Preventing Falls

Risks for falling

If your family member has any of these problems, they have a higher chance of falling:

• Taking more than four medications. The more medications a person takes, the greater likelihood of a fall. This is especially true if any of the drugs are known to also cause dizziness or drowsiness. Talk with the doctor or pharmacist about medication options that do not have these side effects. The pharmacist may also have tips about when to take them. For instance, taking a pill at night may be better so your relative will sleep through the dizzy period. It’s also wise to have as simple a medication regimen as possible. This reduces the chance that your family member will accidentally take too many pills, or the wrong ones. You might also ask about geriatric doses. (Older adults metabolize medicines more slowly. As a result, they can easily “overdose” even when they strictly follow the doctor’s recommendations. A lower dosage may well deliver the benefits of the medicine without the hazardous side effects.)
• Trouble with vision or hearing. Many falls result from stumbling over an object that wasn’t seen. Or because the person didn’t hear a hazard in time to react. Have your relative get yearly vision checks. Hearing should be checked once every three years.
• Alcohol use. Alcohol affects balance. In fact, 10 percent of all ER visits for a fall involve alcohol. And drinking among older adults occurs more often than people think. It tends to start after a loss. For example, after the death of a spouse or after friends move away. Older adults who did not drink before may turn to alcohol in their loneliness. Boredom from retirement is another common cause. And alcohol combined with prescription medications makes the chances of falling even greater. In addition, the metabolism of older adults is slower than that of younger adults. This means alcohol stays in the bloodstream longer. The National Institute on Alcohol Abuse and Alcoholism recommends that men over age 65 have no more than two drinks per day. Women no more than one.
• Depression and isolation. Seniors who are isolated have a greater chance of turning to alcohol. Depression can contribute to isolation. It can also lead to drinking. Fortunately, depression is a treatable condition. If you suspect your loved one is depressed, talk with the doctor. There are many treatment options.
• Incontinence. It is not uncommon for a fall to occur because a person is rushing to get to the bathroom. Your relative may not pay as much attention to the floor and end up tripping. They may clip corners and lose balance. There are medical and nonmedical approaches to address incontinence. Don’t let the hazards of urgency create a fall risk.
• Dizziness when standing. This is the result of a drop in blood pressure. It is always best to talk with the doctor to rule out a medical cause. Some nonmedical situations contribute to this type of dizziness. These situations respond well to simple changes in habits. For instance, drinking more fluids may help with dehydration, which can contribute to low blood pressure upon standing. Sitting up in bed for five minutes before standing in the morning can help get the blood flowing well. Even better, sit in bed and do some arm and leg exercises. It can also help to eat five or six small meals during the day rather than one or two big ones. A large meal causes blood to stay in the area of the stomach for a longer time, contributing to low blood pressure. Last, a person who gets dizzy when standing should also avoid hot showers and hot rooms. Heat tends to lower blood pressure. (Plus, a fall in the bathroom is especially dangerous with all the hard surfaces!)
• Numbness in the feet. When we lose sensation in our feet, it is difficult to keep our balance. Our brains don’t get the balance-related feedback of how our weight is distributed. We also may not notice if there is a pebble underfoot or that the ground beneath is unstable or uneven. Because people with diabetes often lose sensation in their feet, they need to be especially careful about falls.
• Previous falls and a fear of falling. If a person has fallen before, there is a greater chance they will fall again. But the fear of falling is equally disabling. Many older adults who have fallen become afraid of falling. As a result, they limit their activity unnecessarily. When they do less physically, they lose their strength, flexibility, and sense of balance. Ironically, this becomes a downward spiral. Less activity leads to less ability to prevent or catch a fall. Even after a fall, it is a wise idea to remain physically active. Talk to the doctor about an appropriate, low-key exercise program that will strength muscles and increase flexibility and balance. AND confidence!

Home safety checklist

Studies of older adults who went to the Emergency Room as a result of a fall indicate that 79% of falls occur at home. The most common locations are the bedroom, bathroom, and stairs. In that light, here are some general suggestions for changes around the house that can reduce the risk of falling:

• Remove clutter from narrow walkways, especially halls and stairways.
• Remove throw rugs. They often have curled corners or rumpled ridges that can cause someone to trip. Or they can slip on the hard surface beneath. One option is to use double-sided tape. This helps keep corners flat and the rug “glued down” to the floor.
• Use nonskid mats in the bathroom. Add nonskid strips to the floor of the shower or tub.
• Install grab bars in the bathroom, especially at the toilet and beside the shower or tub.
• Put a bath bench in the shower so the person you care for can sit if they feel dizzy.
• Avoid the use of ladders or a step stool. Store items that are used frequently in cupboards or shelves that are low and easy to reach.
• Improve lighting in hallways, stairs, and bathroom. Improved visibility increases the chance your family member will see an obstacle and avoid a tumble. Consider motion-activated lights or at least, nightlights. (A sleepy senior waking up and urgently needing the bathroom is a common scenario for falls.)
• Repair broken or unstable steps or stairs. An uneven or unexpected surface on the stairs can easily cause someone to stumble and fall. Additionally, consider nonskid strips as well as painting the edge of each stair for greater visibility.
• Install handrails at all stairways. Catching oneself from a fall is as important as not falling to begin with.
• Single-story living. Ideally the bathroom, bedroom, living room, and kitchen all are on one floor so there are no stairs required to go through daily life tasks.

