Updated March 3, 2022 – As a physical therapist, one of my duties is to perform a fall risk assessment on my older adult patients.
This tool gives me information on how likely my patient may fall and which ones are at the highest risk of falls.
So, how do you prevent falls in the home if you are elderly? – The answer involves three very important issues. One is to modify the home so that it is as safe as possible. Two is to improve your physical strength and flexibility for better balance and mobility. Three is to make use of appropriate assistive devices.
I treat many different types of injuries that occurred because my patient fell – and many of these patients are older adults who fell in their homes.
Some patients tripped over a piece of furniture or a rug, some say they had a loss of balance, others say their legs just gave way on them.
Of course for some, they fell as a result of a medical event such as a stroke or heart attack.
Rarely is a fall amongst elderly due to a result of a push.
The majority of these patients suffered a bone fracture or head injury of some type which often resulted in surgery followed by months of rehabilitation.
The unfortunate thing is that many of these accidents could have been prevented simply by having a physical therapist perform a physical examination, a thorough assessment and then set up a fall prevention program.
Falls are the leading cause of fatal and non-fatal injuries for older Americans.Hennepin Healthcare
In this same article by the National Council on Aging – they report that according to the U.S. Centers for Disease Control and Prevention – “Falls result in more than 2.8 million injuries treated in emergency departments annually, including over 800,000 hospitalizations and more than 27,000 deaths.“
For younger adults, it may seem that older people should be able to recover from a fall quite rapidly but the truth is that for many seniors, injuries from falling can severely affect their quality of life and their ability to perform daily activities.
Falls among the elderly are prevalent, dangerous, and can diminish their ability to lead an active and independent life. About one in three seniors above age 65, and nearly one in two seniors over age 80, will fall at least once this year, many times with disastrous consequences.Virtualphysicaltherapists.com
Physical and Occupational therapies are two healthcare professionals that offer excellent training and recommendations for any elderly family member so that they can improve their overall chances of avoiding falling.
How Can We Prevent Falls As We Age?
As a physical therapist, my role in fall prevention is to improve my patient’s overall endurance, muscle strength, range of motion and balance.
This involves a series of assessments and strength training exercises which lay the groundwork for the treatment plan.
There are numerous risk factors that can escalate a person’s chances of falling. Factors such as…
- poor reaction times
- poor coordination
- slower speed of movements
- visual acuity
- impaired gait and mobility
- side effects of some medications
- poor balance
- anxiety and fear of falling
“The risk of falling in older adults is usually related to combination of factors, including:
- Balance and/or walking problems. Balance can be affected by vision changes, vestibular problems and altered sensation in the feet.
- The use of multiple medications. Studies indicate that when individuals take five or more medicines, the risk of falls increases.
- Home hazards (including dim lighting and trip hazards)
- Positional low blood pressure (such as orthostatic hypotension, when blood pressure drops upon standing.
- Feet and footwear issues” – source Hopkinsmedicine.org
It all boils down to creating a treatment plan that my patient can follow and build on.
The end result is, of course, to improve their muscle strength and balance to help avoid any future incidences of falling.
But – as I said earlier, there’s more to fall prevention than just balance training and building up the body’s core strength.
There’s also the issue of modifications not only in the home environment but in some personal choices as well.
An Occupational Therapist can assess the person and the home for recommendations of assistive devices, products and home modifications as well.
I’m talking about changes such as…
- Removing rugs throughout the home. But if a rug is necessary (such as in a bathroom) then to secure them with a non-slip pad.
- Increase lighting in as many spots throughout the home as possible. This includes stairways and hallways.
- Declutter the living spaces in the home.
- Wearing proper shoes and avoid walking barefoot and/or in socks.
- Making the floors as non-slip as possible.
- Avoiding doing multiple tasks such as carrying groceries while speaking on the phone and trying to close the car door.
- Focus on the activity on hand. For example, while walking down the staircase, focus on the steps you are taking vs. looking away or being distracted by talking on the phone or to someone.
- Use assistive devices such as a shower chair, raised toilet seat, walker or cane, kitchen stool, grab bars, etc.
- Know your limitations, especially if you are on certain medications that can make you dizzy or cause you to lose your balance.
These are some of the most common types of changes that my patients could have benefited from – changes that could have helped to prevent their fall in the first place.
But overall, as a physical therapist – my main goal is to help my patients to improve their physical well-being. This means to improve their overall strength, balance and mobility.
Where Do Most Falls Occur In The Elderly?
It stands to reason that for elderly adults, most falls occur indoors – inside their homes.
You can probably guess that the reason for this is because most older adults stay in their homes and do not venture out as much as their younger counterparts.
