Understanding fall risks and taking preventive action is important at all ages. Seniors have a higher incidence of falls, as well as a higher incidence of fall related adverse outcomes.
Falls are a leading cause of both fatal and non-fatal injuries in people aged 65 and older. Typically, fall injuries are fractures which occur both to the upper and lower extremities, and vertebrae. Head injuries also can occur. The immediate risks of hip replacement due to a fracture from a fall are low following surgery for a person without chronic conditions such as diabetes, heart disease, or lung disease. These risks (blood clots, heart arrythmias, heart attacks, pneumonia, and urinary tract infections) increase in the immediate post op period when Comorbidities exist.
Hospital care is often followed by care at a rehabilitation facility. Physical Therapy often follows inpatient care. Seniors with falls injuries will often need to be cared for and supported during their acute and convalescence care by friends and family and community and thus affects us all.
Fall prevention can be thought of in terms of environmental risks, and risks associated with the individual’s health:
Environmental safety generally refers to checking the home for hazards and taking corrective action:
- Floors: Floors should be cleared of all obstacles. Pathways should be free of obstruction, including furniture. Floor coverings such as throw rugs should be removed or secured to the floor.
Loose wires from lamps, computers, TV should be positioned to avoid tripping. Remember never tape down or hide any wires under rugs, as this is unsafe and a fire hazard.
- Stairs: Stairs should have adequate lighting with light switches at top and bottom. Handrails should be available on both sides of steps. Pay attention to what you are carrying upstairs. Keep hands free to grab onto handrails. Replace and repair worn or cracked steps. Make sure all steps are equal in height.
- Lighting: Good lighting should be available throughout the home in every room and hallway. Night lights should provide floor illumination throughout the house. Bedside lightening for easy use should be on the nightstand.
- Bathrooms: Bathrooms, especially shower safety, can be aided by a shower seat and grab bars and bathmats or stick strips. Grab bars can also be placed near the toilet to assist getting up
- When walking at home: If an assistive device is needed for walking, such as a walker or a cane, make sure it is available and easy to reach wherever the user may be. Always use the assistive device. Getting up and walking a “short distance “without your device presents a fall risk. Shoes should be worn with soles that prevent slipping.
- Factors that affect alertness, judgement and therefore increase fall risk: Typical examples are lack of sleep, pain, depression and anxiety. Any substance that affects reasoning, and causes drowsiness such as alcohol and recreational drugs, can increase fall risk. Over the counter medications for sleep and some antihistamines that cause drowsiness increase fall risk
- Prescription Medications: Multiple prescribed medications can result in drowsiness and decreased alertness and cause faintness or dizziness. Talk to your medical team so that all prescribers are aware of all the prescribed medications.
Aim for simplifying medications in so far as possible with the help of your medical team. Alternative and effective solutions to pain other than medication can be effective treatment. For instance, physical therapy that lessens joint pain may allow for decrease in medications.
- Impaired Vision, Hearing, Balance, Orthopedic concerns affecting gait:
Poor vision, from any cause is a fall risk. Examples are glaucoma or cataract. Hearing alerts us to our environment and warnings that might prevent tripping/falling. The inner ear is important for balance, and poor balance can contribute to falls. Eye exams, hearing tests, and medical evaluation may offer help and may decrease fall risk. Orthopedic concerns related to feet or joints that affect gait can increase fall risk. Customized orthopedic shoes can be very helpful in improving gait.
Osteoporosis in and of itself does not contribute to risk of fall. Osteoporosis does increases risk of fractures of hips, forearms, vertebrae. Thus, a fall in an individual with osteoporosis significantly increases the risk of fracture. Assessment for osteoporosis and discussion of treatment with medical professionals is not in of itself fall prevention but may mitigate risk of fracture.
Of note there are specific instances when fall risk is heightened. Most commonly this occurs following recent hospitalization. Additional vulnerable times are any acute illness, or any worsening of a known medical condition, such as loss of normally controlled diabetes or COPD.
Finally, improving endurance and balance can be achieved though exercise, particularly exercise to improve thigh and calf strength. Senior exercise classes are designed to emphasize balance, gait, strength and flexibility. Many communities have Senior Services that can direct inquiries concerning exercises for fall prevention.
Community Programs directed at home health and safety are very helpful. As an example, The Green Valley Fire District partners with Valley Assistance Services in a program called SHIM (Safety and Health in Motion). The program is free and offers safety assessment upon request or by referral from medical personnel. The Fire District team member assesses general safety of the home and can offer hands on help as appropriate. Green Valley Assistance Nurses will review any health concerns and medications, which will allow the medical team to develop a plan.
Although the discussion has centered largely on Senior citizens, all ages can invest in decreasing future fall risks through exercise and healthy habits. Additionally, when our Senior loved ones and friends sustain injuries from falls it often falls to adult children to assist with the period of recovery and coordination of appointments and transportation. To quote Benjamin Franklin (who said this in referring to Fire Safety) “An ounce of prevention is worth a pound of cure”