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by Laurence Z. Rubenstein, MD, MPH, AGSF
Many people, as they age, experience
increasing difficulty with balance and safe mobility, which leads
to the common and serious problem of falls. These problems are associated
with loss of confidence and decreasing ability to function independently
and can lead to the consideration of institutional care. Falls are
also a major cause of death in the older population. Fortunately,
most causes of falls and instability can be treated successfully,
with improved mobility, and fall risk reduced.
Fortunately, most causes of falls and
instability can be treated successfully, with improved mobility,
and fall risk reduced.
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Q. How
common are falls and balance problems in older persons?
A. Falls
occur in over a third of persons over age 65 each year, and
in over half of persons over age 75. About a third of the
older population reports some difficulty with balance or ambulation,
and this percentage also increases in frequency and severity
after age 75.
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Q. What are the major causes of falls?
A. The most
common causes of falls include environmental hazards (such as
slippery floors and loose rugs), weak muscles, unstable balance,
dizziness, vision problems, and medication side effects (such
as dizziness and confusion).
Q. How
can I tell if I am at risk for falling?
A. The most
important predictors of fall risk include: muscle weakness (for
example, difficulty rising from a sitting position without use
of hands to push off), unsteady balance (for example, needing
to walk slowly or with a wide base of support to maintain balance),
having had a prior fall in the past year, and taking certain medications
(most importantly certain blood pressure medication as well as
psychoactive medications, such as sedatives or anti-depressants).
Q. What
can I do to decrease my chances of falling?
A. Ask your
physician to evaluate your strength, balance, gait, entire medication
list, and overall risk for falls. The chances are good that there
will be a number of things that can be done to reduce fall risk,
such as adjusting medications, obtaining physical therapy, starting
an exercise regimen, or receiving an assistive device such as
a cane or walker, to make walking safer.
Q. What
can be done to improve balance?
A. Similarly,
there are a number of exercises and assistive devices that can
improve stability. Ask your physician what would be best for you.
Q. I sometimes
get dizzy when I stand up. What causes this?
A. This problem,
called orthostatic dizziness, is often caused by a drop in blood
pressure on standing (orthostatic hypotension). Orthostatic hypotension
can be caused by a number of conditions, including diabetes, Parkinson's
disease, heart failure, drop in blood volume, dehydration, infection,
and a number of medications (such as diuretics and blood pressure
medicines). A less common cause of orthostatic dizziness not associated
with falling blood pressure is caused by abnormalities in the
inner-ear vestibular (balance) system, or its connection to the
brain.
Q. How
can I make my home environment safer?
A. There are
many pamphlets available to assist in hazard-proofing your home
environment. Alternatively, a home health provider, such as a
visiting nurse or occupational therapist, can come to the home
and provide a hands-on inspection and set of recommendations.
Common recommendations include installing bathroom grab bars,
improving lighting in key areas, removing hazardous conditions
on the floor, and making stairways and entrance areas safer.
Q. How
can I find out if any of the medications I take may increase my
risk of falling?
A. Your physician
is the best person to systematically assess the risks and benefits
associated with medications and should be asked to do so. Be sure
to tell your physician about all medications you are taking, even
non-prescribed products such as vitamins and cold tablets and
those that are prescribed by other providers.
Q. What
kinds of walking aids are available and who should I talk to about
getting the right one?
A. A whole
spectrum of walking aids are widely available, ranging all the
way from simple canes to fancy types of walkers and wheelchairs.
Any walking aid should be carefully matched to your particular
needs. It must be measured to the right size and provide the optimal
level of stability without creating too much dependency. This
is best done by an experienced provider, such as a physical therapist,
physician, or prosthesis specialist. When used properly, these
aids can dramatically improve mobility and safety.
Q. Where
can I go for more information?
A. A variety
of services can provide you with guidance on balance and dizziness.
Among them are:
Vestibular Disorders Association 503-229-7705;
website: http://www.vestibular.org/
National Institute on Deafness and Other Communication
Disorders 301-496-7243;
e-mail: nidcd@aerie.com
American Academy of OtolaryngologyÕHead and
Neck Surgery, Inc. 703-836-4444;
TTY 703-519-1585
To locate local support resources including
home health providers, call
Eldercare Locator at 800-677-1116
Perform a MEDLINE
search on Balance and Falling Problems
This Patient Education Forum has been funded
by a grant from the Medtronic
Foundation.
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