Fall Prevention Guide For Older Adults

Seeing a main character in a movie living in constant fear or being fearless never ends well. Living in constant fear results in not enjoying what life has to offer. Being fearless and ignoring all of the warning signs result in failure due to stubbornness. The trope of the story typically goes such that the main character either has a falling out until he or she finds some middle ground between living in constant fear and being fearless. The middle ground normally involves taking advice from others, becoming more knowledgeable, and learning new strategies to become successful with his or her personal endeavors. The same goes for older adults and fall prevention – utilizing the right tools will prevent a fall from occurring. 

Fall Prevention for Older Adults

In this guide, we provide tips and tricks to recognize fall hazards and prevent a future fall from occurring. We also look into which methods are most effective to strengthen your own personal abilities to reduce falls from occurring in the home and in the community. Consider these tips and tricks as a way to keep your fire burning if you’re out in the cold. The more tips and tricks you utilize as wood to feed your fire, the less likely it is that your fire will burn out. The less you utilize the tips and tricks, the more likely your fire is going to burn out and you’ll be in trouble freezing in the cold. The goal remains clear –the more tips and tricks you utilize with fall prevention strategies, the less likely a fall will occur. 

How Falls are Categorized

All falls are not created equal – some we’re able to laugh off and some result in quite serious injuries. Researchers have broken it down into four types of categories.

• Falls resulting in any reported consequences, including specific symptoms (ranging from bruises and cuts to more serious injuries such as fracture) or medical care. 
• Falls resulting in medical care. 
• Falls resulting in serious injuries such as fractures, head trauma, soft tissue requiring suturing, or any other injury requiring admission to hospital. 
• Falls resulting in fractures. 

Understanding a fall is key here because many older adults tend to blur the lines when confronted about their fall experience. Statements older adults often use will be somewhere along the lines of:

• “I just lost my balance and slipped.”
• “I didn’t have a fall, I just slipped off the bed and ended up on the ground.” 
• “I let myself slowly down on the floor because I felt my balance was a bit off.” 

In general, the most clear-cut definition of a fall can be understood as “unintentionally coming to rest on the ground, floor, or other lower level”. Despite which events led to a fall, when a person unintentionally comes to rest on the ground, floor, or lower level, a conversation should be taken to determine what led to the event. Here are some questions to help investigate the culprit of the unintended event:

• Did you trip over something that caused you to end up on the ground or floor? 
• Did you lose your balance when walking and ended up on the ground or floor? 
• Did one or both of your legs suddenly give out without warning? 
• Did you feel lightheaded before you ended up on the ground or floor? 
• Did you experience any dizziness prior to ending up on the ground or floor? 
• Did your muscles in general feel weak and you felt it safer to transition yourself to the ground or floor? 
• Do you remember what caused you to end up on the ground or floor? 
• Do any of your medications cause you to feel physically unstable? 

Using these questions can help guide whether the fall was due to clutter in the home, poor balance, muscle weakness, or perhaps something medical related. Consider it similar to an investigation – the sooner the culprit of the fall is identified, the closer a future fall can be prevented. 

In such a case where a fall leads to seeking medical care, establishing the culprit of the fall becomes even more important. The medical team will likely bombard you with several questions similar to those listed above with the intention of understanding your risk for and history of falls. Healthcare professionals do not take falls lightly because researchers found that falls:

• Are the leading cause of injury for people aged 65 and older
• Can result in serious injuries and the risk future falls increase with age 
• Can cause traumatic muscle injuries, head injuries, and fractures
• Can decrease independence in everyday activities if severe enough 
• Can increase risk for a nursing home admission 

Hearing all of this can be overwhelming and stressful. Although falls do happen on occasion, you shouldn’t live your life in fear that you can fall any minute of the day. This kind of thinking is irrational. As older adults remain judicious with getting rid of clutter in the home and understand the strategies on how to prevent falls, older adults can continue living their lives without constant fear of falling. Let’s dive into understanding how best to reduce older adults’ risk for falls. 

What Increases Your Risk for Falls? 

The ultimate question that is asked is, “How do I prevent a fall from happening?” or “How can I prevent another fall from happening?”. If this is your concern, you’re already moving in the right direction. Older adults that are overconfident in their abilities or live in too much fear of falling are at highest risk for having a fall in the future. What’s the best approach to take? Finding a middle ground between your confidence and learning how to recognize fall risks in both your own abilities and in the environment.   

