Fall Prevention Strategies

Article Highlights

• One of every three older adults will fall this year with subsequent fractures, cuts, and head and brain injuries.
• Although falling is not an inevitable result of aging, the fear of falling and falling itself are huge concerns for older Americans.
• Risk factors for falls among older adults include vision and balance issues, functional impairment, and side effects of medications.
• Prevention strategies are critical, particularly in the bathroom, kitchen, and elsewhere around the home.

Overview: Falls Among Older Adults

One of every three older adults will fall this year, causing hip and other bone fractures, serious cuts and, often enough, deadly injuries to the head and brain. Many people in their seventies and older move around ever so carefully because of a phobia about falling and fall-related injuries. Rightly so, for they’ve read and have been told over and over again that falls constitute the foremost cause of fatal and non-fatal injuries among older adults.

Both the fear of falling and the fall itself are huge concerns for older Americans. Although falling is not an inevitable result of getting older, it is a well-known fact that falls are the most prevalent hazard with aging, mostly occurring inside and around the home. Older adults indeed have cause to be extra weary of how they move around and go up and down stairs, for slipping and falling, at best, threaten their safety, independence, quality of life and, not least of all, their pocket book.

Even falls that do not produce injuries can take a heavy toll on older adults, for fear of falling often prevents people from staying active, getting exercise, and expanding their activities. This inevitably results in added sedentary lifestyles among those who should be engaging in regular exercise for obesity, diabetes, hypertension, and possibly even Alzheimer’s and other types of dementia. That same fear can also lead to social withdrawal, depression, and heightened feelings of vulnerability, all of which can contribute to immune system weakness and disease.

Fall Statistics

The statistics speak for themselves. The U.S. Centers for Disease Control and Prevention share the following alarming facts:

• Falls: More than one third of American adults will experience at least one fall every year.
• Emergency room incidence: An older adult is transported to an ER for a fall every 11 seconds, leading to 800,000 Americans being hospitalized every year.
• Death from falls: An American adult succumbs terminally to a fall every 19 minutes, with 27,000 annual deaths.
• Age 75 and older: Americans age 75 and older comprise more than 60 percent of people who die from falls; they are also four or five times more likely to be admitted to a long-term facility for a year or longer.
• Non-fatal trauma: Falls of older adults lead the way among all causes of non-fatal traumatic events that end up in massive numbers of hospital admissions.
• Cost estimates: It is estimated that the total cost of falls among older adults will reach over $67 billion by the year 2020.

Falls and Fractures

More than 300,000 Americans aged 65 or older are hospitalized each year with hip fractures of different types, and of those, only approximately 25% survive the initial 12 months following their fracture, while the rest live longer, though typically with a diminished quality of life.

A broken bone or joint may not sound all that dangerous, but if you’re an older person, you can pay a heavy price for fractured hip surgery. You could be on your way to serious disability -or worse. Even in the best of cases, there would be a sudden and precipitous decline in independence and quality of life.

In a meta-analysis published in 2010 that involved more than half a million women and over 150,000 men over 50, researchers from both Belgium and the U.S. found the risk of death in both genders three months after broken hip surgery to be five to eight times higher.

Here are a few additional facts relating to aging and falls:

• Among older adults, the majority of fractures are caused by falls, and a large number of all falls cause fractured bones.
• About 30 percent of those who fall suffer moderate to severe injuries such as broken hips or head traumas.
• The most common fractures are of the vertebrae, hip, upper thigh bone, pelvis, hand, arm and forearm, and the leg and ankle.
• The causes of death after hip fracture surgery included pneumonia, accelerated dementia, pulmonary embolism, infection, and heart failure.

Risk Factors and Causes of Falls in Older Adults

Whether it’s electric cords left to run across rooms, slippery floors with water and grease spills left unchecked, or rickety chairs, the data on falls are grim. According to research conducted by the University of Oklahoma College of Medicine, falls are the leading cause of accidental death in older adults, with related Medicare expenditures of over $30 billion in 2015. The other staggering statistic is that half of the entire nursing home population falls at some point.

