Physical therapists and other health care professionals should determine whether their older patients are at risk of falling by asking if they have fallen recently or if they are unsteady walking, according to new guidelines that recommend multifactorial interventions, including exercise for balance, gait, and strength training -- such as physical therapy or Tai Chi.
Providers also should look for the presence of known problems such as muscle weakness, poor balance, or blood pressure that drops too much on standing. If the older adult has these problems, then the provider should prescribe the interventions described in the guidelines. If there is no evidence of gait problems or recurrent falls, no risk assessment is necessary, say the guidelines.
The new recommendations, developed by the American Geriatrics Society and the British Geriatric Society (AGS/BGS), call for a focus on environmental adaptation to reduce fall risk factors in the home and in daily activities; cataract surgery where needed, but they recommend against vision intervention as an individual approach; medication reduction, with particular attention to medications that affect the brain such as sleeping medications and antidepressants; and raising low blood pressure and managing heart rate and rhythm abnormalities.
This is the first update of the AGS/BGSguidelines on preventing falls in older persons since 2001. APTA member Kathy Brewer, PT, MEd, GCS, served on the workgroup that revised the guidelines, which APTA has endorsed.
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