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Defying gravity and fear: the prevention of falls in community-dwelling older adults.

In older adults, falls represent a very common and dangerous problem. Older adults lack the normal overlap or redundancy of cognitive, sensory, and musculoskeletal mechanisms that help younger people avoid falling while remaining active. Many of the risk factors for falls in older adults are modifiable and deserve aggressive attention. Successful prevention of falls, fall-related injuries, and fear of falling is complicated by the multifactorial nature of the problem. Advanced practice nurses' comprehensive health assessment skills, holistic orientation, and willingness to collaborate with healthcare providers from a range of disciplines are helpful in dealing with the complexity of balance problems and falls. Nurse practitioners can be effective case managers for older adults at risk for falling. Older adults need accurate information, and sometimes counseling, to realize that falls, fall-related injuries, and fear of falls are warning signs that can provide direction and motivation for change and prevention.