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To help prevent falls, the elderly should cut down on meds, increase vitamin D, new guidelines say

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elderly man with walker to prevent fallsHow many late-life declines can be traced back to a fall? Whether or not it involves a fractured hip or just a general shake-up, even a minor spill can precipitate a rapid loss of function and independence or even death in seniors.


"Falls are one of the most common health problems experienced by older adults," Mary Tinetti, of the Yale School of Medicine's Program in Geriatrics, said in a prepared statement. The majority of falls in older adults (some 70 percent) occur when no one is looking, and about 60 percent of older adults with cognitive impairment suffer at least one fall each year, according to a new report Tinetti co-authored. These tumbles often lead to an extended hospital stay or an assisted living admission. "Given their frequency and consequences, falls are as serious a health problem for older persons as heart attacks for strokes," she said.


The report features a set of guidelines for preventing falls in the elderly, updating formal recommendations from the American and British geriatric societies for the first time in 10 years. The new recommendations were published online January 13 in the Journal of the American Geriatrics Society.


To reduce falls among community-dwelling older adults, Tinetti and her colleagues recommended:


•    Working with a doctor to reduce the number and dosage of medications, especially antidepressants (including selective serotonin reuptake inhibitors), sedatives and antipsychotics;


•    Increasing vitamin D supplementation to 800 international units per day if a person is likely deficient or seems to be a risk for falls;


•    And careful physical activity, such as physical therapy or tai chi to improve balance, flexibility and mobility.


These interventions and others (including assessing footwear, physical environment, visual acuity and circulatory health) can help reduce a senior's risk of falling, Tinetti and her colleagues found after reviewing nearly a decade's worth of literature on the subject. Older adults are often on a host of prescription medications to address physical and psychological ills, and despite their recommendation to reduce the number and dosage of medications, the research team acknowledged that in some cases, "discontinuation of a particular high-risk is not possible because of medical conditions."


Rather than focusing on just one of the recommendations, as previous studies have suggested, the researchers assert that the guidelines should be considered en masse. "Because we looked at not only what recommendations were given, but also which [were] carried out, we're confident that multifactorial interventions is the best course of action," said Tinetti.


Other recent research has suggested that avoiding alcohol and listening to music while exercising have helped to keep seniors standing.


Image courtesy of iStockphoto/Yuri_Arcurs

The views expressed are those of the author and are not necessarily those of Scientific American.

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