Safety and Independence: Preventing Falls in Older Adults


January 26, 2022

Falls among older people are an important cause of injury, disability, and death. Many older adults who develop a fear of falling often limit their activities, which can result in physical weakness, making the risk of falling even greater. Falls are also an important indication of declining abilities. Reducing fall risk requires careful assessment of the person who has fallen and their environment. 

Facts about falls

  • 60% of fatal falls happen at home
  • 30% occur in public places
  • 10% occur in health care institutions

Falls are common and costly, especially among Americans age 65 and older. But falls are preventable and do not have to be an inevitable part of aging.

According to Centers for Disease Control and Prevention:

  • Every second of every day, an older adult (age 65+) suffers a fall in the U.S.—making falls the leading cause of injury and injury death in this age group. One out of four older adults will fall each year in the United States, making falls a public health concern, particularly among the aging population.
  • About 36 million falls are reported among older adults each year—resulting in more than 32,000 deaths.
  • Each year, about 3 million older adults are treated in emergency departments for a fall injury.
  • One out of every five falls causes an injury, such as broken bones or a head injury.
  • Each year at least 300,000 older people are hospitalized for hip fractures.
  • More than 95% of hip fractures are caused by falling—usually by falling sideways.
  • Women fall more often than men and account for three-quarters of all hip fractures

According to National Floor Safety Institute:

  • One-third of people over 65 will fall at least once a year.
  • Most falls occur on flat surfaces.
  • Falls on the stairs or in the bathroom are relatively rare.
  • Older women tend to fall in the house, older men in the garden.
  • In `care homes’, many falls occur on the way to or from the toilet.
  • Only one in a hundred falls results in a hip fracture, but one-fifth cause serious injury.
  • Of those who fall and lie on the floor for hours, half will be dead within six months.
  • The risk of falls is doubled in dementia.
  • There is an increased risk with depression. The reason is not known.
  • The more drugs an elderly person takes, the greater the risk of falls: the principle of minimal medication is often reviewed.
  • Visual impairment is an important risk factor:
    • patients who use eye-drops for glaucoma have a three-fold increased risk of falling,
    • those with cataract are more at risk of breaking a hip.
  • The importance of footwear is a cause for falls
    • High heels (favored by many older women) reduce stride length, alter toe propulsion and increase lumbar lordosis.
    • Loose slippers can also be a factor in falls.

 What can happen after a fall?

Many falls do not cause injuries. But one out of five falls will cause a serious injury, such as a broken bone or a head injury. These injuries can make it hard for a person to get around, do everyday activities, or live on their own.

  • Falls can cause broken bones, like wrist, arm, ankle, and hip fractures.
  • Falls can cause head injuries. These can be very serious, especially if the person is taking certain medicines (like blood thinners). An older person who falls and hits their head should see their doctor right away to make sure they don’t have a brain injury.
  • Many people who fall, even if they’re not injured, become afraid of falling. This fear may cause a person to cut down on their everyday activities. When a person is less active, they become weaker, and this increases their chances of falling.

What conditions make one more likely to fall?

Research has identified many conditions that contribute to falling. These risk factors can be changed or modified to help prevent falls. Most falls are caused by a combination of risk factors. The more risk factors a person has, the greater their chances of falling. They include:

  • Lower body weakness
  • Vitamin D deficiency (that is, not enough vitamin D in your system)
  • Difficulties with walking and balance
  • Use of medicines, such as tranquilizers, sedatives, or antidepressants. Even some over-the-counter medicines can affect balance and how steady you are on your feet.
  • Vision problems
  • Foot pain or poor footwear
  • Home hazards or dangers such as
    • broken or uneven steps, and
    • throw rugs or clutter that can be tripped over.

Talking to the doctor

  • Ask the person’s doctor or healthcare provider to evaluate risk for falling and talk with them about specific things the patient can do.
  • Ask the doctor or pharmacist to review medicines to see if any might make the older person dizzy or sleepy. This should include both prescription medicines and over-the counter medicines.
  • Ask the doctor or healthcare provider about taking vitamin D supplements.

Falls can be prevented

There are simple things you can do to reduce the risk of falling. Start by assessing the home using these checklists from the CDC: Check for Safety and Home Safety Checklist. Reducing fall risk requires careful assessment of the person who has fallen, as well as his or her surrounding environment. Once the risks are identified, actions must be taken to reduce the risks, such as: 

  • Ensure adequate lighting
  • Eliminate obstacles such as throw rugs and electrical cords
  • Install handrails on stairs and grab bars near toilet and bathtubs
  • Keep eyeglass prescription updated
  • Determine possible side effects of medications
  • Do weight training with 3-5 pound weights to improve strength
  • Get enough calcium and vitamin D (check with the doctor for dosage recommendations, drug interaction, or other precautions)

Exercise and education

Do strength and balance exercises on a regular basis. Especially exercises that make your legs stronger and improve your balance. Tai Chi is a good example of this kind of exercise.

Call 211 or the local area agency on aging and ask about A Matter of Balance workshops, proven to reduce risk and teach ways to improve balance. 

Have an eye exam

Have the person’s eyes checked by an eye doctor at least once a year, and be sure to update eyeglasses, if needed. If the person wears bifocal or progressive lenses, suggest a pair of glasses with only distance prescription for outdoor activities, such as walking. Sometimes these types of lenses can make things seem closer or farther away than they really are.

Make Home Safer

There are many things you can do to make home safer. To Start, get rid of things someone could trip over. Add grab bars inside and outside the tub or shower and next to the toilet. Put railings on both sides of stairs. Make sure the home has lots of light by adding more or brighter light bulbs.

Home Modifications for People with Impaired Mobility

People with impaired mobility may require additional changes in the home environment, including:

  • Assess for wheelchair/walker barriers like carpet (remove pad if wheelchair or Hoyer lift is used).
  • Bathrooms (retrofit for wheelchair).
  • Use a portable sound monitor (aka a baby monitor) to place by individual’s bed.
  • Have access to recliner for bedfast person or a recliner with a lift.
  • Install ramps. Ramps Usually about 2 ½” at the highest end, slanted 14” long by 34” wide. Wooden for entrance to home and steel from house to attached garage area
  • Consider installing an outside deck for someone sitting in a wheelchair.

While the issues surrounding falls can be complex, falls can be prevented. Start by assessing where the person lives, their health and mobility, then begin making simple changes. See what community resources may be available. Call 211 or contact the local area agency on aging or ADRC (Aging and Disability Resources Center) and ask whether ramps and other safety equipment are available. 

Sources: Centers for Disease Control and Prevention, Preventing Older Adult Falls and Patient and Caregiver Resources. National Institute of Health Falls in Older People.
Edited by Zanda Hilger, 2022

We hope this information is helpful to you in the important work you do as a family caregiver.
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