Preventing Falls

Risks for falling

If your family member has any of these problems, he or she has a higher chance of falling:

• Taking more than three or 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. (Seniors 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. Sometimes elders fall because they don’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, ten percent of all ER visits for a fall involve alcohol. And drinking among the elderly 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, seniors 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 seniors is slower than that of younger adults. This means alcohol stays in the bloodstream longer. As a result, the National Institute on Alcohol Abuse and Alcoholism recommends that persons over age 65 have a lower limit for safe alcohol use. They suggest no more than seven drinks in a week, or three in one day.
• 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. He or she 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 5 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 5–6 small meals during the day rather than 1–2 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. We don’t get the balancing 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 seniors who have fallen become afraid of falling. As a result, they limit their activity. 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 balance, AND confidence!

Check for hazards in the home

About half of all falls happen at home. Here are some general suggestions for changes 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.
• Install grab bars in the bathroom, especially beside the toilet and in the shower or tub.
• Put a bath bench in the shower so the person you care for can sit if he or she feels dizzy.
• Put a riser seat on the toilet. This way your relative does not have to struggle to stand up. (Many seniors lose their balance in the effort to stand up from a seated position.)
• 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 the lighting in hallways or stairs. Improved visibility increases the chance your family member will see an obstacle and avoid a tumble.
• Repair broken or unstable steps or stairs. An uneven or unexpected surface on the stairs is a situation that can easily cause someone to stumble and fall.
• Install handrails at all stairways. Catching oneself from a fall is as important as not falling to begin with.

The pain and dangers of a fall can be reduced if the person you care for can get emergency attention as soon after a fall as possible. Although 0% falls is ideal, it may not be possible. It’s wise therefore, to provide for some sort of emergency notification system. This is especially true if your family member lives alone. Called “Personal Emergency Response Systems,” these technologies are available in several formats. Nearly all require installation of some sort of equipment and a monthly fee to a monitoring company. They include the following:

• A bracelet, necklace, or watch-like device that can be used to alert a central monitoring office if the elder suddenly falls. These devices usually involve a monthly fee to the monitoring company.
• Remote sensors that report unexpected periods of inactivity. We humans are surprisingly predictable. These sensors simply measure things such as whether a door has been opened or not. For instance, they can send a notice if the bathroom door or medicine chest has not been opened in the morning. There are no cameras attached, so the senior maintains visual privacy.
• Remote video of the lowest 12″ just above the floor. A human is continually reviewing the screen at some central office. This person knows emergency procedures should he/she observe your family member on the floor. The mouse-eye view allows for more privacy than a regular video camera closer to chest level. But many seniors, and their families, feel that the invasion of privacy, even just the bottom 12″, is still too much.

Talk with the doctor

A surprising number of medical conditions can affect your family member’s risk of a fall. Treating these conditions appropriately can, in turn, help decrease the chance of a fall. Ways the doctor can help:

