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Prevention of Injuries in the Elderly

by James T. Pacala, MD, MS

Falls

The elderly are vulnerable to injury due to falls (see Falls in the Elderly). A falls prevention program, including exercise (with or without physical therapy) and vitamin D supplementation, should be implemented for people who are at high risk of falls or who have already fallen.

Driving hazards

All elderly people should be reminded to use lap and shoulder belts and to refrain from driving when they are under the influence of alcohol or psychoactive drugs.

For the elderly, risk of injuring themselves and others while driving is higher than that for younger adults because of age-associated changes and conditions common among the elderly. Driving ability should be investigated with further questions and, if indicated, with formal assessment for any of the following:

  • Poor visual acuity

  • Dementia

  • Functionally significant impairment of neck or trunk movement

  • Poor motor coordination

  • Bradykinesia

Also, a family member’s or friend’s concern about the patient’s driving ability should prompt further inquiry and assessment.

Formal assessment of driving ability can be done by an occupational therapist (see Functional Assessment of the Older Driver). Many states have laws that mandate physician reporting of suspected impaired drivers. Sensitivity is required when a health care practitioner must recommend cessation of driving because such a recommendation threatens autonomy.

Home hazards

The home may have many hazards. For example, people with peripheral neuropathy are at increased risk of burns from excessively hot water; burns can be prevented by setting the hot water heater temperature at < 49° C. For people with dementia, using electrical and gas appliances is particularly dangerous; use of alarms and automatic shut-off features on appliances can help. Smoke and carbon monoxide detectors should be installed and maintained. Firearms should be safely stored or removed from the home.

All patients or their caregivers can complete a home safety checklist to identify hazards. Physical and occupational therapists may visit a patient’s home to assess its safety.

* This is a professional Version *