Stay Upright, Independent, and Safe: A Fall Prevention Guide
This article was reviewed by our Baystate Health team to ensure medical accuracy.
Courtney Brown, PT, DPT, NCS
In 2021, 28% of Massachusetts adults aged 65 and over reported falling. Lest you think falling is more embarrassing than it is dangerous, consider this:
For Americans aged 65 and over, falls are the leading cause of fatal and non-fatal injuries and annually lead to 3 million emergency room visits, 1 million hospital stays, and 36,000 deaths.
That said, falling isn’t inevitable as you age. Key to keeping upright and independent is understanding your risks, knowing where you’re most likely to fall, and taking steps to prevent falls.
Who is at Risk of Falling?
According to Courtney Brown, a physical therapist with Baystate Health, in addition to age, there are several factors that can increase an individual’s risk of falling. “Some factors,” she says, “are modifiable and others are not. But being aware that you’re at a higher risk—even if you can’t change it—can serve to encourage better choices and behaviors that will work to reduce your chances of falling.”
For example, she notes that women and white people account for more falls than other demographics. “You can’t change your race or gender,” she says, “but you can take extra precautions.”
She notes that certain health conditions can also increase an individual’s risk of falling. These include:
- Diabetes
- Parkinson’s disease
- Depression
- Incontinence
- Dementia
- Muscle weakness
- Visual problems
- High BMI (31% or higher)
In addition, individuals who take five medications or more are also at increased risk of falling. “Medications often include side effects like drowsiness that can often contribute to falling,” she says.
Other common contributing factors to falls are poor choice of footwear and walking slowly.
“It’s really important that your shoes are secured to your feet—that means no flip-flops or mules,” says Brown. “Floppy shoes are more likely to get caught on things or cause you to unexpectedly shift your balance, which can lead to a tumble.”
Interestingly, Brown also notes that how fast you do—or in this case, don’t—walk, can put boost your risk of falling. “It sounds counterintuitive, but the reality is walking too slowly can actually increase your fall risk. You want to aim for a walking speed of 1 meter per second.”
Where Do Most Falls Occur?
As an occupational therapist with Baystate Health, Michelle Lantaigne has worked with patients who’ve fallen in all kinds of places. However, she says the most falls occur at home.
“More specifically,” she says, “the three most common location for falls in the home are the bedroom, bathroom, and stairs.”
She urges people to resist the urge to get complacent about fall risks simply because they’re in the safety of their home. “Very often patients put their walker or cane in the corner when they get home,” she says. “But just because you’re home, your need for assistance doesn’t disappear and walls and countertops are NOT good substitutes for a walker. People also tend to relax in the confines of their space and pay less attention to what they’re doing. Combine those factors and you’ve got a recipe for a fall disaster, not matter what room you’re in.”
How to Reduce Fall Risk to Prevent Falls
To reduce fall risk at home, Lantaigne suggests the following:
Wear shoes, not just socks, when moving about. Shoes or slippers with a tread provide stability and slip-resistance that even grippy socks can’t match. Lantaigne adds that you should put on shoes—slip-ons are ideal—even when you head to the bathroom in the middle of the night.
Sit when dressing. This is especially important for individuals with balance issues.
Remove unnecessary rugs from the bathroom. Given 80% of senior falls occur in the bathroom, it’s important to get rid of any potential tripping hazards. If you need a mat by the tub or shower, make sure it has a grip on the bottom or, better yet, put it on the floor only when it’s needed.
Install grab bars. Lantaigne says many people make the mistake of thinking towel racks and even toilet paper holders are strong enough to support them when attempting to stand. Simply put, they’re not. If you need help getting in and out of the tub or shower or rising from the toilet, invest in proper grab bars and have them professionally installed.
Light frequently used pathways. Soft illumination in the form of nightlights, baseboard lights, and even toilet lights can help you safely navigate your home at night and won’t blind you the way switching on a traditional light may.
Keep stairs clear. As stairs represent a major fall hazard on their own, it’s important to be particularly cautious about maintaining and navigating them. Lantaigne cautions about using stairs as a holding area for items that need to go up or down. “While you may know something is there, others may not,” she says. She also emphasizes the importance of good lighting—with a switch at the top and bottom of the stairs.
Organize your kitchen for safety and ease of use. Make sure heavy pots and pans are stored near the stove so you don’t have to shuttle them across the kitchen and be sure to remove area rugs.
What to Do If You Fall
Another important item that won’t prevent falls but can be critically important if you do fall is a home alert system. “As much as many seniors hate the notion of a fall alert system, they can be literal life savers,” says Lantaigne. She notes that in addition to devices you wear on your body that can detect falls, there are now voice-activated systems that you can program it to respond to “call my daughter” or “call 9-1-1.” “You can even program a smart watch and your phone to serve as an alert system,” she says.
In addition to injury, including broken hips and wrists, concussions and more severe head trauma, falls can have other consequences.
“Quite naturally, people who fall often have a fear of falling again,” says Brown. “In addition, they may experience limited mobility while they recover which can keep them from enjoying activities they enjoy doing. The mental toll can be quite high.”
To help combat these potential outcomes and reduce the risk of falling altogether, Baystate developed the Falls Prevention Initiative (FPI). Offered through Baystate Rehabilitation Care, FPI is for people at risk of falling as well as those who have experienced a fall.
“Offered twice a week over a four-week period, the program begins with an initial evaluation,” says Brown. “We assess an individual’s balance, the mechanics of their gait, and strength.”
With that information, the Baystate Rehabilitation team builds a customized program to address the needs of and reduce the risk of falling for each patient. “When the four-week program ends,” adds Brown, “we provide patients with a home exercise plan to keep building their strength and balance and give them confidence to live life to the fullest of their ability.”
FPI is offered at the following Baystate Rehabilitation locations:
To participate, contact your primary care doctor and ask for a physical therapy order for all prevention or fear of falling and then contact the FPI at 413-794-1600. Select Option 2 to schedule an appointment.
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