…fall-related mortality rates increase exponentially with age, with the greatest increase after age 80. This is because most falls are associated with age-related conditions such as physical frailty, immobility and reduced functional capacity.World Health Organization
Where Do Most Falls Occur In The Home?
What has been shown to be the most dangerous room in the house for an elderly person?
If you guessed the bathroom – you would be absolutely right!
Recent studies have shown that for people aged 65 and older, falls account for approximately 60 percent of all injury-related emergency department visits and over 50 percent of injury-related deaths annually. And up to 80 percent of falls in the home occur in the bathroom.Belvedere Home Care
With the majority of falls occurring in the bathroom – I would encourage you to make the modifications needed to your bathroom to make it as safe as possible for yourself and/or your senior loved one.
These modifications include:
- decluttering the space in the bathroom and the shower stall – you can read more about decluttering tips here
- using appropriate adaptive equipment such as grab bars, shower chairs / transfer benches
- non skid mats and anti slip flooring products
- faucet levers to replace knobs (which are more difficult to turn)
- hand held shower head
- raised toilet seats with grab bars
- possibly replace a glass shower door (if you or your senior loved one has a history of falling)
- reduce the hot water heater temperature to 120 degrees to decrease the risk of scalding the skin
- use a product like these Corner Guards to protect against sharp edged corners
These modifications can be an effective solution to help prevent falling for most any older adult.
Exercises To Help Improve Your Strength And Balance
There are a large variety of different exercises that can help seniors to improve their muscle strength and balance and many can be customized to fit the individual’s abilities.
But here are 4 excellent general exercises that you can do at home that will help you to improve your overall balance and strength.
Be sure to check with your doctor before starting these, or any other exercise program.
1. Respiratory Training To Help Improve Muscle Endurance
- Before you can do any set of exercises I recommend to work on building your overall muscle endurance
- You can do that with the Bas Rutten – a respiratory training device that many of my patients have successfully used
- Use it while you exercise.
2. Standing With One Leg
- Find something stable to hold onto – preferably something that is heavy (you do not want to use a lightweight chair). This is something that you can place your hand on while standing upright.
- While holding onto this stable object – lift one foot off the floor – it can be just a few inches off the floor.
- Hold this position for 30 seconds.
- Then repeat this process with the other foot.
- You can increase the challenge by increasing the amount of time to 1 minute.
- You can also increase the challenge by performing the exercise with your eyes closed.
- You can also increase the challenge by performing the exercise while NOT holding on to something BUT I strongly caution that you should NOT do this without the supervision of another person there to guard you.
3. Walking While Moving Your Head
- Begin this exercise by laying down. Then turn your head to the left and then to the right. If this does not cause any dizziness or a lightheaded feeling, then go on to the next step.
- Sit up in a chair with back and side supports. Then again, turn your head to the left and then to the right. If this does not cause any dizziness or a lightheaded feeling, then go on to the next step.
- Stand upright and hold onto a sturdy object. Then again, turn your head to the left and then to the right. If this does not cause any dizziness or a lightheaded feeling, then go on to the next step.
- You will now be performing this same exercise (turning your head left and right) but this time you will be walking. I recommend that you do this exercise in a location where you will have support on both sides. Using the parallel bars in a physical therapy clinic is the idea location to do this. But you can also ask others to closely supervise you as you perform this exercise just in case you do get dizzy and lose your balance. (This means that they are standing close enough to you to grab you if you do begin to fall.)
4. Testing Your Visual Perceptual System
- You will need a bed sheet or some other material that has a busy and multi colored design. Hang this sheet on a wall.
- You will position yourself about 30 or 40 steps away from this hanging sheet (or as far as you can get).
- You will then focus your gaze on that sheet and begin walking towards it.
- Then repeat this but this time, walk backwards, again keeping your gaze on that sheet.
- CAUTION: Never perform this exercise alone. Visual perceptual problems are extremely common in many older adults and can cause problems with balance.
5. Walking A Straight Line
- In this exercise you will be walking a straight line (heel to toe).
- You begin by standing upright, holding on to a sturdy object (like the parallel bars).
- Take 10 steps, placing one foot in front of the other, walking heel to toe.
- Repeat this same exercise but this time, walking backwards.
- You can eventually make this exercise more challenging by performing it without holding on to a sturdy object.
Again, with all these exercises, I do recommend that you first perform them with a physical therapist to help you identify what issues you may be having and how to best work on overcoming them. I want you to use precaution and to be safe, at all times.
My goal, as a physical therapist is to help my elderly patients to recover from their injuries due to falls but more importantly, to help them to prevent falling again in the future.
Honestly, I would prefer to be able to help them before they fall but most people do not come to see a physical therapist until something has happened.
If you feel that you are having any issues with your balance (or you see that your senior loved ones are having some problems) consider going to see a physical therapist before you or someone falls and injures themselves.