Several things can cause a fall to occur – many of which are outside and within our own control. To put things into perspective, a team of researchers found over 400 factors that can increase an older adult’s risk for falls. Capitalizing on those factors that are within our control is what will ultimately make the difference. In general, fall risk factors can be understood as either:

• Extrinsic: factors that are in the home or community environment and often known as “environmental hazards” 
• Intrinsic: factors that are specific to each person and their body or health condition 
• Behavioral: factors that reflect how older adults choose to interact within their environments 

When uncontrolled for, extrinsic factors can lead to tripping, slipping or having missteps that result in higher risks for falls in older adults. Extrinsic factors that pose the most risk for falls in older adults include: 

• Slippery surfaces
• Inadequate lighting
• Loose, deep, or worn out carpets
• Staircases without railings
• Unsupportive or badly arranged furniture 
• Poorly designed tubs, toilets, and arrangements in the bathroom
• Clutter in the home
• Pets that run underneath or snug against your feet when walking or standing

Intrinsic factors are especially important for older adults as the natural aging process leads to having increased risk for falls that include: 

• Muscle weakness
• Impaired walking or balance
• Decreased reaction speed
• Loss of sensation in legs or feet
• Standing instability due to medication interactions
• Having decreased memory
• Impaired vision
• Having constant fear of falls 
• Overall health condition 

Behavioral risk factors that have been identified that pose the highest risk for falls in older adults include: 

• Rushing
• Not paying attention, not being alert, or not looking where one is going 
• Having risk-taking behaviors
• Standing on unstable objects to reach for items
• Failing to turn on lights when using the bathroom at night 
• Not using grab bars or handrails when they are available 
• Wearing unsafe clothes that are baggy or oversized
• Wearing poor footwear (e.g., socks on stairs, shoes with poor tread, loose shoes, sandals)
• Using outdated prescription for glasses 

Exercise and Fall Prevention

If there was one magic pill out there that can help fall prevention in older adults, the answer would be indisputable – exercise. Researchers have looked at many other tactics that theoretically would help prevent older adults from falls such as attending fall prevention classes, home modifications, or home assessments but none compare to the benefits of exercise. 

Why is exercise so much more beneficial compared to other tactics? Exercise helps build all of the ‘intrinsic skills’ as mentioned before that are much needed to prevent future falls. You’re probably sick and tired of hearing ‘exercise’ as the cure for everything but in fact it makes a clear case for fall prevention among older adults. Exercise tackles the issue of fall prevention by: 

• Improving balance, coordination, and overall physical functioning
• Improving important functions of the brain (memory, attention, becoming more organized, becoming a better planner, more insightful, better brain flexibility) needed to reach appropriately when losing balance or interacting with the environment 
• Increasing the speed and effectiveness of reflexes (e.g., quickly extending an arm or grabbing nearby objects)
• Increasing the ability and size of muscles to absorb the impact of falls (decreases the severity of physical trauma) 
• Improving reaching ability 
• Decreasing older adult’s fear of falling 

Although any form of exercise is beneficial, specific types of exercises that generate the best results for fall prevention incorporates: 

• Balance training and flexibility
• Extensive training on walking safely in different environment settings 
• Motions that simulate sitting and standing transitions 
• Leg strengthening and endurance training  
• Using a workstation format 
• Tai Chi

Still not convinced? Let’s look at some research data that reported on the benefits of exercise on decreasing fall risk among older adults. A team of researchers found that a well designed exercise program for older adults living at home and remain active in the community: 

• Decreased all types of falls by 37 percent
• Decreased severe injurious falls by 43 percent
• Decreased falls that would result in fractures by 61 percent 

Beginning an exercise program isn’t exactly easy and can even seem intimidating. Several exercise programs exist out there for older adults to participate in. Reaching out to community centers or inquiring about the SilverSneakers program is a good start to finding which exercise program currently meets your level of fitness. SilverSneakers is a health and fitness program tailored specifically for older adults. You can find your local facility through their navigation website. Resources from SilverSneakers include the following: 

• State of the art gym facilities with fitness equipment, pools, and walking tracks
• Classes designed specifically for older adults of all fitness levels such as endurance training, weight lifting, overall strengthening, yoga, and Tai Chi 
• Online fitness classes and videos
• Nutrition advice and exercise tips 

Personal Strategies Used by Older Adults in the Community 

Living in constant fear of falling isn’t the right way to live your life. As long as you implement the fall prevention strategies (intrinsic, extrinsic, and behavioral), take initiative to incorporate an exercise routine, and recognize fall hazards in the home and outside environment, your risk for falls goes down significantly. Each person’s situation is unique and each person may have to utilize different strategies in order to stay safe from falls. 

Ever wonder if your own strategies were too out of the ordinary? A team of researchers interviewed older adults and found out personal strategies used in the home and community to prevent falls from occurring: 

• Increasing attention at traffic lights. Pausing after the light turns green, looking both ways twice, making eye contact with drivers, and waiting until no cars are turning left. 
• Raising their hand to stop traffic if they were unable to make it across the street before the light changed. 
• Waiting for the next light if cyclists ran the light. 
• Making an intentional effort to slow down their walking when outside. 
• Picking up their feet more when walking, especially in snowy or icy conditions. Using a wide standing posture and walking with flat feet on slippery surfaces. 
• Increasing attention to not shuffle your feet when walking. 
• Making sure the right footwear is on when going outside (walking shoes or boots)
• Avoid walking on uneven surfaces or sidewalks, particularly those with cobblestones, puddles, or heavy traffic areas. 
• Asking pedestrians to hold their arms when crossing the street. 
• Decrease the amount of items carried when making community trips for shopping. 

