By Elissa Lee and Albert Jiang,
Roger first fell in the shower.
“It could have been worse,” said Roger, 83, whose name was changed for patient confidentiality. “I caught the wall first and slid down. I couldn’t get up and yelled for help for 15 minutes before my caregiver came.
“When she finally found me,” Roger added, “she struggled to get me up because I was naked and slippery (in the shower).”
By the time the caregiver was able to help Roger back up, they were both drenched and exhausted.
“I noticed that the next few days she was limping a bit,” Roger said, “but she denies that she got hurt.”
There are many reasons people fall: You reach over to retrieve the farther-than-you-expected shampoo bottle in the shower, trip over the edge of a rug that slightly shifted during your grandchildren’s last visit, miss a step going down the stairs you go down every day.
One out of four, or 30 million, older adults fall every year in the United States — a leading cause of injury and premature death. The most common falls occur in the home, particularly in the bathroom, bedroom and stairs.
As physical and occupational therapists, after seeing a sampling of those 30 million patients, we have learned to piece together the clues of why a fall has occurred, and how we can help prevent the next one, providing insight on the interaction of individual and environmental factors that result in an incident.
While Roger was lucky to walk away from that ordeal unscathed, his apprehension of falling turned him toward a more sedentary routine in the two months leading up to his initial therapy appointment. The pandemic further discouraged his efforts to move.
“I used to walk four blocks every day,” he said. “Now, I walk once or twice down the hall, if at all.”
A poll by the University of Michigan and AARP suggests that the COVID-19 pandemic may have increased older adults’ risk of falling, as more than 37% of older adults reported less physical activity and 23% reported an increased fear of falling during the pandemic.
The two are inversely correlated — those who did less physical activity feared falling more. Other studies have shown that the fear of falling seems to be as important as other factors, such as previous falls, in limiting older adults’ daily activities.
A vicious cycle persists: The two months of dramatically reduced activity led to increased swelling in Roger’s legs and widespread atrophy, which, in turn, made it harder for him to get up and move.
He was caught in a cycle of withering.
Roger’s therapy reintroduced him to exercise — slowly increasing his distance of walking, from twice down the hall to thrice, then four times. For his generalized weakness, he started with repetitions of moving his body weight through a pain-free range of motion. When that became easily manageable, he was given more resistance with exercise bands and more challenging upright positions. With his gains in strength came gains in self-efficacy.
Changes were also made to his home to further mitigate fall risk.
With his wife and caregiver’s assistance, rugs were nailed down to the floor. Power surges were added and put on level surfaces, to minimize bending over to plug and unplug chargers. Walkers were placed strategically in “high traffic” areas, such as next to the stairs and next to his bed.
After a few weeks, he embarked on his first walk outside with a new rollator walker and strolled two blocks from his house and back — the first time in months.
It’s important to remember that while there are some general pieces of advice to glean from Roger’s tale, his post-fall therapy was specific to him, as were the strategies to minimize his risk of future falls.
If you want a more individualized plan, it may be helpful to consult with your medical provider.
Rehabilitation therapists, such as physical therapists and occupational therapists, often specialize in working with geriatric patients and are well-versed in strategies to mitigate fall risk. A physical or occupational therapist can come to your home, evaluate your fall risk and assess the safety of your living environment. They can also work with you to create a plan specific to your individual needs — to best facilitate your health and safety.
Still, we’ve provided some general tips to help you reduce your risk of falling.
Identify high-risk areas, activities in the home
Consider all the commonly frequented parts of your home that increase risk your risk of falling. Perhaps it’s a dark hallway where you can’t see a certain threshold clearly, or a few steps without a rail.
Making sure areas you frequent are well lit can be very helpful in navigating your home safely.
Certain activities may be more demanding on balance and steadiness, such as bending over to reach low drawers or power strips. By thoroughly examining daily habits and environmental risks, you can be more aware of how you interact with your surroundings.
Declutter, rearrange items and furniture
The home can be an obstacle course when household items encroach on the walkways.
Clutter comes in the form of piles of boxes, stacks of papers and children/pet toys, and can cause slips and trips — increasing the difficulty in navigating the home. Furniture can also obstruct common pathways, but can be rearranged for more spaciousness and home safety.
Add safety equipment
Home safety equipment can increase ease and quality of life — and make you safer in your home. Durable medical equipment can be expensive, so research local programs and organizations that distribute pre-owned DME for free or more affordable prices, or shop online to compare costs.
Durable medical equipment includes rails, ramps, grab bars, shower benches, commodes and raised toilet seats.
Consider assistive devices
Having insight into mobility deficits is essential for longevity and safety. For late night trips to the restroom, a strategically placed bedside cane or walker may help support your balance and endurance as you groggily walk to the toilet.
Using a reacher can make picking objects off the floor much easier and reduces risky movements, such as bending down or reaching into awkward spaces.
Physical fitness is key
We all go through age-related changes, and life can be unpredictable. By incorporating exercise and physical activity in our day-to-day routine, we can maintain the fitness that facilitates the safety and quality in which we navigate our home and community.
Physical and occupational therapists are skillful in developing exercise programs tailored to challenge and effectively strengthen each individual.
Maintaining and developing physical fitness is a preventative approach to reducing fall risk. Having the strength, agility and balance to react confidently if you lose your balance will make you more likely to self-correct and catch yourself.
Be wary of being isolated
Having another set of eyes and perspective on the home environment, as well as movement in home, is important.
Being socially isolated, living alone, and experiencing loneliness poses many health risks for older people. You are not alone in feeling alone.
Reach out to your local senior center, phone a friend or family member, and speak to your doctor to learn more about any other programs they might offer.
Understand past falls and close calls
Falls happen and there can be a plethora of contributing causes. It is important to assess the moments leading up to a fall, where the fall occurred and what activity was being done to mitigate the risk of future falls.
Perhaps it’s the pesky throw rug in your walkway that you keep tripping over, or it’s the medication you take in the morning that makes you woozy. Consult your provider to discuss these falls and make a plan to prevent future falls.
Manage blood pressure
A common cause of falls is orthostatic hypotension — a sudden drop in blood pressure because positional changes, such as sitting up after lying in bed or standing up after sitting down for a while on the toilet. The shunting of blood to the lower extremities and away from the brain can cause a loss of consciousness and lead to a fall.
Frequently checking blood pressure and being aware of the symptoms of syncope, and knowing when and how to rest can be crucial to preventing a fall.
If you’re prone to falling when you sit or stand up, it might be helpful to do so slowly. And gently move your lower limbs to stimulate blood circulation before getting up.
Have a plan for fall recovery
No one expects to have a fall, but preparing for the worst can be crucial in preventing further injury.
In the event of a fall, don’t immediately get up right away. Take some deep breaths and return to a calm state of mind before taking your next actions. Assess yourself for injury. If hurt, call for help if possible.
If you live alone, having a phone or emergency call system that’s accessible from the floor is an essential safety measure.
Elissa S. Lee is a health care reporter, chronic care researcher, occupational therapist and a consultant. She holds a doctorate in occupational therapy from USC and a bachelor’s degree from UC Berkeley. Albert Jiang is a physical therapist in the Bay Area. He has a doctorate in physical therapy, and as an avid hiker, climber, and runner, he enjoys helping patients take the next step in incorporating healthy movement into their lives.