Don’t Fall this Autumn! Tips to Prevent Fall-Related Injuries

We all know that our risk of falling increases with age, but did you know that two-thirds of those who experience a fall will fall again within six months? This increased risk may be due to a decrease in bone density, a lack of exercise resulting in poor muscle tone, decreased strength, and loss of bone mass and flexibility, or even environmental hazards in the home. 

In the blog post below, David Tranchita, MA, PT, OCS, CMTPT, CSCS, of Greenfield Physical Therapy and New Berlin Physical Therapy, describes common causes of fall-related injuries. Plus, he shares his prevention tips for avoiding falls for older adults who are most at risk for fall-related injuries. 

Fall Risk Factors

The causes of falls are known as risk factors. Although no single risk factor causes all falls, the greater the number of risk factors an individual has, the greater the probability of a fall and the more likely the fall will threaten a person’s independence.

Many of these risk factors are preventable. As obvious as it may sound, a lack of knowledge about risk factors and how to prevent them contributes to many falls. Some people believe that falls are a normal part of aging and are not preventable. Lack of knowledge leads to a lack of preventive action, resulting in falls. Discussed below are five key risk factors for falls among older adults. 

Factor #1: Osteoporosis

Osteoporosis is a condition wherein bones become more porous, less resistant to stress, and more prone to fractures. Caused by hormonal changes, calcium and vitamin D deficiency, and a decrease in physical activity, osteoporosis is a chief cause of fractures in older adults, especially among women.

It is debatable whether brittle bones break after a fall or break when stressed, and in turn cause a fall. In either event, a decrease in bone density contributes to falls and resultant injuries.

Osteoporosis Prevention Tips

• Eat or drink sufficient calcium and supplement it with vitamin D. Postmenopausal women need 1,500 mg of calcium daily. Calcium-rich foods include milk, yogurt, cheese, fish, shellfish, and selected vegetables such as broccoli, soybeans, collard greens, turnip greens, tofu, and almonds. 
• Get sufficient vitamin D to enhance the absorption of calcium into the bloodstream. Vitamin D is formed naturally in the body after exposure to sunlight, but some older adults may need a supplement. 
• Regularly do weight-bearing/strengthening exercises. 

Active senior couple on a walk in a beautiful autumn nature.

Factor #2: Lack of Physical Activity

Failure to exercise regularly results in poor muscle tone, decreased strength, and loss of bone mass and flexibility. All contribute to falls and the severity of injury due to falls.

Prevention Tips

• Engage regularly (e.g., every other day for about 20 minutes daily) in exercise designed to increase muscle and bone strength and improve balance and flexibility. Many people enjoy walking and swimming. 
• Undertake safe daily activities, such as reaching and bending without straining, taking time to recover balance when rising from a chair or bed, learning the proper way to fall, and learning how to recover after a fall. 
• Wear proper-fitting, supportive shoes with low heels or rubber soles. 

Factor #3: Impaired Vision

Age-related vision diseases can increase the risk of falling. Cataracts and glaucoma alter depth perception, visual acuity, peripheral vision, and susceptibility to glare. These limitations hinder a person’s ability to safely navigate their environment, whether in their home or a shopping mall. Young people use visual cues to perceive an imminent fall and take corrective action. Older adults with visual impairments do not have this advantage.

Prevention Tips

• Have regular checkups by an ophthalmologist to discern the extent of age-related eye diseases such as cataracts and glaucoma. 
• Use color and contrast to define balance-aiding objects in the home (e.g., grab bars and handrails). 
• Add contrasting color strips to the first and last steps to identify the change in level. 
• Clean eyeglasses often to improve visibility. 

Factor #4: Medications

Sedatives, anti-depressants, and anti-psychotic drugs can contribute to falls by reducing mental alertness, worsening balance, and gait, and causing drops in systolic blood pressure while standing. Additionally, people taking multiple medications are at greater risk of falling.

