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Watch your step: a guide to elder fall prevention

by Sue Lanza

Whether you are a caregiver or just concerned about your future health, learning about falls may help you prevent serious injuries. Check out the simple things you can do to stay safe from falls at home.

It may shock you to learn that falls are the most common cause of injury among older adults. The Center for Disease Control (CDC) reports that about one third of all adults aged sixty-five years and older fall in the U.S. in any given year. Some have injuries that result in hospital admissions and even death.

I'm slightly out of that age range, yet I can tell you first hand that having a fall with an injury can be quite traumatic and costly, both financially and emotionally. One minute I was walking in a shopping mall parking lot and the next minute I had fallen in a pot hole and fractured my elbow. So how do we look objectively at falls and learn how to best prevent them from happening in the first place?

Let's start this quest to making ourselves ""fall savvy"" by looking at a few key areas that can influence fall risk: physical health factors, medication usage and environmental concerns.

Physical Health Factors

Certain physical situations automatically place you or your loved one at risk for a potential fall. To be safe, your health practitioner would be the best person to assess your physical risks for falls through an annual screening test. Here are some areas in your physical health that would typically be examined in a falls risk screening:

  • Balance and gait testing. Simple assessment can identify muscle weakness, mobility limitations, gait disturbances and balance problems.
  • High-risk medical conditions. Certain health concerns, such as cardiac irregularities or vertigo, can predispose a person to unsteadiness that may lead to falls.
  • Past history of falls. The circumstance of any previous falls can shed light on how to prevent falls in the future.
  • Frequency of routine exercise. A habit of regular exercise can often help with fall prevention by keeping muscles and joints active
  • Visual capabilities. The extent of visual impairment will impact a person's risk for falls by limiting their ability to see hazards in their path.
  • Exposure to sunlight, Vitamin D and calcium supplements. Keeping bones strong and healthy is a preventative measure in case of a fall.
  • Cognition impairment issues. Cognitive problems, such as dementia, bring increased fall risk as decision making and attention are often impacted, leading to decreased safety awareness.
  • Incontinence problems. More attempted trips to the bathroom, or urine leakage, can multiply fall hazards.
  • Footwear choices. Painful foot conditions, or improper footwear, can contribute to unsteadiness and potential falling.

Two other aspects - medication usage and the living environment - would also be covered during the falls risk screening and warrant further discussion here.


The use of psychoactive medications presents the greatest threat to fall safety as they may have side effects such as disorientation and drowsiness. Their usage as a mood altering medication to treat depression, anxiety or bipolar disorder may be helpful in relieving those symptoms, yet create new concerns when it comes to fall safety. The health care professional who is conducting the falls risk assessment will be very interested in looking at the number of psychoactive medications your loved one is taking, along with the dosage and potential interactions with other prescribed medications. The goal would be to reduce the number of medications to the safest therapeutic level, while reducing the potential for falls.

Environmental Concerns

Knowledge of the actual living environment is critical to understanding prospective fall hazards. Some of the questions you or your loved one may be asked about your home might be:

  • How many stairs do you need to walk up or down during the day?
  • Do you live alone or with others?
  • Do you have another person or a pet that you care for?
  • What is your schedule on a typical day? Do you leave your home? Take public transportation or drive yourself?
  • Do you prepare your own meals and handle your own daily care?

If hazards are identified, an occupational therapist may suggest specific equipment for use in the home that can minimize these dangers. Grabbers for reaching high places, or organization tools that bring frequently used objects closer to eye level are helpful. If risks are severe enough, an electronic monitoring system that allows the person to call for assistance may be needed.

Your role as caregiver is one of prevention - first, by helping the health care professional analyze the risk factors that exist for your loved one, and secondly, by ensuring that all possible risks have been minimized.

Despite all the best preparation, falls can still occur. If a fall does happen to your or a loved one, learn from it. I know that I will never fall in another pothole!