Falls are the leading cause of injuries (both fatal and nonfatal) among Americans 65 and older. Despite this scary statistic, falls are often easy to prevent. Working together with your family and healthcare team, you can reduce the risks, build strength and confidence, and stay alert for potential problems as they arise.
In this article, we’ve outlined the three most important steps you can take prevent falling. Each of these steps is equally important.
- Talk to Your Doctor and Healthcare Team
- Stay Active and Healthy
- Make Your Home Safe
Step 1 - Talk to Your Doctor and Healthcare Team
Certain changes to our physical body are inevitable as we age. These natural changes can have a huge impact on balance and strength. In addition, many seniors have chronic conditions or take medications that can increase the risk of falling. With so many overlapping risk factors, it’s important for seniors to speak with their doctor about how to mitigate these effects.
Take a Self-Assessment on Senior Fall Risk
Before visiting the doctor, take this self-assessment from the CDC’s STEADI program (Stopping Elderly Accidents, Deaths, and Injuries). If you’re a caregiver, ask these questions of your senior. If they answer yes to four or more questions, they’re at greater risk for falling.
- I have fallen in the past year.
- I use or have been advised to use a cane or walker to get around safely.
- Sometimes I feel unsteady when walking.
- I steady myself by holding onto furniture when walking at home.
- I am worried about falling.
- I need to push with my hands to stand up from a chair.
- I have some trouble stepping up onto a curb.
- I often must rush to the toilet.
- I have lost some feeling in my feet.
- I take medicine that sometimes makes me feel light-headed or more tired than usual.
- I take medicine to help me sleep or improve my mood.
- I often feel sad or depressed.
You may want to take the assessment with you to your appointment to start the conversation. These questions cover a broad range of medical conditions, medication side effects, aging related changes, and behavioral factors that can affect fall risk.
Talk About Medical Conditions that Could Increase the Risk of Falling
According to the New England Journal of Medicine and Age & Aging, the following medical conditions have been linked with an increase in falls. If you or your loved one have any of these conditions, be sure to discuss falling risks and preventative steps with your doctor.
- Alzheimer’s disease and other dementias
- Arthritis and other pain syndromes
- Cardiovascular/cerebrovascular diseases
- Parkinson’s disease
- Seizure disorders
Other conditions that should be considered:
- Chronic pain
- Recovery from a recent injury
- Hearing or vision problems
- Vertigo or other balance conditions
If you have any of these conditions, ask your doctor about how whether you are at greater risk and what you can do about prevention.
Talk About Medications that Could Increase the Risk of Falling
According to the American Journal of Geriatric Pharmacotherapy, adults who take four or more medications at a time are at the highest risk for falling. This study by the University of North Carolina sought to identify which specific drugs can increase the risk. They noted that, “The common denominator among them is that they all work to depress the central nervous system, which can make patients less alert and slower to react.”
The CDC notes that the following types of medications (both prescribed and over-the-counter) should be reviewed with your doctor if you’re concerned about falling. However, do not stop taking these medications before consulting with your healthcare team.
- Medications affecting blood pressure
- Muscle relaxants
If you’re taking any of these medications, talk with your doctor about stopping medications when possible, switching to safer alternatives, or reducing medications to lowest effective dose. Ask about non-pharmacy options to manage your condition or illness.
Get Assessments of Balance and Strength
Your doctor can perform some simple assessments to test your balance and strength, giving him/her more information on how best to advise on fall prevention strategies. Functional tests include:
- 30-Second Chair Stand Test – This will evaluate your leg strength and endurance by sitting and standing repeatedly for 30 seconds.
- Four-Stage Balance Test – This evaluates your “static balance,” or ability to stand with balance. You’ll be asked to adopt four standing positions for ten seconds that get progressively harder to maintain.
- Timed Up and Go Test – This assesses your ability to rise from a chair, walk a few feet, and return to the seated position.
If you have frequent dizziness or balance issues, your doctor may also want to conduct a test to assess your Orthostatic Blood Pressure. Also called postural hypotension, this is a form of low blood pressure that happens when you stand up from sitting or lying down. Orthostatic hypotension can make you feel dizzy or lightheaded, and maybe even faint. If your symptoms appear to be related to vertigo, there are several additional balance tests which induce vertigo symptoms by moving your head and body in specific positions.
Questions to Ask Your Doctor
As you discuss the topics noted above, keep these questions in mind:
- Are there any assistive devices that would be appropriate for me?
- What kinds of physical activity would be okay for my health status?
- Are there any community resources or classes that could help reduce my risk for falling?
- Do I need any referrals to specialists (optometrist, podiatrist, physical therapist or occupational therapist)?
Step 2 – Stay Active and Healthy
A healthy body is better equipped to react to accidents – you’re stronger, more flexible, have better balance, and can bounce back more quickly even if you do have a fall. Regular physical activity and healthy eating should be a core component of your fall prevention plan.
Why Should Seniors Be Active?
According to the US Preventative Services Task Force, exercise is a great strategy for reducing the risk of falling. Their analysis of over 20 studies found a 10 to 20 percent reduction in the risk of falls for people who completed the exercise programs. Another recent analysis by the British Journal of Sports Medicine found that working out for more than three hours per week was linked to a 39 percent reduction in falls.
