Falls are a common fear in older adults—and for good reason. The consequence of a single slip or trip goes far beyond the initial pain. The consequences of falling often lead to hospitalization, surgery, and long-term care. In turn, this can mean increased social isolation, feelings of helplessness, and an increased fear of falling again.
The fear of falling can have a devastating effect on an older adult’s quality of life. It is natural to have some concerns about a potentially painful, unpleasant experience, and someone who has fallen may begin to limit their activities. As older adults generally become weaker and less agile with age, their fear of falling can lead to a more sedentary lifestyle and physical decline. This only makes falls more likely. For these reasons, “fear of falling” is a defined geriatric syndrome.
Minimizing Falling Risk
To avoid falling, it helps to understand the specific risks in older adults. Jenny Sanford, an Adult-Gerontology Primary Care Nurse Practitioner and Caregiving Coach based in New York City, advises, “Because falls are one of the leading causes of life-altering adverse events in older adults, fall prevention is one of the single most important topics to address with this population.”
A balanced gait requires freely moving joints and muscles that contract appropriately with enough strength to support an individual’s body weight. Even accurate visual, vibratory, and proprioceptive input is important for a standard gait and balance. However, joints stiffen and muscles weaken over time. Neurologic feedback loops also change over time, so older individuals are slower to react to a slip. All these physiologic age-related changes, along with other risk factors, increase the likelihood of falls.
The strongest independent risks associated with falls are physical weakness, gait and balance impairments, psychoactive medications, and previous falls. As you may imagine, dizziness and visual and cognitive impairment can play a role. Women and all adults over 80 are also more statistically prone to falling. Other factors include:
Depression
Osteoporosis
Urinary incontinence
Polypharmacy arthritis
Diabetes
Undertreated pain
Polypharmacy (simultaneously using multiple drugs to treat a single issue)
Lifestyle
Fall Prevention And Lifestyle
There are many precautions that you (or your aging loved one) can take to reduce the risk of falls. One of the simplest is to reduce clutter and potential tripping hazards in the home. These include electrical cords, loose throw rugs, clothing, shoes, and anything an aging adult in the home might have to bend down or over to reach. The home should be brightly lit, especially in stairways and hallways. Nightlights are recommended for extra guidance in bedrooms, hallways, and bathrooms.
Even loose and baggy clothes can bunch up or drag on the ground and cause an individual to trip. Practical shoes with proper arch support and rubber soles are also safest to wear indoors. As comfortable as socks or slippers may be, they present an easy slipping risk.
Check in with your doctor and discuss your health conditions and any medications you are taking to determine whether you are at increased risk for falling. If you have fallen in the past, consider the variables that may have caused or contributed to the incident, including the timing, location, and any circumstances that may have made falling more likely. For example, medications have side effects that can lead to periods of dizziness or fatigue.
If you are an older adult at an increased risk of falls, make sure to move slowly and carefully in the home. Even taking small precautions like pausing after rising from sitting or laying down will help to regain and maintain your balance.
Both the American Geriatrics Society and British Geriatrics Society recommended that healthcare providers ask all patients over 65 about previous falls each year.
Lifestyle Tips
Slippers, floppy shoes, heels, and even socks can easily lead to a slip, stumble, or fall. Look for proper fitting, supportive shoes with nonskid soles.
Clutter doesn’t always look like what we imagine (piles of newspapers or clothes thrown on the floor). Check the home thoroughly for tripping culprits like power cords, loose or slippery rugs, and even extra furniture like plant stands and coffee tables.
As we age, we lose depth perception and are at risk of obscured or diminished vision. Older adults also frequently suffer from cataracts, age-related macular degeneration, and glaucoma, all of which can impact visual acuity. Seniors should have their eyes checked at least once a year.
It’s possible your medications and/or health conditions could be contributing to your instability.
Short Steps to Avoiding Slips
Discuss your health conditions and how comfortable you are when you walk with your primary care doctor. Be honest about any shortness of breath, dizziness, joint pain, or numbness in your feet and legs. Be sure to share your history of falls and where and how you fell or almost fell.
If you have fallen or have experienced gait or balance issues, there are now easy in-office fall assessments like the Timed Up and Go test. Together, you and your healthcare professional can discuss fall prevention strategies. They may also recommend assistive devices or refer you to an occupational therapist.
Fall-Proof Your Home
Remove cords and other tripping hazards from walkways and secure loose rugs or floorboards. Use non-slip mats in your bathroom and remove low furniture like coffee tables, plant stands, and magazine racks from high-traffic areas. Place night lights in bedrooms, hallways, and bathrooms, and everywhere you may walk in the dark. Make well-lit, unobscured paths to light switches and consider installing illuminated switches. Make sure that objects like clothes or remotes are always within reach.
Fall-Proof Your Lifestyle
Sometimes ensuring your future well-being means adjusting your habits even if you are still healthy and fully mobile. Don’t walk in dimly lit rooms or climb furniture or stepladders when no one is around. Avoid excessive drinking, as alcohol increases the likelihood of falling, and make sure that your diet is adequate in calcium and Vitamin D for bone health.
