How Not to Fall

We may not prevent all falls, but there are many immediate steps to stay safely on our feet most or all the time. This post focuses solely on prevention.

Step 1 – Do a Home Safety Check. Most falls happen in or just outside the home.

Inside the home: secure stair railings on each side, used consistently; well-lit stairways; stair carpet not loose, torn, or so padded it's hard to feel the stair edge; night lights from bedroom to bathroom; bathroom handrails, grab bars, and adhesive tub-floor strips (at least one secure grab bar in the tub/shower is very important); pet food bowls in easy-to-see (ideally raised) locations; extension cords kept out of walkways; slip-resistant rugs, runners, and mats; clear passageways and exits; avoid flip-flops or loose-fitting shoes/slippers; properly located, working smoke detectors; periodic inspection of cane/walker tips for wear.

Outside the home: walkways free of large cracks or loose pavers; secure railings on entry steps; adequate lighting; after snow clearing, use ice-melt products for traction, assume dark/wet pavement patches are icy and walk around them, and consider YakTrax or MICROspikes traction devices; don't use your cell phone while walking.

Step 2 – Do a Body System Check. Regular checkups are a must for impairments that sneak up over time:

• Vision: multiple studies link poor vision to increased fall risk; first-eye cataract surgery reduced fall incidence by one third (Gutiérrez-Robledo et al.); the VISIBLE study found switching from bifocals to single-vision lenses reduced fall rate by up to 40%.
• Hearing and the Vestibular System: hearing loss affects sound perception and can affect balance; people with diminished hearing may also have poorer balance and higher fall risk (needs more research). Inner ear/vestibular disturbances causing dizziness or vertigo can often be successfully treated by physical therapists specializing in vestibular rehabilitation.
• Balance: the simple One Leg Stance Test (near a sturdy object for safety, raise one foot, don't lean on the other leg, eyes open, count seconds held) has normative values by decade: age 20–29, 43.3 sec; age 30–39, 43.3 sec; age 40–49, 40.3 sec; age 50–59, 37.0 sec; age 60–69, 27.0 sec; age 70–79, 17.2 sec; age 80–99, 8.5 sec.

Step 3 – Do A Periodic Medication Review. Medications are a potentially modifiable fall risk factor — examples include antidepressants, anticonvulsants, antipsychotics, and muscle relaxants. Polypharmacy (simultaneous use of multiple medications) is often associated with adverse outcomes including falls; Shaver and colleagues studied over 400,000 records of adults 65+ and found 94% had prescriptions for one or more medications known to increase fall risk. A periodic medication review with a primary care doctor is essential.

Step 4 – Exercise Regularly. Stronger muscles and good posture translate into better stability, improved everyday function, and reduced fall/injury risk. Prioritize an exercise program focused on postural alignment, balance, strength, and body awareness throughout life.

References

1. yaktrax.com
2. rei.com — Kahtoola MICROspikes Traction System
3. Gutiérrez-Robledo LM, et al. Effect of Cataract Surgery on Frequency of Falls among Older Persons: A Systematic Review and Meta-Analysis. J Ophthalmology 2021.
4. Haran MJ, et al. Effect on Falls of Providing Single Lens Distance Vision Glasses to Multifocal Glasses Wearers: VISIBLE Randomised Controlled Trial. British Medical Journal 2010.
5. Carpenter MG, Campos JL. The Effects of Hearing Loss on Balance: A Critical Review. Ear and Hearing 2020;41 Suppl 1:107S-119S.
6. Shaver AL, et al. Trends in Fall-related Mortality and Fall Risk Increasing Drugs Among Older Individuals in the United States, 1999-2017. Pharmacoepidemiology and Drug Safety 2021 Aug;30(8):1049-1056.