Preventing night-time falls in people with lower urinary tract symptoms

Falls are a significant risk in the elderly, with 30% of falls resulting in moderate to severe injuries.¹ The risk of falls may be attributed to a combination of factors including existing medical conditions, medications, vision impairment and general cognitive or functional decline. Medical conditions that contribute to falls risk include arthritis, low blood pressure (causing dizziness or light-headedness), osteoporosis, dementia, nocturia and incontinence among others.²

 "1 in 2 residents in aged care facilities fall every 6 months" ¹ 

Common urological conditions that have been associated with falls include:³

• Lower urinary tract infections
• Urinary incontinence
• Overactive bladder
• Prostatic disease

"More than 1/3 of all infections in nursing homes are urinary tract infections" ⁴ 

Symptoms of lower urinary tract infections such as increased frequency and urgency to urinate, nocturia (needing to visit the restroom more than once during the night)⁵ and incontinence are significant risk factors for falls.⁶ Lower urinary tract infections have commonly been associated with a general decline in cognitive function⁶ and confusion⁷. Having to urinate urgently, frequently, during the night, or leaking before reaching the toilet can all lead to the individual making potentially unsafe choices to get to the bathroom on time. 

"Fall and hip fracture risk is increased in elderly patients with nocturia." ⁵ 

Strategies to minimize the risk of falls caused by urinary symptoms:²

• Ensure the underlying medical condition is being addressed with appropriate treatment in consultation with a physician.
• Have vision checked by an optometrist at regular intervals.
• Ensure appropriate footwear is being worn.
• Review all medications as some may cause side effects such as drowsiness, confusion or dizziness.
• Ensure adequate lighting in the walkways on the way from the bedroom to the bathroom.
• Fix non-slip mats and hand rails in the bathroom to assist in safe transfer.
• Consider the use of bedside commodes, or absorbent underwear if the person is unable to get to the bathroom in time at most occasions.

 Click HERE to download "5 ways to 'FALL-PROOF' night time bathroom visits infographic.

References:

1. Waldron N, Hill AM, Barker A. Falls prevention in older adults. Australian Family Physician. Vol 41, No.12, Dec 2012 (930-935) Available from: https://www.racgp.org.au/afp/2012/december/falls-prevention/ Accessed: 20Nov2018.
2. ‘Falls can be prevented – A guide to preventing falls for older people’ Australian Govt Dept of Health and Aging. Available from: http://www.health.gov.au/internet/main/publishing.nsf/Content/phd-pub-injury-dontfall-cnt.htm Accessed: 20Nov2018
3. Soliman Y, Meyer R, Baum N. Falls in the Elderly Secondary to Urinary Symptoms. Rev Urol. 2016;18(1):28-32.
4. Rowe TA, Juthani-Mehta M. Urinary tract infection in older adults. Aging health. 2013;9(5):10.2217/ahe.13.38.
5. Prince D, Pedler K, Rashid P. Nocturia – A guide to assessment and management. Australian Family Physician Vol 41, No.6, June 2012 (399-422). Available from: https://www.racgp.org.au/afp/2012/june/nocturia-a-guide-to-assessment-and-management/ Accessed 20Nov2018
6. Hunter KF, Voaklander D, Hsu ZY, Moore KN. Lower urinary tract symptoms and falls risk among older women receiving home support: a prospective cohort study. BMC Geriatr. 2013 May 15;13:46. doi: 10.1186/1471-2318-13-46.
7. Urinary Tract Infections (UTIs) in Older Adults. Available from: https://www.healthline.com/health/uti-in-elderly#utis Accessed 20 Nov 2018.