Senior fall prevention guide

As someone who has looked after an aging parent having to deal with the results of a fall, this guide for seniors, aimed at helping them to avoid falling, and therefore the long term trauma associated with falls, is invaluable. We are all getting older, and there are some key pointers we should all take note of to help us maintain healthy, and happy aging! Many thanks to caring.com for asking me to bring additional attention to this important area.

Even simple things — like stepping out of the bathtub or going down the stairs in your home — can cause falls that will have a massive impact on your life. Following a fall, seniors or their caregivers may choose to limit their activities and social engagements because they’re afraid of further accidents. This can foster feelings of isolation, and lead to loss of independence, declining quality of life, and, at worst, untimely death.
If you or a loved one has recently experienced a scary fall, you’re not alone. One in four senior adults will fall each year, and the risks increase with aging.
Falls are the primary cause of fatal and non-fatal injuries in Americans over the age of 65. According to the U.S. Centers for Disease Control and Prevention (CDC), every second of every day, a senior adult will fall, resulting in 36 million reported cases each year and more than 32,000 deaths.
Furthermore, falls threaten the safety and independence of aging adults. One out of five fall incidences results in serious injuries, including broken bones and head injuries. In addition, over 300,000 seniors are hospitalized for fractured hips, and 95% of them are due to falls or fall-related.
Unfortunately, many people have resigned that falling is an inevitable part of aging, which is not true. Most falls are preventable – you may not be able to completely eliminate the risks, but it’s within your power to reduce them.
This guide aims to provide in-depth information about falls and why they happen. It also offers tips and strategies on preventing and limiting your risks of falling, including lifestyle changes and household modifications.

Causes of Falls in Elderly Adults

Before you start making changes, it’s important to understand the scope of the problem. For older adults, falls are extremely common, affecting more than 25% of seniors each year. Falls are also responsible for more than 800,000 hospitalizations each year and $50 billion per year in medical costs, most of which are paid for by Medicare. Seniors have some unique risk factors that make them more likely to fall at home and in the hospital. For example, many older adults take medications that can worsen their balance and coordination. Seniors are also more likely to have medical conditions that make it difficult to see hazards or maintain their balance when walking or going up and downstairs.
The following are some of the most common causes of falling:

• Use of medications that cause dizziness, drowsiness, loss of coordination or poor balance
• Medical conditions affecting the nervous system, including epilepsy, diabetes and spinal cord injuries
• Vision problems that make it difficult to see potential hazards
• Muscle weakness
• Abnormal walking patterns
• Home and community hazards, such as loose steps, slippery showers and broken handrails
• Slower reflexes
• Low blood pressure when moving from a sitting to a standing position
• Wearing unsafe footwear
• Mental confusion caused by dementia and other medical conditions

Senior Falls and Aging in Place

When a senior ages in place, they stay in their own home rather than moving in with family members or entering an assisted living facility or nursing home. Aging in place has many benefits, such as increased independence and more support from community members, but it also has some risks. If your loved one lives alone and doesn’t have anyone to help with household chores, they may trip over clutter or fall after stepping on a loose stair tread. 
The risk of falls increases dramatically if your loved one lives in a house with more than one floor. Going up and down the stairs can be dangerous, especially if your loved one has any vision problems that make it difficult to see the steps and landings. If the home has inadequate lighting, your loved one may not realize when they’re about to stumble over a hazard.
Aging in place is also more difficult for seniors who have balance problems. Problems with balance can cause dizziness, vertigo, light-headedness and other symptoms, all of which can make it difficult for your loved one to navigate around their home. Without good balance, it’s difficult to maintain control over your body position. As a result, older people with balance problems may stumble, shuffle, trip or fall forward when they try to bend over.

Common Consequences of Falls in the Elderly

Some falls are minor, resulting in little more than a bruised ego and a couple of scratches or bruises. Unfortunately, falls can also cause serious injuries. More than 95% of the 300,000 hip fractures that occur each year are due to falls, leading to costly hospital stays and long recovery periods. Additionally, around 20% of falls lead to serious injuries, including head injuries and broken bones.
These are some common consequences of falls in the elderly:

• Fractures
• Dislocated joints
• Hematomas 
• Severe lacerations
• Sprains
• Painful injuries to the soft tissues

Lifestyle Changes That Can Help Prevent Falls in the Elderly

Although aging in place increases the risk for falls, there are some lifestyle changes your loved one can make to prevent slips, trips, and tumbles. These changes are aimed at addressing any underlying medical conditions and eliminating certain risk factors that can make falls more likely. If your loved one has memory loss due to dementia or another medical issue, provide support by reminding them to engage in the following activities.

