Fall Prevention: When Does this Apply to You?
-Currently using a walker/cane or another form of walking aide
-Have muscle weakness or decreased sensation in the feet or legs
-Have poor vision
-Recently had a lower extremity surgery
-Feeling dizzy or light headed
-Had a fall within the past few months to a year
-Fearful of falling
-On a ton of medications
Well then this if for you!
Falls...the one thing that everyone is afraid off especially when over the age of 65. Falling is the number one reason for fatal and nonfatal injuries in persons 65 and older. Falls are also the most common cause of traumatic brain injury ¹. According to the CDC (Centers for Disease Control and Prevention), 1 in 4 elderly adults 65+ yrs old fall each year ¹. One in five falls will result in a serious injury such as head trauma or a broken bone ¹. “Over 800,000 people a year are hospitalized due to a fall that resulted in injury of either head trauma or hip fracture. More than 95% of hip fractures are a result of a fall. ¹” In addition, ¹ “every 20 minutes an older adult dies from a fall in the United States”. Yikes!!
Prevention is Better Than a Cure
Some of the things that contribute to falls especially in the elderly population are impaired vision, medication, decreased balance, leg weakness, chronic health conditions and home hazards. The key is figuring out which one or ones are a problem for you so that you may seek help to decrease these risk factors and lower your chances of having a fall.
Problem: Impaired Vision
People with visual deficits such as glaucoma or cataracts are definitely at risk for falls as their visual acuity and depth perception are altered. Lighting can also play a role as if walking out at night or when getting up from bed to walk to use the bathroom; if adequate lighting is not available the visual field will be altered thus increasing risk of falls.
Solution: If you notice you have trouble looking at objects either far or near or often misjudge your step when coming on/off an escalator or stair case, you might have a visual deficit. Get your eyes tested frequently. If you were prescribed glasses, make it your duty to always wear them. Update your glasses if need be. The CDC recommends: “If you have bifocal or progressive lenses, you may want to get a pair of glasses with only your distance prescription for outdoor activities, such as walking. Sometimes these types of lenses can make things seem closer or farther away than they really are. ²” Also utilize night lights throughout your home to ensure adequate lighting when going to restrooms and always give yourself a few minutes to adjust upon getting up from bed to walk to restroom to ensure your eyes have adjusted from your awaked slumber.
Certain meds have side effects of dizziness, altered mental state, muscle fatigue and sudden drop in blood pressure including but not limited to blood pressure medication, antidepressants, sleeping pills and some pain meds and muscle relaxers. Not to mention if on more than one of these medications the drug interactions can cause issues with gait and balance and increase risk of falling.
Solution: Have your primary care provider look over ALL your medications to screen for the side effects and drug interactions. Report a list of all your medications to your health care providers. It is important to keep all your health care clinicians in the loop with your list of meds because if one prescribes a medication unaware that you are currently taking a drug for a certain condition he/she might end up prescribing you another medication treating the same condition but with more severe side effects when interacting with that drug. Thus putting you at risk for falling. As a Physical Therapist, I ran out out of fingers and toes to count the amount of times I had patients coming in for gait and balance treatment, with a long list of meds to treat similar or exactly the same conditions in which the physicians prescribing these drugs had no clue the patient was already taking Drug XYZ prescribed already from Doctor A. So I can’t emphasize enough the importance of having your healthcare provider monitor the medications you are on and their interaction with other drugs.
Problem: Decreased Balance/ Leg Weakness
If you have had numerous falls in the past, frequently feel unbalanced when walking, often grab onto the nearby person/wall/furniture when walking then you may have a balance impairment. Many factors can play into why someone has decreased balance for example whether or not you may have decreased sensation in your feet due to Diabetes, or have an inner ear issue such as vertigo, or recently had a stroke and have difficulty moving the limbs due to extreme weakness. Decreased mobility/inactivity can also affect balance because when we are inactive our muscles become deconditioned and if the muscles are weak, they will affect our ability to stay upright thus putting us at increase risks for falls. Not to mention if you do trip, the ability for you to catch yourself or to correct your footing is less likely if the muscle strength is not there.
Solution: Consider using a walking aid whether cane or walker. A Physical Therapist can assess you for the proper assistive device needed to give you more stability when walking and can train you on how to properly use the device. Talk to your health care physicians about falls prevention classes or referrals for physical therapy to work on gait and balance training and/or strength conditioning. Also, stay active! You are never too “old” to exercise. The body is made up of many muscles and like the saying goes “use it or lose it”. It doesn’t mean you have to sign up for the next marathon but just keeping moving, maybe even a gentle daily walking program to build up endurance. You can even join a gym! The American Heart Association, AHA, recommends about 30 minutes of moderate intensity exercises at least 5 days a week to improve overall health ³.
