Fall Prevention Assessments
Statistics Relating to Falls
- Every year one in three adults age 65 and older fall, and 25% percent of people who fall end up with a moderate to severe injury
- Even though one out of three adults age 65 and older falls each year, less than half talk to their doctors about it.
- The severity of injury increases with age
- People who are 75 years or older are four times more likely to be admitted to a long term care facility after a fall than people ages 65 to 74
- Women are more likely than men to be injured in a fall
- Women have more fall-related fractures then men (especially hip fractures)
- Men are more likely to die from a fall
- In 2008, over 19,700 older adults died from fall related injuries
- In 2009, 2.2 million nonfatal fall injuries among older adults were treated in emergency departments and more than 25% of these patients were hospitalized
- The annual direct medical costs of falls is $30 billion/year
Why Do Many Older Adults Fall and What are Key Risk Factors?
Fall risks increase* with age due to a gradual decline in health. In most cases falls occur due to a combination of environmental hazards in and around the home and a gradual decline of a patient’s health. Typical causes include:
- Annual leaf removal from the gutters
- Getting up on a chair to reach for something
- Poor lighting
- Throw rugs
- Unsafe stairways
- Irregular floor surfaces
- Wet surfaces
- Medication: Sleeping pills, Anti anxiety medication; Anti depressants, Blood pressure medication, Heart medication, Corticosteroids
- Poly pharmacy or taking more than 4 drugs at the same time can increase the risk of falling in the elderly
- Changing from one medication to another
- Changes in blood pressure when getting up from a chair or bed
- Alcohol consumption (even modest social alcohol consumption may increase the risk for falls in the elderly)
- Reduced physical activity: Many people who fall, even if they are not injured, develop a fear of falling which may cause them to limit their activities leading to reduced mobility and loss of physical fitness, which in turn increases their actual risk of falling
- Reduced vision
- Slowed reaction time
- Declining balance
- Weakness of the legs and ankles
- Pain from arthritis and joint inflammation
- Reduced sensation in legs and feet
- Acute or chronic illness
- Lack of sleep
*A combination of the above mentioned factors can significantly increase your risk for falls.
How Important Is a Healthy Diet?
Good nutrition keeps muscles, bones, organs, and other body parts strong for the long haul. Eating vitamin-rich food boosts immunity and fights illness-causing toxins. A proper diet reduces the risk of heart disease, stroke, high blood pressure, type-2 diabetes, bone loss, cancer, and anemia. Also, eating sensibly means consuming fewer calories and more nutrient dense foods, keeping weight in check.
For seniors, the benefits of healthy eating include increased mental acuteness, resistance to illness and disease, and a more robust immune system. Foods containing omega-3 fatty acids can especially improve focus and decrease the risk of Alzheimer’s disease. Brightly colored fruit, leafy veggies, certain fish and nuts packed with omega-3 fatty acids can help:
- Sharpen your mind
- Improve your balance
- Stay emotionally balanced
- Resist to illness
- Increase energy levels
- Faster recuperation times
- Better management of chronic health problems
Where Do Falls Occur Most Frequently?
- Most falls occur in the house with the bathroom being the number one location they occur. Why?
- Slippery surfaces when getting into and out of the tub
- Weakness or range of motion limitations resulting from an injury make it difficult to get into/out of a tub
- Bladder control issues (rushing to get to the bathroom)
- Throw rugs (tripping hazard)
- Tight walking surfaces (walkers are unable to manage or they have to side step)
- Poor lighting, especially at night
How Can I Make My Home Safe?
- Remove throw rugs (if you have an oriental rug you can hang it up on a wall or put double stick tape around the edges)
- Use night lights to light up a path to the bathroom at night
- Install grab bars for the tub transfers
- Use a raised commode and transfer tubs for safe transfers in the bathroom
- Remove clutter from the hallways and commonly used walk paths
- Use assistive devices for safe ambulation
Pets and Falls
Many falls are a result of a pet getting underfoot. Falls with pets typically occur where stairs are involved. Train your pets to go first when going up/down stairs. Or train your pets to sit at the top/bottom of the stairs until you safely have gone/up or down. It’s also important to train a pet to stay seated when the doorbell or phone rings.
What Should I Do if I Fall?
- Remain calm
- Assess if it is safe for you to get up
- If you are not able to safely get up without support, scoot yourself to the closest chair or sturdy table to assist you up from the ground.
- If you are unable to safely get up, try to scoot yourself to the closest phone and call 911
- Have wireless phones throughout the house to make it easy to reach if a fall were to occur
- Invest in a life line system that alerts an emergency system with the push of a button
If I Fall, What Should I Discuss with my Doctor?
- How many falls you are having, when they occur, and are there anything that proceeds the falls (keep a record of your falls and bring it to your doctor appointment).
- List of any recent medication changes / medications that are new (some medications will interact adversely with each other and cause dizziness)
- Any uncontrolled bladder issues
- Any pain or strength/motion limitations which can cause for a lack of balance
- Any episodes of light-headedness or dizziness
- Any falls which result in injury or in which the head was involved
What Can I Do to Help Prevent Falls?
- Improve balance
- Keep active. Exercising 3-4 times per week can help maintain muscle strength, cardiac system and extensibility. Make sure your exercise component includes strength training (upper back, lower legs), cardiac (if a person becomes fatigued with minimum activity, they are at a higher risk for a fall) and stretching. Exercise will maintain overall health, thus avoiding the possible use of medications that can cause dizziness (cardiac, blood pressure, DM).
- Tia Chi and yoga are great exercise programs for strength training, stretching and balance and can be found at many local senior centers
- Keep hydrated; drinking water is very important.
- Maintain a healthy diet, and avoid missing a meal. Maintaining proper blood sugar levels helps avoid sudden drops that could result in a fall.
- Discuss your medications with your doctor. Properly manage your medication. Invest in a pill box (there are many out there in which can divide out the days of the week as well as the different times of the days).
- Assistive devices are an important part of fall prevention.
Have a Physical Therapy Assessment
A therapist will review past medical history, and ask questions as it relates to cardiac health, blood pressure, injuries, history of CVA, vision limitations, or musculasketal issues (joint replacements, ROM limitations, muscle weakness).
The therapist also discusses history of falls: how often are they occurring, when do they occur (do they occur with positional changes such as rolling, or at night when the patient is walking to the bathroom), or if the falls have resulted in injuries.
Assessments: address gait, strength, ROM, balance (different balance tests)
What Kinds of Fall Prevention Programs are Available?
A physical therapist can assess if someone is at risk for a fall. Upon assessment a patient can be educated and provided with a strengthening program to address posture and LE/UE strength, as well as assistive devices (proper use of a walker or cane, adjust to the proper height).
An occupational therapist can assess the patient’s home and recommend where to put grab bars, and how to safely use assistive devices in the home.
In therapy: individual balance and coordination programs (gait training drills to challenge the body to react to changes in balance).