Preventing Falls In Older Adults
Updated on: August 2023
Falls are the single largest cause of death and injuries in older Americans. Around 33% of the elderly fall at least once per year, and these falls result in over 2 million visits to the emergency room. Falls are the most common cause of traumatic brain injuries in older adults, and they may also cause other severe injuries, such as fractures of the hip, that can have extremely negative impacts on quality of life—and on our economy in general.
In 2020, there were an estimated 3 million falls among adults aged 65 and older, resulting in 32,000 deaths. The cost of fatal falls was $637 million, and the cost of non-fatal falls was $43.4 billion.
As daunting as these statistics are, they don’t take into account the psychological effects of a fall. Seniors who fall can become more afraid of falling, and this fear can reduce their quality of life and their ability to exercise properly. Reduced physical activity can then lead to a vicious cycle in which an older person’s physical condition deteriorates, increasing the risk of falling even more, and further curtailing the victim’s independence and quality of life. For these reasons and others, fall prevention is an essential component of senior care.
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Myths About Falls and the Elderly
Numerous myths surround falls and the elderly. For that reason, the first step in fall prevention is to learn the truth.
Myth No. 1
Because they have a more physical lifestyle, men are more likely to suffer a fatal injury from a fall. The truth is actually the opposite. Women are more likely to fall and are also more likely to suffer serious injury or death from a fall.
Myth No. 2
If you are elderly, then you will fall – expect it. This is untrue. Seniors should expect—and work toward—a life free of falls. The National Council on Aging has concluded that with the proper care, a senior adult can expect to live a full, healthy, fall-free lifestyle.
Myth No. 3
There is no systemic approach or assistance that can help older adults avoid falls in their homes. The truth is that government agencies are taking the issue more and more seriously. The CDC and other organizations now provide official lists of fall prevention strategies and even tools for assessing fall risk.
Myth No. 4
A fall, especially a serious fall, means the end of a person’s ability to live independently with dignity. Nothing could be further from the truth. The cause of the fall must first be determined. If the cause can be fixed and a fall prevention plan put into place, there is no reason that an older adult cannot continue living a robust, healthy, independent lifestyle.
Myth No. 5
Falls only occur because of muscle deterioration or failing health. The truth is that a variety of factors lead to falls. Many falls actually occur because of vision problems, medications that cause dizziness or mental instability, poor lighting, and other factors.
To learn more about the true facts about falls, view our Falls Fact Sheet.
Common Factors that Lead to Falls among Seniors
As mentioned above, health can be a contributing factor to a fall, but it’s by no means the only contributor, and knowing the variety of factors behind falls can make it easier for you to avoid them. With that in mind, here’s a list of common issues that can lead to falls in the elderly.
While it’s not the only contributor to falls, your medical condition is obviously a potential factor. For that reason, any time you or someone in your care falls, you should take a moment to think: What was their mental state? Did they recently go on a new prescription medication? An over-the-counter medication that causes drowsiness or dizziness as a side effect may also be to blame.
In addition, older adults may suffer from one or more chronic medical conditions. While medications may mask these conditions, they can still contribute to the risk of falling even when controlled. If you or your loved one suffers from any medical condition, ask your doctor if their problem could increase the risk of a fall.
Physical limitations can also lead to falls. There is a difference, however, between a physical limitation and a decline in a person’s physical condition. An older adult may, for example, have suffered the loss of a limb from an accident earlier in life, but while this physical limitation could increase the risk of a fall, it would not make the rest of the body any less healthy. Similarly, vision problems may require specific fall avoidance strategies while having no real bearing on a person’s overall well-being. With the proper fall prevention strategies, any physical limitation can be eliminated as a falling risk.
Your home environment may create falling hazards. A cluttered home, or one that otherwise puts obstacles in your way, can cause a fall even if your health and physical condition don’t predispose you to one. In addition, temporary variations in the home environment can create problems even if the home is normally without risks. Inclement weather, for example, may play a role: if a rainstorm causes the roof to leak water onto a kitchen floor, it’s likely an elderly adult would slip on that floor eventually. (For that reason, It’s usually best to reassess fall prevention techniques after any large scale weather event.)
