Why Does Falls Prevention Matter?
Let’s start by talking about why falls prevention is important. Falls are the leading cause of fatal injury. One out of five falls causes a serious injury such as broken bones or a head injury. Falls lead to hospitalizations, procedures, including surgical repair of fracture, long term rehab stays and in many cases a discharge to a higher level of care.
Falls and fear of falling lead to reduced mobility and participation in daily activities. This in turn leads to further weakness and higher falls risk.
Many think that falls are a normal part of aging. They do not have to be. Strength, health education, prevention of medication side effects, chronic disease management, and activity participation at the highest level possible are great tools in fall prevention.
As a physical therapist, falls and falls prevention is the bread and butter of daily patient care. Unfortunately, in the rehab realm many times I am helping people prevent a second fall since I am treating them following a fall that resulted in injury. This was especially true when working in a skilled nursing facility. It was a very small unit of about 18 rehab beds. At one time we had 9 people admitted with hip fractures that had been surgically repaired. Working in outpatient and home health, where I currently practice, the diagnoses I see are more varied and some people are referred for falls prevention, or due to recent decline in endurance or strength and I get to work on a more proactive basis to maintain functional level and quality of life.
This post will provide you with information on the considerations of falls prevention and links as appropriate to further resources.
What is Falls Prevention?
Falls prevention are interventions implemented with the goal of reducing accidental falls in a population, such as older adults. People of all ages fall. Think of a 1 year old that is learning to walk and how many times they fall. However, they do not typically get injured. Learning to stand and walk are natural parts of human development and the body is designed to withstand this training period. Babies are close to the ground, they have softer bones, and usually a few baby rolls to help cushion the fall. Adults fall as well. I have tripped, or sprained an ankle and fallen on multiple occasions over the years. However, again, the risk of injury is typically lower due to muscle bulk, speed of recovery due to immunity and metabolic factors and bone density that lessens the risk of serious injury.
Falls prevention is important in order to reduce risk of serious injury and need for higher level of care than desired. Falls cost financially, emotionally, and lead to reduction in quality of life in many cases. True limitations in mobility, strength, range of motion, and balance as well as fear of falling self-limiting factors increase the risk of falls.
The good news is that even a single intervention can contribute to a significant decrease in falls risk. The article linked highlights a home assessment for safety as one intervention. It also cites medication review, exercise, and regular visits to your healthcare professionals for falls risk assessment as important to falls prevention.
Below we will discuss some facets of falls prevention to give you an idea of some steps you can take or help you can seek in identifying and reducing your falls risk. In this post I link to a 12 question quiz that I recommend in identifying factors specific to your health that may be increasing your falls risk.
Some Factors of Falls Prevention
Home Safety
According to the National Institute of Aging 6 of every 10 falls occur at home. So, it would make logical sense that the home is the first place to look in identifying falls risk factors. Since I work in home health I visit about 5-7 homes per day and have seen many different environments. I think one of the best parts of my job is that I get to work with people in their own environment and can see their mobility and help them decide on home modifications to make to decrease their falls risk. There are so many different things that you can change in your home to improve your safety. I hope to discuss that in a further post at some point but for now you can find other resources online and refer to the quick list below. Both occupational therapists and physical therapists are great at assessing for home modifications to improve safety and mobility. There are whole businesses that are built on this premise and can be found near you potentially.
Some of these recommendations include:
- Removing or securing rugs
- Adequate lighting especially for nighttime bathroom trips if applicable
- Shower bench, non slip floor covering
- Hand rail/s on stairs
- Limiting clutter and narrow walkways
Take a look around your home and see if you can start to identify some areas that may contribute to a fall and if they need to be modified. Get my free safety checklist HERE to take a room by room approach to assessing for falls risks.
Watch the video here on Youtube
Medication Review
Have you ever thought about how your medications effect you and may contribute to a fall? At one point in grad school I did an entire presentation on polypharmacy. Polypharmacy is typically defined as the use of 5 or more medications. This is very common in the older adult population. Obviously, there are many uses for medications and you may actually need all of them to help manage chronic or acute disease. However, many people are taking 1 or more medications that they no longer need. Sometimes this occurs when someone was hospitalized and never discontinued a medication they were prescribed while admitted, or other scenarios. Reviewing medications with your primary care is important to reduce overuse of medication. The more medications you take the more likely you are to experience one or more side effect.
Medication side effects most likely to contribute to increased falls risk are dizziness and fatigue. Going along with medication management is also blood pressure monitoring if applicable. Many people are on cardiac medications and blood pressure that is too low contributes to dizziness and lightheadedness and too high increases stroke risk and other complications. Discuss your medication list with your physician, especially if you are prescribed something in the emergency room or hospital to make sure it is something that needs to be continued or not.
Disease Management
Do you have a chronic condition? Do you know very much about it? Is it being managed well? I have found that I really can’t make any assumptions about people’s level of knowledge about their health conditions even if they have been diagnosed with them for many years. Honestly, it shouldn’t be very surprising since doctor’s visits seem to be getting shorter and shorter, and the shuffle of specialists and referrals and level of retaining information at healthcare visits can vary. The other factor in this is that education about these conditions seems to keep changing. It seems like you could read an article every day about the best food for a healthy heart and a few weeks or months later read that it is not recommended.
All this to say, knowing about your health and diagnosed conditions is important and may give you insight into how they effect your falls risk. Take diabetes for example, managing blood sugar is important to prevent falls due to hypoglycemia. Heart conditions and the medications prescribed for them typically means that your heart rate is not a good indicator of exercise response and you need to monitor exercise another way to prevent over exhaustion. Back pain, knee pain, hip pain-you should know more about how these effect your walking pattern and balance and how to treat them so you can be mobile and strong and not let increased weakness contribute to a fall. I hope that this website can be a resource for you as it grows.
Exercise
Last, but of course not least, is EXERCISE! Obviously, as a physical therapist I view exercise as amazingly important in overall health. I didn’t go to college for 7 years to learn about it just for fun. 🙂 I could go on and on. Exercise has so much evidence for its use in managing chronic disease, preventing falls, improving strength, balance, and range of motion. Exercise releases endorphins and can contribute to improved mood. It helps with blood sugar regulation, energy, sleep cycles. The information and scientific proof that exercise helps everybody is endless. As a therapist I help people exercise at their level and also coach and push them to improve. I have had patients that are wheelchair bound work on exercises and their cardiac surgeons even say that they would not have done so well going through surgery if they had not been as strong going into that surgery.
Exercise works! Exercise does not have to be some long formal 60 minute workout routine. It can fit into your daily routine and lifestyle and can definitely be enjoyable. I love working with individuals to improve their health with exercise and education and believe it is one of the most important pillars in falls prevention.
The Last Thing You Need to Know about Falls Prevention
This post is full of information but I hope it is not overwhelming. There is definitely more that could have been included, such as diet and hydration. It is important to remember that even the implementation of one of these can reduce your chance of a fall. Implementing 20 minutes of exercise 3 days a week, having your medications reviewed by your primary care physician or a pharmacist, or picking up some tripping hazards in your home are a great start. Falls prevention is multifaceted and involves you as an active participant as well as a healthcare team.
I hope that Aging with Ability can be a part of your health education resources and feel free to subscribe to my email list to be notified when new posts are available.