Falls among older adults are hardly ever caused by a single factor. The more typical fall accident is caused by two or more risk factors, usually including health problems, age-associated cognitive decline, and the side effects of the multiple medications that many older adults take.

Here are age-related and other factors that, individually or in combination, become prime risk factors for falls:

• Balance issues (grogginess and other unsteadiness factors)
• Instability (while walking or changing from one activity to another)
• Muscle weakness and insufficient muscle power (when first taking on an activity like navigating uneven surfaces, or rushing to the bathroom)
• Lack of adequate vision (particularly peripheral vision)
• Functional impairment due to conditions like dementia, arthritis and anemia
• Prescription drugs (fall risks increase in direct relation to the number of medications taken)
• Particular medications (antidepressants, tranquilizers, sedatives, and more)
• Multitasking (like staying steady while stepping in and out of bathtubs, or doing something while being distracted by something else)
• Inadequate lighting and other environmental hazards in the home
• Foot pain or oversized slippers and shoes
• Typical home hazards like electrical cords, throw rugs, etc.

Fall Risk Assessments

We summarized in the above sections on risk factors and causes of falls why people, particularly older adults, tend to fall. These factors have been well documented in the recent past, starting with lower body weakness, and extending to vision and spatial deficiencies, to foot pain or inappropriate footwear.

We also cited some alarming facts and figures about falls. For example, one of every three older adults will fall this year with subsequent fractures, cuts, and head and brain injuries, and although falling is not an inevitable result of aging, the fear of falling is common among older Americans.

This has given rise to develop methods for measuring these risks of falling and, sure enough, several risk assessment tools have been developed of late, mostly by healthcare systems led by researchers and experts in aging and fall risks.

Assessment Tools

Here are the three most prevalent fall risk measurement scales currently in use:

Morse Fall Scale

The Morse Fall Scale (MFS), developed in 1985 by Janice Morse, is a quick and easy way to assess an individual’s probability of falling. Health care professionals who attend to patients in health care settings such as rehab centers and hospitals describe this scale as a fast and readily usable method that can be put to task within 3 minutes or so. This scale assesses:

• The patient’s history of falls (given that someone who has sustained significant fall in the past is more likely to fall again)
• Secondary diagnosis (this assesses those conditions that also occur at the time of admission to a medical center, or immediately thereafter, that impact the plan of care)
• Use of ambulatory aids (ambulatory aids such as canes, crutches, and walkers that are used to provide an extension of the upper extremities to distribute weight and balance factors in a manner that helps in ambulating)
• Intravenous therapy (intravenous infusions, commonly referred as drips, constitute the fastest way to introduce medications and fluids into the patient’s body)
• Gait (this assesses a person’s manner of walking, including such accounts as stride, pace, bearing, and other)
• Mental status (the mental status examination, aka MSE, is an important part of the clinical assessment as it measures the patient’s ability to coordinate between abilities to coordinate thought patterns necessary for fall prevention)

These six items are thus evaluated in the Morse Scale with a “yes” or “no”, the final score establishing whether the patient’s risks of falling are high, medium, or low.

Hendrich II Fall Risk Model

The Hendrich II Fall Risk Model, developed by Ann Hendrich in 2003, is designed to be administered rapidly. It focuses on the following 8 risk factors:

• Confusion, disorientation, and impulsivity (in the Morse Scale, this was covered in the tests for gait, mental status, and secondary diagnosis)
• Symptomatic depression (symptomatic depression is a term used to indicate that a person’s depression symptoms do not rise to the level of a clinical depression)
• Altered elimination (this relates to conditions that cause elimination of bowel or urine to be substantially altered)
• Dizziness or vertigo (when the room is spinning, you are mor elikley to fall)
• Being male
• Administration of antiepileptics (or changes in dosage or cessation)
• Administration of benzodiazepines
• Poor performance in rising from a seated position in the Get-Up-and-Go test

Fall Prevention Strategies and Techniques

One in three older adults fall at least once, and as they age, the odds of a fall increase dramatically, particularly for those who’ve already fallen once. What is alarming, and to a large extent preventable, is that half of all fall incidents occur in the home.

