Falls Prevention for Older Adults

People start falling from the first months of life when they learn to stand up. Falling is a normal part of life: mistakes are guides demonstrating what not to do. Falls are the leading cause of injury, hospital admission, and death in older people. In the United States, one fourth to one third of adults over age 65 will fall, and the tragedy is that a large percentage of those falls are preventable. Why, with decades of experience, do seniors fall so much?

What Are the Causes of Falls in Older Adults?

The number one cause is … lots of causes. Global studies over time demonstrate that there isn’t a single, simple answer. Most elderly people fall due to a combination of various risk factors: physical conditions, cognitive conditions, and poor safety practices.

1. Physical Conditions

Age brings physical changes regardless of lifestyle. Some changes are inevitable, while others result from many years of poor health habits. Here is a list pf physical risk factors arranged in the approximate order of their impact:

• History of previous falls: Statistics consistently show that once a person falls, the risk for future falls increases significantly.
• Balance impairment: Whether from old injuries, inner ear disturbances, lack of physical activity, neuropathy or other conditions, poor balance inevitably leads to falls.
• Decrease in muscular strength: Loss of strength doesn’t have to be “a normal part of aging.” Unless used often and properly nourished, each decade muscles rapidly decrease in size and ability to move heavy bones and body parts.
• Visual impairment: Cataracts, glaucoma, and macular degeneration are common causes of vision loss because obstacles are simply unseen.
• Polypharmacy or medications: All medications have side effects and interactions, but some, including sleepiness, dizziness, blurred vision, weakness, and increased urination, multiply the risk factors. Polypharmacy refers to fact that many elderly patients may be prescribed several different medications or taking over the counter medications. As the number of medications increases, the risk of side effects or drug-drug interactions increases. This can increase the risk of falls or other complications. For this reason, it is important to be very mindful and careful when one is creating medicine regimen for the elderly.

If you are concerned that you might be taking too many medications, tell your healthcare provider. It can also be sometimes useful to seek a consultation with a Geriatrician. Geriatricians are physicians with special training in managing elderly patients and experts in their medication management.

• Mobility impairment: Falls increase with one or more disabling conditions such as dizziness, orthostatic hypotension (sudden low blood pressure upon standing), arthritis, diabetes, and pain.
• Age: Statistically, the older a person is, the greater likelihood of falling.
• Urinary Issues: Urinary urgency which can be due to bladder or prostate issues can increase risk of falls. Not only do they generate urgency, but it often occurs at night when people are most often sleeping. Losing bladder control can result in a slippery puddle in the dark accompanied by feelings of shame with reluctance to report such falls.
• Other studies emphasize the impact of sleep disorders such as sleep apnea. Loss of hearing interferes with sounds that might alert a person to warning sounds such as a child or pet moving into their path. Losing sensation in the hands and feet prevents accurate perception of surfaces. Slowed reflexes disable rapid response time following positional changes.

2. Cognitive and Psychological Conditions

The mind holds tremendous power over the body. With age, people can lose their alertness, especially when experiencing sensory impairment, lacking regular mental stimulation, or when living under severe emotional stress. Although you gain experience throughout your lifespan, you have to apply the lessons by practicing your skills. The adage “use it or lose it” is true. Here is a partial list of cognitive and psychological conditions contributing to falls:

• Depression: Falls and depression have a “bidirectional” relationship, each making the other worse. Depression often contributes to body weakness, lack of interest in surroundings, poor sleep, neglected nutrition, and fear generated by previous falls.
• Cognitive impairment or Dementia: Memory changes often cause people to omit or double-dose medications. Poor cognition interferes with judgment during risky situations as well as the ability to make safe decisions. It can even lead people to forgetting what their functional abilities and limits are or they should be using an assistive device, e.g. walker.

3. Poor Safety Practices

Statistics reveal different results about the location where most seniors fall. One study asserts that active people tend to experience more falls outdoors but frail people tend to fall more in their homesIt is human nature to pay little attention in familiar surroundings where one feels safe and confident, relying on old habits instead of thinking things through. Listen to that voice inside your head reminding you of all the common sense things you know you should be doing. And not doing!

What Are The Types Of Falls Seniors Experience?

Researchers classify falls in several ways, usually by cause, location, or the kind or severity of resulting injury. The reason for this disparity lies in the ways researchers use the data. One basic classification separates falls by mechanical or non-mechanical:

Mechanical falls: Mechanical falls occur due to loss of balance without any significant symptoms before the fall. For example, slipping on a rug, or missing a step on the stairs would be classified as a mechanical fall. The risk factors for this type of falls typically come from either muscles or balance issues.

