Falls

FACTS

• Falls are the leading cause of injury and injury death in the United States for the elderly.
• One out of four older adults fall each year.
• Preventing falls reduces hospitalizations and subsequent medical complications.

CAUSES OF FALLS

• Decline in physical fitness
  • Muscle mass and strength decline 30-50% between the ages of 30 and 80.
  • Rate of decline after the age of 50 is approximately 12-14% per decade.
• Medications
  • Benzodiazapines
  • Sedatives
  • Antipsychotics
  • Narcotic analgesics
  • Sedating antihistamines
  • Muscle relaxants
  • Drugs that lower blood sugar or blood pressure
• Chronic diseases
  • Impaired vision
  • Stroke
  • Chronic kidney disease
  • Diabetes
  • Orthostatic hypotension
• Surgery
  • Orthopedic procedures
• Environmental hazards
  • Area rugs
  • Electrical cords
• Behavioral hazards
  • Irritability
  • Impulsiveness

UNIQUE CAUSES OF FALLS

• Frontal gait apraxia with Alzheimer’s Disease, Frontotemporal Dementia or Normal Pressure Hydrocephalus
  • Slow short strides
  • Feet barely clear the ground when stepping
  • Arms do not swing naturally when walking
  • Difficulty walking in a straight line
  • Falling backward
• Strokes
  • Weakness and loss of balance
• Parkinson’s
  • Flexed forward at the hips
  • Shuffling of feet
  • Short strides
  • Arm tremor may increase when walking
  • Classically fall backward
• Peripheral neuropathy
  • Numbness in the feet which can progress to the ankles, shins, and knees
  • Uncoordinated gait
  • Unstable posture or feeling of imbalance
  • May hear a foot slap when walking
  • May develop foot deformities
• Spinal stenosis
  • A narrowed spinal canal squeezes nerves to the legs
  • Weakness in legs
  • Poor balance
  • Wide-based gait
• Vertigo
  • A sense of spinning or movement in the head
  • Poor balance

FALLS PREVENTION

• Complete a home safety checklist.
  • Read the website document Home Safety Assessment Checklist for more information.
• Simplify the home setting by removing excess furnishings.
• Adjust position of furnishings to keep walkways clear.
• Provide adequate lighting especially at night.
• Remove area rugs. If area rugs are needed, choose ones with non-skid padding.
• Determine if handrails on stairways are present and secure and install or replace as needed.
• Ensure chairs have armrests to assist with standing from a seated position.
• Consider installing grab bars in the shower and near the sink and commode.
• Place brightly colored tape on stair edges.
• Place a gate across the top of the stairs if balance and judgement are problematic.
• Position electrical items so that the cord does not pass through a walking area. Consider tacking cords to baseboards.
• Pets are a tripping hazard. Contain pets at night. Have a pet wear a collar with bells to know where the pet is in the home.
• Clean up spills when they happen.
• Wear flat, thin soled, fabric topped shoes.
• Do not drop a person off at a curb side if there is a risk of falls. Park the car, assist the person out of the car, and walk beside to reduce the chance of falling.
• Ask the provider about a handicap parking placard.
• Get regular check-ups to evaluate eyesight, hearing, orthopedic limitations, and blood pressure when sitting and standing.
• Participate in exercises to preserve and improve strength.
• Avoid medications that increase the risk of falling.
• Avoid alcohol which can impair balance and alertness.
• Consider a fall alert system with GPS technology.
• Physical therapy may be ordered for help with improving gait and balance.
• Assistive devices such as a stick, cane or walker may be necessary.