The Choreography of Balance, Part 2: Fall Prevention for Everyone
- mclapham9
- 21 hours ago
- 5 min read
The article The Choreography of Balance, part 1 explored the complex mechanisms which the body uses to maintain physical balance. This article, The Choreography of Balance, part 2, will examine the incidence of falls in the U.S., risk factors for falls, ways to address risk factors and also explore fall prevention for everyone, regardless of age.
Incidence of falls in the U.S.
According to the Centers for Disease Control (CDC), falls are the leading cause of injury for adults ages 65 years and older (1). One in four older adults (approximately 14 million) reported experiencing a fall every year (1). It is estimated that approximately less than half of falls are not reported to healthcare providers.
These numbers are concerning. Falls are the leading cause of fatal and non-fatal injuries in older adults (1). Falls are the leading cause of injury-related deaths amongst adults ages 65 and older (1). Per the CDC:
One out of 10 falls results in an injury that causes the older adult to restrict their activities for a day or more or to seek attention from the healthcare system (2).
Each year, there are about 3 million emergency department visits due to older people falling (2).
Each year, there are about 1 million fall-related hospitalizations among older adults (2).
It is estimated 83% percent of hip fracture deaths and 88% of emergency department visits and hospitalizations for hip fractures were caused by falls (2).
Each year, over 300,000 older people are hospitalized for hip fractures (2).
Falls are the most common cause of traumatic brain injuries (2).
What are the risk factors for falls?
Risk factors include environments, physical issues, medications and external factors which increase your predisposition to falling. The medical and non-medical risk factors for falls include (3,4):
Muscular weakness in the lower body
Vitamin D deficiency
Problems with walking and balance
Use of certain prescription medicines which may contribute to dizziness or drowsiness such as tranquilizers, sedatives, or antidepressants.
Over-the-counter medications which may cause dizziness or drowsiness
Vision problems
Foot pain
Ill-fitting or loose footwear
Home hazards or dangers, such as broken or uneven steps, the use of throw rugs, poor lighting
What are the injuries associated with falls?
A fall can lead to a variety of injuries including:
Broken bones - wrist, arm, ankle, rib, pelvic and hip fractures are common after falls (4)
Head injuries - head injuries can result in life-altering consequences including memory loss, difficulty with balance, mental reasoning and physical coordination (4).
Serious contusions (bruising) which may limit mobility
Of note, a fall with or without injury may cause a person to become afraid of falling again. These fears may result in a person cutting back on their activities of daily living. When anyone becomes less active, overtime they can become physically weaker and this, in turn, increases their risks of falling (4).
What to do after a fall
If you have been experiencing falls, it is critical that you speak with your healthcare provider.
While not all falls result in an injury, over one-third of those who fall reported an injury that required medical treatment, or the fall restricted their activity for at least one day (3). These injuries can make it hard for a person to get around, do everyday activities, or live independently.
Fall prevention
The need to prevent falls in the elderly is a serious public health issue. The incident of falls is increasing as the population ages. Complications of falls lead to an increase in mortality and morbidity for the person experiencing falls. Fall prevention programs may allow elderly persons to remain in their home environment, avoiding nursing home placement.
Screening adults for their fall risk is a valuable tool to reduce the rising number of deaths and injuries from falls. Common falls risk assessments include:
30-second chair test – this test is where you are asked to sit in a chair with your arms crossed to prevent you from using your arms to help you stand up. The number of times you can stand up and sit down is counted in 30 seconds. Your results are compared to age-based standards (3).
Four stage balance test – you are asked to hold four different positions for 10 seconds. The positions vary in difficulty and include standing on one foot (3).
TUG (Timed Up and Go) test – You begin by sitting in a chair, you are then asked to get up and walk 10 feet at your usual pace and return to the chair and sit down. If the total time to complete the task is 12 seconds or more, you most likely have a high fall risk (3).
Your healthcare provider will review the results of your testing and will also make recommendations to address any fall risk found as a result of the screening.
Multi-disciplinary approach to fall prevention
Fall prevention programs should be a multi-disciplinary effort to reduce or eliminate fall risk. Education regarding fall prevention could be provided by registered nurses. An evaluation of the home environment for fall risk factors could be completed by a home health team. A person’s medication should be re-evaluated by a licensed healthcare provider in an attempt to eliminate medications known to contribute to falls.
Persons who have a fall history should be evaluated by a physical therapist for balance and strength. The therapist could then determine the best exercise program to build muscle strength and improve balance and also determine if the use of an assistive device, such as a cane or a walker, is appropriate.
Fall prevention for everyone: What you can do to prevent falls at home
There are things you can do at home to reduce your fall risk. Simple things which provide fall prevention for everyone in your household include (5):
Removing throw rugs and securing loose carpeting
Installing grab bars in showers and bathrooms
Repairing broken steps
Wearing well-fitting shoes with non-slip soles, avoid slides and slippers with open backs and/or open toes
Wiping up spills as soon as they occur
Installing handrails on stairs
Use a non-skid mat in your shower or bathtub
Eliminate clutter especially in high-traffic areas
Make sure your home is brightly lit to avoid tripping and turn on the light before going up or down stairs.
Other ways to reduce your risk of falls
Make an appointment with your healthcare provider to review your medications, medical history and history of any falls (5). Your healthcare provider will be able to determine if your falls are related to undiagnosed medical issue. Developing a care plan to address any medical issues will assist you in reducing your fall risk.
Maintain a regular exercise program. Strong muscles help improve your coordination, balance, strength, and flexibility (5). Speak with your healthcare provider about a referral to a physical therapist. A physical therapist will evaluate you and will assist you in developing an effective exercise program to address your individual needs.
In conclusion, fall prevention is a something to take into consideration as a person gets older. If you are not yet a senior citizen, take the time to incorporate some of the above recommendations to prevent falls later in life. If you are getting older, be mindful that falls are more likely to occur as you age. By utilizing simple and proven interventions, as well as working with your healthcare providers, you can continue to enjoy your life and aim to remain living independently for as long as possible.
Assessed and Endorsed by the MedReport Medical Review Board