For Overall Cardiovascular Health:
At least 30 minutes of moderate-intensity aerobic activity at least 5 days per week for a total of 150
At least 25 minutes of vigorous aerobic activity at least 3 days per week for a total of 75 minutes; or a combination of moderate- and vigorous-intensity aerobic activity
Moderate- to high-intensity muscle-strengthening activity at least 2 days per week for additional health benefits.
Problem: Chronic Health issues
Patients with comorbidities and chronic illness such as Diabetes, Arthritis, Heart Disease, COPD, Parkinsonism, Multiple Sclerosis, Alzheimer’s, history of stroke, and etc are at increased risk to falls due to the general weakness, impaired muscle tone, reduced sense of position in relation to gravity, altered mental state, decreased cardiovascular endurance and decreased oxygenation.
Solution: Follow up with health care provider regarding treatment interventions and exercise regimens to ensure optimal functioning despite health conditions. Routinely check blood pressure if feeling lightheaded, check glucose levels, use assistive device of need be for conditions that can impact gait and take prescribed meds at routine time of the day.
Problem: Home hazards
As we often like to think we are the most safe in our homes, that is not always the case. Clutter can lead to tripping and falling. Incorrect placement of furniture may narrow spaces and increase risk for falling. Throw rugs and small pets are very easy to trip over or get your walking aides caught up over. Poor lighting can affect your visual field and depth perception. Cracked stairs and loose carpet, lack of or shaky railing can also increase your risk of falling. The bathroom can become a complete nightmare without grab bars or a shower stool. High kitchen cupboards may prove difficult to reach and can lead to a safety issue if you are constantly trying to climb up onto the counter. Step stools are helpful but if unsteady can be very dangerous.
Solution: Remove the clutter from your home. Wires, stacks of books, that step stool you refuse to place under the table or in a closet can all lead to clutter and increase risk of falling. Furniture placement is also essential making sure everything is strategically placed so that you are able to maneuver around your home without sliding through the corners or stumbling around your furniture. Even more so, if you use an aide whether cane or walker to move around; it can easily get caught in the clutter causing you to misstep and fall down. Get rid of or properly secure throw rugs to the floor especially if you notice the ends curling upwards.
Be mindful of pets when walking about in your home; they love to lay near your feet. As lovable as they are, they are very easy to trip over if not paying attention!
Be mindful of steps especially if you already had visual issues. Depth perception and busy colors can really impact the way we see our stairs. Also if living in an older home make sure the railing is secure and if steps are slanted revealing wear and tear, maybe time to revamp as this can all lead to falls. Make sure to hold onto railing when ascending or descending stairs and be aware of foot placement to ensure you don’t misplace your feet at the edge. You may even consider installing rails on both sides if need be for safety. Don’t forget having a step stool in the kitchen can be very helpful. Ensure the step stool is leveled before using.
Grab bars and/or shower stool are also neat for bathrooms especially in showers where it tends to get slippery. May even consider anti-slip bath mats. Also grab bars near the toilet as to assist with transfers on and off.
Lighting is essential in both daytime and especially at night. Broken bulbs?? Replace it! Make sure your home always has adequate light to ensure that you can see where you are going especially at night time walking down hallways to get a glass of water or use the bathroom. Night lights tend to come in handy for that or if you are feeling fancy, motion sensor lights can also do the trick. Also make sure there is adequate light over staircases. Is the light switch only at the bottom or top of the staircase? You may need both to ensure safety.
“Home and Recreational Safety.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 11 Oct. 2016, Accessed on 20 July 2018 at www.cdc.gov/homeandrecreationalsafety/falls/index.html.
“Home and Recreational Safety.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 10 Feb. 2017, Accessed on 20 July 2018 at www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html.
American Heart Association Recommendations for Physical Activity in Adults. (2017, December 14). Retrieved July 23, 2018, from http://www.heart.org/HEARTORG/HealthyLiving/PhysicalActivity/FitnessBasics/American-Heart-Association-Recommendations-for-Physical-Activity-in-Adults_UCM_307976_Article.jsp#.W1Ydo-gvxD8
Yoshida, Sachiyo. “A Global Report of Falls Prevention: Epidemiology of Falls.” Retrieved July 24, 2018 Http://Www.who.int/Ageing/Projects/1.Epidemiology%20of%20falls%20in%20older%20age.Pdf