which increase the chance of falls include – balance disorders, nutritional deficiencies, and malnutrition, reduced muscular strength, impaired vision,  postural hypotension, etc. Several medications can cloud the person’s ability to focus falls. An important additional factor affecting one’s risk of falls is reduced cognition or slowing down of the brain.

    These patients require a detailed evaluation to assess the reason for the fall. Some factors which should be taken into consideration include –

    1. Assessment for a new illness – A detailed systemic evaluation is required. Some common problems include:
    • Dehydration
    • Heart problems
    • Neurological problems – like stroke
    • Urinary tract infection
    • Anemia – may be due to bleeding in the digestive tract.
    1. Orthostatic hypotension is a common disorder seen in the elderly, especially in patients who are hypertensive or diabetic. It is detected by measuring the blood pressure in the lying down position and then again on standing up. If the BP falls by more than 20mg Hg on standing, this indicates the presence of Orthostatic hypotension. This condition can decrease the blood supply to the brain on standing and cause instability and an increased tendency to fall.
    2. Blood tests like Hemoglobin, fasting blood sugar, and electrolytes should be evaluated. Electrolyte imbalance can cause a state of confusion and slow down reflexes. Inadequate sugar control in diabetics adversely affects all parts of the body.
    3. Review of prescriptions. Often older patients have various medical problems which will require a variety of medication. It is essential to check for duplication of any medicine or adverse interactions between different treatments. We must pay special attention to some of the following types of drugs-
      Sedatives and tranquilizers- can cause drowsiness, disorientation, and increased fall risk.
      Blood pressure and diabetes medications- it is essential for these medicines to maintain the BP and blood sugar at optimum levels.
      “Anticholinergic” medications. They include medicines for allergies, overactive bladder, vertigo, nausea, and certain types of antidepressants which may also be given for nerve pain. They can increase the risk of falls.
      Painkillers – older patients with osteoarthritis often take painkillers to relieve their joint pains. A physician should regulate their use to avoid detrimental side effects.
    4. Vision- Proper correction of eyesight with spectacles is vital for the correct orientation of the body. Conditions that reduce vision like cataracts and glaucoma should be treated. Bifocal or progressive lenses can make things seem closer or farther away than they really are.

    What are Fall Clinics?

    Our Fall Clinics specializes in the evaluation of fall-risk and fall prevention in the high-risk population. The clinic has developed specialized tests to evaluate the risk of falls. We perform tests to assess the stability in different conditions with Stabilometry and Computerized Posturography. Videonystagmography is used to evaluate for any spontaneous nystagmus, oculomotor dysfunction, and positional tests are done for BPPV. There is a higher incidence of BPPV in older patients and can make them quite dizzy.BPPV is caused by displaced calcium carbonate crystals in the inner ear. Diagnosis of this condition followed by the appropriate repositioning maneuver can treat these patients almost magically.VOR and VOR suppression tests give us information about balance reflexes and central nervous system control. By performing all of these tests, we can ascertain the balance status of the patient. This helps us to design customized treatment plans for each patient. Balance training, stabilization techniques with ankle and hip strategies, gaze, saccade, and optokinetic training  – are all taught to the patient in a customized and progressive manner. We provide patients in-clinic, online, and app-based rehabilitation programs. We use virtual reality(VR) and augmented reality(AR) to give patients a more immersive feeling of challenging situations within the controlled clinic setting. Cognitive rehabilitation is included to help make the patient mentally more active as this helps in restoring balance. It has been seen that balance training also improves cognition and mental agility in patients. Thus, these clinics improve the quality of life of the older population and reduce the burden on the healthcare system.

    How can we prevent falls?

    A comprehensive and multifaceted assessment is required to devise strategies for fall prevention.  Reducing the risk factors is the key to fall prevention. Treating any underlying medical conditions like orthostatic hypotension, electrolyte imbalance, etc., are prerequisites to a good outcome. Helping the patient with balance and stability training exercises by trained health professionals can help prevent falls and be saved from its sinister consequences. We help patients to create a safer environment that can lower the risk of falls. Some tips to help the elderly include adding grab bars near the toilet and bathing area and putting railings on both sides of the stairs. Ensure that there is enough light in the room, especially when the person has to go to the washroom at night.

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