Aging safely – Prevent falls and help maintain independence
Falls are unpredictable for nearly everyone, but more so for people age 65 and older. According to the Centers for Disease Control and Prevention (CDC), more than one-third of people in this age category fall each year. In addition, those who fall once are two to three times more likely to fall again. Injuries from falls are responsible for significant disability, loss of independence and reduced quality of life.
If you are an older adult (or provide care for a family member who is), fall intervention studies* show that preventive steps like home modification and exercise-based activities can help prevent falls and maintain independence.
Preventing falls is especially important as autumn turns into winter — the most notorious season for accidental falls due to ice and snow in some areas of the country and greater inactivity. Follow these safety tips for making your home, property and yourself safer:
- Safeguard your home by removing throw rugs, electrical cords and paper piles that could trip you up.
- Keep your driveway and sidewalks clear of leaves and other debris that could cause you to trip during the fall months. Repair cracks, lips or dips.
- Once winter arrives, consider hiring a snow removal service or a neighbor to shovel your sidewalk, steps and driveway if it snows where you live. Spread rock salt, grit or sand to help prevent slips and falls.
- Use shoe traction devices when walking outside in ice and snow.
- Have your pharmacist review all your medications several times a year to check for potential interactions that could trigger dizziness.
- Get your eyes checked. Impaired vision contributes to falls.
Staying as active as possible is another way to prevent falls. Seniors who are less active during the fall and winter seasons experience higher levels of instability. Activity helps you to maintain balance and build muscle strength. Here are some tips:
- Move your walking regimen indoors to continue it year-round. Fitness clubs and shopping malls are great places to keep moving.
- Build core muscle strength and strengthen your thigh muscles by exercising or attending fitness classes. Weakness from underuse of the quads and lack of physical strength are major contributors to falls.
- Learn about safe ways to fall (read “Avoid injuries from a fall”). Being aware of safer ways to fall may lessen the impact should a fall occur. Start by consulting a physical therapist or martial arts instructor who studies the effects of falls for their advice on safe falling techniques.
You can find more fall prevention and safety tips on the CDC’s website at www.cdc.gov.
* Source: A CDC Compendium of Effective Fall Interventions, 2nd Edition, 2010.
Avoid injuries from a fall
- When falling forward, turn your head to one side to avoid a direct hit to your face or nose. Open your palms to the floor to protect your wrists.
- When falling sideways, tuck your chin to your chest and keep your elbows close to your body.
- Be prepared to fall in a crouched, accordion-like position by bending at your knees and the waist. Your lower legs will hit first, protecting your hips.
Slips, trips or falls can happen at any time of life, however, the likelihood of having a fall and the impact that this can have on health and independence becomes more significant with age.
Falls are a major cause of hospitalization, especially amongst the elderly. For some people the consequence can be quite devastating resulting in loss of confidence, permanent injury and a restricted ability to lead an active, independent life.
Around 75% of falls occur in or around the home, but many of these can be prevented by being aware of personal risk factors, finding safer ways of performing tasks and making simple and practical adjustments to the home environment to reduce slipping and tripping hazards and improve safety.
- Ensure that there is good lighting in and around the home and that switches are easy to reach. Sensor lights can be strategically placed along hallways and at entrance doors to help with night time visibility.
- Glow in the dark products can be placed next to or on door handles, light switches and other objects that may need to be located in the dark. Luminous reflective tape can be used to mark exits, stairs and other hazards.
- Allow time for eyes to adjust when moving from brightly lit areas to darker areas and vice versa. Decrease glare by adding net curtains.
Floors, Stairs and Hallways
- Check carpeting regularly for worn spots or raised patches. Avoid using throw rugs and runners but if required secure them with carpet tape to prevent slipping. Avoid polishing floors with wax or other slippery materials.
- Use contrast to highlight changes in floor surfaces and depth. Avoid heavily patterned flooring which can obscure small obstacles from vision.
- Take care when walking through doorways as sometimes the threshold makes the floor surface uneven. Small threshold ramps may help individuals to negotiate these uneven surfaces, especially for walking frame users.
- Avoid leaving clutter on the floor (books, handbags, packages, toys and so forth), as these may become a tripping hazard. Ensure any electrical cords are tucked under furniture or taped to skirting boards and do not cross walkways.
- Install stair handrails on both sides of steps and stairs.
- Bathroom surfaces can be very slippery when wet. Keep water spray to a limited area where possible and clean up quickly. Avoiding using talcum powder (especially on tiled surfaces) which makes floor surfaces extra slippery.