Non-mechanical falls: Non-mechanical falls are falls due to some other situations that involves some symptoms before the fall. For example, a person could have a vestibular problem causing vertigo leading to a fall. They would have the sensation of room spinning prior to the incident. Another example would be a person getting light-headed or even passing out causing the fall. This could be due to the dehydration and orthostasis, medication side effects or even heart problems.

What Are the Consequences Of Falls In The Elderly?

1. Fractures

Falls affect older people more severely for multiple reasons. With slower reflexes, they often can’t correct their body position in time to prevent the fall or even break it effectively. Elderly humans also no longer have the same kind of firm, cushiony fat that used to pad their elastic two-foot-high toddler skeletons. With less body fat and muscle, they have less padding. This fact combined with more fragile bones from osteoporosis, seniors experience more fractures.

2. Post-Fall Complications

Complications from significant injuries can be life-threatening. Limited movement during recovery causes muscles to weaken further due to inactivity, increasing fall risk when patients finally try to resume normal activities. This can increase the risk of more falls in the future. It can also increase the risk of infections such as pneumonia and increases the risk of pressure ulcers.

3. Blood Clots

Blood clots can be a major complication of fall. When the body is immobilized, the large leg muscles are no longer squeezing the blood vessels as they did pre-injury. Without this constant pumping movement, blood pools in some regions of the bloodstream in the same way strong river currents deposit sand in the shallows around curves. When blood stagnates, it forms clots. If the clots break away, they clog major vessels in the lungs which can be life threatening.

Clots in the lower legs can also locally starve large areas of tissue, generating deep, slow-healing sores. Sometimes leg clots build up into long internal clogs several inches long that later result in gangrene, amputation, or death. Some clots move to the heart, lungs, and brain with life-altering consequences.

4. Internal Bleeding

Internal bleeding can also be a major complication from falls. Bleeding in the brain is of particular importance. As the brain ages, the tissue will shrink or atrophy. This leads to a stretching of the blood vessels between the brain and the skull. These vulnerable vessels can bleed with even fairly minor head trauma, leading to what’s known as subdural hematoma. This is collection of blood in between brain and skull, and can be insidious. A person who had subdural hematoma may have a life-threatening condition but the danger can occur days to weeks after the fall.

5. Depression

It’s difficult enough being elderly and experiencing your body changing before your eyes, but when the ground you walk on threatens your life, you cannot help but feel afraid of getting up or going out. Compounding such fear is the fact that many older people live alone. Depression and loss of independence are other major consequences of falls.

What To Do When You Fall?

1.What To Do First

Often the first impulse is to get back up. This can be dangerous itself. If are uninjured and not in any pain and know why fell, you can try to get back up if you it’s safe. For example, if you slipped on a rug but you are not in any pain.

If you are in pain, especially in your neck, back or hips, you should not get up alone. Also, even if you are unhurt but have some symptoms such vertigo or light-headedness, you should be very careful as you may fall again as soon as you get back up. For this reason, anyone at risk of injury should always be able to call for help. This could be family or friends if you are not alone. If you are alone, then you should have a medical alert device or cellphone on your person so that you can call 911.

2. What To Do Next

Get comfortable, then check for broken bones, bleeding, and changes in your vision and alertness. Once help is on the way, you need to lie quietly.

One of the greatest dangers of falling is a blow to the head causing bleeding inside the skull. People tend to panic at the sight of visible blood, but the most deadly bleeding is invisible, seeping unnoticed while causing pressure on the brain. If there’s any chance at all that you’ve hit your head, you need to be examined in the emergency room. You may not experience pain or other symptoms but the situation can become critical within hours. The ER staff may choose to hold you overnight for observation, or release you but recommend that you have someone stay with you to check you over the next 24 hours.

Another danger of falling is fracturing a large bone such as the femur, the bone in your thigh. If you’ve ever gnawed on chicken legs or rib bones, then you know that thick bones are rich in marrow where the body manufactures blood cells. In the event of fracture, clumps of fatty marrow can break loose and cause the same kind of damage as clots by blocking blood vessels and starving the tissues of oxygen. Whenever a fracture is suspected, the fallen person needs to lie still until professional help arrives.

How to Prevent Falls in Older Adults?

