Preventing Falls

Among community-dwelling adults aged 65 or older, 30—40% fall at least once per year. Many of these falls have accompanying injury and many of these falls and injuries are preventable.

A sound approach to fall prevention focusses on risk factors which increase the chance of falling and intervention strategies to reduce or mitigate these risks. A helpful way to sort this out is to consider individual fall risks and environmental fall risks.

Individual fall risk factors

When you stop and think about all the body components and systems that play a role in keeping us on our feet, you begin to understand why the elderly are at high risk to fall. Many of these body parts do not function as well or become impaired with advancing age. Our neurologic system has a central (the brain and spinal cord) and a peripheral (everything else) portion. Our brains and cognitive function, hearing and balance, vision, reflexes, and sensation all help to keep us on our feet. When any of these singly or in combination are impaired, we increase the chance that we might fall. Poor safety awareness is very common among individuals with dementia.

Many orthopedic factors contribute to fall risk. These include weakness in our muscles, less endurance, and degenerative changes in our joints resulting in a greater chance of falling. Loss of muscle mass is part of the aging process. Preferential loss of fast twitch muscle fibers (involved in rapid position correction) over slow twitch muscle fibers (involved in strength) makes it more difficult to keep our balance, especially on uneven surfaces. Thinning of the bones, as occurs with osteoporosis, increases the chance that falling episodes may result in serious fractures. Postural changes in the spine affect our center of gravity and  may alter our gait resulting in a greater likelihood of falling.

Other medical problems such as cardiovascular and lung disease, strokes, cataracts, and  macular degeneration, to name a few, can also contribute to fall risk. The autonomic nervous system helps in part to adjust our blood pressure, especially as we change position from lying or sitting to standing; as we age, the adjustments are not as rapid.  Sudden falls in blood pressure as may occur with position change can result in momentary unsteadiness which leads to falls. Urinary frequency and  nocturia (getting up at night to urinate) can also increase risk. Many medications, and in particular many blood pressure, pain, and psychotropic medications (those that affect mood and/or behavior) have the potential to increase fall risk. A multifactorial fall risk assessment can help determine what specific individual risks are present.

Environmental risk factors

Taking stock of the home environment both indoor and outdoor is a worthwhile effort to help reduce fall risks. Areas should be well lit. Pathways should be free of obstructions and easy to navigate. Throw rugs and scatter rugs should be removed. Floor surfaces both inside and outside should be level especially in areas of transitioning from one room or area to another. In the winter, keep outside walkways and entryways free of ice. Doorway thresholds with even a small height differential represent trip hazards. Inside floor surfaces should not be slippery. Pay particular attention to floor surface transitions such as from carpeted to tiled surfaces as the change in surface friction is difficult for many older adults to safely negotiate.

Low, deep chairs can be difficult to arise from. The same is true of chairs without arms. Grab bars should be present in the bathroom adjacent to the toilet and in the bath or shower area. Wet floor surfaces are particularly hazardous. Anti-skid strips and decals may help reduce the fall risk. Stairs are potentially dangerous and should have handrails. The use of high contrast colors to demarcate individual stairs and landings may help reduce some risk.

What you can do

If you have fallen in the last six months, you are particularly at risk to fall again. Pay attention to your footwear. Shoes should be laced. Do not walk around with only socks. Ask your health care provider if your shoes and/or slippers are safe. Schedule an appointment for a comprehensive fall risk assessment including a review of your medications. Review your environment focusing on some of the specifics I covered above. Some health insurers will pay for a home assessment by qualified personnel such as physical and occupational therapists who can help evaluate the home safety.

There are many ambulation assist devices such as canes, walkers, wheelchairs, scooters, etc. Many of these should be individually measured. Grabbers and  reachers can reduce the need to bend over to pick things up. Keep up with your vision checks and wear your glasses. Elevated seats for the toilet and special chairs which assist getting in and out may be helpful. Regular exercise, physical therapy, and vitamin D supplementation may also play important roles in reducing fall risk.

Falls are serious, particularly for adults after age 65. Do not wait to fall to review your individual and environmental risk factors and intervene with efforts to reduce the chance of falling and/or injuring yourself.

Stay healthy!