Fall prevention

Interventions to prevent injury in domestic settings
prevention of domestic falls in older adults
Fall prevention includes any action taken to help reduce the number of accidental falls suffered by susceptible individuals, such as the elderly (idiopathic) and people with neurological (Parkinson's, Multiple sclerosis, stroke survivors, Guillain Barre, traumatic brain injury, incomplete spinal cord injury) or orthopedic (lower limb or spinal column fractures or arthritis, post surgery, joint replacement, lower limb amputation, soft tissue injuries) indications. Adults aged 65 years and older have a 30% chance of falling each year, making fall related injuries the leading cause of accident related death for this demographic. Current approaches to fall prevention are problematic because even though awareness is high among professionals that work with seniors and fall prevention activities are pervasive among community living establishments, fall death rates among older adults have more than doubled. The challenges are believed to be three fold. First, insufficient evidence exists that any fall risk screening instrument is adequate for predicting falls. While the strongest predictors of fall risk tend to include a history of falls during the past year, gait, and balance abnormalities, existing models show a strong bias and therefore mostly fail to differentiate between adults that are at low risk and high risk of falling. Second, current fall prevention interventions in the United States are limited between short term individualized therapy provided by a high cost physical therapist or longer term wellness activity provided in a low cost group setting. Neither arrangement is optimum in preventing falls over a large population, especially as these evidence based physical exercise programs have limited effectiveness (approximately 25%). Even multifactorial interventions, which include extensive physical exercise, medication adjustment, and environmental modification only lower fall risk by 31% after 12 months, and by 21% after 24 months. The final challenge is adherence. Average adherence in group based fall prevention exercise programs is around 66%, mostly due to the highly repetitive nature of the programs and the extremely long duration required for noticeable benefits accrue. Adherence to physical therapy can be even lower. When adherence is below 70%, effectiveness of fall prevention physical exercise programs can drop to less than 10%. that could be introduced to all adults over 65. The scientific basis of this approach is an understanding of how the dual task paradigm induces neuroplasticity in the brain, especially in aging populations. This is driving a growing body of research that specifically links the cognitive sub domains of attention and executive function (EF) to gait alterations and fall risk.

Falls and fall related injuries are among the most common but serious medical problems experienced by older adults. Nearly one third of older people fall each year, half of which fall more than once per year. Over 3 million Americans over the age of 65 visited hospital emergency departments in 2015 due to fall related injuries, with over 1.6 million being admitted. Because of decreased bone density due to osteoporosis, mobility, and reflexes, falls often result in hip fractures and other fractures, head injuries, and death in older adults. Accidental injuries are the fifth most common cause of death in older adults. One approach that has been researched is the introduction of semi immersive virtual reality simulation during treadmill training. Initially conceptualized by the Tel Aviv Sourasky Medical Center with funding from the Michael J Fox Foundation and the European Commission, V TIME projects a real time image of participants' feet onto a large screen at eye level while the participants are walking on a treadmill. The virtual environment introduces multiple physical and cognitive challenges while the participant is in dynamic motion. This one approach to motor cognitive training was found to repeatedly reduce falls by 50% after 5 weeks of 15 sessions across multiple clinical trials and multiple indications (idiopathic, Parkinson's, Multiple sclerosis). The biological manifestations of this improvement were identified through functional MRI, which showed changes in brain activity patterns for patients that were exposed to combined motor cognitive training, as opposed to exclusively physical training. Other preventative measures with positive effects include strength and balance training, home risk assessment, the withdrawal of psychotropic medication, cardiac pacing for those with carotid sinus hypersensitivity, and tai chi. Resistance exercise two or three times a week with ankle weights or elastic bands has been proven in tests to rebuild lost muscle mass and reduce falls in adults of all ages: it was first tested in New Zealand by the Otago Medical School in four controlled trials, in which about 1,000 older adults with an average age 84 participated. Falls among a test group that did the Otago routines three times a week for 12 months was 35% fewer than a control group that did not use the routines. Two similar 12 month tests were conducted in the US using residents in assisted and skilled nursing facilities with one group showing a 54% reduction in falls. After the age of 50, adults experience a decrease in muscle mass (sarcopenia) by approximately 2% every year. A systematic review concluded that resistance training can slow down the rate of loss in muscle mass and strength. It has been recommended that older adults participate in resistance training two to three times a week to weaken the effects of sarcopenia. Exercise as a single intervention has been shown to prevent falls in community dwelling older adults. A systematic review suggests that having an exercise regimen that includes challenging balance workouts for three or more hours per week results in a lesser chance of falling. Falls are well known amongst community dwelling individuals ages 65 and older. The risk of fall related incidents nearly doubles when individuals are institutionalized. The impact on different falls in certain situation of fall prevention programs on the rate differences of falls in elderly population has not been reported. As well as cognitive impairment, functional impairment, gait, and balance disorders, certain medications can increase fall risk factors for patients. At an advanced age, these risk factors are double and more likely to occur. It's important to identify the risk factors that increase the likelihood of injurious falls. State level fall prevention strategies can also mitigate fall risk for community dwelling older adults.

