Falls and Fall Prevention Among Older Adults

Larry Weiss

Falls are a major threat to the health and independence of older adults. Each year, one in three older adults aged 65 and older experiences a fall, and people who fall once are two to three times more likely to fall again. Every second of every day, an older adult (age 65+) falls in the U.S. Falls can be devastating, I know firsthand. Several years ago, my sister at age 50 fell down her stairs and died. Then, last year I fell, which resulted in brain surgery, a 5 week stay in rehab, and about a year to fully recover. Falls are the leading cause of nonfatal injuries among older adults. One out of ten falls causes a serious injury, such as a hip fracture or head injury, which requires hospitalization. Due to falls, every 11 seconds an older adult is treated in the emergency room; and, every 19 minutes an older adult dies. In addition to the physical and emotional pain, many people need to spend at least a year recovering in a long-term care facility. Some are never able to live independently again. I was lucky and have been able to recover.

Falls can be deadly. Among older adults, falls are also the leading cause of fatal injuries. Each year, many older adults die as a result of falls. The rate of falls and related deaths among older adults in the United States has been rising steadily over the past decade. Falls result in more than 3 million injuries treated in emergency departments annually, including over 800,000 hospitalizations and more than 32,000 deaths. Each year about $50 billion is spent on medical costs related to non-fatal fall injuries and $754 million is spent related to fatal falls.

Falls are preventable. People are living longer and falls will increase unless we make a serious  commitment to providing effective fall prevention programs. Falls are not an inevitable consequence of aging. However, falls do occur more often among older adults because fall risk factors increase with age. A fall risk factor is something that increases a person’s chances of falling. This may be a biological characteristic, a behavior, or an aspect of the environment. These risk factors include: Muscle weakness or balance problems; Medication side effects and/or interactions; Chronic health conditions such as arthritis and stroke; Vision changes and vision loss; Loss of sensation in feet; Behavioral risk factors; Inactivity; Risky behaviors such as standing on a chair in place of a step stool; Alcohol use; Environmental risk factors; Clutter and tripping hazards; Poor lighting; Lack of stair railings; Lack of grab bars inside and outside the tub or shower; Poorly designed public spaces.

Usually two or more risk factors interact to cause a fall (such as poor balance and low vision). The more risk factors a person has, the greater their chances of falling. These shocking statistics highlight the importance of preventing falls by taking deliberate precautions. Age related losses in muscle strength, flexibility, or balance reactions can be addressed through balance, strength assessments, or rehabilitation therapy.

Some issues associated with falls:

  • When an older adult falls, their hospital stays are almost twice longer than those of elder patients who are admitted for any other reason.
  • The risk of falling increases with age and is greater for women than men.
  • Annually, falls are reported by one-third of all people over the age of 65.
  • Two-thirds of those who fall will do so again within six months.
  • Alcohol or substance use;
  • Socioeconomic factors including poverty, overcrowded housing;
  • Among people aged 65 to 69, one out of every 200 falls results in a hip fracture. That number increases to one out of every 10 for those aged 85 and older.
  • One-fourth of seniors who fracture a hip from a fall will die within six months of the injury.
  • The most profound effect of falling is the loss of functioning associated with independent living. A growing number of older adults’ fear falling and, as a result, limit their activities and social engagements. This can result in further physical decline, depression, social isolation, and feelings of helplessness. 

Areas that we need to pay attention to:

Low vision: Many elders have vision problems like macular degeneration and glaucoma, making it hard for them to see obstacles or hazards when walking.

Weakness and Balance Issues: Without consistent efforts to improve strength and balance, older adults will become weaker, losing muscle mass, flexibility, and endurance. Balance deteriorates due to inactivity, which may increase the odds of a fall. 

Poor Lighting and Accessibility Features: Nighttime is a prime time for falls. Low lighting along the pathway to the bathroom, in particular, can increase risk. Missing bathroom accessibility features like a shower chair or grab bars make it difficult for a weaker person to bathe or use the bathroom safely. Adding adequate lighting to the bathroom and throughout the home is a cost efficient and easy update that will greatly improve the safety of the home.

Medication Problems: You probably think we can manage medications appropriately, just follow the prescription directions. Medication mismanagement is a huge problem leading to multiple issues for older adults.  Approximately 30 percent of hospital admissions are drug-related due to mismanagement and interactions. Here are some of the common medication issues that contribute to falls:

  • Even with proper medication management, many medications cause dizziness and lightheadedness. 
  • Mixing several different medications can cause balance problems. More than half of people age 65 and over report taking four or more drugs.
  • Most importantly, consult a “geriatric trained pharmacist” for drug interactions with other medications and over the counter meds.

Poor Hearing: This may not seem like a fall risk, but even mild hearing loss can increase falls. According to the American Speech and Language Association, the risk of a fall increases by 140 percent for every 1 decibel of hearing loss.

Doctor visit: Request a medication review (perhaps eliminating some medications is possible) and a hearing and eye examination. Check for dehydration, a common problem for elders. Dehydration can lead to low blood pressure and dizziness. 

Exercise: Gradual increase of activity is critical. The safest way to approach this idea is to ask for a physical therapy evaluation. A physical therapist can “start low and go slow” by evaluating your medical condition and making recommendations to increase balance, strength, and endurance. A healthier, stronger person is less likely to fall, and recovery will be faster if they do.

Grab Bars and Accessibility Additions: Waiting for a fall or some other crisis will leave you scrambling at the last minute, so be pro-active and have a physical therapist work with you to make your home safe.  At a minimum, think about installing grab bars in the bathroom, a toilet riser, stair rails, and a shower chair with a handheld shower nozzle. There are now plenty of beautifully designed grab bars and accessibility products that will blend right in while providing safety.

And lastly, stairs are hazardous, and many older homes are multi-level, requiring some significant renovations to eliminate the use of stairs. While this may be a larger change, it may be well worth it. At least, always have a hand free walking up and down stairs in case you need to grab on to the railing. 

Eliminate Clutter:  We are very attached to our home environments and we may not even realize that we have clutter. Start by making small, achievable steps. Get rid of throw rugs or make sure they have non-skid backing or a non-skid underlayment and that they don’t have edges that curl. Clear pathways to common areas like the kitchen and bathroom. Clutter is likely to return, so this needs to be made an ongoing effort. 

There are four essential components of a complete Fall Prevention program:

  • Education;
  • Behavior change;
  • An initial exercise intervention designed to improve to a certain baseline level those physical attributes that affect fall risk (balance, gait, strength and flexibility); and
  • An ongoing exercise program that you take part in indefinitely, and which is designed to maintain and improve the physical attributes that relate to falls.

There is no question that we all have to be aware of the impact that falling has on all of our lives and the community. Each one of us, as well as community organizations and government programs have to open our eyes and work on fall prevention. Prevention pays off in many ways.

Falls are preventable. Click here for more resources on Home Modifications and Medical Equipment.

For more information on other resources, please call the Community Foundation at 775-333-5499.


Lawrence J. Weiss, Ph.D.