New Strategies for Preventing Falls

Updated guidelines recommend tai chi, reducing medications

by: Katharine Greider, from: AARP Bulletin, February 8, 2011

En español | Newly updated fall prevention guidelines from the American Geriatrics Society and British Geriatrics Society call for a multipronged approach that begins with a thorough evaluation for fall risk in older people with a history of falls or who report feeling unsteady on their feet. The updated guidelines recommend exercises to improve balance, gait and strength — specifically advocating tai chi — and places greater emphasis on reducing medications.

Falls are the single biggest cause of fatal and nonfatal injury in people 65 and older; roughly one in three experiences a tumble every year. The problem, though often overlooked in a specialty-driven health care system that focuses on one physical system at a time, "is as serious as heart attacks or strokes," says Mary E. Tinetti, M.D., a leading specialist on falls at Yale School of Medicine.

There is plenty of evidence to suggest these accidents can be prevented. Based on dozens of published studies, "Older people are as good as anyone at knowing when they feel unsteady," says Tinetti, who cochaired the expert panel that wrote the guidelines. This is definitely something to bring up at a doctor's visit, she says.

— Christopher Wahl

According to the panel's review, interventions that work to minimize fall risk include:

Regular exercise focusing on strength, balance and gait. For people who feel sure-footed, joining a tai chi class (a discipline specifically mentioned in the guidelines update), strength training at the gym, and walking all can fit the bill, says Tinetti. Those who feel unsteady will likely need the help of a physical therapist to design a safe, graduated program of strength-building exercise.

Cutting down on medication, especially psychoactive drugs. This is where the fragmented approach to medical care fails many older people, says Tinetti. "What's best for a patient's blood pressure may be bad for their fall risk. What's good for their depression may be bad for their fall risk. It's all about trade-offs." The ideal, she says, is an individualized approach that takes into account how multiple prescriptions increase the chance of falling.

Assessment and correction of hazards in a person's environment. For effective fall prevention, this is best done by someone trained for the purpose. "My own feeling is that older people and their families should get trained," says Tinetti. Grab bars in tubs, handrails on stairs, secure rugs, clutter-free floors and good lighting are among the simple features that can make a home safer.

Other measures endorsed by the guidelines include taking a vitamin D supplement if you're at risk for falls or have a deficiency, wearing flat shoes with good floor contact and, if surgery to remove cataracts is called for, scheduling the procedure without delay.

Katharine Greider lives in New York and writes about health and medicine.

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