There isn’t a ‘one size fits all’ formula to prevent a fall. As you make your way around the home or community, increasing your awareness to all things that can potentially be fall hazards should be on the back of your mind. The more you’re practicing this strategy, the more natural you’ll become attentive to all surroundings. The motto that should be embedded in your head should include, “It doesn’t matter how things are done, so long as it’s done safely.” 

Home Assessment and Home Modifications 

Older adults spend a large portion of their day inside their homes. Homes are supposed to be a safe space but can also pose a risk for falls if fall hazards roam throughout the home environment. Learning how to recognize fall hazards can ultimately reduce the likelihood of a fall from occurring. 

Completing a ‘home assessment’ for fall risk is one way to recognize the fall hazards within your own home. The process for a home assessment typically involves identifying problems and offering a safe solution to fall hazard areas in the home. Utilizing a checklist is a free and user-friendly method that older adults can use to recognize fall hazards. An example of a checklist that can be used was developed by the Centers for Disease Control and Prevention (CDC) known as ‘Check for Safety: A Home Fall Prevention Checklist for Older Adults’. See below for examples from the checklist: 

• When you walk through a room, do you have to walk around the furniture? 
  • Ask someone to move the furniture so your path is clear. 
• Do you have throw rugs on the floor? 
  • Remove the rugs or use double sided tape or a non-slip backing so the rugs won’t slip. 
• Are there papers, shoes, books, or other objects on the stairs?
  • Pick up the things on the stairs. Always keep objects off stairs. 
• Are you missing a light over the stairway? 
  • Have an electrician put in an overhead light at the top and bottom of the stairs. 
• Are the things in your kitchen you often use on high shelves? 
  • Move items in your cabinets. Keep things you use often on the lower shelves. 
• Is your step stool steady? 
  • If you must use a step stool, get one with a bar to hold on to. Never use a chair as a step stool. 
• Do you need some support when you get in and out of the tub or up from the toilet?
  • Have grab bars put in next to and inside the tub and next to the toilet. 
• Is the path from your bed to the bathroom dark? 
  • Put in a night-light so you can see where you’re walking. Some night-lights go on by themselves after dark. 

A second checklist that offers more solutions is named the Home Safety Self Assessment Tool. This checklist can be done by yourself or with a caregiver or family member and includes a comprehensive approach: 

• Illustrations of common fall hazards and solutions in common indoor and outdoor areas of the home
• Use of assistive devices (e.g., walkers, canes, wheelchairs) and equipment used to prevent a fall
• Strategies that can be used to improve older adult’s ability to recognize fall hazards 

A formal home assessment can also be facilitated by a healthcare professional, such as an occupational therapist. Let your primary doctor know that you would like a home health referral for an occupational therapist to come inside your home and offer their professional assessment. A comprehensive approach is used by the occupational therapist and includes: 

• A functional assessment. The occupational therapist may ask you to perform your daily routine in your home environment to better understand if things are done safely or unsafely. 
• Collaborative decision making. The occupational therapist will directly involve the older adult with identifying the greatest needs or problems that occur inside the home. 
• Involving caregivers or family members to share input to identify problems, set priorities, and determine the best solutions for the older adult’s ability to continue living in their home. 
• Continued ongoing assessment to address gradual changes in health of the older adult living in their home environment. 
• Extensive interview with the older adult and caregivers or family members focused on fall history and physical examination. 

A formal assessment completed by an occupational therapist is effective because the removal of fall hazards within the home typically isn’t enough to prevent a fall from occurring. It cannot be stressed enough that each older adult is unique. Understanding how each older adult interacts with their home environment provides an occupational therapist with the best opportunity to provide feedback to an older adult to remain safe within their own home. 

On the surface, it may seem like a great idea to get rid of certain items or furniture inside an older adult’s home. Removing such items may in fact cause further fall risks if the older adult has adopted personal strategies to use these removed items to stabilize their standing balance when moving around the home. Occupational therapists can then explore unique ways in collaboration with older adults to learn safe ways how to navigate the home while staying safe and free from falls. Rather than going by a generic playbook to rid fall hazards, it’s often best to figure out what works best for each person. 

Fall Prevention in Older Adults

Don’t live your life in continuous fear that a fall can happen any minute. The probability of a fall occurring in older adults remains low among those that are able to actively participate in the community. If you notice your daily routine becoming more difficult to do in the home or have noticed slight changes in your standing balance, let your primary doctor know immediately. A formal assessment can be done by a healthcare profession to identify your own fall risk. 

Utilize the many strategies presented above and remain vigilant with your surroundings. As you embed the multiple tips and tricks into your lifestyle, you can live your life free of falls.