21 - Nonpharmacologic Prevention and Management of Falls and Fractures

Abstract

This chapter emphasizes on the nonpharmacologic prevention and management of falls and fractures. Usually, ninety percent of hip fractures occur after a fall resulting in less than five percent of hip fractures. The medications causing postural hypotension, confusion, dizziness, stiffness, and peripheral edema, long lasting hypnotics, tricyclic antidepressants, and antipsychotics are associated with falls and fractures. The basic medical factors that contribute to falls and fractures are postural hypotension, sway, impaired thermogenesis, cognitive impairment, sensory, motor, and vestibular malfunction, and slow reaction time. The major biochemical risk factors for hip fracture independent of low bone mass are discussed. The multi factorial intervention to reduce the risk of falls among community dwelling elderly is controlled by three domains— namely, (1) medication adjustments, (2) environmental evaluation, and (3) exercise and physical therapy. Skeletal Integrity can be maintained by appropriate calcium, vitamin D intake, external hip protectors, and weight-bearing exercise. To prevent falls and fractures certain measures are to be followed— such as medical assessment, physical assessment, and occupational therapy assessment. The home safety measures to prevent fall includes general precautions in bathroom, bedroom, and stairs. Thirty percent of vertebral fractures usually take three months to heal and can be managed by scheduled non narcotic drugs, moist heat, limitation of bedrest and inactivity, and nasal calcitonin.