A Physical Therapist’s Top Tips to Keep Older Adults Safe from Falls

UNLV professor Jennifer Nash has made it her mission to prevent older adults from suffering a devastating fall. 

According to the CDC, falls among adults 65 and older caused more than 36,000 deaths in 2020, making it the leading cause of injury death for that segment of the population. That same year, emergency departments across the country recorded 3 million visits for older adult falls.

A board-certified neurological clinical specialist by the American Physical Therapy Association, Nash teaches neurologic rehabilitation, balance and vestibular rehabilitation, geriatrics, and pharmacology in the Department of Physical Therapy within the School of Integrated Health Sciences at UNLV.

Here she shares what people at home should be cognizant of to help keep their older family members and friends safe from falling.

Why hip fractures are so dangerous

One of the most serious fall injuries is a broken hip. It is hard to recover from a hip fracture and afterward, many people are unable to live on their own. As the U.S. population gets older, the number of hip fractures is likely to increase. More than 95% of hip fractures are caused by falling, usually by falling sideways.

In addition, women more often have osteoporosis than men, which weakens bones and makes them more likely to break. Women actually experience three-quarters of all hip fractures. 

Simply put, an injury to the hip changes your mobility. Sometimes the doctor can allow you to walk on that leg, but there’s going to be pain and healing time that limits your activities. Chances are, you’ll have been laying in the hospital for at least a week and not moving around as much, making it harder to regain any mobility that you lost which puts you at an increased risk for developing pneumonia. 

Why recovering from a fall is so hard

As we age, our strength and endurance decrease so it’s more difficult for patients to put in the hard work needed to get back to their pre-fall selves. In addition to the pain, there could be comorbidities affecting the patient. What if they have arthritis in their hands, so they can’t use a walker very well? A hip fracture often changes your ability to go to the bathroom, to get up and down from a chair, to get around your home, etc. 

There is also a vicious cycle that comes with physical inactivity. The less you do, the less you will be able to do. Decreased activity leads to decreased strength and function, which leads to deconditioning, increased fear of activity, and decreased quality of life. This can all lead to even greater inactivity.

How to Reduce the Risk of Falls

The National Council on Aging actually has a six-step plan to help prevent falls. 

1. Find a good balance and exercise program

This could be a community exercise program or maybe through a physical therapist to get an individualized program to do on your own. A lot of times, what we try to do is get our patients stronger so they have the confidence to go into a community exercise class, specifically one with a social component.

2. Talk to your healthcare provider about your concerns

There are several things we need to look at. We need to look at their medications to make sure they aren’t making our patients dizzy. How’s their blood pressure? Does their blood pressure drop when they stand up? These are things that their medical professional should go over with them. 

3. Regularly review your medications with your doctor or pharmacist

There are plenty of people who take more medications than they need. It could be that two different doctors prescribed them blood pressure medicine, so their blood pressure is actually lower than it needs to be. This can lead to a patient becoming being light-headed and falling when they stand up. 

4. Get your vision and hearing checked annually and update your eyeglasses

Our senses are critical to our balance. There are three components that make up our balance system: vision, proprioception (the ability to sense where you are with your feet), and the vestibular system (the inner ear). Hearing is just as important to your balance. If you can’t hear someone coming up from behind you, you might get startled and trip. Or maybe you can’t hear someone warning you about an uneven surface which could lead to a fall. We encourage that both hearing and vision are checked every year.

For vision, we really want the older adults to consider a single-focal lenses vs. the bi-focal or the tri-focal. With a bi-focal or tri-focal lens, we look through our reading lens to climb stairs or uneven surfaces, and that can create depth-perception issues. Single-focal lens is the way to go. 

5. Keep your home safe

We need to remove any and all tripping hazards in our home. A lot of people keep their homes more cluttered than they probably should, or they might keep cords along the floor, or the carpet is coming up off the floor because it hasn’t been fixed. All of these instances could lead to a trip and fall. Be sure to also increase your lighting. The better you can see, the more balance you’ll have. 

Also, make sure your stairs are safe. Your staircase should have at least one railing and some light. We want to make sure older adults can see, they can hold onto something, and that the surface is solid. We also want to install grab bars in key areas, like the shower and the toilet. A lot of toilets are really low to the floor. When you start to decrease your activity level, or you have additional health issues, it can tend to create weakness in your legs. So, if you can’t get up from a chair or toilet, grab bars are really helpful. 

Bedside tables and bathrooms are other places where older adults can get head injuries from falling. These can be very serious, especially if the person is taking certain medicines, like blood thinners. An older person who falls and hits their head should see their doctor right away to make sure they don’t have a brain injury. If you wake up in the middle of the night to use the restroom and you can’t see well in the dark so you trip or get light headed when standing, there’s a good chance you could fall and suffer a hip fracture or a traumatic brain injury (TBI). Hip fractures and TBIs are the two key areas that are real problems with falls.

6. Talk to your family members and your healthcare providers

It’s important for family members to be involved. Falls are not just an older adult’s issue; they affect the entire family. Also, speak to your doctor about any falls you have. Most people hide this from their healthcare providers because they are fearful of the consequences and stigma associated with falls.