Fall Prevention and Management

person walking with cane

Due to the increased risk of developing severe medical problems and potential difficulties in receiving adequate care or preventative services, the elderly are among some of our most vulnerable populations. A major concern among older communities that contributes to these health-related problems, is the increasing tendency of a slip-and-fall. Between 2007 and 2016, the Center for Disease Control (CDC) reported that the fall death rate for older adults increased by 30%. This alarming statistic only legitimizes the fear of becoming a fall risk that older adults may have.

The outcome of a slip-and-fall can be devastating. Aside from any immediate injuries and potentially lingering medical conditions, a loss of independence can also develop. However, it may help to know that family members, caregivers, doctors, and nurses can work with an older adult to deploy effective fall prevention strategies, and respond appropriately if a fall should occur.

Risk Factors for Falling

A risk factor is something that increases the chances of developing a problem, disease or injury — and there are many factors involved with being a fall risk. Identifying these risk factors can significantly minimize the chance of a catastrophe happening.

There are personal, medical, and external factors that can cause a fall, which can, in turn, lead to further injuries. For example, according to the CDC resource mentioned above, 95% of hip fractures are caused by falling, which can complicate mobility and increase the likelihood of an elderly adult falling again. In many cases, preventing falls may stop the cycle of further accidents and injuries from happening.

Medical Conditions

Pre-existing or the recent onset of medical conditions are major contributors to slip-and-fall incidents. Diabetes, chronic obstructive pulmonary disease (COPD), and arthritis have all been listed as causes for falls among the elderly. Additionally, and according to the National Institute on Aging, “problems with your thyroid, nerves, feet, or blood vessels can affect your balance.” Naturally, balance is essential in stable mobility and preventing falls at home. These medical conditions — which are prominent in an aging body — can directly affect mobility, and therefore increase the chance of a slip-and-fall.

Medications

Whether taken for the medical conditions mentioned above or not, medication can increase the chances of a fall. Medications like psychotropics, blood pressure medications, and sleep aids, may come with side effects such as drowsiness, dizziness, blurred vision, and difficulty thinking. These effects may impact an older adult’s gait, and may cause them to lose their balance and/or fall. Whether it be prescription, over-the-counter, or herbal supplements, the CDC advises that you “review medications with all patients 65 and older,” and notes that “medication management can reduce interactions and side effects that may lead to falls.”

Additionally, many older adults take several medications for various medical conditions daily and can experience unexpected side effects. The Gerontological Society of America reported that “between 1988 and 2010 the median number of prescription medications used among adults aged 65 and older doubled from 2 to 4, and the proportion taking more than or equal to five medications tripled…” Medication, while instrumental in treating some conditions, will need to be closely monitored by family, caregivers, doctors, and nurses to help minimize the risk of an elderly family member or patient falling. It should also be noted that alcohol (and/or other drugs) can further endanger an older adult.

Home Hazards

The National Institute on Aging reports that six out of every 10 falls happen at home. Making changes to the home – where more than half of all falls happen — can help minimize the fall risk. Due to poor lighting, cluttered walkways, dangerous stairways, and slippery floors, an elderly adult may be at risk of falling in the places they spend the most time. It is highly recommended that homes for seniors be made fall-proof — directions for which are be detailed below.

Hearing and Vision Problems

Hearing and vision impairment are more prominent in older adults, and can make them less aware of their environment. Spatial awareness is essential to an individual’s balance and understanding of their surroundings. As a result, those with hearing and vision loss are more at risk of falling, due to not being able to see or hear obstacles in their walking path. Those with hearing and vision problems may need a friend, family member, caregiver, or nurse to assist them when taking walks outside or getting around the house.

Elderly Fall Prevention Tips

There are a variety of hazards that could potentially give rise to slip-and-fall accidents for seniors. However, there are also many preventative steps older adults can take to minimize the risk of falling. The tips below can help a senior build muscle for better balance, organize their home to prevent a fall, and work with their doctor and/or nurse to make sure they follow a care plan after a fall.

Tend to Your Health

Becoming healthy — mentally and physically — can enhance balance and mental awareness. Both of these abilities can significantly minimize an accident when walking, and can contribute to the overall wellness of an older adult.

  • Do Balance and Strength Exercises. Strength, endurance, balance, and flexibility exercises can strengthen many muscles. However, strengthening core and leg muscles will be key in maintaining sure-footedness while walking. Physical activity is great for anyone, however staying healthy with age can reduce medical issues, risk of injury, and increase quality of life.
  • Get Vision and Hearing Checked. As mentioned above, hearing and vision problems put an older adult at risk of falling. Continually getting vision and hearing checks can keep auditory and visual senses up to speed. The persistent monitoring of hearing and vision can make sure corrective lenses and hearing aids are performing the way they should so an individual can be as aware of their surroundings as possible.
  • Prioritize Sleep. Making it a priority to get a full night’s rest every night can prevent falls. A regular sleep schedule can make a person more mentally aware, increase mental health, and minimize movement disorders that can contribute to a slip-and-fall accident.
  • Limit Alcohol Intake. Besides potentially leading to liver damage, high blood pressure, osteoporosis, diabetes, and certain types of cancer, alcohol can affect motor skills and cause many accidents. Impaired walking — not to mention driving — can affect the judgment, coordination, and reaction time necessary to safely navigate around any area.
  • Don’t Stand Up Too Fast. Standing up too fast may cause dizziness, lightheadedness, and may even cause fainting. Additionally, a leg or foot may “fall asleep” which can momentarily and unexpectedly impede mobility — adding to the risk of a fall.
  • Consider Using an Assistive Device. Walking canes, two-wheel walkers, and other ambulatory assistive devices can reduce chances of a fall, increase mobility, and provide independence.
  • Wear the Right Shoes. Wearing slippers, socks without shoes, and being barefoot may lead to an in-home fall. Wearing the correct footwear can provide the balance and stability needed when walking safely.