Here is an abbreviated list of tips and strategies that can be taken to reduce the odds of predictable and unnecessary falling accidents:

• Clutter: A home full of clutter is asking for trouble. Make it your strategy in an Alzheimer’s patient’s home to routinely put pieces of furniture and other odd items away neatly where they belong, and keep passageways clear.
• Light: Keep all the areas where the patient dwells well lit, and place night lights throughout the areas of likely passage such as from the bedroom to the bathroom, back and forth to the kitchen, and on any staircases that may be used.
• Slip resistant mats and materials: Replace throw-rugs throughout the home with slip-resistant rugs, and fix other items sternly on the staircase so that handrails and possible carpeting are fastened securely.
• The bathroom: Pay special attention to the bathroom where the majority of accidents occur. Bump-proof all the sharp edges, and use slip-proof rubber mats that don’t move or twist on the bathroom and shower floors, and also use textured adhesive on the tub floor. Grab bars are critical for your loved one’s safety: by the toilet, tub and shower, and on the wall on the opposite side of the tub.
• Keeping the floors dry: Any water spills on the floor of the bathroom and kitchen should be quickly mopped and wiped dry.
• Medications: Take regular inventory of all the meds your loved one takes. Your doctor or pharmacist can counsel you as to the specific medications that cause interactions or symptoms such as lightheadedness or drowsiness.
• Reaching up: Keep items you use often like towels, blankets and cooking materials in low, easy-to-reach places; try not to reach up or use a stool, both risky, particularly if you are unsteady on your feet.
• Footwear: Large-fitting slippers can be hazardous, as can high heels. Use snug-fitting slippers and shoes with non-slip soles. Use Velcro wherever possible instead of shoelaces.
• Pets: Pets cause tumbles and falls as they dart around, so make sure your household pets don’t get in your loved one’s way when he or she is moving about the house.
• Vision: Aging eyes can require extra care. It’s important to get a proper exam regularly from an ophthalmologist as well as visiting an optical retailer that has appropriate options for your loved ones. Your optician should be well-versed on the main features that are required when choosing glasses for an older face.
• Outside pavement: If you spot that the outdoor pavement is wet or it might be icy, walk on the grass or hold someone else’s hand, but whatever you do, don’t take needless chances that can put you at risk of a fall

Fall Prevention Techniques for the Bathroom

According to the Centers for Disease Control and prevention (CDC), individuals between the ages of 75 and 85 are twice as disposed to experience a fall accident in the bathroom as an average person, and seniors over the age of 85 are between 4 and 5 times as likely as the average person to have such a bathroom accident.

Here are safety strategies for the bathroom:

• Grab bars: Grab bars are the first and foremost way of improving safety factors in the bathroom. Make sure your safety bars are fixed to wall studs, and have them easily accessible by the toilet, by the bathtub, and on the inside of showers by the far-side wall, so that someone having a shower can hold steady on those.
• Floors: Add a non-skid mat, adhesive strips or textured coating to the shower floor, and fit your loved one’s bathroom flooring with texture that has a non-glare and non-slip finish. In addition, it is preferable to do away with all types of bath mats or throw rugs, keeping the floor clear of clutter and dry.
• Toilet area: It may be difficult to sit down and get up from a regular toilet seat. Beyond the above-described grab bar by the toilet, consider getting a comfort-height toilet seat, a riser for the seat or a frame with arm rests. Keep the toilet paper also in an easy to reach place and at a convenient height.
• Bath chair or stool: Get a shower or tub seat, even if your loved one ambulates well. This, at the very least, will prevent your loved one from getting tired during a shower or bath and thereafter taking risks.
• Caregiver planning: If you are the caregiver of an older loved one, careful planning for giving your loved one a bath or shower is critical. Plan every step of the activity you are about to undertake, and place items like a bath chair, towels, and whatever other materials you will need in advance of the activity itself. That way your loved one is not left to feel cold, or to exert themselves beyond their stamina, or encounter other unforeseen.

