FALL PREVENTION

For most people the idea of falling rarely, if ever, crosses their mind. If it does, for a fleeting moment, they probably decide that if they did fall they would get up, brush off their pride and go on about their business. What if you couldn’t do that? What if when you fell you couldn’t get up, either because you were too weak, or it hurt too much to move? What if every trip to the bathroom was a journey in fear because of the possibility of falling? For many of the 35 million Americans over the age of 65 the "what if " scenario is a frightening reality. One of three Americans over the age of 65 will fall this year. One third of those falls will result in a trip to the emergency room or the Doctor’s office. About 350,000 of those people who fall will break a hip, and their life will be changed forever, or end. The CDC has recommended that you do the following:

Review your medications with your doctor.
There are many side effects of medications, which can increase your risk of falling. If you take medication to control your blood pressure or heart rate you may get dizzy or light headed. If that happens, you need to give yourself extra time to acclimate to changes in position such as getting out of a chair or bed. Any time your doctor gives you a new medication be sure you tell him other medications you’re taking to avoid dangerous drug interactions. The first step in averting the accident is to recognize that you or someone you love is at risk. If you are over 65 and/or have significant health or mobility problems you are at risk of falling.

Have your vision checked regularly.
As we age our vision changes. Those changes are more than just losing the ability to read the fine print. People also have trouble adjusting to changes in light. In that time they are more apt to trip and fall. As people age they also have more trouble with depth perception, so changes in levels of the surface they are walking on can present problems. This can be especially difficult if they wear bifocals or trifocals. Those people need to learn to lower their head and scan the surface they’re walking on.

Take a close look around and see what you can do to make your home safer.
Inside your house and out, there are probably things you can do to make your home safer. Fix loose steps or railings. Remove throw rugs from slippery floors, or at least put double-sided tape on the rug to secure it to the floor. If you have extension cords stretched across the room consider moving appliances or having an electrician install new outlets. Take a look at the lighting in your home. Consider adding fixtures, lamps, or changing the size of bulbs to keep lighting even and consistent. Many falls occur in the bathroom. Put a non-slip surface in your tub or shower. Consider having grab bars installed by your toilet and/or tub/shower.

Start an appropriate exercise program, and stay with it.
Exercise has so many benefits if you’re exercising regularly you reduce your risk of heart disease and stroke as well as helping you to prevent falls. The exercise helps keep you alert so you notice the risks. It increases your strength and balance so you can recover from situations that would otherwise result in a fall. If you have health problems be sure to ask your physician before starting an exercise program.

FACTS REGARDING RISK OF FALLS


Vision
Visual acuity decreases with age. Therefore, periodic eye exams or checkups are recommended. Be aware that either old prescriptions or new prescriptions can alter the visual field and cause falls. Also, clean glasses daily.

Changes in contrast sensitivity occur. This is related to the ability to detect and discriminate objects in the environment. One way to accommodate this is to increase the lighting (wattage).
Decline in depth perception occurs as a decreased ability to judge distances and relationships among objects in the visual field. Stairs, carpets with patterns, and curbs are risk factors for individuals with such declines in depth perception. The person may have difficulty estimating the height of the step and therefore misplace the foot. Or, the person may think that the carpet is uneven and alter balance and walking to accommodate the misperception.

The ability to recover from a sudden exposure to a bright light or glare decreases. When moving from a dark to bright lighted environment or the reverse, the person should pause a second to allow the eyes to accommodate to the change in light.

Feet and Shoes

Over 75% of older adults have foot pain. Foot pain is caused by, but not limited to, thin heel pad, corns, bunions, dry and cracked skin, ingrown or over grown toe nails, and sores. Foot pain can cause a change in the biomechanics or alignment of the body, thereby increasing the risk for falls.

Another potential risk factor for falls is decreased sensation in the feet. This is more noticeable in the person with diabetes, but gradually occurs with the aging process. Sensation can be tested on the person using a Q-tip or something soft and brushing it on the sole of the foot. It is not recommended to use a sharp object (eg, tip of a pen).

Recommended topics here would include daily foot inspection for red areas, sores, condition of toe nails; application of cream; avoidance of abrasive substances such as pumice stone or acid to reduce calluses or corns; and, shoe inspection for worn areas.

Also noteworthy is the condition of the person’s currently worn shoes and slippers. Ill-fitting or badly worn foot wear can lead to tripping and falling or sprains and strains. This problem is especially hazardous when combined with ill-fitting clothing that drags on the floor.

Medications
Four or more medications is a risk factor for falls. Single or multiple medications (polypharmacy) can cause side effects such as dizziness, drowsiness, or low blood pressure. We recommend that prescription medicines and regularly taken over-the- counter medications be checked by the physician or pharmacist

Balance and Gait
A gradual decline in balance abilities and speed of gait occurs with age. These two are linked with activity level. One cause of tripping and stumbling is the anterior tibialis muscle, which dorsiflexes the ankle and toes to clear the toes during walking. With age, it becomes a little ‘out of sync’ in its timing with other muscles in the leg. As a result, the timing of toe clearance is a little off and the toe may catch on the floor. During walking, toe clearance is approximately 1 cm.

Gait speed also decreases and the person may not have sufficient time to cross the street; or may have to hurry to perform various activities. To have to walk faster, particularly when it is associated with anxiety, can cause a fall.

Remaining active and participating in leisure and social activities helps maintain balance and gait.

Blood Pressure

Both high and low blood pressure can cause a person to become unsteady.
When moving from one position to another, such as either from the bed to sitting or from a chair to standing, the person should pause for a couple of moments to let the blood pressure adjust and to orient to the new position.


SUGGESTIONS TO PREVENT FALLS IN YOUR HOME

Remove boxes, stacks of newspapers or magazines, electrical cords and phone cords from walkways. Move coffee tables, magazine racks and plant stands from high-traffic areas. Secure loose rugs with double-faced tape, tacks or a slip-resistant backing. Repair loose wooden floorboards and carpeting right away. Store clothing, dishes, food and other household necessities within easy reach. If you reach too far, you are more likely to fall.Immediately clean spilled liquids, grease or food. Sleep on a bed that’s easy to get in and out of. Replace satiny sheets and comforters with less-slippery cotton or wool ones. Use non-slip mats in your bathtub or shower. Consider handrails for your bathtub or shower.Place a lamp near your bed, and use it when you get up to use the bathroom. Install easily accessible or glow-in-the-dark switches in room entrances. Place night lights in your bedroom, bathroom and hallways-make sure you can see your path to the bathroomInstall light switches at the top and bottom of stairs. Create color contrasts between walls and floors, ideally with lighter colored carpets-consider putting hazard tape on the top and bottom of the stairs. Store flashlights in easy-to-find places in case of power outages.