Aging & Health A to Z

Falls Prevention

Care & Treatment

Start with Fall Prevention

Falls and fractures are not an unavoidable outcome of getting older. Many underlying causes of falls can be treated or corrected, with the goal of preventing any future falls. These steps can also make you more confident in your abilities to carry out your daily activities safely. A qualified healthcare professional should evaluate your personal situation and condition.

Treatment Plans Combine Medical Approaches and Lifestyle Changes

Once you have been evaluated and your personal risks identified, a multi-pronged plan can be devised tailored to your particular needs. These treatment plans may involve a physiotherapist or occupational therapist, and may include medical interventions as well as lifestyle changes within any or all of the following categories:

• Medical assessment and management
• Exercise and physical therapy
• Medication adjustment
• Home environmental hazards
• Behavioral therapy
• Education.

Medical Assessment and Management
If you have fallen or you are at high risk of falling, your healthcare professional may find an underlying medical cause. For example, you may have a new cardiac problem that puts you at risk of fainting, a nerve or joint problem that you weren’t aware of, or a foot disorder that makes walking difficult. Your diet may need to improve, or you may need hormone supplements (for example, thyroid problems).

Your vision and hearing may need to be tested, and new glasses or a hearing aid prescribed. Vision problems, in particular, are often blamed for falls in older people. Older adults frequently suffer from poor depth perception, cataracts, macular degeneration (loss of sight in the center of your visual field) or glaucoma. Wearing bifocal glasses while walking can also lead to falls. Appropriate glasses and visual aids, surgery, or other medical treatment will reduce your chance of a fall.

If you have a chronic debilitating illness such as Parkinson’s disease, arthritis, Alzheimer’s disease, heart disease, or others, you healthcare professional must make sure that you are getting the best possible treatment, and that your symptoms are being well-monitored. Your doctor may recommend a pacemaker if your heart rhythm has become unstable, for example.

If you are diagnosed with bone loss (osteoporosis or osteopenia) you will need to take calcium supplements (1200 mg every day) and vitamin D at least 800 IU of vitamin D with the goal of keeping blood vitamin D (25-hydroxyvitamin D) levels in a range that is better for your muscle strength, bone health, and balance. Your doctor may also recommend medicines to increase your bone mass. Strong bones are crucial in the prevention of fractures.

Many medical problems can be successfully treated once they’ve been diagnosed. Follow your healthcare professionals’s instructions. This will reduce your risk of falls and fractures.

Exercise and Physical Therapy
Exercise to improve your balance and strengthen your muscles helps to prevent falls. Your healthcare professional may recommend programs, usually through a physiotherapist, for an individual at-home regimen, a group approach, or both. The program should include:

• resistance and weight training  to increase strength

• gait training

• balance and coordination exercises

• Tai chi, yoga, dance, or similar programs to increase flexibility and stretching

• training in skills needed for daily living, such as transferring from chair to bed

• training in the use of assistive devices; for example, a walker or a cane.

Medication Adjustment  
Some types of medications (especially diuretics or “water pills,” other blood pressure pills, sedatives, anti-depressants, anti-anxiety pills, steroids, anti-epileptic pills, or medicines for psychiatric illnesses) are associated with an increased risk of falls and fracture, particularly hip fracture. Your healthcare provider will review all the medicines and over-the-counter products that you take, and try to reduce the number and dosages of all medications as much as possible. He may also switch medicines to ones that aren’t as likely to cause a fall. 

Home Environmental HazardsIn some regions of the country, a qualified technician will perform a home safety evaluation. Typical improvements that can help reduce fall risk around the house include

• better lighting (night lights, lamps within reach of bed)
• removal of loose carpeting and other floor clutter
• removal of hazardous furniture (wrong bed height, unstable chairs or tables)
• addition of grab bars in bathrooms, railings on stairs and in corridors, raised toilet seats
• non-slip bathmats.

Behavioral Therapy
Many older adults are afraid of falling, even if they haven't fallen themselves. This fear can make some older people avoid activities such as walking, shopping, or taking part in social activities. But this may make the situation worse by limiting your activitiesand reducing your confidence.

Tell your doctor if you are afraid of falling. If fear is making you avoid activities, a cognitive behavioral training program may be very helpful. 

Education
Your healthcare professional should offer information and education as part of your multifactorial fall prevention plan. For example, here are some safety tips your program should provide:

• Understand the appropriate use of your medications, and how they should be monitored
• Wear safe, well-fitting footwear that have flat, non-skid, soles with large surface contact area. Backless shoes and slippers, high-heeled shoes, and shoes with smooth leather soles are examples of unsafe footwear that may increase fall risk.
• Do not wear bifocal or multifocal glasses when you walk, especially on stairs
• Try using a bedside commode if you have to use the bathroom frequently at night
• Learn to get up slowly to avoid sudden low blood pressure on standing
• Take advantage of products like pressure stockings, grab bars, and handrails
• Eat an adequate diet that includes protein, fresh fruits and vegetables, and any supplements that are recommended for you.
• Drink plenty of fluids
• Learn how to safely get up if you have fallen.

Updated: March 2012
Posted:  March 2012