Fall Risk and Fall Prevention
While falls leading to injury are possible at all ages, falls can be devastating to older people. According to the Centers for Disease Control and Prevention (CDC), one out of four older people falls each year. Over 20% of falls, or one out of five, resulting in serious injury – broken bones or head injury. A serious injury such as a hip fracture or head injury can lead to hospitalization and loss of independence.
When patients are in the hospital, their fall risk is assessed, and sometimes bed alarms are used. If the patient is on the edge of the bed or gets up, a bed alarm rings, leading to intervention. Once patients are at home from the hospital, prevention of falls is the responsibility of both them and caregivers or family members.
Risk of Falling
Doctors have studied many of the factors that contribute to fall risk. The highest risk factors include previous falls, weakness, problems with gait or balance, and use of medications that increase dizziness, sleepiness, or other side effects. Older people who have stiff joints (such as arthritis), decreased muscle strength, or visual impairments are more likely to fall. Even foot pain or poorly fitting footwear can increase falls. The more risk factors an individual has, the more likely they are to fall. One study suggested that if a person has four risk factors, they are 78% more likely to fall, and falling once doubles the risk of falling a second time.
Fear of Falling
Since most falls do not lead to serious injury, less than half of people tell their doctors about falls. Some people develop a “fear of falling” which can lead to limiting activities, becoming more sedentary to avoid falling. However, limiting activities can lead to decreased muscular strength and deconditioning, which increases fall risk.
Ways to Prevent Falling
The CDC has developed a program of online resources called STEADI, for Stopping Elderly Accidents, Deaths, and Injuries. These resources include downloadable brochures to help people check their own homes for safety, resources for family caregivers, ways to stay independent, and ways to prevent falls from happening.
One of the ways that people can stay independent is to assess their own risk for falling and then share results with their doctor. People who have fallen in the past year have increased risk. In addition, people who already use a cane or walker, use furniture to steady themselves, or feel unsteady when they walk may have developed poor balance, which increases the risk of falling. People who have numbness in their feet, often must rush to the bathroom, or take medicines that cause dizziness, sleepiness, or drowsiness are also at increased risk of falling
- Talk to Your Doctor
Doctors can be important to stop falls. If a patient reports a fall, they might do a quick test to check how stable they are when walking. The office procedure is as simple as rising from the chair, walking about 9 feet, turning around, walking back to the chair, and sitting down. The doctor observes such things as gait, stability, how long it takes, and how the patient does each task.
If the results of the office test are not typical, the doctor can consider a physical therapy referral for strengthening exercises or assistive devices. If the gait is slow or painful, it might be due to pain from osteoarthritis, peripheral neuropathy, or other foot disorders.
Doctors and pharmacists can also review medicines for side effects such as dizziness or sleepiness. Medications might be prescriptions or over-the-counter. Another side effect of some medications and medical conditions is called postural hypotension. This can be caused by dehydration, some medical conditions such as heart problems, thyroid disorders, Parkinson’s disease, or being overheated. Some of the signs and symptoms include feeling lightheaded or dizzy after standing up, weakness, or blurry vision. The dizziness or blurry vision can lead to increased falls.
Some of the ways to manage postural hypotension include getting out of bed in 3 steps. Sit up, then sit on the side of the bed for a few minutes, then stand up. Take your time when changing position, make sure you have something to brace yourself against after standing up and do not walk if you feel dizzy. Drink plenty of water, 6-8 glasses a day, unless you must limit fluids due to a medical condition. March in place or clench and unclench your hands to get the blood flowing before getting up or after standing for a while. Try not to lock your knees while standing for a long time.
If injuries are caused by Vitamin D deficiency – very common for people who live in northern latitudes or who do not get enough sunlight – medical providers can prescribe Vitamin D supplements.
Once a year vision checks to keep eyeglasses updated are important to prevent falls. Blurry vision makes it more difficult to see obstacles and judge how close or far away things are located.
Have a healthcare provider check both feet once a year, and make sure footwear is well-fitting.
- Increase Activity
Dancing, Tai Chi, and walking are fun activities to keep moving and increase strength and balance on one’s own or in a group. Many senior centers have exercise groups, dance classes, and Tai Chi, as well as recreation centers. If it is too blustery outside to walk, many malls have indoor walking groups.
Physical therapists may prescribe exercises and activities to strengthen leg muscles and improve balance. While they work on supervised movement during the therapy session, they also prescribe homework–home exercises designed to build endurance and strengthen specific muscles. Patients practice sitting and standing, using resistance bands, and other activities between sessions. Physical therapists can also help people learn better ways to fall.
One of the simplest home exercises to do is called the “chair rise” exercise. Since using the hands to get up from a chair is a sign of weak leg muscles, it is important to exercise to strengthen muscles in the thighs and buttocks. The goal is to eventually be able to sit in a sturdy chair, rise from the chair without using hands, stand, and sit back down, to repeat 10-15 times in each sequence.
- Be Safe at Home
Be safe indoors and outdoors by checking for hazards. Fix loose, uneven, or broken steps or boards indoors or out. Put carpet tape on the underside of throw rugs so they do not slip. Keep objects off stairs.
Watch out for uneven surfaces such as tree roots in the yard when out walking or gardening. Make sure the path is clear.
Make sure there are handrails on the stairs, and they are the same length as the stairs, so the person walking up or downstairs does not have to reach to grab the handrail.
Tape cords or wires down close to the wall so they are not a trip hazard. If the light bulb in the hallway has burned out, so the stairway is dark, have a friend or family member help to change it.
Put nightlights in so that the path is lighted between the bedroom and the bathroom. Place a lamp close to the bed so it is easier to reach.
Keep frequently-used items on lower shelves in the kitchen so they are easier to reach. Use a sturdy step stool to reach objects on shelves, preferably one with a bar to hang on to.
Make sure every room is well-lighted and add extra lighting whenever possible.
To minimize falls in the bathroom, use a non-slip rubber mat or self-stick strips in the tub or shower. Use grab bars or a shower chair in the tub, and grab bars around the toilet.
If a person is prescribed an assistive device such as a cane or walker, use it when moving from place to place inside or outside the house.
Falls leading to injury often have devastating results for older adults, as well as their friends and family. Fall risk can be minimized by partnering with medical professionals. Talking to the doctor to check fall risk and fall prevention is often the first step. Exercise to strengthen muscles and keep moving. Be safe at home in order to stay at home.
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