Fall Prevention in The Elderly – High Risk for Falls?

Fall Prevention

Are you at high risk for falls? If you’re older, the answer is likely yes. This article focuses on fall prevention for the elderly and the steps you can take to stay safe.

It’s a topic I never thought I’d find myself writing about—until yesterday. While trying to take off my jeans in the closet, I nearly lost my balance. That’s when it hit me: good gracious, I’m at high risk for falls too!

Nursing School

As a retired nurse practitioner, I can’t help but think back to my old nursing classes. I vividly remember how incredibly boring it was to study some of the phases in Erikson’s stages of development!

It was all pretty fascinating—until we got to stages 7 and 8. Watching a baby or toddler do something and proudly announcing to your friends, “That’s a classic stage 1 or 2 behavior,” was fun. We felt like such experts. But when it came to those final stages, the excitement faded. Learning how to deal with aging parents felt like a distant issue, something for the future or for someone else to worry about. But life has a way of reminding us—it’s not so distant after all. Learning how to deal with aging parents. You think that’s for the future, or that’s for someone else. Not so.

Erikson’s Stages of Development

• Trust vs Mistrust (birth to 18 mo) – Stage 1
• Autonomy vs Shame and Doubt (18 mo to 2-3 yr) – Stage 2
• Initiative vs Guilt (3 -5 yr) – Stage 3
• Industry vs Inferiority (6 – 11 yr) – Stage 4
• Identity vs Confusion (12 – 18 yr) – Stage 5
• Intimacy vs Isolation (19 – 40 yr) – Stage 6
• Generativity vs Stagnation (40 – 65 yr) – Stage 7
• Integrity vs Despair (age 65 to death) – Stage 8

So here we are, right in the thick of Integrity vs. Despair. Don’t worry—I’m not here to give you a lecture on this stage of development. Instead, I’m focusing on something more immediate: the high risk of falls (and trust me, I’m right here with you on this one). Let’s go over some practical tips to help prevent or reduce the chances of a serious fall.

Fall Stats

First off we need to look at exactly how many falls are occurring among our age group. According to the CDC: You might be surprised, I sure was!

• About 36 million falls are reported among the elderly each year, resulting in more than 32,000 deaths (This is astounding to me!)
• About 3 million elderly adults are treated in the ER for a fall injury. (Been there, done that, how about you?)
• One out of every 5 falls causes an injury such as a broken bone or head injury. (Both my parents had hip fractures.)
• Each year at least 300,000 elderly are hospitalized for hip fractures. (Both my parents.)
• More than 95% of hip fractures are caused by falling, usually falling sideways. (My dad fell like that, and he passed away within a week.)
• Women fall more often than men and account for 75% of all hip fractures. (My mom turned over the bed and had a hip fracture.)

What Can We Do?

There are plenty of practical steps we can take to help prevent falls in the elderly! Let’s focus on realistic, everyday actions that are within our control. While we can’t change factors like age or genetics, we can certainly address and improve other risk factors.

Health

It’s clear that staying as healthy as possible is essential for many reasons. But when it comes to fall prevention, there are specific areas we can actively work on. Simply understanding how certain factors affect our risk of falls can be incredibly eye-opening—and empowering.

Pursue Optimal Weight

• Obesity is linked to a higher risk of falls, but being underweight increases the risk of fractures. While some might find a bit of comfort in this fact, it’s important to remember: bone density isn’t directly tied to body weight. Maintaining a healthy, balanced weight is key for overall health and fall prevention.

Stay Active and strengthen your core

• Regular exercise, lightweight training, and staying active are essential for building strength and stability. A strong core improves your ability to recover and prevent a fall when you stumble—and it’s bound to happen at some point.
• Consider trying Tai Chi as well. This gentle, flowing practice is excellent for enhancing balance, flexibility, and overall body awareness, all of which help reduce the risk of falls.

