Falls
Falls are a leading cause of injury and death in older Americans. The incidence and severity of falls rises with increasing age. Approximately one-third of US adults older than 65 years fall each year, yet less than half talk to their physicians about it. In 2010, about 21,700 older adults in the United States died as a result of unintentional fall injuries. In 2014 alone, older Americans experienced 29 million falls, resulting in 7 million injuries and incurring about $31 billion in annual Medicare costs. Falls are responsible for more than 60% of all traumatic brain injuries (TBIs) in people over 65 years old. In the United States, fall-related TBIs are responsible for 14,347 deaths per year. Men are more likely to die from a fall. Older white individuals are 2.4 times more likely to die from falls than are older black individuals. Also, there are differences in fatal fall rates among ethnic groups; older non-Hispanic persons have higher fatal fall rates than do older Hispanic persons. Fear of falling may cause elderly persons to limit activities, leading to reduced physical fitness, which, in turn, increases the actual risk of falling.
Prevention of falls is key. Older adults may reduce their chances of falling by
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exercising regularly
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increasing leg strength and balance
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asking their physician or pharmacist to review any of their medications that might cause dizziness or drowsiness
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having their eyes checked annually to update glasses or evaluate for eye diseases that limit vision
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getting assistance to make their living areas safer by
Visual disorders are a frequent cause of falls. Recent studies in the United States and the United Kingdom suggest that elderly individuals are almost twice as likely to fall if they are visually impaired. An ophthalmologist may help patients reduce the risk of falls by
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asking patients appropriate questions about the activities listed above that might reduce fall risk
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recognizing and treating visual disorders, including refractive errors, to identify and minimize ocular reasons for falls
Patients with reduced vision from eye disease, most often macular degeneration, are at the highest risk of falling. Once a history of falls is obtained, it is incumbent upon the ophthalmologist to notify the patient’s primary care physician about this finding or refer the patient to a multidisciplinary medical facility with resources for managing falls in the elderly.
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Centers for Disease Control and Prevention (CDC). Stopping elderly accidents, deaths injuries (STEADI): Older adult fall prevention. www.cdc.gov/steadi. Updated March 23, 2017. Accessed February 21, 2019.
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Stevens JA, Ballesteros MF, Mack KA, Rudd RA, DeCaro E, Adler G. Gender differences in seeking care for falls in the aged Medicare population. Am J Prev Med. 2012;43(1):59–62.
Excerpted from BCSC 2020-2021 series: Section 1 - Update on General Medicine. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.