- Be extra careful when using non-slip mats. Ensure the edges are firmly stuck down and the rubber-backed mat is held in place. Consider whether these mats create another tripping hazard—applying slip‑resistant tapes or a non-slip floor treatment to the floor and shower tiles may be a safer alternative.
- Install grab rails in or adjacent to the shower, bath and toilet to provide stability and support. Replace towel rails with grab rails for extra support.
- The hot, wet shower environment can sometimes affect balance—using a shower chair, flip‑down seat or removable stool can give extra support. Ensure soap, shampoo and towels are within reach to avoid bending or reaching. Be careful of dangerous lips/edges around the shower and eliminate if possible.
- Consider whether using a bath is really necessary. A clamp on bath rail, non‑slip tape and a bath hoist may make it slightly safer to get in and out of the bath. If the shower is over the bath consider a bath board or bath seat.
- A toilet seat raiser could be appropriate if the toilet seat is too low.
- Ensure beds are adjusted to an appropriate height to help you get in and out. Bed blocks may be an option if the bed is too low. Always get up slowly. Sit for a short time before standing up.
- Always turn a bedside lamp on before getting out of bed during the night and have a phone next to the bed for easy access in case of an emergency.
- A commode chair, urinal or bed pan can avoid the need to get up to go to the toilet in the middle of the night.
- For walking aid users, ensure that walking frames can be accessed very close to the bed.
- Remove or tuck away any tripping hazards like overhanging bedspreads, electrical cords, clothes or other clutter.
- Organise storage to reduce the need for reaching high or bending low as these actions can put you off balance.
- Considering sitting down on a kitchen stool when doing the dishes or preparing a meal. Use a tray mobile or trolley to carry items around. Pick up dropped food and mop up spills as soon as they occur.
- Put hoses, tools, toys and other objects away after use. Remove any hanging plants that could be walked into. Keep a look out for pets before moving around the garden.
- Repair uneven or cracked paths. Ensure lawn areas are as flat as possible. Kill moss and slime on paths. Be especially careful if the ground is frosty or wet and ensure that areas that get wet have non-slip surfaces. Ensure leaves, gravel or other debris are raked up regularly and removed.
- Mark the leading edge of steps with a contrasting color and install handrails.
- Sit down to dress. Avoid long clothing such as nighties and dressing gowns which may create a tripping hazard when standing up.
- Wear low-heeled shoes with rubber soles for good traction. Ensure shoes fit well, are in good repair and are free from grease or dirt. Avoid wearing socks or stockings without shoes when walking on tiled floors or polished floorboards.
- For those at high risk of falls, hip protectors may provide extra protection. These are plastic or foam shields worn in special underpants that protect your hips in the event of a fall.
People often down play a slip, trip or fall, blaming clumsiness or error. It is important to take any fall or near miss seriously and take the time to work out what may have caused or contributed to the event.
- Keep up with regular health checks and keep an eye out for health problems such as poor balance, dizziness, muscles weakness, incontinence, reduced sensation in legs and feet, poor nutrition, unsteadiness or loss of confidence in walking/using steps. It is important to discuss these with a doctor to ensure any medical conditions are well managed.
- Continue regular exercise to help maintain supple joints, muscle strength, balance and walking ability.
- Be aware of vision changes and use glasses if required. If your vision is deteriorating, see a low vision advisor to recommend home modifications.
- If getting to the toilet on time is a concern talk to a doctor or continence nurse.
- Review your medications regularly. Some medicines don’t mix, may cause nasty side effects or may be affected by alcohol. A medication reminder can assist with taking medication correctly. For those who are forgetful, there are timers that can remind them when to take medications.
- Ensure good access to telephones to prevent rushing. Consider getting a cordless telephone or install extra telephone extensions.
- Don’t rush, concentrate on tasks and take the necessary time. If you’re feeling light headed or exhausted, sit down and rest straight away. Have a plan of how to get help if a fall does occur.
- Avoid hazardous tasks such as standing on a chair to reach something from a high cupboard. Look at rearranging the home environment so that frequently used items are at an easy to reach appropriate height. Be aware of the implications of falling from a height and consider asking someone else to assist.
- Consider the direction that bathroom and toilet room doors hang—can they be opened outwards if someone has a fall inside the bathroom or toilet room?
- Consider the use of a mobility aid such as a walking stick or walking frame. It is important to discuss this first with your doctor.
