Falls in Older Adults: A Multifactorial Approach

People aged 65 and older have the highest risk of falling. According to the NICE guidelines, around a third of people aged 65 and over, and around half of people aged 80 and over, fall at least once a year.

      (Falls in older people: assessing risk and prevention, NICE Clinical guideline, 12 June 2013)

Falls can cause many problems and worries for individuals, as well as their family and carers. Falling is a cause of distress, pain, injury, loss of confidence, loss of independence, hospital admission and mortality.

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What is a multifactorial approach to falls prevention?

The multifactorial approach to falls prevention is a comprehensive strategy that addresses the many different risk factors that contribute to falls in older adults. It involves identifying and then addressing multiple factors that increase the risk of falls and begins with a systematic risk assessment.

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Falls risk assessment

This involves identifying any of the risk factors that contribute to falls in the individual who is being assessed. The following are some components of this assessment:

• History of falls
• Medical conditions
• Gait, balance and mobility, and muscle weakness
• Possible visual impairment
• Cognitive impairment and neurological examination
• Osteoporosis risk
• Medication side effects
• Environmental hazards
• Urinary incontinence
• Perceived functional ability and fear relating to falling

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Falls risk prevention interventions

Following the risk assessment, and depending upon the findings, the following interventions or changes should be considered to minimise risk of falls as far as possible.

• Physiotherapy exercise programs: Physical activity programs that include balance and strength training, as well as stretching and range of movement exercises can help reduce the risk of falls by addressing any reduced physical ability.
• Visual assessment: Poor vision can contribute to falls, so regular eye exams can help identify any visual problems that need correction.

Avoiding wearing varifocal or bifocals may also be safer.

• Cognitive assessment: Reduced cognitive ability can also increase the likelihood of falling. This may be due to several reasons such as being less aware of risks. If cognitive difficulties are present, it is important they are identified and resolved as far as possible, and strategies implemented to support as required.
• Bone health, nutrition and hydration assessment: It may also be advisable for some individuals to take vitamin D supplements to protect or improve their bone health thereby reducing the risk of fractures if they were to fall. This is important if there is any osteoporosis, which is why osteoporosis risk is part of a multifactorial falls risk assessment. There is also emerging evidence that vitamin D deficiencies or insufficiency, may be linked to an increased risk of falls itself, as well as risk of fracture from falling but this is not yet determined.

Furthermore, it is important to stay well hydrated as dehydration can lead to low blood pressure and dizziness upon standing.

• Medication review: Reviewing medications with a healthcare professional is important as medication is one factor that influences risk of falls in older adults. The most appropriate healthcare professional to help with this would be a G.P. or pharmacist. They can identify any medications that may cause dizziness or impair balance and coordination, thereby increasing the risk of falls due to these side-effects. Furthermore, they may identify medications that interact with each other and be able to suggest more suitable alternatives in order to minimise the risk of falls.
• Home environment modifications: Making home adjustments can be a simple, quick and inexpensive way to help reduce the risk of falls. This may include changes such as installing grab bars and handrails, using non-slip mats, ensuring lighting is adequate, or removing trip hazards for instance rugs or clutter.
• Urinary incontinence: Continence is linked to falls and it is important to manage continence well to minimise the risk of falls.
• Fear of falling: Fear of falling can, in itself, increase the risk of falls due to anxiety. Therefore, it is an important aspect of falls prevention to tackle and can be addressed in several ways. For example, some people fear not being able to get up if they do fall and this is a major source of anxiety around falling. For this reason, it can be very helpful to practise getting up off the floor with a physiotherapist. The therapist can teach safe methods where this is possible or can advise on how to summon help if it is not possible to get up independently. The latter may include referral for a lifeline.
• Education and awareness: Providing education and awareness to older adults and their caregivers about risk factors, fall prevention strategies, how to safely get up from a fall and the importance of seeking medical attention after a fall can all help reduce the risk.

It also includes important advice on what type of footwear is safest.

Overall, a multifactorial approach to falls prevention involves a full, systematic and coordinated effort to address the various factors that contribute to falls in older adults. It also requires education to ensure the understanding and motivation of the individual so that they engage and comply with recommendations.

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Physiotherapy and occupational therapy for falls prevention

As outlined above, falls risk assessment and falls prevention require a multifactorial approach, which involves assessing and addressing all the factors that contribute to falls. Physiotherapy and occupational therapy are two important components of this approach.

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Physiotherapy

Physiotherapy focuses on improving physical function. A physiotherapist can assess an individual's risk of falls and develop an exercise program tailored to their needs. The program may include exercises to train strength and balance as well as to improve coordination and flexibility. The physiotherapist may also provide advice on footwear, walking aids, assistive devices, and home modifications to reduce the risk of falls.

For information on our physiotherapy services, please visit our website:

www.strokeandneurotherapy.co.uk

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Occupational therapy

Occupational therapy focuses on improving an individual's ability to carry out everyday activities. An occupational therapist can assess an individual's home environment and identify any hazards that may increase the risk of falls. They may also provide advice on home modifications and assistive devices, such as grab bars and handrails, to improve safety. It is also important to address factors, such as lighting and flooring, that may contribute to falls. Additionally, an occupational therapist may provide training on how to safely carry out daily activities, such as getting in and out of bed, using the bathroom, and navigating stairs. They may also review cognition and work on strategies to improve cognitive functioning.

For information on our occupational therapy services, please visit our website:

www.strokeandneurotherapy.co.uk

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Other healthcare professionals

As outlined above, aside from therapy, other important components of a multifactorial approach to falls prevention include medication management, vision assessment, and addressing any underlying medical conditions that may increase the risk of falls. To address these factors, referral onto other healthcare professionals may also be required. The latter may include:

• The G.P.
• A pharmacist
• An optician
• A podiatrist
• A dietician
• The continence service

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Summary

In conclusion, a multifactorial approach to falls risk assessment and falls prevention, including physiotherapy and occupational therapy, can help individuals reduce their risk of falls and improve their overall quality of life.

For more information on the multifactorial approach to falls, please see the NICE Clinical Guidelines 2013:

https://www.nice.org.uk/guidance/cg161

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