Clinicians should evaluate the risk of injuries in older patients and advise them and/or their caregivers on how to prevent injuries.
Falls
Older adults are vulnerable to injury due to falls
Driving hazards
All older 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 or medications.
For older adults, risk of injuring themselves and others while driving is higher than that for younger adults because of age-associated changes and conditions common among older adults. 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. Many states have laws that mandate physician reporting of suspected impaired drivers. Sensitivity is required when a health care professional 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, including those that increase the risk of falls. Physical and occupational therapists may visit a patient’s home to assess its safety.
