Fear of Falling? Key Fall Prevention Strategies

You are at work and receive a call from your parents’ neighbor. Your father has fallen and is in the Emergency at the hospital. This is a scenario many of us with older parents can imagine. Indeed, the stats on falling are alarming. According to Statistics Canada, 1 in 3 seniors aged 65 or older are likely to have a serious fall, and 85% of injury-related hospitalizations of seniors are due to falls. As seniors grow older, the risk of falling increases; the seriousness of injuries escalates; and mortality due to falls increases to the extent that a fall and the ensuing medical complications among 90+ year olds can frequently result in death.

The purpose of this article is to explain why falling as we get older is more likely, and provide information on how to implement safety measures in a senior’s living environment to prevent falls, along with other fall prevention strategies.

Falling: Summary of Risk Factors

The physical and environmental factors contributing to falls are complex. It is important to recognize that falls among seniors carry higher risks and can result in more severe and long-lasting injuries compared to younger individuals. By carefully evaluating each risk factor, practical measures can be implemented to create safer living environments and effectively prevent falls.

Illnesses Increase the Risk of Falls

Symptoms associated with acute illness (such as weakness, dizziness, and pain), combined with medication side effects, significantly increase the risk of falls. Additionally, balance issues resulting from physical impairments, sensory deficits, or cognitive limitations can affect one's gait or stepping ability, making timely and accurate foot placement challenging. Age-related cognitive changes further complicate this issue by delaying reaction times, particularly when shifting attention, thereby elevating the likelihood of losing balance.

Growing older often comes with an increased likelihood of experiencing chronic health conditions and mobility challenges. Conditions such as arthritis, cardiovascular disease, renal disease, or stroke can significantly impact mobility, balance, and coordination. Additionally, foot-related problems, such as pain, ulcers, and neuropathy, can further affect gait and stability. Neurological conditions, including Parkinson’s disease, dementia, and Alzheimer's disease, may also cause physical and cognitive limitations that increase the risk of falls.

Age-related changes in vision, such as reduced visual acuity, diminished contrast sensitivity, or narrowed visual fields, can make it challenging to identify obstacles or hazards, particularly in less familiar environments. Furthermore, muscle strength typically declines with age, making recovery from a stumble or loss of balance more difficult.

Environmental factors also play an essential role. Slippery surfaces, unsecured rugs, and slick outdoor conditions can significantly contribute to falls. However, recognizing these risks and implementing preventive measures can substantially mitigate these hazards and promote greater independence and safety among older adults.

Primary preventive measures include: 

• Regular strength and balance exercises

• Adequate lighting

• Home modifications

• Safe footwear

Preventive Measures to Reduce the Risk of Falls

In the previous section, we identified that the risk of falling can be attributed to multiple physical and environmental factors, and effectively preventing falls requires assessments and expertise from various clinicians, including pharmacists, occupational and physical therapists, and physicians. Assistive device experts at pharmacies and home health care stores can also be a very important resource.

Five important fall prevention strategies:

1) A clinical assessment applying the 2011 AGS/BGS guidelines “Falls prevention in the older person” is an excellent starting point to identify potential physical problems.

2) A pharmacist can perform a medication review to identify potential issues with drowsiness/dizziness and other meds that can affect the severity of a fall, such as drugs that decrease bone density or increase the risk of bleeding.

3) There are many mobile assistive devices that are designed to enhance balance. Expertise to confirm the appropriate fit and instruction on proper usage is important. However, research has shown that many seniors avoid using the devices due to inconvenience or stigma. Using them needs to be encouraged by the support groups.

4) In the home, decluttering spaces, adding appropriate lighting, and providing additional balance aids is crucial. Start with adding bathroom safety items such as grab bars around the tub and toilet. Next, evaluate the bedroom and other frequently used spaces for potential tripping hazards. Rearrange or remove furniture and ensure there is adequate space for walkers and canes. Add or enhance handrails, particularly for climbing and descending stairs.

5) Exercise Programs designed specifically to address balance and strength are important in reducing overall risk. Continued physical activity with moderate challenges to balance will help address physical impairments.