IDENTIFYING AND REDUCING FALL RISK
Per the Center For Disease Control:
Each year, millions of older people—those 65 and older—fall. More than one out of four older people fall each year, but less than half tell their doctor. Unfortunately, falling once doubles your chances of falling again.
- One out of five falls causes a severe injury such as broken bones or a head injury,
- Each year, 3 million older people are treated in emergency departments for fall injuries.
- Over 800,000 patients a year are hospitalized because of a fall injury, most often because of a head injury or hip fracture.
- Each year at least 300,000 older people are hospitalized for hip fractures.7
- More than 95% of hip fractures are caused by falling, usually by falling sideways.
- Falls are the most common cause of traumatic brain injuries (TBI).
- In 2015, the total medical costs for falls totaled more than $50 billion. Medicare and Medicaid shouldered 75% of these costs.
What Can Happen After a Fall?
Many falls do not cause injuries. But one out of five falls does cause severe harm, such as a broken bone or a head injury. These injuries can make it hard for a person to get around, do everyday activities, or live independently.
- Falls can cause broken bones, like wrist, arm, ankle, and hip fractures.
- Falls can cause head injuries. These can be very serious, especially if taking certain medicines (like blood thinners). An older person who falls and hits their head should see their doctor right away to ensure they don't have a brain injury.
- Many people who fall, even if they're not injured, become afraid of falling. This fear may cause a person to cut down on their everyday activities. When a person is less active, they become weaker, and this increases their chances of falling.
What Conditions Make You More Likely to Fall?
Research has identified many conditions that contribute to falling. These are called risk factors. Many risk factors can be changed or modified to help prevent falls. They include:
- Lower body weakness
- Vitamin D deficiency (that is, not enough vitamin D in your system)
- Difficulties with walking and balance
- Use of medicines- such as tranquilizers, sedatives, or antidepressants. Even some over-the-counter medicines can affect balance and how steady you are on your feet.(Use this link for Medicine Alternative Per Beers Protocol )
- Vision problems - When one is over 65 years old it takes approximately 60% more light is needed to see the same items we could see at age 20. If you have bifocal or progressive lenses, you may want to get a pair of glasses with only your distance prescription for outdoor activities, such as walking. Sometimes these types of lenses can make things seem closer or farther away than they are.
- Cognitive Impairment- Executive function, a set of cognitive processes that includes attention, inhibitory control, working memory, and cognitive flexibility, is essential for everyday walking. For example, suppose a person has to focus all attention on maintaining themselves upright the moment that person shifts their focus, for example, on reaching for something. In that case, a fall is likely to occur in that moment of distraction. When what is automatically responsive to changes of position- our balance system -becomes impaired, then simple activities of daily living become frightening and place a person at risk for falls.
- Foot pain or poor footwear-Falls are more likely when wearing inappropriate footwear, such as flip flops or slippers that don't cover the heel. Instead, wear shoes that fit well, have a firm heel to provide stability, and have a textured sole to prevent slipping.
- Home hazards -broken or uneven steps, and throw rugs or clutter that can be tripped over.
A research study finding reports the following for nonfatal unintentional fall injuries in people age 65 years and older treated in US emergency departments and associated with carpets and rugs from 2001–2008; Carpet falls 20,571, and falls from rugs were at 17,408. Now you know why all therapists attempt to remove inappropriate rugs and carpets; this includes bath mats, toilet floor mats, all hallway runners, living room area carpets. The same research indicated that a smooth, consistent level flooring was ideal such as vinyl. However, most of my clients do not want to remove their rugs. Although I am respectful and sympathetic to the aesthetics of their home, I also know that if my client falls, she will likely not be in her lovely aesthetic home. Instead, she will be in a hospital for a broken hip or head injury and then end up in a facility. Life is all about choices, and risk management/ mitigation is a choice.
- Use the equipment recommended by a Physical or Occupational Therapist. If your Physical Therapist recommended using a walker, then use it instead of the furniture. If it does not fit in your bathroom, ask your Physical or Occupational Therapist what they recommend. For example, if your loved one has to get up at night to use the toilet, using a bedside commode may be a good compromise if they are not steady on their feet when they first get up. Doesn't it make sense to perform a simple stand pivot transfer from bed to bedside commode and back to bed when one has a full bladder than walk to and from the bathroom?
- Move frequently used items to an easy-to-reach position (between the shoulder and hip height) without bending over. In the kitchen and bathroom, this likely is counter height and includes the refrigerator. In the refrigerator, move frequently used items to the front. While we are at the refrigerator, never hold onto the door, particularly when using a walker- always hold onto something solid such as the counter that will not move. If an over oven microwave is in place, you may want to move it to counter level so that the risk of burns or falls is reduced when reaching to remove a hot item. In the bedroom, place frequently used items in reach, such as underwear, to the dresser's top drawer, or use a closet hanger system to lower items to the ideal height.
