Fall Prevention

It’s no joke.  The “I’ve fallen and I can’t get up” line has been used and abused as humor since its inception in the late 1980’s as a television advertisement for a personal emergency alert system.

I will confess right here, that age 23 in 1989 when it came out, I participated in the joke as well.  But it’s really not funny anymore, and it should never have been funny in the first place, to me or anyone.

I see the aftermath every day at work.  I am a medically based speech/language pathologist, and many of my patients—all adults—are being treated in the rehabilitation gym because of a fall.  Many people sustain a head injury as they fall, thus incurring cognitive and memory problems, and thus, requiring my treatment.

I see it at work, and lately, it has been present all around me at—literally.  One week ago, we received a call from our 71-year old neighbor who had fallen on his bathroom floor and had laid there for a few hours.  He wanted his wife to wait at least until 7:00 a.m. to call us on a Sunday, which she did.  The call came in at the stroke of 7:00.  We went over, and helped him up.  He refused medical treatment.  His gout was acting up again he said, and his feet were swollen and not able to bear weight.

Today, as I do every week day, I check in on my 74-year-old neighbor before I leave for work.  He has Parkinson’s disease, and his wife leaves for work several hours before I do.  It had been several weeks since he had fallen, but just ten minutes before I arrived, he fell when he tried to pivot too quickly.  He said he was fine, and didn’t hurt himself. 

Our friend’s father didn’t fare so well.  Joe moved his parents from 500 miles away to be closer to him and his sister, their only children.  They found a nice apartment, and decided to take a springtime trip back north to see old friends.  They stopped about halfway, and never made it further than that.  His dad fell on a curb simply stepping up, and broke a hip.  He has been in a rehab facility and  hasn’t been able to return home since, and they are now moving into an assisted living facility.

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Fall will soon be upon us, which makes it a perfect time to increase awareness of falls and their prevention.  The only falling any of us see should be the beautiful leaves from the trees.  Fall, of course, is our precursor to winter, which always sees an increase in falls due mostly to ice.  So, once again I am on a soapbox to preach fall prevention, because nearly 100% of falls can be prevented.

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Approximately 32,000 people die annually in the United States as a result of falls.  The vast majority—about 29,000 of these people are over 65 years old.  There are many injuries as well that are not accounted for in that figure.  One in four adults 65 and older report falling at least once annually. 

The 85-and-older population demographic in the United States is the most rapidly growing segment of our population, as the lifespan continues to increase.  Therefore, these numbers will likely grow as well. 

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Any person of any age can sustain a fall.  At one end of the age spectrum are children, who are more likely than younger adults to fall due to their higher level of physical activity and lack of safety awareness.  Most falls with injuries, however, do involve older adults.  Age, in itself, is a risk factor for that reason.  Other risk factors include:

  • decreased physical activity
  • side effects of medication
  • loss of balance—common with aging
  • poor mobility
  • decreased cognition
  • decreased vision/decreased depth perception
  • unsafe physical environment—fall risks present include clutter, pets, oxygen tubing, poor lighting
  • poor adherence to medical advice to use a walker or cane
  • alcohol or other substance abuse
  • inner ear disorders
  • vertigo
  • low blood pressure causing lightheadedness upon standing
  • attitude of invincibility—“It won’t happen to me.”

…and many more.

Any and all of us are at risk, but again, older adults—65-plus– are the most common age group to experience falls.   Age brings with it a natural slow-down of movement, and we should respect that change.  At age 53, I am already feeling this.  I exercise nearly every day and remain in good physical shape, but I can feel the change, so I work with it, instead of fighting it.  I used to bound up and down the stairs—we have two sets in our home—without using the railing.  I no longer bound, and I always use the railing.  When I am walking downstairs to the laundry room and my arms are full of laundry, I am sure to lean against the wall, and take it even more slowly.

I know I am not immune to falls. 

A fellow speech therapist who is not yet 40 fell going down her stairs last year, and was laid up and off work for several months.  Her dog got under foot as she went down the stairs.

It can happen to any one of any age, at any time, for multiple reasons.

Now that I have sufficiently laid the foundation for the why and how it happens, lets cover the most important topic:  how to prevent falls.

First of all, please know that none of us are immune.  As I pointed out, it can happen to anyone.  Given that, here is what you can do to prevent falls, perhaps with a little help from your provider and/or other medical professionals:

  • Review medications to check for any side effects that may contribute to a fall
  • Keep measures in place to monitor blood pressure
  • Participate in screenings either in your home, a facility or a public place to assess for fall risk factors
  • Engage in regular exercise, including community-based programs/classes that enhance balance, such as yoga and Tai Chi.
  • Proper use of assistive devices such as a walker or a cane
  • Installing and using grab bars in the shower/bath.  A raised toilet seat or armrests are helpful
  • Ensure adequate lighting—especially places like the basement or garage, that may not be lit up.  Most people get up at night to use the bathroom, so ensure adequate night lighting as well.
  • Wear sensible shoes with good traction.  This is especially important in the wintertime, as the fall risk multiplies on snow and ice.  Attaching crampons—rubber nets with short spikes that stretch across the bottoms of your shoes—may be a good idea if you know you will be on questionable outdoor surfaces in the winter.  My father-in-law fell last winter when there was a surprise freezing fog.  It wasn’t predicted, and he simply stepped outside and hit the slippery spots and went down.  If there is any chance of this in freezing temperatures—predicted or not—take an extra moment to “test the waters” by hanging on to something as you run your foot over the surface you intend to walk on.
  • Be aware of and clear all possible physical factors in your home environment, such as clutter and throw rugs.  Always keep your eyes on any pets that may get in the way, as well as oxygen tubing that may wrap around your leg.  Be aware of stray electrical cords as well.

A word to caregiving family members who may be frustrated because your loved one needs to adhere to this advice, but doesn’t take it from you:  don’t take it personally.  This is nearly a universal phenomenon, as almost 100% of patients don’t like to hear the advice from their spouse/partner/family member.  Ensuring that the medical professional lays down those laws to them may help when you remind them of what they need to do.

For those who have difficulty ambulating and/or getting up and down in/out of a chair, a gait belt is a very simple and handy tool.  It is a strong canvas belt that can be easily wrapped around the upper abdomen and buckled to allow someone to assist with these transfers and/or ambulation by hanging on to it, and gently pulling up and lowering down.   These are available at most pharmacies and online.  

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Just prior to finishing this post, I checked in on my neighbor.  He had fallen once again yesterday.  This time, he laid there for about 30 minutes, and was forced to scoot himself to a point where he could reach something to help pull himself up.  He was home alone, and he is now scuffed up on his head and arm from the fall, but no major injuries—this time.

 “I happened in one second, for no reason,” he said. 

That’s usually how most falls happen. 

He has received home health physical, occupational and speech therapy in the past, and I encouraged him to ask his doctor about it again.  If a person qualifies as “homebound,” through the doctor and home health agency, they can receive home health therapy—not around-the-clock caregiving—for several sessions per week.  It is covered at 100% by Medicare and some insurance companies.  Ask your provider if you think you are in need, and may qualify. 

Have a great fall, and enjoy the beautiful autumn.  The falling leaves will soon be splendid and beautiful.  Please aware that a fall can happen to you in any season, but your chances of preventing it are much greater with a little thought and effort.