Make Your Home Fall-Proof

Home is where many people spend a significant amount of their time. While younger people may be able to get around the house with ease, older adults may need to fall-proof their home. There are many state and local governments that provide education and/or home modification programs in an effort to minimize falls in the home. However, many steps can be taken in fall-proofing a home, including:

  • Identifying and Eliminating Tripping Hazards. Keeping high-traffic areas clear of obstructions can minimize the fall risk for elderly adults who have vision and hearing loss — and who are therefore less spatially aware. Boxes, books, clothes, shoes are all items that should be regularly put away to help prevent tripping.
  • Making Safety Modifications. Grab bars near the toilet and shower, handrails for the stairs, no-slip carpets, and non-skid mats can all be additions to the house for further stability when visiting these necessary, but high-risk areas.
  • Improving Lighting. Poor lighting can hide potential obstacles. Make sure there is good lighting and accessible light switches in risky areas, such as the top and bottom of stairs, long hallways, and in the bedroom, to maximize vision and awareness.
  • Home modification resources. As mentioned above, many organizations provide research, training, technical, and financial assistance in modifying a home to make it more accessible. Visit the following organizations below to learn more:

Rebuilding Together – An organization that aspires to build safe homes and communities for everyone by repairing homes and building up communities.

  • The National Association of Area Agencies on Aging – An Association to help older adults and people with disabilities regain their independence by providing resources on caregivers, transitioning into care, elder justice, healthy aging, and more.
  • Consumer Affairs – Provides a comprehensive home modification guide for seniors resource in which they lay out DIY projects for families to make their parents’ home safe and free from hazards

Watch For Hazards Outside

Although more than half of these falls happen in-home, the others generally happen outside. Assistive devices and elevators may not always be available, so it is imperative that older adults understand the hazards and takes precautionary measures to remain safe when getting around and enjoying time with loved ones.

  • Avoid Slippery Surfaces. Wet and/or icy surfaces are dangerous for anyone, but older adults are more at risk of falling. If these areas can’t be avoided, place sand or salt on them to help melt the ice and create traction to help prevent slipping. Additionally, place non-skid supports under carpets and other surfaces that may move and disrupt their footing.
  • Use Handrails and Wheelchair Ramps. Whenever possible, it is best to use handrails for extra stability when walking up and downstairs. Wheelchair ramps can also minimize the risk of tripping, as they are generally easier to walk up and down than stairs.
  • Look Out for Tripping Hazards. Uneven surfaces, rocks, and curbs, are just part of being outside. Make sure they are on alert whenever they’re are walking outside to avoid tripping over one of these unexpected disruptions.

Talk to Your Doctor and Nurse

Checking in with a doctor and/or nurse frequently can help them stay healthy, and to help take the proper fall precautions. For instance, if your loved one is losing weight, feeling faint, having vision issues, or if they have fallen but aren’t injured, they can talk to a medical professional for personalized advice and assistance with each of these concerns or issues. It is the duty of nurses in assisted living facilities to understand if they’re showing some signs that may lead to an accident, and talking to a doctor or nurse can help take proactive steps that may minimize the chances of falling.

What to Do After a Fall

Even while being as safe as possible, an accident may still happen. An emergency response necklace or bracelet with a button that alerts 911 is a good option. This service comes with a fee that normally isn’t covered by insurance. In addition to activating a medical alarm, consider taking the following steps soon after an incident happens.

Tips for the Elderly

If Injured: In the unfortunate event that there’s an injury after a fall, it is important to remain calm. If they’re able, use an emergency alarm or a phone to call for help. It is important that they do not try to get up during this time. Instead, make noise to attract attention and/or call for help.

If Uninjured: Check to make sure that they’re not hurt and, if able, get up off of the floor. When getting up (if able) try to rolling to one side to then have them pull themselves up onto their hands and knees, crawl to an object that can be used as support and themselves up if possible. It is also important to sit for a few minutes before doing anything else.

Tips for Caregivers

Friends, family, and professional caregivers can also do their part if an elderly companion has an accident. In the event of a fall, it is extremely important to assess the problem, check on the fall victim’s condition, and reassure them before helping them up. If a fall victim cannot get up, caregivers can call for help, administer first-aid, and keep the victim as comfortable as possible.

If the victim can get up, consider grabbing a chair to help the person get into a semi-seated position. Place yourself behind the victim, gain a firm grip on their hands, and help them into a kneeling position.

How Nurses Can Help

Nurses will most likely work with patients in hospitals, whether their patients are there because of a fall or not. Universal fall precautions will need to be implemented by nurses to mitigate the risks of falling. To learn these skills, and to make a larger impact, nurses can consider becoming a Family Nurse Practitioner to decrease the risk of patient falls, counsel patients who have a fear of falling, give care, and provide valuable advice when working with older patients.