Other environmental factors can come into play as well. Too much sunlight, for example, may cause an older adult to become lightheaded or woozy, and lead them to trip over a misplaced item in the house or even a door curb. Fall prevention is a holistic discipline: many factors can create a high-risk fall environment, and reducing the risks requires an ongoing commitment.
Many falls in the senior community occur because of vision problems or limitations, but some of these risks can be reduced by using adequate lighting and making sure that lighting is working properly. Good lighting can help even those without diagnosed vision problems, and the reverse is also true: even if you have excellent vision, poor lighting can put you at risk for a fall by obscuring obstacles or making even clutter-free areas more difficult to navigate.
Lighting that is too bright can create its own problems. Sunlight is often the culprit in this situation, but so can lamps that create a glare. A room that is too bright can prevent you from properly assessing hazards in the room, and bright lights may also trigger lightheadedness that leads to a loss of balance.
Attire and Shoes
Beyond these environmental factors, an older person may carry a falling hazard around with them in the form of clothing. Tight clothing can heat up too fast or restrict blood flow, causing an older adult to lose short-term mental capacity or motor skills. Extremely loose clothing can put you at risk as well: it can get caught on doors, windows, or furniture, causing a fall.
Shoes bring their own set of issues. In general, seniors at a high risk of falls should avoid loose-fitting shoes and shoes with slippery soles. If you have foot problems, shoes that fail to address them may cause trouble as well. For example, normal shoes can increase the pain and discomfort of those with fallen arches, and this pain may increase the risk of a fall.
In general, people who are at a high risk of falling should avoid shoes with soles that are too slick, high heels, flip-flops, and stockings.
Physical and Emotional Well-being
With these risks in mind, you should begin putting together a strategy for avoiding falls. Here, the first line of defense is taking stock of—and taking steps to improve—your or your loved one’s physical and emotional state. Here are some of the most important physical and psychological issues you should consider.
Once again, many falls have nothing to do with a person’s underlying medical condition. That said, however, your physical well-being is essential to an independent life, and physical fitness is the key to preventing falls. This includes a holistic program that includes nutrition, regimented exercise, and a general openness to physical activity throughout the day. You should also have your physical well-being checked far more often than younger adults, and you should get into the habit of listening to your body and consulting with your doctor about any unexpected symptoms.
Outside of the doctor’s office, some of the most effective deterrents to falls are simply healthy daily habits. For instance, drinking a healthy amount of water each day can help you avoid lightheadedness or fainting. Good nutrition is also essential, as is frequent physical activity. As you get older, healthy habits do more than just help you avoid disease: they can help you prolong your ability to live independently.
One particular set of conditions to be aware of and act on are disorders of the ear. Since the ears are an essential component of balance, you should get your ears checked regularly, and should make an extra effort to do so if you are experiencing any form of imbalance, nausea, or dizziness during your normal day to day routine.
Other conditions that may need to be checked out include numbness in the legs, shortness of breath, and joint pain. Each of these conditions may be addressed through a physical regimen.
In general, medications have a more extreme effect on elder adults than they do on younger people, and sedatives and antidepressants routinely increase the risk of a fall in an older adult. Take special heed of all side effects and symptoms, even when taking an over-the-counter medication. If you find you experience side effects that impact your mobility, work with your doctor to wean yourself off them, and do the same with any medications that may reduce your ability to locate hazards or control your body.
Physical Immobility & Injuries
Elder adults who have suffered injuries are at special risk for falls in the home. This is doubly true for people who have a previous history of falls. As you look to lower your fall risk, be aware of the following factors—and think about ways of reducing their impact.
- Lower body weakness – If the core, back, hips or legs are weak or in pain, it will have an effect on a person’s balance. Symptoms of lower body weakness include a short or impaired gait, an inability to walk for extended periods of time, pain in the lower body when performing normal activities and imbalance with no provocation.
- Foot pain – Pain in the feet can come from any number of causes. Foot injuries that are not allowed to properly heal may affect your balance in numerous ways. If your footwear is in any way uncomfortable, consider changing it as a priority within a fall prevention plan.