- An emergency call system may help to increase your confidence and independence by helping you contact someone if a fall does occur, particularly for if you live alone.
The concept of a self-propelling wheelchair to aid in mobility for those who are unable or who have difficulty walking due to illness, injury, or disability, dates back to the mid 1600’s. This design evolved over time becoming lighter, easier to use, adjustable, and more comfortable.
Wood frames have been replaced with lightweight alloys such as aluminum, titanium, and carbon fiber.
Wooden wheels are now made from composite materials wrapped with tires that are solid rubber, treaded, pneumatic, or flat free.
Seats are now padded nylon or vinyl and are available in all sizes.
Backs are fixed, adjustable, or fully recline.
Arm rests flip back, are removable, and height adjustable.
Even with all of the innovation and new materials used in manufacturing the wheelchairs of today, two basic principles of physics remain the same: Motion and Gravity, which often result in falls and injuries.
These two principles apply when the user either forgets or is unable to secure the manual wheel locks on a wheelchair during transfers. When the locks are not used as a person attempts to sit into or stand from a wheelchair; the wheelchair, along with their seat will roll away from them, with gravity leaving nowhere to go but down.
This type of wheelchair fall can easily be prevented, yet they happen every day. Those using a wheelchair are already dealing with limited mobility and an unexpected fall can cause new injuries or exacerbate the conditions that resulted in the need for a wheelchair in the first place.
Falls such as this, especially to those who are elderly, most often lead to a greatly reduced quality of life as well as robbing them of living their life independently.
“Aging in Place” is a term used to describe the process of adapting one’s home for the current and changing needs of aging. The primary objective of aging in place is to create a living environment which allows you to safely remain in your home independently as long as possible.
A home assessment will identify risk factors within your home that may inhibit your goal of aging in place and offer a plan to resolve these issues based not only on current, but long term needs as well.
One major focus of a good home assessment is fall prevention, especially in bathrooms where a fall is most likely to occur. Good lighting is essential. Grab bars, safety poles, bath seats or lifts, and slip resistant surfaces offer additional safety.
Handrail systems, floor to ceiling safety poles and other types of safety railing will help prevent a fall from happening in other areas of the home.
A significant amount of time and thought goes into a good plan to age in place. However, one major fall risk that often results in the same devastating impact as a fall in the bath tub and is all too often overlooked is wheelchair falls.
- Roughly 1/3 of the elder population over the age of 65 will fall each year
- Over half of all seniors will fall by age 80
- Those who fall are up to three times more likely to have another fall
- 40% of nursing home admissions and 25% of hospital admissions are due to falls
- 40% of individuals who fall and are admitted to a nursing home or hospital never return home to live independently
- Close to half of all seniors have a fear of falling; resulting in a damaging impact on health and overall well-being, as well as a loss of confidence and restricting themselves from activities with others
Obviously, not all of the falls in these statistics are attributed to individuals who simply do not lock the wheels on a wheelchair, but those that are could have been prevented.
The most common reasons that wheel locks are not used include:
- Dementia and other cognitive disorders
- Lack of strength or dexterity in hands to full engage them
- New to wheelchair use
As a nursing home Medical Director for over thirty years, Dr. Grady Dugas of Marion, Louisiana saw this need first hand. Having witnessed residents routinely fall and suffer injuries while using wheelchairs, Dr. Dugas made it his mission to find a way to stop these preventable falls from ever happening.
His solution was to create an automatic wheel lock that would lock the wheels the moment the user stands from the seat and unlock the wheels the moment the user was safely seated. This would ensure that each and every time a wheelchair user sits in or stands from a wheelchair, there is a fixed and stable seat to sit into, or a fixed and stable base to push off of while standing.
Experimenting with different wheelchair locking and fall prevention systems, he was awarded a patent in 1993. After redesigning and perfecting the system over the next six years with United Plastic Molders, Inc. in Jackson, Mississippi, a new design was patented in 1999, and Safer Automatic Wheelchair Locks, or Safer Locks, was formed.
Today, with over twenty years of refinement and proven use, Safer Locks is the standard in fall prevention for wheelchair users across the country.