Whenever practical and within your budget, get professionals to help you with making your bathroom fall-proof, including licensed persons to help with installing the grab bars. You may also want to consider installing a walk-in bathtub. In addition, let your doctor counsel you on how to mitigate any physical or mental health condition your loved one may have that might increase his or her risk of falling.

Fall Prevention Tips for the Kitchen

Despite what you might have read or thought, fall accidents don’t always happen in the bathroom, although that is the likeliest place for falls, cuts, and injuries. And while cooking and preparing snacks and meals are vital for seniors to maintain their independence, the kitchen is another prime culprit for falls and fractures.

Here is a checklist of techniques for preventing fall accidents and transforming your kitchen into a safe and fall-free zone:

• Keep things within easy reach: Kitchen utensils and cooking materials should all be stacked where you can easily reach them. Make sure the items that are most often used are in low, easily accessible locations, for all it takes is one slip while reaching up or using a stool to put a permanent dent in your quality of life.
• Keep the kitchen tidy and spotless: Use one of those lightweight sweepers and mops to help you clean up spills right away to avoid slips and falls.
• Wear skid-free shoes: Shoes, particularly those with support, are much safer than slippers or going around barefoot, both of which can easily slide on kitchen floors.
• Sit down whenever practical: Whenever you have some food preparing to do, including cutting vegetables and organizing things, it is best to sit down and do your work on the kitchen table.
• Don’t do any waxing: Although that may sound obvious, you’d be surprised at the number of cleanliness fanatics who go ahead and wax the kitchen floors, making them all that much more slippery.
• People with Alzheimer’s: Use safety locks and other burn-proof devices for individuals with Alzheimer’s or other types of dementia.

Fall Prevention Strategies for People with Alzheimer’s

People with Alzheimer’s or some other type of dementia who come and go freely and without ambulating issues are particularly vulnerable to fall accidents because they may:

• Have lost some of their judgment
• Tend to get up from a sitting position impulsively and without forethought
• Forget to call for help or ignore the need for assistance
• Take an excessive quantity of medications
• Be subject to the above list of risk factors that apply to other older adults

The impact of falls, particularly on more frail older adults, can be massive, frequently leading to ghastly injuries, stressful visits from medical first responders, a trip to the nearest hospital and, only too often, death.

In addition to the above risk factors, people with Alzheimer’s disease or other types of dementia are all the more vulnerable, for not only do they frequently have balance, coordination, mobility, and vision issues but, because of their mental impairment, their spatial awareness is also suspect, and the multiple medications they take can make them groggy and off-balance. They also may have nutrition issues (e.g. malnutrition) contributing to feelings of dizziness.

Because older adults spend the vast share of their time in the home, most falls occur at home. Researchers have also revealed that the majority of injuries caused by falls are not from falling down stairs, as might have been expected, but from falls happening on the same level and from a standing position, such as tripping while walking. Therefore, it is important to conduct a thorough assessment of fall risks around the house and take action to mitigate both the obvious and less evident hazards.

Final Thoughts

Although many falls do not have serious outcomes, one out of five falls does tend to result in serious injury such as bone fractures, severe bleeding if the person is on blood thinners, or trauma to the head and brain. In the best of circumstances, these injuries still tend to degrade the person’s health and quality of life.

One of the worst results from a fall that causes only scrapes and bruising, i.e. no serious harm, is that the individual may acquire a phobia about falling. This fear can make people distrustful and over-cautious about all of their movements which, in turn can lead to a sedentary lifestyle with little activity, withdrawal, isolation, depression, and greater susceptibility to diseases like diabetes and hypertension.

However, with the right information, home modifications, diligent planning, and a lack of complacency, many falls can be averted and injuries can be avoided. As we are living longer, we need to ensure that we are also living better by supporting trajectories of healthy aging. Fall prevention makes up a key part of healthy aging, so keep our tips and strategies in mind as you or a loved one gets older.

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