Falling is an especially common and dangerous risk for older adults. With age, the likelihood of falling and the severity of falls increases. Not only can the result of a Fall be physically debilitating, the fear of falling itself can take hold and keep you from being active and engaged, accelerating health decline.

The good news is, there are many strategies you can employ to prevent falls. This comprehensive guide will help you understand what causes falls and what you can do to dramatically reduce the risk. You will learn how to implement a general fall prevention plan and how to create a personalized fall prevention plan, both of which will make you safer in and outside your home.

The Danger of Falling

Falls are the leading cause of fatal and non-fatal injuries to older adults (65+). According to the Center for Disease Control:

• Close to 30% of older adults experience a fall each year - half will experience more than one fall a year!
• 20% to 30% of those who fall suffer serious injury, loss of independence or premature death according to the World Health Organization
• 2.8 million seniors are treated in emergency rooms each year due to fall injuries
• More than 95% of hip fractures are caused by falls
• Falls are the most common cause of traumatic brain injuries

What Happens After a Fall?

Falls cause broken bones, traumatic brain injury and most commonly soft bumps and bruises. Falls can also cause significant psychological trauma, which can lead to embarrassment, isolation, inactivity and loss of independence.

• Fear of falling can cause a person to become less active, which can cause them to become weaker and increase their chance of falling - a downward spiral;
• After being released from the hospital due to a fall, 4 out of 5 seniors lose independence and are not able to take care of themselves, according to a University of Mississippi study;
• 20% of seniors who fall and got to the hospital, die within 12 months of discharge
• Unfortunately, once a person has had a fall, they are more likely to fall again

Why Do Older People Fall

What Triggers a Fall:

Falls happen when a sudden challenge to our balance overwhelms our ability to stay upright, according to Dr. Leslie Kernisan. In plain english, a fall is triggered when something like a trip, a stumble or a push knocks you off balance, and you don't have the strength or balance to recover, resulting in a fall.

Common triggers include:

• Tripping
• Slipping
• Stumbling
• Alcohol
• Exhaustion / Overexertion
• Dizziness

Why Do Falls Happen:

The fact is, no matter your age, most of us will experience those same triggers from day to day. However, seniors are far more susceptible to falling after a trigger event, because of issues with their strength and/or balance. There are 5 general conditions that increase a seniors chance of falling:

• Chronic Health Conditions:
  • Arthritis
  • Heart disease (e.g. bradycardia, tachycardia, atrial fibrillation)
  • Low blood pressure (e.g. postural hypotension)
  • Cognitive disorders (e.g. dementia, alzheimers)
  • Anemia
  • Parkinson's
  • Stroke
  • Vertigo (benign paroxysmal positional vertigo (BPPV)
• Health Impairments
  • Weak muscles, especially the legs
  • Poor vision (macular degeneration, glaucoma, cataract)
  • Muscle Weakness (especially legs)
  • Aging of sensory system (poor reaction time)
  • Foot conditions (bunions, in-grown nails)
• Illness
  • Labyrinthitis (affects the ear and balance)
  • Urinary tract infection (running too and from bathroom)
  • Dehydration
  • Malnutrition
• Medication
  • Psychotropics
  • Anti-depressants
  • Blood pressure lowering medications
  • Sleeping pills & sedatives
  • Anti-convulsants (medication for epilepsy)
• Environmental
  • Home Hazards
    • Slipping in bathtubs and showers
    • Falling while sitting down and getting up from toilets, chairs and sofas
    • Tripping on the lips of area rugs
    • Slipping on throw rugs and mats
    • Wires (lamps, computers, radios, TV)
    • Floor clutter (bags, shoes, laundry, books)
    • Poor lighting (especially hallways and stairs)
  • Outside Hazards
    • Slippery surfaces (ice, water)
    • Uneven surfaces (cracks, sidewalk lips, stairs, rocks, uneven grass)
  • Accessories
    • Footwear (slippers & heels)
    • Assistive devices (improper use of walkers, canes, etc...)

General Fall Prevention Plan

When looking to reduce the likelihood of falls, there are some very easy steps you can take that are entirely within your control and relatively easily to deploy. Here are a few solutions that help most seniors because they address the most common risk factors, as outlined above.

