Falls – a complicated problem with wide-reaching impacts

Falls are a significant concern for older persons, and for older persons with medical conditions in particular, and as such they feature frequently in the injury prevention literature. A number of articles addressing this considerable source of injury, examining the problem from a variety of perspectives, have caught my attention.

The perceptions of older community-dwelling residents regarding falls’ vulnerability was examined in a recent Australian study. Interestingly older persons rated their own likelihood of falling as quite low, whilst the majority rated other older persons’ likelihood of falling as higher than their own. There was a relationship with their own experience of a recent fall, such that recent-fallers rated their likelihood of falling as higher than those who had not recently fallen (read more at http://onlinelibrary.wiley.com/doi/10.1111/j.1741-6612.2012.00597.x/full). The authors highlighted a potential stumbling block for falls intervention: the protective messages may not reach the target audience as they may find the messages personally-irrelevant.

Whilst I am on the topic of falls-prevention for community-dwelling elderley persons, the controversy surrounding single vs multiple fall prevention interventions is highlighted in a number of articles in the Journal of the American Geriatrics Society, including http://onlinelibrary.wiley.com/doi/10.1111/jgs.12095_3/abstract.

A variety of programs are available to support older adults in managing their health conditions and to reduce their falls’ risk (eg, read more at http://www.ncbi.nlm.nih.gov/pubmed/23437585); however it is noteworthy that elderly persons may not always be able to manage their medical conditions, and some conditions are associated with greater risk of recurrent falls. A systematic review of recurrent falls experienced by persons with Parkinson’s Disease revealed that greater symptom severity and treatment with dopamine agonists were among the factors associated with a history of recurrent falls. The authors suggest that falls’ intervention efforts target recurrent fallers in particular (read more at http://www.hindawi.com/journals/pd/2013/906274/).

The final paper to draw my interest examined the impact of falls upon the primary caregiver of the fallen. In the majority of instances, and also speaking from personal experience, carers are the unsung heroes in the lives and welfare of the cared-for. The Australian research which used both surveys and focus groups in a 12-month prospective study found that there was a significant increase in caregiver burden after a fall, and that caregivers became hypervigilant in response to an increased fear of future falls. There was also no increase in the number of support services used, and practitioners were encouraged to ensure that caregivers are well-informed regarding fall prevention strategies such as individual exercise programs and home modifications (read more at http://www.publish.csiro.au/paper/AH12168.htm).

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