Fall Prevention: Some Quick Tips

Falling is a significant cause of injury and death in older individuals.  This article elaborates on risk factors for falls and steps that should be taken to reduce those risks.  Between thirty to forty percent of people over 65 and more than fifty percent over the age of 80 fall each year. [i]   

Many factors contribute to the risk of falling.  One common cause of falls is the environment, in that loose rugs, wet floors, inadequate lighting, clutter on the floor, and poor choice in footwear all may contribute.  It is recommended that all rugs be tacked down well or taken away, and that there is good lighting throughout the house.  This is especially important between the bed and the bathroom, as people often get up at night to urinate. Any obstacles (tables, chairs, boxes) in the way should be eliminated.  Supportive shoes such as sneakers are useful in preventing falls. Particularly in women, the use of fashionable shoes can increase risk.

Another common cause of falls is medications taken for blood pressure control, depression, and other conditions.  These may cause excessive drop in blood pressure, alterations in the heart rate or heart rhythm, loss of normal sensation in the feet, confusion or dizziness.  It is therefore very important that people discuss their medications with their doctor and that extraneous medications are eliminated.  It is important to include over-the-counter supplements and herbal remedies, as these also can be culprits.

Medical Illnesses such as Parkinson’s disease, cardiovascular disease, stroke and diabetes can all contribute to the risk of falls.  Patients who are in poor physical condition can lose muscle strength, balance, and agility.  Long periods of immobilization, such as during a prolonged hospitalization, lead to muscle wasting and subsequent risk.  Thus, it is important to maintain conditioning by exercising as much as possible.  Diarrhea, urinary tract infections, and urinary and fecal incontinence can contribute to falls by urgent needs to visit the restroom.  Dementia increases the risk for falls due to poor safety awareness and judgment.  Arthritis and podiatric conditions also contribute to falls because of pain and abnormal gait.   Visual loss is also a factor contributing to falls.   Those over 65 should have an eye exam yearly to evaluate vision.

Risk factors for significant injury from falls include use of anticoagulants (blood thinners), which increase blood loss from any injury.  Patients with osteoporosis are more likely to sustain a fracture with a fall.  Patients lacking muscle, fat, and subcutaneous tissue will absorb less impact from a fall, and therefore are at risk for greater injury.  Falls can cause cuts and bruises, internal and external bleeding, concussion, fractures, and subdural hematomas, and lead to fear of falling in the future.  The fear itself may lead to loss of confidence and diminished independence.

Thus, it is clear that many things contribute to falls and injury, so a multifaceted approach must be taken.  A thorough history and physical from your primary care physician is essential in identifying these risks.   There are many things that help can help prevent falls.:

●As mentioned above, adequate lighting and a clear pathway to the bathroom should be instituted.

●Treatment of urinary and gastrointestinal conditions help reduce urgent visits to the bathroom.

●A thorough review of medications by your primary care physician to eliminate any medication that may contribute to falling is important to do at least yearly.

●Maintenance of muscle tone through exercise and activity programs are very helpful.  A rehabilitation program that includes balance training, muscle strengthening, gait training and assistive devices (such as canes and walkers) is useful.

●Installing grab bars in the bathroom and safety railings can be very helpful for fall prevention.

●It is important to have vision testing on a regular basis.

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[i] Kiel, Douglas P. M.D.  UpToDate.com.  Falls in Older Persons:  Risk Factors and Evaluation, July 29, 2014: