I’m definitely not saying rugs aren’t public enemy #1 when it comes to fall prevention–in fact my peers have joked before about my personal vendetta against the throw rug. But fall prevention is a much bigger issue–falls are the #1 cause of injury, hospital visits due to trauma and death from injury among people 65 and older. It’s time we take fall prevention one step further (but seriously, get rid of those throw rugs, people).
Falls are a Serious Cause of Injury
Especially if you’re working with geriatric populations. It is estimated that in a year, one out of every three older adults will experience a fall per year and that every ~11 seconds, an older adult in the US will be treated for injuries related to a fall. Falls result in almost 3 million injuries treated in ED’s annually, including over 800k hospitalizations and 27k deaths. If all of this wasn’t enough to stress the severity of falls–they also account for 48% of all acquired brain injuries. There are losses associated with falls that aren’t represented in many data points that are important for practitioners to be cognizant of– loss of mobility, independence, functional decline, mental health and overall quality of life–all things we aim to prevent or protect for our patient populations.
Well that’s intimidating—Who specifically is at risk for falls?
Is it helpful if I say everyone? On a serious note, it is important to recognize that not just elderly people are at risk for falls. People challenged with low vision, polypharmacy, balance and gait issues, and any impaired memory or mental status are all at increased risk for falls both within the home and community. It may seem obvious that people with a history of falling are at increased risk–but even the first initial fall doubles the likelihood of subsequent falls–so it is worth the mention. People with ill-fitting footwear are also at an increased risk for falls, so be sure to exercise extra caution with your slipper-loving patients.
Fall Risks Within the Home
It can be terrifying for patients to consider the possibility of falling within their home–what is normally a safe space for them is suddenly a potential danger. For good fall prevention interventions within the home, it will be important to empathize and respect your person’s potential hesitancy to make changes. After all, if someone came into my home and tried to tell me my Target haul of decor was a potential safety hazard, I probably wouldn’t invite them back.
For fall prevention within the home, generally you will want to be sure that paths, stairways and any thresholds are clearly lit, secure and free of clutter. If there are concerns about low vision or impaired perception, contrasting colored tape can be used to mark steps and thresholds. Bilateral, sturdy handrails are ideal for any stairs or inclines. Encourage your patients to reduce or eliminate floor clutter including shoes, decorations, power cords and the like. Poorly lit areas and low-visibility areas like a tight bedroom space also present a fall risk. Encourage your person to consider properly installed grab bars in the bathroom and educate them on safe use. And it almost goes without saying–those loose throw rugs are a huge fall risk and should be secured down at all edges if your person is unwilling to part with them.
Fall Risks Within the Community
Falls within the community are difficult to track and therefore underreported, however people with good community mobility are naturally at a higher risk for outdoor and community falls. Uneven pavement on sidewalks, lack of sidewalks or interruptions in sidewalk continuity and sloped surfaces are potential sources of falls. Areas with poor lightning, poor drainage and potential for ice also increase the risks for community falls. If you are working with a person that is an active driver, consider referring them to the CarFit program and ensuring their balance is strong enough for getting in and out of their vehicle. Balance will be an important area to look at for persons mobile at the community level–looking at you, uneven sidewalks–to be sure they can navigate walking spaces that are not necessarily the safest. Footwear with proper fit and traction for grip will also help reduce the likelihood of a slip and fall.
Assessments for Fall Prevention
There are a plethora of outcome measures for use to determine a persons’ potential risk of falling–check out these two resources here & here for some great measures. These outcome measures should always be used in combination with skilled observation and clinical judgement in order to best determine someone’s fall risk and preventative steps to take. Having a strong understanding of your person, their habits and lifestyle will aid you greatly in enacting fall prevention measures.
What fall prevention interventions can I use?
It goes without saying that your interventions should be tailored to the needs and priorities of your person, so keep that in mind while we suggest the following starting places. In addition to the aforementioned education & environmental modifications, there are a few great interventions to check out for fall prevention. Primarily, recognize that there is a way to fall right. Reviewing and practicing with your person how to fall correctly, get up from a fall and ways to protect their body best in case of a fall is an excellent harm reduction method. This can take some of the fear out of the potential of falling and empower your person to feel more secure in their ability to recover safely should a fall happen. Reactive balance training can be a great way to improve your person’s ability to recover their balance and prevent falls in addition to strengthening full-body. In addition to this, balance rehabilitation approaches in general are always a key intervention point for fall prevention.
Okay, I got it. Fall prevention is serious and not just limited to in-hospital and in-home measures…where can I find more information?
Thrilled you asked! The National Council on Aging has amazing resources & educational information valuable for both clinicians and families. USC Leonard Davis school of gerontology has excellent resources including state-specific links, considerations for patients of different ethnic backgrounds and economic backgrounds, and fantastic resources for home modifications. They host an expert in home modifications for fall prevention monthly, so be sure to not miss out!
Spenser Bassett graduated from the University of Findlay with her Doctorate in Occupational Therapy in 2022. She currently works in subacute & LTC, and is ARC Seminars’ Associate & Social Media Developer. Spenser is passionate about promoting diversity in rehab spaces & empowering rehab professionals to succeed beyond classroom walls.
Spenser Bassett graduated from the University of Findlay with her Doctorate in Occupational Therapy in 2022. She currently works in subacute & LTC, and is ARC Seminars’ Associate & Social Media Developer. Spenser is passionate about promoting diversity in rehab spaces & empowering rehab professionals to succeed beyond classroom walls.
Learn More About Practical Aspects to Fall Prevention ?
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