Keep Up With Doctor Appointments

Keeping up with medical appointments can help your loved one address underlying medical problems that increase their risk for falls. For example, seeing an eye doctor regularly ensures that your loved one has the right prescription for eyeglass lenses or contacts. An eye doctor can also diagnose and treat glaucoma, cataracts and other eye conditions before they make it too difficult for your loved one to see. Regular appointments with a primary care provider are also beneficial, as a PCP can determine if your loved one has any neurological disorders likely to result in impaired balance and coordination. They can also prescribe and adjust medications that help reduce falls and prescribe therapies to help with strength and balance, such as physical and occupational therapy. 
If you accompany your loved one to medical appointments, be prepared to ask questions and bring up any concerns you have. Let the doctor know if you’ve noticed your loved one stumbling, tripping or having difficulty maintaining their balance when they climb stairs or stand up after lying or sitting down. Remember to include your loved one in the conversation rather than conversing exclusively with the doctor.

Stay Physically Active

Staying active has been shown to help older adults improve their balance. Therefore, getting enough exercise is a good way to reduce the risk of falls; however, it’s important to exercise safely. Make sure the exercise environment is safe and your loved one has a way to call for help if needed. 
Your loved one should speak with a medical professional before embarking on a new fitness program, especially if they have arthritis, diabetes or another chronic medical condition. A well-rounded program should include aerobic exercise, resistance exercises to strengthen the muscles, balance exercises, and stretching to improve flexibility. If your loved one has been relatively inactive up to this point, advise them to start slowly. Taking a short walk is better than no activity at all.

Eat a Nutritious Diet and Stay Hydrated

A nutritious diet is essential for building muscles and maintaining muscle strength, making good nutrition critical for preventing falls. Many seniors don’t get enough protein or vitamin D, resulting in a loss of muscle mass. Decreased muscle mass may lead to weakness and a loss of coordination, increasing the risk of falls. To reduce your loved one’s risk, make sure they eat plenty of protein-rich foods, including lean meats, beans and low-fat dairy products. Just have them check with a doctor before making any dietary adjustments, as some people need to limit their intake of protein due to kidney disease or other medical conditions. Fatty fish is one of the best sources of vitamin D, so encourage your loved one to eat tuna, mackerel, salmon or trout often. If they don’t like fish, ask their doctor if it’s safe for them to take a vitamin D supplement.
Dehydration also increases the risk for falls, mainly because it can cause dizziness and low blood pressure when standing up from a sitting or lying position. If your loved one doesn’t have to restrict their fluid intake due to kidney disease, congestive heart failure or another medical condition, make sure they drink plenty of liquids. Some seniors have trouble drinking large amounts of fluid, so you may want to try making smoothies, purchasing ice pops made from fruit juice or preparing soups or broths for several meals each week.

Limit Alcohol Consumption

Drinking alcohol impairs your motor skills and cognitive abilities, increasing the risk of falls for older adults who may already have balance problems or poor coordination. Alcohol may also interfere with one of the medications your loved one takes, making a serious fall more likely. In some cases, drinking alcoholic beverages can cause an older adult to become dehydrated. This usually happens because consuming alcohol causes the body to produce more urine than usual.

Wear Stabilizing Shoes

It’s important for your loved one to wear stabilizing shoes that reduce the risk of falls in a variety of environments. In a study published in the journal Footwear Science, researchers from the University of Massachusetts Medical School, the Institute for Aging Research and Beth Israel Deaconess Medical Center selected 765 participants and asked them to record their falls. They also asked each participant what kind of footwear they had on when the falls occurred. The researchers determined that just under 52% of in-home falls occurred when participants were barefoot, wearing slippers or wearing socks without shoes, indicating that it may be wise for older adults to wear shoes around the house.
If your loved one decides to wear shoes most of the time, encourage them to choose shoes that have low heels and slip-resistant soles. You must use caution when buying shoes with slip-resistant soles, however. Some shoes have an extremely high level of slip resistance, creating too much friction between the soles and the floor’s surface, causing older adults to slip and fall when they try to pivot. This is especially concerning for people with Parkinson’s disease and other conditions that cause a shuffling gait.

Fall Safety at Home: Home Modifications for Fall Prevention

Now that your loved one is making beneficial lifestyle changes, it’s time to make some home modifications to keep them safe. Older homes can be full of hazards, including loose flooring, missing handrails, loose steps, broken light fixtures and worn-out furniture. Home can be especially dangerous if your loved one has hoarding disorder, a form of obsessive-compulsive disorder that makes it difficult to part with personal possessions. You can help reduce the risk of falls by minimizing potential hazards and making some modifications to make your loved one’s home safer.

Limit Potential Hazards

Start out with some simple modifications that don’t cost a lot of money or require advanced repair skills. If your loved one has an area rug that tends to bunch up, replace the rug with one that lies flat to reduce the risk of tripping. Electrical cords are a major tripping hazard, so make sure the cords to lamps, televisions and other items aren’t in your loved one’s walking paths. If necessary, tape them to the floor to keep them from moving around. You may need to remove or reposition a few pieces of furniture to widen walkways and make sure your loved one can get around without bumping into tables, chairs and couches.

