Falls happen. They are an inevitable part of life. Simply watch an infant take their first step or a highly skilled athlete on the field of play, and it’s pretty clear we’ll all have our share of falls through life’s journey.
For the most part we view a fall as an isolated event, one that may – or may not – be accompanied by some period of rehabilitation, but, for the most part, an event without long-term sequelae. While this might be a relatively safe assumption for the majority of falls early in life, the story is quite different as we age. Later in life falls can be painful, depressing, accompanied by prolonged convalescence and associated with permanent disability ... or worse. In a 6-year study of more than 1,300 geriatrics in Sweden, Stenhagen and colleagues found “fallers” to report statistically significantly poorer health-related quality of life and life satisfaction when compared to their “non-faller” peers, a distinction that persisted years. Perhaps falls shouldn’t be such an accepted fact of life.
The National Council on Aging reminds us that falls are the most common form of nonfatal and fatal injuries in older Americans, and the CDC estimates one in every four adults older than 65 years falls each year, accounting for 2.8 million emergency room visits. Sadly, an older American dies from a fall every 19 minutes.
Given the public health crisis falls have become, much attention has been directed to identifying risk factors as well as promoting effective prevention strategies. It is commonly accepted that age-related muscle decline, balance issues, postural hypotension, polypharmacy and confusion (cognitive decline) all place older adults at risk for falls. To address this crisis, prevention strategies have largely included educational, environmental and health-related initiatives. It is the mantra of every physician (optometrists included) to discuss falls with our older patients, and it has become a priority for many aging agencies to provide fall prevention education. Environmental efforts run the gamut from creating a safer living space to providing proper footwear. While these efforts are essential, perhaps none is more central than that of optimizing health. Providing physical exams, harmonizing medications, implementing core strength and balance exercise programs, testing hearing and – yes – performing comprehensive eye examinations are all instrumental in optimizing health and mitigating falls.
As optometrists, this comes as no surprise. We know our vestibular, visual and proprioceptive systems collectively serve as an internal gyroscope. If one is out of synch, so is our sense of balance and stability. We witness this daily as conditions such as cataract, glaucoma and macular degeneration play a significant role in visual function and balance. But what about the more mundane things? Even something as simple as a monovision contact lens adjustment, new pair of progressive multifocal lenses or improved refractive error after cataract surgery can alter an older individual’s visual landscape. While well intended – and providing clearer vision – each can impact an older patient’s sense of balance, and not always for the better.
In this month’s feature article, “Better fall prevention includes prescribing conservatively in those at higher risk” we’ve asked colleagues for their expertise in this area. Each provides advice that is clinically relevant, can easily be implemented and brings a fresh perspective on optometric care for our aging patients. Most importantly, they challenge each of us with a call to action. Simply put, taking a more active approach to fall prevention just might be a life-saver. Literally.
- CDC. Older adult falls. www.cdc.gov/homeandrecreationalsafety/falls. Reviewed October 11, 2016. Accessed February 28, 2019.
- National Council on Aging. Falls prevention facts. Ncoa.org/falls-prevention-facts. www.ncoa.org/news/resources-for-reporters/get-the-facts/falls-prevention-facts. Accessed February 28, 2019.
- Stenhagen M, et al. Arch Gerontol Geriatr. 2014;doi:10.1016/j.archger.2013.07.006.