Fall Prevention

As people age, the risk of falls increases that can result in major injuries, including fractures. While there has been more focus on preventing falls, this problem persists among older adults. For older adults with HIV, the risk of falls appears to be higher than the general population. An estimate has found that one-third of adults with HIV suffered a fall during the past year. Some studies have found a 50-year-old with HIV experiences falls as often as a 65-year-old person without HIV. This is both a public health and individual issue that can adversely affect quality of life and health.

The National Institutes of Health have conducted long-term studies of both older men and women to understand falls and their causes. 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.” The study found that 18% of study participants had a fall during the past year. Frailty, as defined by a standard definition, was found in 6% of people who had experienced a fall. Among the frailty group, 49% had experienced a fall. Peripheral neuropathy (diagnosed by nerve injuries in the feet, legs, and hands) was associated with falls and a condition in 39% of those who experienced a fall during the past year. In another study of a group of older adults with HIV and another group at risk for HIV, rates of falls were similar. Of those adults with HIV, 24% had a fall during the past year versus 18% in the group without HIV. Overall, women and those with symptoms of poor balance had more falls. Among older adults with HIV, other risks for falls include smoking, the number of medications, and poor balances.

With an understanding of the risk factors, studies have or are being conducted to identify interventions to prevent falls. One study, which had participants adjust for the number of medications, follow behavioral instructions, and implement exercise programs, found that 35% had a fall compared to 47% of people in the control group that did not receive interventions. A large study is underway of “fall managers” who will identify major fall risks and personalize an intervention for participants. Results of the study will not be known for several years, but are expected to inform new interventions for 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 risk factors with your healthcare providers. Your doctor can evaluate you for peripheral neuropathy and frailty and suggest treatment (discussed under “Conditions” here in the Resource Center). To manage frailty, your healthcare provider may recommend strength building, or balance exercises (also summarized in Conditions). Your doctor should review your prescribed medications and determine whether they might be contributing to falls (presented in “Polypharmacy in Health Management”). Other factors that can contribute to falls include smoking, alcohol, and drug use, vision and hearing problems, other comorbidities. You may need expert assistance in controlling these risk factor. Good communication with your physician is essential.

What can you do?

Fear of falling can be a vicious circle. If you reduce your activity because of this fear, your strength and confidence will diminish, and you will be more likely to fall. The National Institute on Aging has a resource titled “Prevent Falls and Fractures” available at https://www.nia.nih.gov/health/prevent-falls-and-fractures.

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