Prevention Tips

• Know the common side effects of all medications taken. 
• Talk with your physician or pharmacist about ways to reduce your chances of falling by using the lowest effective dosage, regularly assessing the need for continued medication, and the need for walking aids while taking medication that affects balance. 
• Remove all out-of-date medications and those no longer in use. 
• Have a physician or pharmacist conduct a “brown bag” medicine review of all current medications. 
• Limit intake of alcohol as it may interact with medications. 

Factor #5: Environmental Hazards

At least one-third of all falls in the elderly involve environmental hazards in and around the home. The most common fall hazard is tripping over objects on the floor. Other factors include poor lighting, loose rugs, lack of grab bars or poorly located/mounted grab bars, and slippery surfaces (water on bathroom or kitchen floor, snow and/or black ice on sidewalk or driveway).

Prevention Tips

To identify possible problems that may lead to falling, conduct a walk-through of your home. A home visit by an interior designer or occupational therapist might also be useful, as they can identify risk factors and recommend appropriate actions.

Outdoors 

• Repair cracks and abrupt edges of sidewalks and driveways. 
• Install handrails on stairs and steps. 
• Remove high doorway thresholds and trim shrubbery along the pathway to the home. 
• Keep walk areas clear of clutter, rocks, and tools. 
• Keep walk areas clear of snow and ice. Use de-icer or salt.
• Install adequate lighting by doorways and along walkways leading to doors. 

All Living Spaces

• Use a change in color to denote changes in surface types or levels. 
• Secure rugs with non-skid tape as well as carpet edges. 
• Avoid throwing rugs. 
• Remove oversized furniture and objects. 
• Have at least one phone extension in each level of the home and post emergency numbers on each phone. 
• Add electrical outlets. 
• Reduce clutter. 
• Check lighting for adequate illumination and glare control. 
• Maintain nightlights or motion-sensitive lighting throughout the home. 
• Use contrast in paint, furniture, and carpet colors. 
• Install an electronic emergency response system if needed. 

Bathrooms

• Install grab bars on walls around the tub and beside the toilet, strong enough to hold your weight. 
• Add non-skid mats or appliques to bathtubs. 
• Mount the liquid soap dispenser on the bathtub wall. 
• Install a portable, hand-held shower head. 
• Add a padded bath or shower seat. 
• Install a raised toilet seat if needed. 
• Use non-skid mats or carpets on floor surfaces that may get wet. 

Kitchen

• Keep commonly used items within easy reach. 
• Use a sturdy step stool when you need something from a high shelf. 
• Make sure appliance cords are out of the way. 
• Avoid using floor polish or wax to reduce slick surfaces. 

Living, Dining, and Family Rooms

• Keep electrical and telephone cords out of the way. 
• Arrange furniture so you can move around it with ease. 
• Make sure chairs and couches are easy to get into and out of. 
• Remove caster wheels from the furniture. 
• Use television remote control and cordless phone. 

Bedroom

• Put in a bedside light with a switch that is easy to turn on and off (or a touch lamp). 
• Have a nightlight. 
• Locate the telephone within reach of your bed. 
• Adjust the height of your bed to make it easy to get in and out of. 
• Have a firm chair, with arms, to sit and dress. 

Stairways, Hallways, and Pathways

• Keep free of clutter 
• Make sure your carpet is secured, and get rid of throw rugs. 
• Install tightly fastened handrails running along both sides of the stairs. 
• Handrails should be 34 inches high and have a diameter of about 1.5 inches. 
• Apply brightly colored tape to the face of the steps to make them more visible. 
• Optimal stair dimensions are 7.2-inch riser heights with either an 11 or 12-inch tread width. 
• Have adequate lighting in stairways, hallways, and pathways, with light switches at each end. 