• Minimize the number of medications. One always needs to weigh the benefits of a medication against the negatives of its side effects. Looking at the big picture, ask the doctor to suggest ways to decrease the number of medications. He or she can also prescribe them in a routine and dosage that will reduce the chance of dizziness.
• Address blood pressure concerns (too high and too low). Again, balance is needed. The goal is to bring blood pressure down to avoid a stroke. At the same time, there are dangers from a fall if the patient has a sudden drop in blood pressure and gets dizzy when standing.
• Examine the eyes and ears. Many falls are a result of not seeing or hearing a danger in time enough to respond. It is recommended that seniors get an eye exam once a year and a hearing exam once every three years.
• Examine the feet and evaluate footwear. Painful feet and poorly fitting shoes can contribute to the likelihood of a fall. Bunions, deformed nails, and sores on the feet can be evaluated and treated by a doctor. Good footwear can also support the feet in ways that reduce pain and promote better balance.
• Test for muscle strength, healthy nerves, and reflexes. We all lose our balance from time to time. But we are able to recover because of a complicated interaction of muscles, nerves, timing, and reflex. The process begins with receiving nerve impulses that tell us there is a problem. Then the brain sends messages to the body to respond. Our muscles react to those messages with varying degrees of success. It all depends on their strength, ability to stretch, and how quickly they receive and respond to the messages. If you are concerned about falls, ask the doctor to do a basic screening for nerves, reflexes, and muscle strength.
• Treat arthritis pain. Stiffness in joints can make it difficult to move easily and effectively. It can lead to a sedentary lifestyle, which in turn increases the risk of falling. Lack of activity results in poor muscle tone and reduced flexibility. This leads to an increased chance of not being able to respond well or quickly, which can result in a fall.
• Evaluate for a vitamin D deficiency. Many older adults do not get enough vitamin D. This nutrient not only helps build stronger bones, it also promotes muscle strength and a healthy nervous system.
• Consider occupational therapy. If particular activities pose special risks for your family member, it may be worth an assessment by an occupational therapist. He or she can watch how your relative completes various tasks around the house. Suggestions can be made for modifications or devices that can reduce the chance of a fall.
• Prescribe an exercise program. Strength, flexibility, and balance all work together to keep us upright. Fortunately, we can improve our abilities in these three areas with regular exercises. Muscles get stronger when they encounter resistance. Lifting even small amounts of weight can do much to build healthy muscle. Stretching and moving the arms and legs in wide arcs can help with flexibility and range of motion. Many senior centers offer classes in yoga as a way to help older adults safely improve their ability to stretch and reach out to catch themselves. Research into the Chinese balancing exercise of tai chi has shown that it is extremely helpful in reducing the risk of falls. Seniors often report this calm, slow form of movement is also pleasant and relaxing.

More than one fall in the past year, or a fall with an injury warrants the attention of the doctor. Even, if the person you care for just seems to have balance problems, to walk unevenly, or simply to be worried about falling, it’s worth consulting a physician. Ask for a falls assessment. The stakes are so high, that in the case of falling, an ounce of prevention really is worth a pound of cure!

Start a light exercise program

We are never too old to exercise. Studies show that no matter our age, our bodies respond well with just small increases in physical activity.

There are more than physical benefits. People who start even a light activity program report they feel happier than before. They also report feeling more confident.

People who have an easier time moving keep their balance better. Focusing on activities that improve balance and mobility will greatly reduce the chance of a fall.

Your family member does not have to become a fitness buff to reap the benefits. Even a regular walk once a day can make a difference.

The types of exercise that help prevent falls are very simple. They focus on three types of activities: balance, strength, and flexibility.

• Balance exercises work to help us stay upright. They train the brain to be more aware of the body’s position. The brain receives cues earlier in the fall so we have more time to recoup. They also train the muscles to more finely control posture. Balance exercises can be done standing in one position with a hand on a chair. Generally they are done with eyes open. Gradually, balance exercises can be done without holding on to anything. More advanced versions involve the same activities, but with eyes closed. The National Institute on Aging has pictures and instructions for balance exercises. In addition, “tai chi” is another form of balancing exercise. It is an ancient Chinese movement program that has been shown to be both pleasant and very effective at improving balance. Check with senior centers, local television, or the library for classes or videos with tai chi instruction.
• Strengthening exercises help build and tone muscle. Strong muscles help us hold ourselves straight. Strengthening exercises are sometimes called “resistance training.” This is because they generally involve lifting weights against the pull of gravity. You don’t have to become a muscle-bound athlete to feel the benefits. Many seniors report an easier time getting around even after a short period of strength training using very small weights. In this case, resistance is NOT futile. What’s more, you don’t need a gym! The National Institute on Aging has pictures and instructions for strengthening exercises that can be done at home.
• Flexibility exercises allow us to move more freely. They generally involve stretching. This improves the range of motion in the arms and legs. The more fluidly we move, the less likely we are to stumble or fall. With loose, as opposed to cramped muscles, we can also reach out easily to catch ourselves if we do start to lose balance. The National Institute on Aging has pictures and instructions for flexibility exercises. Yoga is another form of flexibility exercise. It has been practiced in India for centuries. Yoga is not a religion. But it does involve breathing and calming both the mind and body. As a result, many people report feeling physically better and “spiritually” more peaceful.

Before beginning any new regimen, check with your family member’s physician. Simple as these activities are, you want to be sure you are aware of any specific limitations your relative should keep in mind.