Reduce Your Risk From Head To Toe
Not only do high heels compromise your balance, but bedroom slippers and socks can cause you to slip or trip. Invest in socks with non-stick material on the underside to prevent slips or a pair of comfy but supportive non-slip house shoes. Make sure that all your footwear fits properly, is supportive, and has non-skid soles. Consider taking a favorite pair of shoes to a cobbler to alter for you so you can ensure the perfect fit. The right shoes can also reduce joint pain and prevent foot-related injuries.
Don’t Stop Moving
Remaining physically active not only makes you less likely to fall, but it also improves your chance of catching yourself before a fall. Walking, water aerobics, and tai chi (a Chinese martial art that promotes balance) can reduce the risk of falls by improving strength, balance, coordination, and flexibility. If your physical condition allows, activities like jogging, dancing, hiking, climbing stairs, and weight training can build bone strength and slow the progression of osteoporosis.
As you grow older, it’s important to manage your fear of falling as well as your actual risk. That means assessing your likelihood of falls and consciously mapping out prevention strategies. Particularly if you want to age in place at home, a sound safety and wellness plan are great steps to ensuring a long, active future in your home.
Mobility
How You Can Stay Mobile And Prevent Falls
Regular mobility and exercise help with fall prevention by keeping you more limber and more balanced.
In addition to regular exercise, balance exercises assist in keeping your feet firmly on the floor. It’s smart to include balance exercises in your routine at least three days a week, for 10 to 15 minutes per session. Increasing your balance and maintaining a regular exercise routine also builds your confidence in your physical abilities and strength.
Walking aids such as canes and walkers were designed to assist us as we grow older, but it can often be difficult for older adults to accept that it’s time to start using these devices regularly. If you or a loved one feels resistant to discussing fall prevention, speak with a provider about the best (least intrusive) fall prevention or fall detection devices to start incorporating into daily life.
The best fall prevention is to be purposeful in your actions and aware of your surroundings. Too often falls occur when we are rushing or not paying attention to the path under our feet. Consider whether a floor is wet, if the lighting is dim, if a sidewalk is slick or icy, and any upcoming steps (and use the handrail if there is one).
Mobility Tips
Keeping active and mobile can go a long way in avoiding falls. Simple activities such as daily walks, tai chi, or water aerobics improve your strength, balance, and coordination.
Balance exercises specifically target lower body strength and help you remain steady on your feet.
Always employ the aid of a walking cane or walker when necessary. Mobility aids were designed to ensure you remain as mobile as possible, for as long as possible.
You are more apt to slip or fall if you are fatigued or rushing, or trying to multitask.
Pay attention to the surfaces and obstacles in front of you—curbs and uneven sidewalks are common potential fall hazards.
Facts On Falling
One out of five falls causes a serious injury such as broken bones or head trauma. Falls are a leading cause of injury and death in adults over the age of 65 according to the Centers for Disease Control and Prevention (CDC). The CDC also reports that more than 800,000 patients a year are hospitalized because of a fall injury, most often because of a head injury or hip fracture.
Total medical costs for falls are about $50 billion each year. Medicare and Medicaid shoulder almost 75% of these costs.
Home Modifications
Home Modifications For Fall Prevention
Home modifications can range from simple DIY fixes to minor and major renovations in your home. Start by walking through your house with an eagle eye as to what could contribute to a fall.
Floors should be clear of clutter and rugs secured with either tape or non-skid pads. Tuck away any power/electrical cords that could present a tripping hazard.
The bathroom should have grab bars in the tub, shower, and next to the toilet, as well as non-slip mats in the tub or shower and on the floors. Consider a shower seat or chair for shower safety.
Items frequently used in the kitchen, especially heavy items, should be stored within easy reach. If you must use a step stool, make sure you have a sturdy stepladder with a safety bar to hold on to.
Timed or remote-controlled lights make it easier for seniors to navigate as it gets darker, and touch-operated lamps are a better option than a switch, which may be difficult to locate or operate with arthritic fingers.
Handrails, if not already installed in the stairway, are a sure safety measure. If your home already has handrails, ensure they are securely fastened.
If you find there are further modifications that require a contractor, be sure to check references, review companies in your area recommended by the Better Business Bureau, and ask for examples of past projects.
Home Modification Tips
Make sure rooms, hallways, and stairways have adequate, bright lighting. Place nightlights in the hallway and bathroom.
If not already in place, install handrails and grab bars in any location you might feel unsteady, specifically hallways, stairways, and the bathroom.
Place commonly used items, especially in the kitchen, within easy reach. Avoid having to stretch or reach for something. If needed, purchase a grabber and a sturdy stepladder with a safety bar.
Walk through and view your residence as a potential fall waiting to happen. If you can find and fix the trouble spots before they find you, you’re ahead of the game.
Jenny is an Adult-Gerontology Primary Care Nurse Practitioner in NYC with a passion for working with aging adults and their family members. Prior to her clinical training at Vanderbilt School of Nursing, she worked in business and medical research at Harvard Business School and Massachusetts General Hospital. As a Caregiving Coach at Givers, Jenny helps family members manage the financial, emotional, and educational stresses of caring for their loved ones who are aging in place.