How to Get Started with Exercise
Even if these stats have you ready to hit the gym, your best bet is to talk with your doctor before starting any exercise program. This is especially true if you've been feeling dizzy or if you have a chronic health condition like heart disease, diabetes, or asthma. The best way to ensure you're exercising safely is to ask your doctor to refer you to a physical therapist or ask a personal trainer to walk you through your routine.
What Kind of Exercise is Best?
Once you have the go-ahead, the National Institute on Aging has created a campaign called Go4Life, that offers free, evidence-based resources for older adults in one convenient place. They recommend focusing on four key areas: endurance, strength, balance, and flexibility.
Here are few low-impact ideas:
How Healthy Eating Can Reduce Fall Risks
Most seniors wouldn’t connect what they eat to their risk of falling. But what what we put into our body influences how our body works, moves and reacts. If your body is not receiving enough food or perhaps not the right types of food, you may be malnourished. Malnutrition can lead to weight loss, poor immunity, fatigue and dizziness which could result in a fall. The same goes for dehydration. Here are some great tips on healthy eating from the Stay on Your Feet program.
- Don’t skip meals, even if you don’t feel hungry
- Eat regular, healthy meals from a variety of food groups
- Keep your kitchen well stocked with long lasting staples
- Use frozen and canned fruit and vegetables
- Cook big batches of your favorite foods to freeze
- Have a range of healthy snacks available
- Drink a glass of water first thing in the morning and drink water with all meals
- Have a water bottle with you through the day, at home and when you are out
- If you are drinking alcohol, have one drink, followed by a glass of water
- Seek advice from your doctor if needed
Step 3 - Make Your Home Safe
Last but not least, there are many precautions you can take in your home to create a safe environment. Many non-profit and community organizations have fall prevention programs that may provide a home safety assessment. Visit the National Council on Aging to find a local program and find out if you’re eligible. We’ve summarized several tips for fall prevention at home, categorized into different areas.
Eyesight often declines over time, so seniors need better lighting to accommodate changes in vision as well as eye disorders such as cataracts and glaucoma. Improving the lighting in the home is a quick and inexpensive way to reduce fall risk.
- Be sure entryways, hallways, and areas frequently navigated are well-lit
- Position on/off switches to be accessible
- Use nightlights, motion lights, clap lights, remote-controlled lights, and timed lights
Choose Safe Rugs and Flooring
Flooring choices can have a huge impact on reducing falls in seniors. Most importantly, you want flooring that’s consistent throughout the living areas. This will minimize the number of transitions (i.e. saddles or thresholds) as these can become tripping hazards. Many older adults drag their feet a bit and/or don’t lift them as much.
For areas where a hard surface is needed (like kitchens and bathrooms), look for flooring that has some cushioning and shock absorption as well as texture and slip resistance. Additional tips include:
- Removing area rugs that are loose
- Installing ramps with grab bars
- Using non-skid floor wax
- Installing carpeting on stairs and in bedrooms
It’s also very important to wear properly fitted shoes or grip-socks.
Incorporate Smart Technology
Smart technology such as sensors, voice activation, GPS, and smartphone monitoring apps can keep seniors in close touch to their loved ones and alert someone if an accident does occur. We recommend:
- Wearing sensors that can be pressed to alert emergency contacts
- Using smart home (verbal audio) assistants like Google Home or Amazon Alexa
- Using fall-detectors that immediately alert authorities even when unable to speak
Make Your Bathroom Safe
Due to its hard surfaces and slippery conditions, bathrooms are often the location of senior accidents. Many contractors specialize in this area of home modification if you need to remodel your bathroom. Some basic steps should include:
- Add grab bars near the toilet and in the shower
- Use non-slip mats and rugs in and outside of the tub
- Install a zero-entry tub can be installed to ease tub entry
- Add a shower seat to prevent falls
- Install a tall toilet seat to increase stability
Even a small amount of clutter in the wrong place can cause an accident. If there’s a major clutter problem, bringing in a professional organizer might be helpful as a neutral third-party. At a minimum, you should:
- Arrange belongings and furniture in a way that is easy to navigate
- Clear out clutter and put unnecessary items into storage
- Be sure paths are wide and clear
Check-ins are important to make sure your senior loved one is okay, but also to evaluate safety hazards regularly. Schedule a friend, family member, or caregiver to call, text or visit and create a regular calendar of such visits. There are numerous programs that help with quick check-ins, if family is away on vacation.
Prepare for Pets and Visitors
While everyone loves company, the hustle of coming and going could create the risk for a fall. Think ahead to prevent an accident:
- Secure pets in a designated area
- Put a bell on the pet's collar to help be aware of location when active
- Use a play pen or designated area for young grandchildren
Improving the comfort and accessibility of your home could just mean a few easy modifications to have a better layout and organization of your belongings.
- Move items off high shelves and into more accessible locations
- Purchase a “grabber” to reach items without getting up
- Arrange belongings you need frequently into one central area
- Maintain clear walkways
- Consider rearranging furniture layouts for better access
Falls are not an inevitable part of aging. As you can see, there are a number of proactive steps seniors and their families can take to prevent injury from accidents. Act today to stay healthy, active, and independent.