Recently the Resource Center reviewed more than 300 fall-related documents and conducted interviews with more than 50 health care professionals in an attempt to identify health education approaches and the most effective channels to enhance the awareness and knowledge of health professionals and older adults about fall and fracture prevention. An analysis of the literature led to the development of a fracture prevention model, known as the Fracture Prevention Triangle. This triangle provides a conceptual model of the three fracture intervention points:
- Prevent the fall.
- Minimize the force of the fall.
- Reduce the fragility of bone.
Falls occur because of both internal (host) factors and external (environmental) factors. Internal factors associated with falls include: decreased vision, postural hypotension, impaired balance and/or gait, chronic diseases that impair mental or physical functioning and certain medications, such as sedatives and antidepressants. Poor lighting, lack of handrails on staircases, objects in pathways and non-secured rugs are commonly reported external risk factors for falls.
Several fall risk factors and proposed interventions are outlined below:
- Postural hypotension. Practice hand clenching, ankle pumping, dorsi/plantar flexing.
- Impaired muscle strength/range of motion. Balance and strengthening exercises.
- Use of sedatives/hypnotics/psychotropics. Educate on proper use of medication. Non-pharmacologic treatment of sleep disorders.
- Complex drug regimens. Drug evaluation review with pharmacist or physician. Review medications and alcohol.
- Physical symptoms or impairments. Address dizziness, disability, poor vision. Install grab bars, handrails. Correct for foot or leg problems.
- Psychological functioning. Address cognitive impairment and depression.
- Balance impairment. Exercises for balance and gait abnormalities.
- Lighting hazards. Accessible light switches, brighten lighting.
- Presence of environmental hazards. Remove hazards, such as cords and throw rugs. Use safe/steady furniture and chairs with arm rests, bed at proper height, visible/accessible light switches, night lights.
- Carpets, rugs, furniture. Replace torn rugs, anchor loose edges of carpet,and add non-skid back to slippery rugs. Arrange furniture so it is not obstructive. Use high back chairs.
- Bathroom. Clearly label all medications. Ensure adequate lighting. Keep toilet seats raised. Use non-skid surfaces in bath/shower and grab bars in or near commode.
- Kitchen. Use non-slip wax on floor and use assistive devices (walker, handrails). Keep wood or vinyl floors dry and clean.
- Stairways. Improve lighting, install handrails, apply non-skid treatments to stairs.
Minimizing the Force of a Fall
Bones break when they encounter an outside force that exceeds their strength. Vertebral fractures aside, most breaks occur because of the force created by a fall. The mechanics of a fall are significant in determining whether one will fracture. For example, falling sideways or straight down is more likely to result in a hip fracture than falling in a different direction. Also, the height of the fall can affect whether one will fracture: the greater the distance of the trochanter to the floor, the greater the risk of hip fracture. For this reason, taller women are generally believed to have an increased risk of hip fracture.
Protective responses, such as reflexes and changes in posture, can minimize the force created by a fall. Individuals who land on their hand or grab an object on their descent are less likely to sustain a fracture. Surfaces can also be important: landing on a soft surface is less likely to result in a fracture than landing on a hard surface. Recent studies suggest that the use of trochanteric (hip) padding may also play a role in fracture prevention.
Osteoporosis prevention and treatment strategies can protect bone health, while decreasing the likelihood that a fracture will occur after a fall. A diet rich in calcium and adequate in vitamin D, weight-bearing and resistance training exercises, and a medication approved by the Food and Drug Administration (FDA) for the prevention or treatment of osteoporosis can result in enhanced bone strength.