- Vision disorders – Any eye injury or visual impairment can increase a person’s risk of falling. People with impaired vision may misinterpret a hazard or fail to see it altogether.
- Ear disorders – The ears are essential to maintaining proper balance, and proper balance is essential to reducing the risk of falling. Elder adults should have their hearing checked as often as their eyes.
- Loss of limbs – The loss of an extremity that does not require seated transportation may increase the risk of a fall. In most cases, too, walking will require the use of an implement. The fall prevention program for such a person may include fall-protective netting, window fall prevention, lanyard fall protection, and other fall prevention tools.
Physical Exams/Annual Check Up
Again, health can be a significant factor in avoiding falls, and so it’s essential to be aware of—and seek to address—any health-related falling risks. This means that physical checkups are an essential part of any fall-reduction attempt. Checkups will usually begin with a general assessment from a family doctor and progress to specialists who will address specific issues. If possible, make sure your doctors include the following checks:
- Your gait – The way you walk says a lot about your general health, both mental and physical. This will usually be one of the first things that your doctor tests.
- Balance – Your balance is another holistic measure that will allow your doctor to drill down into more specific issues if a problem is found.
- Mobility – Your general ability to move affects your ability to react quickly to an unexpected event that may cause a fall. You also gain the ability to avoid hazards that may cause a fall if you are relatively mobile.
- Physical fitness – This is defined as the ability to easily perform day-to-day tasks. If you cannot, then you are more likely to experience a fall in the home.
- Heart rate – The heart rate affects many other aspects of the body, including brain function, motor skills, and vision.
- Blood pressure – High blood pressure may be indicative of stress, which increases the risk of a fall.
- Muscle strength – Stronger people can resist imbalance and step over hazards. People with stronger muscles will also be able to walk more effectively and balance themselves to avoid falls.
- Nerve health & reflexes – Reflexes are very important, because many falls are caused from unexpected events or hazards.
- Diet – The way that you eat speaks to your general health and may affect your heart rate, balance and vision.
- Pain – If there is any pain in your body, then your body may be trying to tell you something – something that will help you avoid a fall.
- Arthritis – Joint pain makes it harder to avoid falls. Symptoms of arthritis must be controlled as a part of a fall protection strategy.
- Fear of falling – As mentioned above, people who are more fearful of falling are actually more likely to fall. Your doctor should assess this psychological condition if it is present and work to remove it.
- Brain function – The ability to think fast speaks to your reflexes and muscular reactions. The better these are, the more you will be able to resist a fall.
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Actively Reducing the Chances of a Fall
There are many fall protection systems marketed through private companies and public websites. Many of these programs use similar strategies, and as you work to reduce the risk of falling, you should take advantage of these common approaches. And most fitness trackers and smart phones & watches include fall detection tools. The Apple Watch 8 can automatically detect a fall and call for emergency help, so if your phone is out of reach then the watch can alert 911 and emergency contacts.
- Address any medical conditions – As stated above, you should seek frequent medical checkups. The health of the individual is the most important aspect of fall protection.
- Modify the environment – To reduce the risk of a fall, reduce the number of hazards in your home. And as you do so, keep in mind your or your loved one’s physical limitations you can to eliminate risks that you may face in particular. Some common modifications include front-door showers, putting carpet on floors, widening door frames, reducing door curb height, and installing various fall protection systems.
- Improve the older adult’s physical fitness – Beginning a daily exercise regimen greatly reduces the risk of a fall. The benefits include stronger muscles, bones, and connective tissue, an increased awareness of the environment, more energy for greater balance and a stronger gait, and a higher resistance to unexpected events. Special exercises may be employed to bolster weaker areas and improve holistic physical fitness.
- Get the right clothes and shoes – Any and all loose clothing that could catch on a door frame, nail, or furniture should be removed from the home. Choose shoes that fit and follow the limitations mentioned above (no slick soles, no loose material, etc.).
- Improve your home’s lighting – Your home should be neither too bright nor too dark. A dark home hides hazards, and a home that is too bright can be just as dangerous. In general, if there is so much light that it causes the residents of the home a problem, then it should be reduced. This includes rooms in the home that may let in too much sunlight during peak hours.
