Fall prevention gets harder when elderly leave hospital

(Reuters Health) - More efforts are needed to prevent falls among the elderly, especially those just discharged from the hospital, Australian researchers say.

Older adults have a greater risk of falling to begin with. But this risk heightens considerably within the first six months of a hospital release, authors note in Age and Ageing.

More than half of those who do fall during this period suffer serious injury, such as hip fractures, they say.

Exercise interventions, vitamin supplementation and patient education about high-risk scenarios are known to reduce the risk of falling for elderly people in general. But in a new review of previous research, the Australian team found that these strategies were not as effective in older people following hospital discharge.

The shift from “hospital to home” is a sensitive transitional time, said study leader Chiara Naseri from the School of Physiotherapy and Exercise Science at Curtin University.

“Hospital stays are an adverse event,” Naseri told Reuters Health by email. “The older patient faces prolonged bed-rest, changes in medications, diet and daily routine. And their progressive deterioration doesn’t stop once they reach home, especially as they are generally still medically unwell and recovering from their hospital stay.”

“So when older people reach home, they may still be physically deconditioned and dependent on others while they attempt to recover to their normal function,” she added.

Naseri and colleagues evaluated 16 studies - including 15 “gold-standard” randomized controlled trials - that tested 12 intervention strategies in eight countries. Overall, the studies involved 3,290 men and women with an average age of 77.

Most fall prevention interventions included home modifications, vitamin D3 supplements, and exercise.

Home modification involves things like installing rails as well as reorganization and reducing clutter in the home. Vitamin D supplements are given to ensure bone integrity and decrease the risk of fracture should a fall occur. Exercise programs included strategies to build muscles and improve balance.

Results suggested that home modifications were the most useful - at least, for people who already had a history of falling. In one study, participants with a previous history of falls were 37 percent less likely to experience a second fall after home modification. In another study, this intervention cut fall rates by 25 percent among patients who’d already experienced a fall.

Overall, vitamin D therapy wasn’t effective. In one study, however, giving high-dose vitamin D to patients who had low vitamin D levels when they were discharged reduced falls by 59%.

Home exercise interventions did not significantly reduce falls or fall injuries. In fact, two out of the three studies that tested this approach showed a 74 percent increased likelihood of falling among participants.

Other strategies - such as a single phone call from an occupational therapist, fall education sessions before discharge, and a home exercise program using an instructional DVD - were also ineffective.

Differences in the way the studies were designed made it difficult to pool and synthesize the data, the authors note.

The finding that standard approaches to fall prevention don’t work as well when elderly patients come out of the hospital might reflect the complexity of the discharge process for older people, said Naseri.

“Our own thinking is that more support is required than what is currently widely recognized and available,” she said.

One problem is the fear of falling itself.

“One of the biggest risks of falling (among the elderly) is fear,” said Leigh-Ann Plack, a physical therapist at the Hospital for Special Surgery in New York City, who wasn’t involved in the study. “Fear can cause avoidance of activities which can lead to weakness and instability. This then leads to more fear due to a feeling of being unsteady.”

The challenge is not only to educate patients but also to educate health care providers and communities about the risks of falls and how to train and teach adults about ways to be safe, Plack said.

Naseri agrees.

“When you have been in the hospital, recognize that you need to take care of your health when you first return home,” Naseri said. “Visit your family doctor or seek help from your health care team if you don’t feel that you are recovering well. It’s very common to need some support when you first return home from the hospital. So, discuss this with your family and health care team.”

SOURCE: Age and Ageing, online March 23, 2018.