We tried so hard to keep my parents at home. And when I say we, I mostly mean my sister who put her own life on hold for six years while she cared for them there. My mom was famous for saying that they would die in that house; that was always their plan. But a bad fall down the stairs, in which my mother broke her ankle in two places and got a nasty concussion, put an end to their dream of aging in place. That's why I wanted to write this caregivers guide to preventing falls in seniors. Of course the biggest variable in how much this will work is your senior's willingness to cooperate. And we all know that that is the hardest part of the equation.
Managing old age necessitates being prepared for a multitude of possibilities, but there are many that are hard to foresee. One thing that you should be prepared for no matter the state of your seniors’ health, are falls. Look at the statistics:
More than a third of adults over the age of 65 report at least one fall each year.
Those who fall once are two thirds as likely to fall again within 6 months.
Half of all falls take place in the home.
Falls are the most common cause of traumatic brain injury.
Falls are the leading cause of death from injury in people over 65.
Over a third of fall related ER visits are from people living in nursing homes (just in case you thought it wouldn’t happen there – it does. Oftentimes because of slippery or wet floors and poor lighting).
The risk of falling increases with age and affects more women than men (maybe because women do all the work in the house? Just kidding. Sort of).
In 2021, 38,742 adults over 65 died from falls, and nearly 2.9 million were treated in emergency rooms.
Older adult deaths from falls have increased by 60% and ER visits for falls have increased by 20% over the past 10 years.
Falls, even minor ones, can reduce a senior’s independence and quality of life. Not only can they cause physical injuries; it also produces a lot of anxiety over falling again, feelings of helplessness, even depression. A senior who is fearful of falling is more likely to fall again, which can cause them to withdraw, making the propensity for depression and anxiety worse.
One good thing is that falls are expensive; medical care costs for falls run about $50 billion dollars a year. How is that good, you ask? Well, Medicare and Medicaid pay for the majority of that, and they don’t like to spend that kind of money on something that is somewhat preventable. So, there is LOADS of information out there about fall prevention. Medicare will pay for an in-home safety assessment by an occupational therapist or medical social worker. If it isn't offered to you, ask for it by name. Fall risk assessments should be performed at medicare annual wellness visits. If you doubt that your senior is talking to their healthcare provider about this, but you're worried about their fall risk, let your senior’s healthcare provider know. If your senior is poo-pooing this, you can also share this fall risk assessment test with them. It includes related outcomes to the answers, like if they answer yes to the question “I steady myself by holding onto furniture when walking at home,” they will see that this is a sign of poor balance.
You can get started with fall prevention on your own by looking at the following items:
Assess your seniors living situation. How can you limit fall risks in their home?
Do they have area rugs? Get rid of them. They are a huge cause of falls. If they won’t let you remove them, “redecorate” and relocate the rug to a less trafficked area of the home.
De-clutter the space. Minimize the amount of furniture in each room, and make sure there is plenty of room for your senior to move around it.
Make sure the floor is free of debris including cords and piles of “treasures”.
Install bars in the bathroom, especially in the bathtub and next to the toilet
Make sure their living space is well-lit and use night lights.
If you have a senior who tends to wander at night, consider installing a door alarm that either sounds an alarm when the door is opened, or can send an alert to your phone (we prefer the latter option to prevent your senior from being frightened by an alarm and putting them at a greater risk of falling from that surprise)
Pet factors to consider. Pets are harder to get rid of than rugs. Instead, consider the following:
Make sure that their toys are put away and food and water bowls are kept in a place where your senior is least likely to trip over them. Put bells or tags on their collars so that your senior can keep track of where they are.
If they have a habit of jumping up, consider obedience training to curb that behavior or any others that could easily startle a senior and cause them to lose balance. The likelihood of your senior agreeing to this is somewhere between slim and none, but it’s worth a try.
When outdoors, animals can be less predictable – your senior’s and other people’s. It may be time to get someone else to walk the dog. Having a fenced-in yard where a senior could let their pet out on their own might also be a good addition to that plan.
Improve stability. Sometimes it's hard to get senior buy-in, but this is a non-negotiable one. My dad didn't want to use his cane because it made him feel old. I reminded him how much older he'd feel if he fell and broke his hip and had to recover in a skilled nursing facility. He didn't like that.
If your senior has a walker or cane they should use it! Sometimes, especially if it's new to them, they will leave it in another room, or forget to use it on the way back. Consider keeping back-up canes or walkers so that they have them in more than one spot.
If your senior doesn’t use a cane or a walker and you notice them holding onto furniture or counters they could probably use one. Medicare Part B covers some of the cost of assistive devices but they have to be ordered by a healthcare provider. Don’t be shy - ask for an order.
Wear proper-fitting stability shoes at all times! No bare feet, no socks without shoes, only slippers with rubber soles. Wear weather-appropriate shoes outside.
Physical fitness plays a huge role in fall prevention. A little exercise goes a long way for senior fitness and stability.
Exercise regularly – walking, cycling, and swimming are all good for building strength and improving balance. Community classes or working out with a friend is a twofer- they get exercise and are less isolated.
Strength training – weak muscles can cause poor balance. We’re not suggesting they pump iron; using light weights, or doing body weight exercises will go a long way in improving their stability and strength. Look for senior-specific exercise videos on YouTube. There are lots. Ask your senior’s primary care doctor for a physical therapy referral. They can help a lot in this area and get them out of the house.
Improve nighttime sleep. Improving their nighttime sleep lessens your senior’s risk of falls by improving their mental and physical functioning.
Limit day-time naps to 30 minutes or less so that your senior is more likely to sleep soundly at night.
Avoid sleep aids like benzodiazepines (eg: xanax), benadryl, etc.
Medicine considerations. Some medications can have an adverse effect on a senior’s balance or alertness.
Be sure to frequently go over medications with your senior’s medical providers and/or pharmacist, especially if they’re taking anything new. Sometimes medication or medication interactions can cause effects that increase fall risk.
Keep providers informed of any over the counter vitamin, supplements, or herbs your senior takes, as these too can have side effects and adverse interactions.
Some medications can lower a person’s blood pressure, which can cause dizziness which in turn can increase the likelihood of – you guessed it - falling.
The NIH has a more complete chart on these and other recommended behaviors, specific ways to implement them, and why. Print it out for yourself and your loved one! As with most things with the elderly, the best time to start thinking about this is before it’s a problem. The second-best time is RIGHT NOW.
There is no way to eliminate risk 100%, but there are many ways to lower the risk of a senior fall. Stay vigilant, and try to get your senior on board to do the same. The advice listed here is great and we are well aware that a lot of seniors will pleasantly (or begrudgingly) agree to modify their homes and living spaces and then promptly ignore or forget the recommendations. One of Nancy’s favorite patients is a lovely woman in her 90s who lives alone. She loves area rugs to keep the floor warmer and since her family removed all the rugs she throws towels on the floor to recreate the look. Do the best you can. You can lead a horse to water and…you know the rest.
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