- Incorporate the appropriate assistive devices – Older adults who have physical limitations may need to use a walker or cane to help them get around, and you should adjust your fall prevention plan accordingly. In addition, many fall prevention programs include installing grab bars throughout the home.
- Get proper nutrition – Eating properly helps an elder adult engage more thoroughly with the surrounding environment. A good diet improves the nervous system, gives energy to the body’s muscle systems, and encourages heightened brain function. And getting adequate liquids can produce similar benefits.
What to Do If a Fall Happens
Prevention is the best way to avoid injuries and other problems related to falls. But accidents happen despite the best-laid plans. If you witness a fall, you experience a fall or you are called into a situation involving a fall, follow the steps below.
If You Fall
Remain calm. Assess your physical well-being. Can you get up? Do you feel pain if you try? Stay down as long as it takes to assess your condition, and do not make any overly strenuous or sudden movements. Many fitness trackers and smartwatches, like the Apple Watch 8, include fall detection which can immediately call for emergency help such as 911.
If you think you can get up, follow these steps.
- Lie down on your side. Bend your top leg and lift your upper body into position resting on your elbow.
- Pull your body towards a sturdy stationary object. Drag yourself up into a kneeling position while using your hands to pull yourself up.
- Put your strong leg in front of your body while you are holding the stationary object.
- Stand up.
- If you are near a chair, turn, sit down, and call for medical assistance.
If you cannot get up, follow the steps below.
- If you feel as though you will be heard, call out for medical assistance.
- If you have a fall prevention lanyard, take it out to serve as identification. Use your cell phone to call for assistance if you have it on hand and you can reach it without straining yourself.
- If you do not have your cell phone or emergency call device on hand, slide yourself to the nearest phone or bench.
- Make as much noise as possible to draw attention to your situation. Use your walking implement if you need to.
- Get into a comfortable, safe position and wait for help. Make sure to protect your joints.
If Your Loved One Falls
If the person who has fallen cannot get up, call for medical assistance first, if necessary, and then administer first aid without moving them. If you do not know first aid, make sure the person is as comfortable as possible until professional medical assistance arrives. Pay special attention to the joints.
If the person who has fallen can get up, help that person by bringing a chair. Help the person achieve the positioning mentioned above in the section entitled, “If You Fall.”
Whether you are the victim of a fall or the witness, never underestimate the gravity of a fall in an older adult. Do not assume that just because no side effects are readily apparent that there are none.
If any of the following things seem to follow as a result of a fall, call a doctor immediately: lingering pain, dizziness, nausea, weakness, loss of consciousness, any visually apparent injury, drowsiness, headache, or vision problems. These symptoms may appear in the days after a fall or immediately afterward. A doctor should be called in either situation.
How to Contact People in the Event of a Fall
It is always best for an elder adult to have a cell phone in an easily accessible place. Lanyards are great ways to ensure that even if a person falls, the communication device will be within reach of the hands.
Even better than a cell phone is an emergency fall device. These devices only have one function—summoning professional medical help immediately. The also have a much longer battery life and are much more accessible to many older adults. Some of these devices are connected to insurance programs that may help pay for the equipment.
How Loved Ones Can Help Prevent A Fall
The loved ones of an older adult are the most important resource when it comes to fall prevention. Loved ones can research and install the home improvement features that can help prevent a fall, and they can check on an older adult frequently to assess the home for hazards and provide rides to the doctor for checkups.
Most importantly, loved ones can provide emotional support. Older adults must be informed that falling is not a normal part of aging, and that they can take steps to assure their continued independence. Relatives can also help with common fall avoidance strategies, including helping the older adult stay more physically active, and relatives can inform other family members about fall prevention techniques.
Falls among the elderly are a serious problem, and a bad fall can can have a huge impact on an otherwise healthy and independent life. The good news, however, is that falls can be prevented. By doing a little planning and by taking concrete steps, this threat can be reduced or eliminated, giving you and your loved ones many years of independent living.
Content on this site is for reference and information purposes only. Do not rely solely on this content, as it is not a substitute for advice from a licensed healthcare professional or personal trainer. Aging.com assumes no liability for inaccuracies. Consult with your doctor before beginning any new exercise program.