Falls Prevention

Care & Treatment

Falls and fractures are not an unavoidable part 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 feel more confident in your abilities to safely carry out your daily activities. A qualified healthcare professional should evaluate your personal situation and condition.

Medical and Lifestyle Approaches to Treatment

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

Medical Assessment and Management

If you have fallen or you are at high risk of falling, your healthcare provider 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, for thyroid problems).

Your vision and hearing may need to be tested, and new glasses or a hearing aid prescribed. In particular, vision problems are often blamed for falls in older people. Older adults frequently suffer from poor depth perception, cataracts, glaucoma, or macular degeneration (loss of sight in the center of your visual field). Wearing bifocal glasses while walking can also lead to falls. Appropriate glasses and visual aids, surgery, or other medical treatment may reduce your chance of a fall. Having surgery for cataracts in one eye decreases the rate of falls (however, getting cataract surgery for the second eye does not further decrease the rate of falls).

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

If you are diagnosed with osteoporosis or osteopenia (bone loss), it is important to keep vitamin D levels in your blood in a range that is better for your muscle strength, bone health, and balance. In order to manage your vitamin D levels, your provider may have you take calcium supplements (1200 mg every day) and vitamin D supplements (at least 800 IUs every day). Your provider may also recommend medicines to increase your bone mass. Strong bones are necessary for the prevention of fractures.

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

Balance, Gait Training, and Muscle Strengthening Exercises

A way to help prevent falls is exercise that improves your balance and strengthens your muscles. As part of your falls prevention program, you should follow an exercise program designed to increase your muscle strength (especially in your legs and feet) and to improve your skills in walking (gait), balance, and coordination. You can ask your healthcare provider for recommendations for exercise programs.

Your healthcare provider may recommend programs, usually through a physiotherapist (physical therapist).  There are programs where you can do the individualized exercise routines at home, in groups, or both. Programs can vary from once a week to three or more times per week, and sessions vary in length. Whatever you choose, it should fit your own specific needs.  It should also be combined with other strategies to reduce falls, such as improving nutrition, reducing medications, and making your home safer.

Research has shown that the following programs are effective for older people:

  • Gait training
  • Balance and coordination exercises.  Balance training can be done throughout the day in a variety of situations. For example, while you brush your teeth, stand on one foot for several seconds and then switch to the other foot.  (When you first start balance training, you can hold on to a wall for gentle support.)
  • Resistance and weight training to increase strength
  • Stretching exercises such as Tai Chi, yoga, dance, or similar programs to increase flexibility
  • Cardiovascular, endurance, and fitness training 

All exercise programs designed to reduce falls should include a regular review of your progress. As you become more secure and physically strong, the exercises can be adjusted to maximize their benefits. 

Use of Assistive Devices

If you are having difficulty with walking, balance, coordination, reaching for things, or other activities of daily living, your healthcare provider can refer you to a trained physiotherapist or occupational therapist. These specialists can provide resources, information, and training in the use of all types of assistive devices.  These helpful devices can make life simpler and allow you to function more normally. Among the most commonly used devices are:

  • canes
  • walkers
  • reachers (to pick up items without bending over)
  • handrails, grab bars, and raised toilet seats in the bathroom

Depending on your situation, your healthcare provider may also recommend training in skills needed for daily living, such as transferring from a chair to a bed. 

Medication Adjustment

Some types of medications are associated with an increased risk of falls and fractures.  These include opioids/narcotics used for pain, sedatives and sleeping pills, antidepressants, anti-anxiety pills, anti-epileptic pills, or medicines for psychiatric illnesses. Your healthcare provider should review all the medicines and over-the-counter products that you take.  They should try to reduce the number and dosages of all medications as much as possible. They may also switch your medications to ones that aren’t as likely to cause a fall.

You are at an increased risk of a fall if:
  • You take four or more prescription medications
  • You have recently changed the number of medications you take
  • You have recently changed the dosage

Never stop taking medications, or reduce the dose you are taking, unless directed by your healthcare provider. Follow instructions carefully to avoid withdrawal symptoms or side effects.

Home Environmental Hazards

In some cases, you may be able to have a qualified technician perform a safety evaluation in your home. Typical improvements that can help reduce fall risk around the house include:

  • Using better lighting. This can include using night lights so you can see better in the dark. You can also keep lamps within your reach in bed. That way you don’t have to get out of bed in the dark to turn the lights on.
  • Removing loose carpeting and other floor clutter.  This makes it less likely that you will trip.
  • Removing hazardous furniture such as beds at the wrong height, or unstable chairs or tables.
  • Adding grab bars, raised toilet seats, and non-slip bathmats in bathrooms.
  • Adding railings on stairs and in corridors.

Behavioral Therapy

Many older adults are afraid of falling, even if they haven't actually fallen yet. This fear can make them avoid activities such as walking, shopping, or taking part in social activities. But this may make the situation worse by limiting activities and reducing confidence.

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

Tell your healthcare provider if you have a fear of falling that is keeping you from activities that you used to enjoy. Fear of falling can be treated.

Education

Your healthcare provider should offer information and education as part of a falls prevention plan that covers many different factors. 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.  Your shoes should be non-skid and have flat soles with a large surface contact area. Some examples of unsafe footwear are backless shoes and slippers, high-heeled shoes, and shoes with smooth leather soles. These shoes may increase the risk of falling
  • Do not wear bifocal or multifocal glasses when you walk, especially on stairs.
  • Try using a bedside commode (toilet chair) if you frequently have to use the bathroom at night.
  • Learn to get up slowly to avoid sudden low blood pressure when standing up.
  • Use 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.

Last Updated October 2017