Basophobia is a term used in many circumstances to describe the fear of falling in either normal or special situations. It refers to uncomfortable sensations that may be experienced by older people. These sensations can include lower body weakness or loss of balance, which can induce a frightening sensation of falling that can lead to serious and potentially fatal injuries.

Accidents are the most common cause of falls involving healthy adults, which may be the result of tripping on stairs, improper footwear, dark surroundings, slippery surfaces, uneven ground, or lack of exercise. Studies suggest that women are more prone to falling than men in all age groups. The most common injuries among younger patients occur in the hands, wrists, knees, and ankles. Stairs can be improved by installing handrails on both sides, improving lighting, and adding colour contrast between steps. Improvement in lighting and luminance levels can aid elderly people in assessing and negotiating hazards. Occupational therapists can help clients improve fall prevention behaviours. In addition, they can instruct clients and their family members on factors that contribute to falls, and implement environmental modifications and strategies to decrease the risk of falls. Evidence suggests that pre discharge home assessments are associated with a reduced risk of falling. There are special handles and closed handgrips available in bathrooms and lavatories to help users bend down or over. For example, extra support for users when moving include walking sticks, crutches, and support frames, such as a walker. Flexible handles such as hanging straps can also be useful supports.

Bifocal spectacles and trifocal eyeglasses are used to provide refractory correction ideal for reading (12–24 inches (30–60 cm) when the wearer looks downward through them. Reading glasses are not ideal for safe walking, where correction for 4.5–5 feet (137–152 cm) would be more appropriate.

Studies show that balance, flexibility, strength, and motor cognitive training not only improve mobility but also reduce the risk of falling. This may be achieved through group and home based exercise programs or engagement with physical therapy clinics with the appropriate equipment. The majority of older adults do not exercise regularly and 35% of people over the age of 65 do not participate in any leisurely physical activities.

In older adults, physical training and perturbation therapy is directed to improving balance recovery responses and preventing falls. Gait related changes in the elderly provide a greater chance of stability during walking due to slower speed and greater base of support, but they also increase the chance of slipping or tripping and falling. Appropriate joint moment generation is required to create sufficient push off for balance recovery. Age related changes in muscles, tendons, and neural structures may contribute to slower reactive responses. Interventions involving resistance training along with perturbation training may prove to be beneficial in improving muscle strength and balance recovery.

Stroke exercises help patients regain mobility and strength in their bodies, and must be done regularly in order to regain muscle tone that helps prevent falls.

One of the most important things for fall prevention in elderly populations is to stay physically fit. Specialized facilities and programs like seniors' parks are a good place to keep the elderly in shape and increase their resistance to falling. These facilities contain specialized equipment and training stations where elderly people can exercise. The parks usually have an extended amount of space and different stages reserved for different body exercises. Research suggests that participation in such programs successfully mitigates fall risk in the majority of attendees.