Medications

• Review your medications with your doctor and eliminate any that aren’t absolutely necessary. Be sure to ask about side effects, as some medications—particularly those for blood pressure—can cause lightheadedness or dizziness (a condition known as orthostatic hypotension). Muscle relaxants, sleeping pills, and pain medications can also come with significant side effects that may increase your risk of falls..
• To manage orthostatic hypotension, take your time when changing positions. Sit on the edge of the bed for a few seconds before standing, and once you’re upright, pause again before walking. The same applies when getting up from a chair—stand and steady yourself before moving.
• If you’ve reached the point where an assistive device like a walker or cane is necessary, don’t let embarrassment hold you back. Prioritizing your health and safety is far more important!

Your Environment

When it comes to fall prevention for the elderly, assessing the environment is crucial. Let’s take a closer look at key areas in the home—the living room, bedroom, bathroom, and kitchen—to identify potential hazards and make them safer.

Living Area

• It’s time to sort through your belongings and declutter your home! A tidy, organized space not only makes it safer to move around but also makes cleaning easier and more manageable.
• Take the time to sort through the items you’ve been holding onto. Invite your children to take what they’d like now, and discard anything that’s no longer needed. Donate usable items to charity, and keep only a few meaningful mementos. Letting go of the rest will create a safer, more streamlined space for you to enjoy.

I know decluttering can be a challenge—trust me! We downsized six years ago, and even after all the things we sold or gave away, we still ended up putting boxes in the attic. Those boxes haven’t been touched in years, which really makes you wonder—how important were they after all?

Floors

• Throw rugs and accent rugs can be a tripping hazard, but let’s be realistic—we all use them, especially at doorways. Instead of removing them entirely, make sure they’re non-skid or secured to the floor with double-sided carpet tape designed for safety.
• Ensure that larger rugs are firmly anchored and free of curled-up corners that could cause you to trip. Use rug grippers or non-slip pads to keep them flat and in place.Make sure larger rugs are secure and don’t have corners that curl up that could cause you to trip.
• Electrical plugins on the floor, keep any cords out of the walkway.
• Position your furniture to allow for clear, open pathways, so you can move around freely without zig-zagging through a maze of tables and chairs. Remember, downsizing helps!
• Keep walkways free and uncluttered.

Lighting

• Use nightlights in living areas or leave a lamp on to ensure safe navigation at night. If you or your spouse worry about the light bill, think about the potential cost of a fall with a broken bone! Opt for LED nightlights—they’re energy-efficient and cost only about $0.17 a year to run, so you can use as many as you need without worry.

watch out for Pets

• Most of us have furry friends, and while they don’t mean any harm, they can be a hidden hazard. Pets often move softly, quietly, and quickly, appearing at your feet in a nanosecond without warning.
• In our home, we crate our dog when we have company—not because he isn’t loving, but because he’s big and can be a bit unpredictable in crowded spaces. We’re always mindful of where he is, but I can’t shake the thought that it’s only a matter of time before he accidentally causes one of us to fall. I hope that day never comes!

Kitchen

• Wipe any spills up immediately.
• Forego waxed floors. Do people still wax floors anyway?
• Do not get up on countertops! Well, that’s kind of a no-brainer, most of us don’t have the strength to get up on the countertop. But, don’t use a step stool and then get on the countertop!
• Avoid using a step stool whenever possible. If you absolutely must use one, choose a sturdy stool with just a single step for added safety.
• If you’re storing items in cabinets that require a step ladder to reach, it’s time to stop using them! This ties right back to decluttering. I have cabinets in my home that require a 6-foot ladder to access, and honestly, anything stored up there might as well have been donated or thrown away—it’s just not worth the risk to retrieve them.
• Take my Christmas dishes, for example. I haven’t laid eyes on them in years! If I ever decide they’re truly essential, I’ll ask one of my grandchildren to get them for me. After that, I’ll store them somewhere more accessible. And really, isn’t helping with things like this what grandchildren are for? 😊

Bedroom

Bedrooms account for 30% of falls that occur in homes without stairs. In homes with stairs, approximately 14% of falls among older adults occur on or from the stairs or steps.

