With winter approaching, the incidence of injuries related to falls increases dramatically, especially here in Alaska where snow, ice, and gravel all contribute to slippery walking surfaces. Among the elderly, even mild falls can be dangerous. The fifth leading cause of death in older adults is unintentional injuries—and falls cause two thirds of these deaths. Falls are a factor in 40% of nursing home admissions. The elderly are often unaware of their risks of falling and do not discuss risk factors with their physicians. New guidelines from the American Academy of Orthopaedic Surgeons Panel on Falls Prevention aim to assist with reducing the risk of falls in the elderly through assessment of an older patient’s risk of falling, and in the management of older patient’s who have fallen previously or who are at risk of falling.

Risk factors for falling can be divided into two categories: modifiable and non-modifiable. Modifiable factors include muscle weakness, medication side effects, and low blood pressure. Non-modifiable factors include blindness, and weakness or paralysis from conditions such as stroke. The likelihood that a patient will fall increases dramatically with the number of risk factors. The key to reducing the risk of falling is to identify modifiable risk factors, and then to intervene to eliminate as many risk factors as possible. For older people who live in their homes, interventions can include:

1. Using assistive devices (cane, walker) to improve balance.

2. Adjusting medications that may affect balance or thinking. This can include pain medicines, sedatives, sleeping pills, and alcohol.

3. Exercise programs that feature strengthening and balance training.

4. Management of low blood pressure

5. Modification of potential environmental hazards such as loose rugs, objects on the floor, placement of furniture, uneven walking surfaces

6. Treatment of heart conditions that can lead to dizziness and falls.

Similar interventions can occur in the nursing home or assisted-living facility. Falls that occur outdoors can also be minimized with additional interventions that improve traction on slippery surfaces, including:

1. Using strap-on cleats or spikes.

2. Clearing snow and ice around walkways, driveways, and porches.

3. Using chemical agents to melt ice, or spread gravel on icy surfaces.

4. Limiting walking in icy or snowy areas.

There are other interventions that may help to reduce the risk of injury during a fall. Treatments of osteoporosis with exercise, diet, and in some cases, medication, can help to reduce the risk of fractures during a fall. Fractures that may be caused by osteoporosis include spine, hip, and wrist fractures. Patients with vision difficulties should have their vision formally assessed, and any abnormalities should be treated. Ultimately, education of patients and health care providers may help to reduce the risk of falls and subsequent injuries in elderly people.