• Review and modifications of medications

The goal here is to reduce or eliminate medications that increase the likelihood of a fall. Now is that time to review your medications with your doctor and discuss if any might cause confusion, lethargy or dizziness. Some medications like benzodiazepine are associated with a 44% increase in night time falls. There is also an increased risk if someone is on more than 4 medications, regardless of the type - there is actually a nine fold increase in cognitive impairment and fear of falling! Some of the riskiest medications are:

• Sleeping pills (Ambian, Ativan)
• Sedating pills (Benadryl)
• Bladder Drugs (Ditropan, Detrol)
• Muscle Relaxants (Flexaril)
• Over the counter night time medicatons (e.g. Tylenol PM has sedatives)

• Exercise programs with strength and balance training

Exercise is proven to maintain and increase the strength and balance required to sustain a fall trigger like a stumble, trip or slip. There are many evidence based fall prevention exercise programs. Some of the more popular include:

• A Matter of Balance
• YMCA Moving for Better Balance
• Otago Exercise Program
• Stay Active and Independent for Life (SAIL)
• Community Aging in Place - Advanced Better Living for Elders (CAPABLE)
• Tai Ji Quan Moving for Better Balance

You can also do several strength and balance exercises on your own that can make a significant difference:

• Walking
• Sports (swimming, biking, tennis, etc...)
• Movement activities (Tai Chi, dance, yoga)
• Squats
• Single Leg stand (think Karate kid)
• Toe raises
• Plank

Try to do at least 30 minutes of activity a day. Again, activity can simply be walking at a nice brisk pace. Aside from the overall health benefits that come with exercise (increased energy, better mood, less sickness, longer life), gaining strength and balance, especially in your legs, will dramatically reduce your risk of falling.

• Modification of environmental hazards

There's a lot you can do to reduce the likelihood of tripping, stumbling or slipping in your home. The most frequent place falls happen in the home is in the bathroom. You might want to look into working with an occupational therapist and a professional home modification expert to make and install the appropriate changes. Here are a few to consider:

• Slip proof bathtub mat in tub and in front of tub
• Grab bars (shower, bath, toilets)

• Handrails by all stairs in and outside the house
• Shower seat
• Lights in hallways (especially night lights along well traveled paths)
• Lights at top and bottom of stairways (get stick on motioned sensored LED nightlights if its more convenient)
• Remove area and throw rugs
• Don't place coffee tables too close to the sofa or in the way of walking paths
• Remove / flatten uneven surfaces (cracks in cement or paved walkways, stone walkways, etc...)
• Non-slip socks,shoes and slippers (rubber soles)
• Non-heeled shoes, sandals and slippers
• Slippers with backing around the heel
• Clothing that does not come to the ground (especially nightgowns, PJ's and bathrobes)

• Medical Check-up

Aside from your annual check-up with your doctor, get an eye and ear exam at least once a year. A John's Hopkins study has shown that even a mild loss of hearing can result in tripling the risk for falling.

When you're with your doctor always bring a list of medications you're on and review the list and dosages, discussing how you feel, risk/reward for each medication and possible alternatives. Make sure you get your sitting and standing blood pressure tested and address any significant drop in blood pressure when standing.

• Nutrition & Supplements

Make sure you're getting the proper nutrition and hydration to maintain energy levels, alertness and muscle & bone strength. Dehydration is an especially significant risk for falls, because it can cause dizziness, fatigue, confusion and weakness. During periods of urinary tract infections, gastrointestinal issues and diarrhea, stay especially vigilant to avoid dehydration.

If you're suffering weight loss, see your doctor. It could be a sign of malnutrition. Discuss with your doctor, but if your diet is not giving you enough nutrients, consider supplements:

• Vitamin D: Helps maintain bones and muscles. Vitamin D has been shown to prevent falls and fractures and is recommended by the US Preventive Service Task Force. Older adults should take between 800-1,000 units of vitamin D every day.
• Calcium: Strengthens bones and prevents osteoporosis. Minimizes and prevents fractures from falls.
• Meal replacement shakes: Adds calories, vitamins and minerals in easy, ready to drink format.

Avoid alcohol. Alcohol, especially in the elderly, causes fatigue, confusion, reduced reaction times and poor decision making. Moreover, if you're on a lot of medication, it's important to ask your doctor if drinking alcohol while on your medications is permitted.

What To Do If You've Fallen

Despite our best intentions, not all falls can be avoided. However, there are a few tips you can use to minimize injury from a fall.

• Don't panic. stay calm and collect yourself before doing anything else.
• Try to determine if you've been injured. Don't get up until you're sure you're ok. Sometimes moving while injured can make things worse.
• If you've determined you can get up safely, roll over on your side. Rest, while you're blood pressure normalizes. Get on your hands and knees and crawl to a nearby chair.
• Put your hands on the chair and raise one leg, placing your foot flat on the floor.
• From this position, pull yourself up to stand.
• Turn around and sit back down on the chair.

Obviously the above strategy only works if you're conscious and not injured. Some people prefer the security and peace of mind that come with a life alert system, also known as a medical alert system. With the simple press of a button, that's worn around your neck or on your wrist, help will be on its way, whether it's your family, friends, neighbor or emergency services. Some medical alert devices even offer automatic fall detection that will call for emergency help in the event you fall and are unable to press the help button yourself due to loss of consciousness, shock or confusion.

Why Its Important To Get Help Quickly After A Fall

Getting help quickly after a fall reduces hospitalization rates by 26% and risk of death by 80%! Whether you make sure to have a phone nearby, supervision or a medical alert system, make sure you're prepared, especially if you've already had a fall or suffer from a medical condition that makes you more prone to falling.

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