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91-229
TPDN 1991, Vol. 51, No. 18
OCT i 1991
Page 2
Actions for prevention of
osteoporosis include:
" Adequate calcium to slow the
rate of bone loss
" Vitamin D for optimal absorp-
tion of calcium
" Moderate weight-bearing exer-
cise for both prevention and
treatment
" Estrogen therapy for post meno-
pausal women
It has been postulated that reduc-
tion or elimination of smoking, al-
cohol, caffeine, and excessive salt
intake may also help prevent
osteoporosis.
For the very elderly (80+ years),
measures to prevent falls may be
more beneficial than therapies to
prevent further bone loss.
Medication
The multiple diseases of the elderly
encourage polypharmacy. Inappro-
priate or excessive medication has
been shown to contribute signifi-
cantly to falls in the elderly. One
contributory factor to this is that
elderly people frequently see sev-
eral different physicians for differ-
ent medical conditions and may not
make clear to each the other medi-
cations that they are already taking.
The drugs implicated most fre-
quently include sedatives,
hypnotics, psychotropics, anticon-
vulsive agents, and antihyper-
tensives. These drugs tend to inter-
fere with coordination, cause pos-
tural hypotension confusion, or
generally interfere with the patient's
sense of reality and orientation.
There is a clear need to increase
provider review of prescribed and
over-the-counter medications taken
by patients.
Exercise
Lack of exercise is another ex-
tremely important fall risk indica-
tor. Frequently, older people cut
down considerably on the amount
of exercise they obtain because they,
or their relatives, worry over pos-
sible falls. This results in a decline
in physical vigor. Rapidly declin-
ing vigor has been shown to be
positively correlated with the onset
of falls. What lies at the core of this
tendency is the mobility of the per-
son. When mobility declines, one
finds the greatest liability to falls
and fractures.
In fact, many of the balance prob-
lems that appear to be caused by
hypertension, faulty vestibular
mechanisms, or other conditions
often are related simply to poor
muscle tone. Muscle tone will im-
prove markedly after walking with
someone a half mile to a mile a day.
Gait training on how to walk cor-
rectly or use assistive devices can
be done in exercise classes, or taught
by clinic or physical therapy staff.
This may resolve insufficient activ-
ity levels due to fears of falling.
Facilitation of formation of older
adult exercise classes and walking
clubs by senior citizen centers,
YMCA, health clubs, and adult
apartment/condominium complexes
may help preserve mobility and
vigor and decrease the propensity
to fall.
Dementia/Confusion
According to one researcher, in
comparing characteristics of "fall-
ers" and "non-fallers," the most
striking difference between the
groups was the presence of
dementia, especially confusion. Not
only can this be addressed by re-
evaluation of medications, but there
are also steps that family and other
social contacts can take to reduce
the symptoms.
REDUCTION OF
ENVIRONMENTAL HAZARDS
It is important to facilitate the iden-
tification and reduction of environ-
mental hazards and modification of
the environment to compliment the
abilities of the older adult. The US
Public Health Service estimates that
potentially avoidable environmen-
tal factors are the cause of 40-50 %
of falls.
Although some of the modifications
may involve modest monetary ex-
penditures, it can be pointed out
that it is much cheaper and easier to
prevent a fall than to treat a fall-
related injury and its potential com-
plications.
The home is the most frequent site
of accidents. In 1986, 5,788,000
elders were involved in accidents.
Of these, 3,079,000 (53%) were at
home, according to the National
Safety Council.
Environmental Corrective
Measures
Some of the primary environmental
risk factors that lend themselves to
modification include:
" Improve lighting (especially at
night)
" Repair, replace, or discard worn
carpeting and throw rugs
" Move foodstuffs to lower
shelves, don't use high shelves
" Raise toilet seat or install hand
rails
" Adjust height of bed so it is
higher
" Obtain corrective footwear
" Tie up or fasten electrical cords
to wall so they aren't "trailing"
" Place solid pieces of furniture
in pathways so they won't tip
over if grabbed
" Secure or install stairway banis-
ters
" If in unfamiliar surroundings:
give a tour to familiarize; in-
crease lighting at night
* If isolated: instigate a daily
buddy call-system; let neigh-
bors/family have a key in case
of emergency
" Organize a signal system (an
alarm or physically banging on
wall) for emergencies or if hurt
" Install cushioned floors (rugs)/
surfaces
" Round corners on furniture,
counters so there aren't sharp
corners