Talk with the doctor

Fall risk assessment
If you are concerned about a family member’s risk for falling, ask the doctor to perform a “fall risk assessment.” It will determine whether they are at mild, moderate, or high risk. From there, the doctor can recommend a variety of approaches. They may include exercise, a medication review, or further examination. They might also suggest working with a physical therapist to strengthen muscles or an occupational therapist to learn how to effectively use a cane or walker.

A fall risk assessment has two parts:

• Screening. This is simply a set of questions such as “Have you fallen before?” “Are you worried about falling?”
• Assessment tools. These are activities that allow the doctor to get a sense of your loved one’s strength, balance, and gait. (Gait is a description of how stable a person is when walking).

There’s nothing to prepare for with an assessment like this. The results will simply point to the most appropriate steps to reduce the likelihood of a fall.

Vision screening
Poor vision contributes to falls. If your loved one cannot see well, they may not see obstacles that could lead them to trip, slip, and fall. Clutter on the ground, the edge of a stair, a slippery patch of water or ice can all lead to an accident. A yearly vision exam and keeping prescriptions updated can substantially reduce the chance of falling.

Hearing tests
Scientists aren’t completely sure why, but the data across many studies show that a person with even just a mild hearing loss has a three times greater risk of falling than does a person with no hearing loss. It could be that problems with hearing may affect balance, since the ear governs both hearing and balance. Another theory relating to “cognitive load” is that portions of the brain dedicated to balance get “borrowed” as the brain puts extra resources toward trying to increase hearing and comprehension. Last, it may be that an individual with hearing loss is missing audio cues that might alert them to a trip and fall hazard. Hearing tests can help determine if your loved one has a greater risk of falls. There’s some thought that hearing aids can help compensate and reduce the risk.

Start a light exercise program

When it comes to fall prevention, nothing underscores the “use it or lose it” maxim more than exercise. It’s not that the person you care for has to run marathons. Or even do any running at all. In the case of fall prevention, the issues are primarily balance and strength.

• Losing one’s balance is the very definition of a fall. Balance relies on many systems that together, provide information to the brain. The inner ear registers head position and motion. Muscles, joints, and tendons give the brain information about action and location, as well as about gravity. The eyes help orient us in space. Standing on one foot with the eyes closed, for instance, will force your brain, muscles, and ears to work together to fine tune your inner sense of staying upright versus leaning over.
• As we age, we do not retain our muscle mass and strength as easily as before. (Involuntary muscle loss starts in our thirties! Without consciously working on our muscles, by our seventies we may have lost up to 50% of our muscle mass.) Lower body strength exercises are recommended because people with greater strength in their legs are less likely to fall. If they do fall, they are less likely to sustain injuries such as a hip fracture.

Work with a physical therapist. The doctor can write a referral and Medicare will pay for it. Physical therapists are medically trained professionals who specialize in helping people move better. They work with exercises that can be done, even at home, to improve strength and balance. No special equipment is needed. They will also teach safety precautions so the person you care for won’t fall while doing the exercises.

Take classes

• Tai chi is a fluid motion, balance, and strengthening exercise that began as a “soft” martial art in China in the late 1600s. It can be described as movements performed in a slightly bent-knee position that involve continuously shifting the center of gravity from one leg to the other, with arms reaching out in various positions. These movements integrate posture, transference of weight, strength training, and trunk rotation. No special equipment is required. With appropriate supervision, tai chi is effective and safe even for very sedentary older adults and those who are at high risk of falls. In clinical trials it has been shown to reduce fall risk and to actually reduce the number of falls. Its effectiveness increases with the length of sessions and the frequency per week. There are different forms of tai chi. The “yang-style” has been demonstrated to offer the best outcomes.
• Yoga is a form of exercise developed in India. Hatha yoga in particular consists of holding poses (asanas) and incorporating deep breathing while holding those poses. Studies have shown that it seems to help with balance, strength, and mobility. No studies have verified an actual reduction in falls. However, tests used in a fall risk assessment have shown that it seems to reduce the chance of falling. It also helps reduce the fear of falling.

To find classes, check with your local senior center or ask your doctor or physical therapist. Senior centers offer many exercise programs adapted for older adults. (Plus, once your relative goes to a class, they may find that they like the atmosphere. Senior centers have been modernizing. They aren’t the bingo and shuffleboard centers they used to be. The programming is much more active and engaging.)

Before starting a nonmedically supervised exercise program, it’s always wise to check with the doctor to see if there are any concerns. Most physicians will probably be delighted that your loved one is giving exercise a try!

Walking
Exercise doesn’t get simpler than good old-fashioned walking. No special equipment is needed. It can be done indoors or outdoors. And it’s entirely at your loved one’s convenience. By its very nature, walking integrates all the body systems needed to maintain balance and stay upright. Some studies have shown that it is more effective at reducing falls and the risk for falls than are balance exercises alone.

For what it’s worth, walking doesn’t build up strength unless your relative is going up and down hills. Another disadvantage: There is a greater chance of falling while walking than while doing balance and strength exercises. As such, those who are notably frail or at high risk for falls might be better served focusing on balance and strength. But those who are generally healthy and stable can benefit. Ask the doctor or physical therapist about the best combination of activities for your relative.

It’s never too late to start moving and getting in better touch with the body. Even people in their nineties have been able to make improvements with very simple strength-building exercises. The key is to start slow and build gradually.