Falls

As the general population ages, more falls occur, some with accompanying major injuries, including fractures. This reality has resulted in much effort to reduce the number of falls with only limited success. For older adults with HIV there has been an estimate that even more falls occur with one-third suffering a fall during the past year. This is both a public health issue and also a personal one that can adversely affect quality of life or something more serious. Some have suggested that the frequency of falls for a 50 year old with HIV is similar to that of a 65 year-old person.

For both study numbers and reasons for falls, studies have been completed that included men and women from long -term studies sponsored by the National Institutes of Health. In one study a fall was defined as “an unexpected event in which the individual loses their balance and lands on the floor, ground, or at a lower level/or hits an object”, and 18% had a fall during the past year. Frailty, as defined by a standard definition, was found in 6%, and 49% had a fall. Peripheral neuropathy (diagnosed by nerve injuries in the feet, legs and hands) was present in 39% and associated with falls. In another study, there was both a group with HIV and one at risk for HIV, and they were very comparable by various measures. Of those adults with HIV 24% had a fall during the past year versus 18% in the comparison group. Overall, women and those with imbalance symptoms had more falls. Among older adults with HIV, smoking, the number of medications and also imbalance symptoms were related to falls.

Using such information intervention studies have been done or are in progress. One study that adjusted for the number of medications, had behavioral instructions, and exercise programs found that in a year 35% had a fall compared to 47% in the control group not receiving an intervention. A large study is underway that will use “fall managers” to identify major fall risks and personalize an intervention for participants. It will be a few years before the result are known, but the experience will be a very useful tool in reducing falls.    

What can you and your doctor do to prevent falls?

 

If you have had a fall during the past year, you should take it as a warning sign and discuss with your medical team in order to identify possible risk factors. Your doctor can evaluate you for peripheral neuropathy and suggest treatment (discussed under “Conditions” here in the Resource Center). Frailty can be evaluated and possible strength building or balance exercises can be arranged (Also summarized in Conditions). Some of the multiple medications prescribed for you might be contributing to falls, and a review should be undertaken (Presented in “Polypharmacy “ in “Health Management”). There are a number of other factors that can contribute to falls, including smoking, alcohol, and drug use, vision and hearing problems, other comorbidities. Each of these may need expert assistance in controlling them. Good communication with your physician is essential.

What can you do?

Fear of falling can be a vicious circle. If your activity becomes limited, your strength and confidence will diminish, and you will be more likely to fall. Various suggestions for preventing falls are made in a document called “Prevent Falls and Fractures” prepared by the National Institute on Aging.   https://www.nia.nih.gov/health/prevent-falls-and-fractures

Many falls occur at home and are preventable. These involve stairways, bathrooms, bedrooms and other living areas. Again, the National Institute on Aging has prepared information called “Fall-Proofing Your Home”. https://www.nia.nih.gov/health/fall-proofing-your-home

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