Example of toilet assist bars and tub grab bars.

The Fall Prevention Program offers the elderly home safety assessments and the installation of free fall prevention devices. To qualify, individuals must be 65 years or older, reside in King County, live independently, have fallen at least once during the past year, and be low income.

Firefighters and public fire educators perform the home assessments. They also install such risk reduction devices (RRDs) as tub grab bars, toilet assist bars, shower chairs, transfer benches, bed assist railings, wall grab bars, rug slips, bath mats, night lights, tread tape, smoke alarms, and carpet tape.

Fire Department personnel interview patients about the risk of certain prescriptions that can cause falls.

The program identifies participants through Medical Incident Report Forms (people who have called the 911/EMS system for assistance). Additional participants are being referred from Valley Medical Center Transitional Care Unit, Visiting Nurse Services, Swedish Hospital, Virginia Mason Hospital, Department of Social and Health Services, Senior Services, and Aging and Disability Services, Group Health, and Providence.

The preliminary data from this program reflect some of the findings from previous studies of elderly fallers. First, patients have reported many different reasons for their falls. There may, in fact, be many contributors to a given fall. Those specializing in geriatrics are taught to look for multifactorial causes of falls. Patients may be cautious about reporting the true incidence or causes of their falls for fear of being placed in a nursing home. In talking to patients about their falls, it is important to ask about past falls and the circumstances surrounding those falls without sounding judgmental.

An especially crucial component of any fall evaluation is an assessment of the patient's medications. The use of four or more prescribed medications has been found to be a risk factor for falls¹. Some medications that have been associated with an increased risk of causing falls are: psychotropic medications (including benzodiazepines, sedatives, antidepressants, and antipsychotics), antihypertensives, diuretics, narcotics, muscle relaxants, hypoglycemics, and antihistamines. In addition to reviewing the medication list, it is important to find out which of these are actually being taken and whether any over-the-counter or herbal preparations are being used. Seemingly benign medications such as diphenhydramine (Benadryl) can adversely affect the elderly because of their anti-cholinergic properties.

Falls in the elderly are a serious problem with high morbidity and mortality. It has been estimated that of those 65 and older who are living in their own homes, nearly one-third will fall each year. Of those who fall, one in forty will be hospitalized. Of those who are hospitalized, only half will be alive at the end of the year². Those who have had one fall are at increased risk for further falls. It is hoped that the relatively inexpensive intervention of making the home environment safer will prevent elderly patients who have had a previous fall from having another potentially more dangerous fall.

1 Tinetti, M. et al. A Multifactorial Intervention to Reduce the Risk of Falling Among Elderly People Living in the Community. The New England Journal of Medicine. 1994; 331: 821-827.
2 Kane, R., J. Ouslander, I. Abrass. Essentials of Clinical Geriatrics. New York. McGraw-Hill, Inc. 1994 pg. 197.