Identify & Reducing Your Risks of Falling

posted by Kellie Perry on Thursday, December 14, 2023

The fraction of a second it takes for a person to experience a fall can be life altering.

Each year over 800,000 patients are hospitalized in the United States as the result of a fall injury. Falls are the most common cause of traumatic brain injury in all ages, and more than 95 percent of all hip fractures are caused by falling.

In my 13 years of treating patients for a variety of health concerns, I’ve seen too many people experiencing life-altering injuries as the result of a fall, many of which could have been prevented. I'm passionate about teaching others how they can lower their risks of falls and injuries. Here are some commonly asked questions and answers to aid in better understanding how to avoid a fall.

Q: What are some health conditions that puts a person at risk for falling?

The three main motor and sensory systems that integrate to make up our balance are inner ear, vision, and sensors in the joints/muscles, which are like your body’s internal GPS system and give input to the brain on how your body is positioned/moving. The brain and the nervous system process this input and even have specific brain centers such as the cerebellum and basal ganglia that control balance. Health conditions that impact any of these systems (vision changes, neuropathy, muscle weakness, heart disease and others) can increase a risk for falling.

Q: What are some routine habits someone can adopt to help decrease their fall risk?

Make exercise a part of your lifestyle. Staying active, flexible, and strong can help to decrease fall risk. Muscle loss increases with age but can be impacted by a regular exercise/strengthening program, at any age, to build muscle and bone density and combat muscle loss.

Also, schedule regular eye exams. If you wear prescription eyewear, make sure to wear them as directed and keep them clean. Don’t delay cataract management.

Annually review medications with physician and/or pharmacist. Being on four or more medications is linked to increased fall risk and certain medications, such as anti-depressants, anti-anxiety, and sleeping medications, have stronger evidence of increased fall risk. General guideline that if a medication states “caution with driving” it is reasonable to consider “caution with walking” since they often slow down movements/reaction time and can cloud thinking.

Other quick tips include:

Minimize clutter and keep doorways and pathways clear.
Get enough sleep.
Have proper fitting footwear and clothing. Long and/or loose pants/skirts can be a trip hazard.
Carry a flashlight at dusk and at night.
If you need them, make sure to wear your hearing aid or glasses when you are outside.
Avoid or limit alcohol.
Reaching back and pushing up for chair/support surface when you go from sitting to standing.
Use a railing if present for climbing stairs or stepping onto a curb.

Q: What are some balance and strengthening exercises you’d recommend to help prevent falls?

I have several I’d recommend to help strengthen ankles and legs, plus others for flexibility and balance. Here are a few quick examples:

Seated Heel Toe Raises – The first line of defense for better balance comes from strengthening a person’s ankles. Sit upright with your feet shoulder width apart. Slowly raise your heels off the floor, then lower then back down, and then raise your toes from the floor. Lower your toes and repeat this series 10 times each day.

Sit to Stand with Armchair – This exercise works on all the muscles in the lower body and helps with practicing weight shifting and improving your balance. Begin by sitting upright with your feet flat on the floor and your hands on the armrests of the chair. Lean your torso forward so your head is over your toes, then press your feet and hands to push your body up into a standing position. Slowly sit back down, using the armrest for support. Repeat 10 times and try to do this exercise daily.

Side Stepping with Counter Support – The second line of defense for balance in hip strength. Strengthening these muscles can help keep toes from catching when walking. Begin in a standing position with your hands resting on a counter in front of you. Step sideways along the length of the counter. When you reach the end of the counter, side step in the opposite direction, back to your starting position and exercising both hips. Aim for doing 10 repetitions each day.

Q: What are some other techniques to help prevent falls?

Do not rush.
Look around and choose path with least number of hazards (quickest route is not always the safest).
Scan a few feet ahead of you when walking. Aim for 4-6 steps or the length of a car ahead then look down if/when you reach a hazard.
Improved lighting, especially in walkways and common pathways. Consider “photosensitive” night-lights that turn on automatically when it is dark to illuminate the path to the restroom or pathway you frequently use when it might be dark or low lightening. Remember, use 75 or 100 watt bulbs or compact fluorescent bulbs that have higher wattage for poorly lit areas.
Be cautious of your pet’s location and feed them away from doorways/pathways.
Wipe up spills and address slippery surfaces right away. In areas where water is present, such as bathrooms, kitchens and entryways, consider adding a non-skid surface/applications to improve traction.
Focus on your foot going from heel to toe as you walk and avoid scuffing your feet.
In the winter, make sure your shoes have good traction on them. Take slower and smaller steps and consider an ice tip for your cane.

Q: Do adaptive devices help and which ones would you recommend?

Assistive devices such as a walking stick, cane, or walker can help by increasing your base of support for stability and by providing more support and input for your body to improve safety and keep you moving.

Sometimes people who would benefit greatly from using a cane or walker avoid doing so due to a perceived stigmas around their use. Unfortunately, this can increase problems, leading to decreased activity around the house and tendency to limit social outings. As a result, the person may experience greater mobility issues, from greater weakness from decreased activity and from lack of challenging the balance centers with different environments. It’s important to use an assistive or adaptive device consistently and properly when indicated.

Q: If someone feels like they’re starting to fall, are there tips to help minimize potential adverse outcomes?

If you cannot avoid a fall, here are tips to minimize potential adverse outcomes:

Protect your head.
Tuck your chin to protect your head and neck. Turn head to the side if falling face first and bring arms up to level of the head for additional protection if able.
Turn as you fall.
Try to turn your body so you land more towards the side of your body since landing directly on your back or forward can increase risk of injuring your head, arms, face, and spine.
Keep arms and legs bent.
It’s tempting to try and put out an arm to “break the fall” but this can lead to the arm absorbing the impact of the fall and can injure the arm/shoulder and break the wrists/arm bones.
Stay loose.
Try breathing out as you fall to try and keep the body more relaxed so the impact is dispersed rather than being absorbed by the body when it is tense which can lead to injury. Roll out the impact.
If able, try to tuck and roll to decrease the energy from the impact being absorbed by the body and causing injury.

Q: When should someone consider scheduling an assessment and appointments with a PT?

Unfortunately, many people don’t seek assistance for addressing balance or falls until they have already had a fall. It’s never too early to schedule an appointment or assessment with a PT for a thorough assessment of strength, range of motion, functional mobility, quality of walking, and standardized balance testing to determine if you are at risk of falling and to provide exercises, tips, and strategies to decrease fall risk, minimize risk of injury and increase confidence and safe mobility.

Falling is not a normal part of aging. Balance and strength can be improved at any age. Even if falling/balance is not a concern for you at this time, it is important to adopt healthy lifestyle habits now to keep your body healthy, strong, and moving well to improve your quality of life and set you up for success in the future and decrease your fall risk.