Guest Post by:
Automatic Wheelchair Wheel Locks
105 E. Rankin Street Jackson, MS 39201
601-353-3193 ext. 215
DESIGNED, BUILT, ASSEMBLED, & SUPPORTED IN THE USA
Falls are the leading cause of injury-related deaths among persons aged 65 years and older, and the age-adjusted rate of deaths from falls is increasing. The rate of deaths from falls among persons aged 65 years and older increased 31% from 2007 to 2016, increasing in 30 states and the District of Columbia, and among men and women. The study last year by the Centers for Disease Control and Prevention (CDC) also found, not surprisingly, that the risk of dying from a fall increases greatly with age. Among Americans aged 65 to 74, there were 15.6 deaths for every 100,000 people in 2016. That rate jumped to 61.4 deaths per 100,000 for people between the ages of 75 and 84, and it soared to 247.9 per 100,000 for people aged 85 and older.
The CDC researchers did not investigate the reasons fatal falls have increased among older Americans, but they point to several possible factors: reduced physical activity; people living longer with chronic diseases (which can make them more vulnerable to falls); increased use of prescription medications (which can slow down thinking and reaction time); and age-related changes in gait and balance.
The researchers recommend that physicians assess how much their older patients are at risk of falling, and then help patients address any risk factors that are modifiable — by changing the patient’s medications, for example, or encouraging the patient to engage in specific physical activities to improve gait, strength and balance.
Falls Are Serious and Costly
- One out of five falls causes a serious injury such as broken bones or a head injury
- Each year, 3 million older people are treated in emergency departments for fall injuries.
- Over 800,000 patients a year are hospitalized because of a fall injury, most often because of a head injury or hip fracture.
- 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.
- Falls are the most common cause of traumatic brain injuries (TBI).
- In 2015, the total medical costs for falls totaled more than $50 billion. Medicare and Medicaid shouldered 75% of these costs.
Outcomes of falls range from the minor cuts and bruises that anyone could expect to the worst possible results—disability and death. Overall, unfortunately, because of pre-existing health issues, lower bone and muscle strength, and other factors, falls among the elderly tend to have worse outcomes than among the general population. This leads to substantial costs both to the families of fall victims and to society at large.
Earlier this year, the United States Preventive Services Task Force reported that regular exercise was the most effective action older people could take to reduce their risk of falls.
Check out the Go4Life website: https://go4life.nia.nih.gov/
Check out the STEADI website: www.cdc.gov/steadi
Preventing falls is one of the biggest concerns that family caregivers face. Falls have a lot of consequences for older adults. For one, there is the very real risk of falls leading to severe injury and even death, especially if the senior has no resources to get help in their time of need. Potential issues can range from broken bones to even brain injuries. Even if older adults are unharmed by their falls, fear of future injury can lead to changes in lifestyle and inability to enjoy activities they once did. Here are some key ways to start preventing falls:
1. Keep the home clear. One of the biggest things that lead to falls is basic clutter, especially since it’s easy to forget that item is in place. If regular cleaning is too much for a senior to do, consider either paying a visit on a regular basis to check the home or even hiring a professional for some basic cleaning. Certain home fixtures like loose carpet and rugs also present an added risk.
2. Modify the bathroom. The combination of slippery floors and hard surfaces mean a fall in a bathroom can do some serious damage. Something as simple as installing a grab bar or toilet safety frame can cut down on risk significantly. In addition, there is such a thing as slip-resistant flooring if you are planning a remodel.
3. Have a discussion with your loved one’s doctor. This may be a surprising method of fall prevention, but in some cases, certain medications can lead to dizziness or light-headedness. The doctor may be able to recommend alternatives or give your aging family member advice on when to take certain medications to avoid falling.
4. Provide proper lighting. Along with cluttering, one of the major issues that makes a home unsafe is fall hazards obscured in darkness, especially at night. Good things to do on top of buying more powerful bulbs for seniors, are making sure that you give extra lighting in certain areas. This can include bathrooms, hallways and cooking area. Even a night light in the bedroom can go a long way.
5. Use some added support. In some cases, walking aids and other similar items can do a lot to lower the risk of falling, but there’s a variety of new technology and tools that help deal with these various issues. One interesting example is a wearable airbag worn like a belt to help prevent falls. If this sounds like a bit much, you may be better served just looking into something like a medical alert system. Getting medical help quickly can keep falls from becoming a major health issue.
Think of this as a basic guide for helping your aging loved ones prevent falls. Every home and environment is different, and every senior has a different health profile that affects their chances of falling. The best thing you can do is be prepared. This means not only using all the above tips, but also looking into other resources to stay on top of other advances in technology and practices behind fall prevention.
if you are concerned, it may be a good idea to have a trained professional to do a comprehensive home safety assessment. Look for a certified Senior Home Safety Specialist™, Occupational Therapist or Certified Aging in Place Specialist (CAPS) in your area.