Bathroom Modifications

Many falls occur when older adults slip in their showers or bathtubs, so it’s important to make a few key bathroom modifications. Installing a walk-in shower or walk-in tub eliminates the need for your loved one to step over the edge of the shower or tub, reducing the risk of falls due to a loss of balance. If the bathroom doesn’t already have grab bars, install them immediately so your loved one has something to grab if they feel unsteady. Finally, make sure the bath mats have a nonskid backing to prevent them from sliding around when your loved one steps on them.

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Stairlifts

A common problem among older adults is the inability to get to the second or third floor of a multistory house, which can make their world smaller by making it impossible to get to a master bedroom or full bathroom. Installing a stairlift is one way to get around this problem. Stairlifts are especially beneficial for anyone with reduced mobility caused by arthritis, osteoporosis, prosthetic joints, and other issues. Before installing a stairlift, research models carefully and make sure your loved one’s stairway is large enough to accommodate the one you choose.

Enhanced Lighting

Inadequate lighting makes it difficult to see, increasing the risk of in-home falls. Fortunately, adjusting the lighting is one of the easiest modifications you can make. Add at least one table lamp to each room to illuminate walkways and make it easier to see the contents of drawers. Each lamp should be 22 to 30 inches high and have a shade that doesn’t block too much light. You may also want to look for a few lamps with flexible necks to make it easy for your loved one to change the direction of the light source when needed. Floor lamps are also useful for lighting dim spaces, making it easier for your loved one to see where they’re going.

How to Help After a Fall

Despite your best efforts, your loved one may fall at some point. It’s important to respond appropriately to a fall, as the wrong approach could put your loved one’s physical or emotional well-being at risk. Follow these tips to ensure your loved one recovers from a fall as quickly and fully as possible.

• Check for injuries: Falls can cause fractures, dislocations, sprains, and head injuries. If your loved one falls, check for signs of these injuries and call for medical attention if needed. Fractures may cause the affected limb to look out of place; they can also cause swelling and difficulty moving the limb. You should also look for bruises, lacerations and other injuries to the skin. To determine if your loved one might have suffered a head injury, examine their head carefully. Ask if they have blurry vision, nausea, vomiting, ringing in the ears or a sudden headache. It’s important to note that seniors on blood thinners may have injuries that cannot be seen. It’s a good idea to have a doctor examine your loved one after a fall, even if it seems like a minor fall. 
• Stay calm: A fall is upsetting, especially when it results in a painful injury. To keep your loved one as calm as possible, try not to panic. Encourage your loved one to take deep breaths while you check for injuries and arrange for medical care.
• Ask about their symptoms: Checking for injuries is important, but it’s possible for your loved one to have a serious injury even if you don’t notice any outward signs. Ask if they’re in pain; if they tell you they are, ask how bad the pain is on a scale of 1-10. 
• Call the doctor: Even if your loved one doesn’t need immediate medical attention, it’s still important to let their doctor know that a fall has occurred. Tell the doctor what happened and what caused it.
• Help them up: If your loved one isn’t injured and wants to get up, encourage them to take it slowly. Offer your arm for support, but be careful not to lift your loved one on your own, as you can injure yourself in the process.
• If possible, address the source of the problem: Ask your loved one what caused them to fall. If they report that they tripped over a wrinkled rug, electrical cord or some other hazard, eliminate the hazard immediately. If they got dizzy or felt faint, schedule a doctor’s appointment to make sure they don’t have a new medical condition requiring treatment.

Fall Prevention Checklist

Download the checklist

Frequently Asked Questions

Q. How can senior falls be prevented?You can prevent senior falls by eliminating in-home hazards and encouraging your loved one to make certain lifestyle changes. These changes include getting more protein and vitamin D, drinking plenty of water, staying active, wearing nonslip footwear and limiting their alcohol consumption.

Q. Where do most elderly falls occur?While stairs can be hazardous, most falls occur on flat surfaces in bedrooms, dining rooms and kitchens. Falls may also occur in showers and bathtubs, when using ladders or step stools and when an older adult is getting out of bed.
Q. What should you look for after a fall?
Look for signs of injury, such as bones protruding from the body, heavy bleeding, severe lacerations and widespread bruising. Ask your loved one if they’re in any pain; if they reply in the affirmative, ask them to rate their pain on a scale from 1 to 10. Even if you don’t call 911, you should still let your loved one’s doctor know that they had a fall.
Q. What are the risk factors for falls in elderly people?
Older adults have several risk factors that make them more likely to fall, including poor balance, muscle weakness, loss of coordination, vision impairments, hearing impairments and the use of medications that can cause drowsiness, dizziness or poor motor skills.
Q. What are the signs of a concussion in an elderly person?
​Signs and symptoms of a concussion in an elderly person include headache, nausea and vomiting, trouble walking, memory problems, dizziness, mood changes, fatigue, vision changes and sleep pattern changes.