1. Personal Lifestyle Measures to Prevent Falls

You have more power than you realize to protect yourself. Paying attention to simple safety practices can reduce the frequency and severity of falls:

• Stay active: Talk to your healthcare providers about an individualized exercise program. You can exercise effectively in bed, sitting in a chair, using only one half of your body, doing your everyday chores, dancing through the day (either standing or sitting) – all kinds of ways!
• Stay aware of your environment, indoors and outdoors: Although wisdom reportedly comes with age, not all elderly people take note of their surroundings, especially what is under their feet.
• Wear secure footwear: Your feet need to be stable, so choose thick-soled, well-fitting shoes that allow enough room for your toes to move comfortably. Shoes with laces or Velcro straps provide a personalized fit. Flip-flops, fabric-soled slippers, and loose, strappy sandals are not safe for people without strong ankles and a solid sense of balance.
• Wear safe clothing: Avoid clothes that are too tight or too loose. Adjusting uncomfortable waistbands or freeing your sleeve caught on the doorknob will put you off balance.
• Maintain proper nutrition and hydration: Think of food as medicine! Every time you eat, you’re making a choice to nourish or abuse your body. Follow your doctor’s recommendations. Malnutrition and dehydration heighten the risk for falls.
• Get enough sleep: Let your health team know about any sleep changes and problems. For example, if you’ve worked nightshift all your life, switching sleep patterns may be difficult. Do you even need to? Train your mind to respond to your bedroom or recliner as a place of rest. Turn off TV and computer screens at least an hour before retiring; studies show that light, especially electronically generated, interferes with falling asleep. Learn to recognize your own sleep triggers such as certain music. Avoid using alcohol because it disrupts your brain’s sleep cycles. Try to enjoy most of your fluid intake earlier in the day to prevent bathroom visits from interrupting your rest.
• Don’t get up too fast: Many people experience dizziness from a sudden drop in blood pressure caused by standing quickly after lying flat. Arthritis and other conditions often cause stiffness and weakness when arising, so pause while sitting or just after standing for several moments until you’re steady.
• Use incontinence supplies: If you need underwear inserts, special briefs, or bed pads, use them. How many times have you bruised your legs trying to get to the bathroom in a hurry? Keep tissues at the bedside and consider getting a bedside commode.
• Be safe with medications: Either you or a home care nurse should set up a pill pack and daily calendar along with any other aids to organize your daily routine. Large-print handouts with drug information are available online or from the pharmacy, and be sure to report side effects to your health team immediately. Keep a medication list with you at all times in case of emergency. Your pharmacist is a good resource to learn more about your prescriptions and over-the-counter medications. If a particular medication seems to increase your risk to fall, it’s important to let your team know; often the dosage or brand of medication can be adjusted to reduce the side effects. If you consume alcohol, marijuana, or any other mind-altering substance, be sure your healthcare team knows. They won’t have you arrested but they will advise the safest ways for you to proceed.
• See your healthcare providers regularly: A lifetime of good health without seeing doctors is no guarantee of health in old age. Regular appointments to evaluate general health, as well as vision and hearing, are vital to prevent irreversible complications. Keep a copy of their contact information with you at all times. Bring a written list of questions and concerns to each appointment — if you worry about forgetting the information they give you, ask for a copy in writing. Know how often you need to have your assistive devices such as walkers, canes, crutches, shoe inserts, etc., adjusted. See your eye doctor at least once a year to check for changes because damage from glaucoma is irreversible. Have your hearing checked annually. Talk to your healthcare providers and your insurance company about ways to finance necessary devices.

2. Standard Fall Prevention Measures in the Home

Ask your physician to write a prescription for a home safety assessment by an Occupational Therapist or specialist trained in making recommendations for adaptations. The same professional can teach you how to get up safely from the floor. Here are other suggestions to make your home safer.

• Eliminate clutter: Not only do you need clutter-free paths leading to the bathroom but also to outside doors. Eliminate throw rugs, cords, footwear on the floor, low furniture, and everything else that might cause a slip or trip.
• Keep important things in reach: If you normally use a cane or walker for support, make sure it’s nearby without blocking your way. Make sure you can easily get to your phone, tissues, grabbers, purse, and anything else you might quickly need such as emergency phone numbers.
• Ensure good lighting: Stick-on battery-powered lights are inexpensive and can be placed anywhere you need immediate illumination.
• Have places to sit: Place stable chairs and hassocks strategically throughout your home in case you feel a sudden need to rest.
• Install grab bars and railings: Insurance and other funding sources will often pay for durable medical equipment that promotes in-home safety.
• Invest in a cell phone and medical alert system: If you fall, your life may depend on being able to contact someone quickly.
• Be mindful of dogs/cats, children, and robotic vacuum cleaners: They’re easy to miss as they zip around below eye level. Around 86000 falls occur per year occur due to cats and dogs. Falls caused by dogs are 7 times more likely to lead to injuries than cats. Older adults have the highest risk of bone fracture due to pet involved falling instances.