Vitamin D deficiency, diminished muscle strength, and somatic dysfunction can all directly influence the musculoskeletal system and are known risk factors for falls in older adults.
5,8-10 However, other factors not directly related to the musculoskeletal system are important as well, including those that are behavioral and environmental in nature. A patient's emotional state and the medical treatment that he or she has received or is receiving may not only be potential risk factors for fall but also need to be considered by physicians when they are using a comprehensive approach to patient care.
Fear of falling is very common among older adults living independently in the community.
24 In addition, older adults who are depressed are at greater risk of falling. Both fear of falling and depression are important points to consider when taking care of elderly patients because these factors can cause activity restriction, social isolation, and decreased quality of life.
25 It is important for osteopathic physicians to recognize the integral role of the mind and spirit in health and disease. Addressing depression if it is present will enhance an elderly patient's mental health status and ultimately maximize the patient's function, independence, and quality of life. In addition to appropriate medications, physicians can manage depression with interventions such as tai chi and exercise programs, which have been shown to reduce the fear of falling in older adults living in the community.
26
Although the use of medication can be helpful in treating older adults with depression, it should be remembered that the use of antidepressants, sedatives and hypnotics, and benzodiazepines are associated with falls in the elderly.
27 It is also well known that older adults who use a higher number of different medications are at increased risk of falling.
28 Managing medications by weighing the benefits and adverse effects, understanding potential interactions, and reducing or stopping medications when appropriate is therefore essential to reducing fall-related risk in older adults. A meta-analysis by Woolcott et al
27 showed that the use of sedatives and hypnotics, antidepressants, and benzodiazepines was associated with falls in elderly individuals, and another study
29 revealed a 66% decrease in the risk of falling in elderly patients with whom the dosage of psychotropic medications was gradually reduced.
A multifaceted approach to fall prevention in older adults, especially those with impaired vision, should also include an assessment of environmental or home hazards, such as tripping hazards (eg, rugs, low-standing furniture) and dim lighting. In addition, physicians should recommend that patients institute basic safety measures such as grab bars and antislip bath mats. In-home visits are 1 helpful way in which physicians can ensure that necessary home-hazard modifications are put in place. The risk for falls appears to be reduced by home-hazard modification, but not necessarily by clinical education alone.
30,31
Table 2 summarizes fall-related risk factors in the older adult population and the types of interventions that can be used to reduce these risks.