• Use nightlights or leave the bathroom light on with the door cracked.
• If you must have absolute darkness to sleep, use an eye mask and remove it before getting up.
• Keep your phone on the nightstand.
• Keep a flashlight on the nightstand in case of a power failure.
• Evaluate the height of your bed—if it’s too low, it can be difficult to get up, and if it’s too high, you risk falling when sliding off. Aim for a height that allows you to get in and out safely and comfortably.
• Avoid tossing clothes, pillows, or anything else on the floor when you go to bed (guilty as charged!). A clutter-free floor reduces the risk of tripping during the night or when getting up in the morning.
• Keep a chair or sturdy stool where you change clothes. Mine is in the closet. It’s a dressing stool and the perfect height for sitting when putting on my shoes.

Consider adding an LED light to your closet or other safe space. We have one stuck on the wall in our closet, which we got from Amazon. In case of a tornado or emergency, if we can’t make it to Carrie’s house (where they have a safe room), the closet is our fallback. Having that light ready provides extra safety and peace of mind.

Bathroom

My last fall happened in the bathroom on a wet tile floor. Even though I thought I was being careful, I still slipped. Water on tile can be incredibly dangerous. Thankfully, I didn’t break anything, but the experience made me much more cautious about getting in and out of the shower or tub.

When we built our current home, we were fortunate to incorporate some safety features, thanks to Carrie’s encouragement. One bathroom includes a shower with a built-in seat, a handrail in the shower, and handrails near the bathtub and toilet. The shower door has a flat threshold, allowing for easy wheelchair access if needed in the future. Additionally, all the doors in the house are wide enough to accommodate a wheelchair, ensuring accessibility and safety for years to come.

Not everyone has the benefit of building a home with safety features in mind. If you’ve lived in your house for years without them, you’re not alone—we did too for a long time. Fortunately, you can add safety features to an older home. Handrails, for example, are available for purchase and can be securely installed on tile walls and other surfaces to enhance safety.

• Handrails
• Non-slip bathmats
• Shower seat
• Shelf for soaps and shampoo so you don’t have to bend over
• Raised toilet seat
• Nightlight
• Make sure drains work freely and water doesn’t pool on the floor of the shower.

Stairs

We don’t have stairs in this house, but the main thing I can say about them is to avoid them like the plaque! Sometimes you can’t of course, so here are a few fall prevention tips for the elderly.

• Handrails on both sides when possible
• Remove any rugs at the top of the stairs
• Keep stairs clear of all objects – pretty Pinterest pictures show plants and decor decorating steps. Avoid this.
• Good lighting

Outside

• Good lighting
• Install handrails for steps
• Repair any loosened bricks, tiles, or wood
• Keep the area clear of water hoses or spills
• Remove tree roots that protrude from the ground

Personal

• Baggy clothes or pants too long can lead to falls
• Sock feet! Just don’t walk around the house in sock feet! But if you must, use socks with non-skid soles like they use in the hospital. Alligator feet that’s what we called them….they look so bad it will prompt you to put your shoes on!
• Flip Flops are cute and comfy in the summertime, but at this point, it’s best to avoid them.
• Opt for house shoes with a secure back, non-skid bottoms, and a snug fit. Avoid slides or loose-fitting shoes that can easily slip off or cause you to lose your footing.
• Be vigilant when you’re out shopping or traveling. Use the handrail on escalators!
• Stay off ladders. Let someone younger do that.
• Stay out of the attic whenever possible. We recently rented a storage unit specifically to avoid the hassle and risk of putting the Christmas tree and decorations up in the attic again. Naturally, we ended up finding plenty of other things to store there too! 😊

On a recent trip, I found myself juggling a rolling suitcase, purse, and sweater while teetering on the escalator step, trying to avoid touching the handrail—Covid concerns, of course! Eventually, I realized it was safer to hold onto the rail and just use hand sanitizer afterward. Prioritizing stability over germs is always the better choice.

final thoughts

I hope these tips have been helpful—and not too discouraging! It can be tough to accept that these precautions are necessary to protect ourselves from falls, but awareness is key. Even when we’re doing everything right, it’s still possible to trip over a flat floor while wearing sturdy shoes in good lighting. Sometimes, it just happens! After all, it doesn’t take a banana peel to send us tumbling. Stay safe and take care!

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