Fall-Related Injury Statistics

• The risk of falling increases with age (>65) and is higher for women than men. 
• Annually, one-third of all people 65 and older report falls.
• Two-thirds of those who fall will fall again within six months. 
• Falls are the leading cause of death from injury among people 65 or over. 
• Approximately 9,500 deaths in older Americans are associated with falls each year. The elderly account for seventy-five percent of deaths from falls. 
• More than half of all fatal falls involve people 75 or over, only 4 percent of the total population. 
• Among people ages, 65 to 69, one out of every 200 falls results in a hip fracture. Among those 85 or over, one fall in 10 results in a hip fracture. 
• One-fourth of people who experience a hip fracture die within six months of the injury. 
• The most profound effect of falling is the loss of independent functioning. Twenty-five percent of those who fracture a hip require life-long nursing care. About 50 percent of the elderly who sustain a fall-related injury will be discharged to a nursing home rather than return home. 
• Most falls do not result in serious injury. However, there is often a psychological impact. Approximately 25 percent of community-dwelling people 75 or over unnecessarily restrict their activities because of fear of falling. 
• The majority of the lifetime cost of injury for people 65 or over can be attributed to falls. 

Other Fall Risk Factors

• Pre-Existing Medical Conditions
  • Osteoporosis – weak bones/frail
  • Parkinson’s Disease – unsteadiness/tremors
  • Diabetes – peripheral neuropathy (numbness in feet) 
• Low Blood Pressure – lightheadedness/faint
• Prior Stroke or TIA – one-sided weakness/neglect 
• Lack of Exercise – weakness in legs and trunk 
• Vision Problems – depth perception/blurred
• Vertigo and Syncope – dizziness or pass-out sensation
• Anemia and Low Iron – tiredness/fatigue
• Foot and Ankle Arthritis – pain and stiffness
• Wearing Poor Shoes – heels, narrow shoes, slippers, no dread on bottom
• Smokers and/ or heavy alcohol drinkers
• Cognition Impaired – medication-based or dementia
• Taking four or more medications – dizziness, unsteady, confused, or disorientated

Tips to Prevent Fall-Related Injuries

• Maintain physical activity such as gardening, dancing, walking, and swimming.
• Engage in an exercise program such as weight training, Tia Chi, yoga, pilates, or an aquatic class.
• Wear supportive, wide shoes with non-skid soles.
• Keep stairs and hallways well-lit, and use night lights around the house.
• Get rugs with non-skid backing and remove all throw rugs. Tack down edges.
• Clear pathways and hallways of clutter and electrical cords.
• Use sturdy hand railings on both sides of all staircases and adhere non-slip treads on all stairs and steps.
• Use bright color strips/tape at the top and bottom of the staircase to alert the transition area.
• Rearrange furniture to provide adequate walking space in each room of the house.
• When getting up after sitting for a long period (reading, eating, television), be cautious and stand for a minute before taking a step. You may get lightheaded or dizzy.
• Have grab bars put in your bathtub, shower, and toilet areas
• Use raised toilet seat or commode if having difficulty getting up from a seated position.
• Use slip-resistant strips or rubber mats in the tub and/ or shower.
• Use a shower seat.
• Avoid using step stools or ladders. Keep frequently used items at waist or chest height.
• Don’t wax your floors or use a non-skid wax product.
• Use a rubber mat at the kitchen sink to avoid water slips.
• In the winter, wear boots with plenty of treads and good traction.
• Clean off sidewalks and driveways after snow as soon as possible to avoid melting and refreezing.
• Use salt on sidewalks and the driveway to avoid black ice.
• Have cracks and lips on walkways repaired to avoid tripping.
• Have your eyes checked annually for vision changes, cataracts, glaucoma, etc.
• Have your hearing check every other year.
• See a podiatrist if you have foot problems – bunions, corns, nail issues.
• See your physician if you experience dizziness, fainting, unsteadiness or confusion.
• Discuss your medications with your doctor annually, especially if you get dizzy after taking them.
• See a physical therapist if you have vertigo, weakness, loss of balance, or pain.
• Stop smoking – will improve your endurance, healing processes, and longevity.
• Limit your alcohol consumption.

If you’ve experienced an injury due to a fall, do not hesitate to make an appointment with an orthopedic specialist at Orthopaedic Hospital of Wisconsin. A physical therapist can help assess your injury and provide treatment that can help to address any pain or discomfort. Call (414) 961-6800 or visit our website to make an appointment today.