Am I Going to Fall?

Being a fall risk means you have factors that give you a higher chance of falling.  Many people don't know they have risk factors that lead to a fall. 

What are the risk factors for a fall?  And do you have one or many and can these factors be removed or changed to lessen your chance of falling?  What can I do next to help decrease my risk and prevent a fall?

Many of these questions are asked by the elderly and any aged person that has previously fallen or been hospitalized.  If you have returned home from the hospital followng an illness, a fall or surgery thennyou may be very weak.  Weakness places a person at risk for a fall.  If you have had a recent fall then you are at a higher risk to fall again within 6 months.

Fall Risk Factors in the home:  Some factors rate at a higher risk than others.

The following list are medical conditions that place you at risk of falling.  Most people that fall have more than one risk factor.

  •    deconditioning or general weakness
  •    Vertigo or dizziness/giddiness
  •    hip fracture
  •    Peripheral neuropathy
  •    diabetes
  •    stroke
  •    orthostatic hypotension
  •    Parkinson's disease
  •    Dementia
  •    Alzheimer's
  •    depression
  •    Osteoporosis
  •    Blindness

   

Other factors such as symptoms, mobility level or present living situations may place you at risk of a fall.  Some of these are:

  •    Recent fall in the previous year
  •    high pain or chronic pain
  •    Weakness or foot drop
  •    poor balance(you trip or lose your balance on a regular basis)
  •    use of an assistive device to walk
  •    use of a wheelchair as your primary locomotion
  •    poor sensation in your feet
  •    poor vision
  •    tripping hazards in your home or an unsafe environment
  •    incontinence
  •    dizziness &/or inner ear problems
  •    current infection or sickness
  •    dehydration or malnutrition
  •    Low physical activity level &/or social activity level(no regular exercise program or regular social activities)
  •    Taking more than 3 medications a day
  •    Taking medications such as diuretics, laxatives, sedatvies/hypnotics, vasodilators, antihypertensives and antidepressants.
  •    Impaired mental status or sudden decrease in mental status such as confusion or disorientation
  •    Over the age of 80 is a risk alone.  Over the age of 65 including other risk factors such as taking more than three medications daily.
  •    recent hip fracture
  •    Females
  • vitamin D deficiency

  

The most common FALL risk factors are:

   1. Environmental hazards

   2. Poor physical conditon or decondtioning that has resulted in one or more of the following: weakness, paralysis or balance problems.  This risk factor usually involves the use of an assistive device such as a walker, cane or wheelchair.  Many people that have deconditioning have had a recent illness or an orthopedic surgery and have recently been discharged from the hospital.  Other conditions that lead to deconditioning may be a new diagnosis that has lead to weakness or sensation or balance problems such as a stroke. An old diagnosis that suddenly become worse or exacerbated may cause an increase in physical limitations.  Most conditions lead to the use of an assistive device or an assistive device should be used to decrease a fall risk.     

   3.  Poor Vision

   4.  Vertigo or vestibular problems

   5.  Sudden illness or depression that has not been treated and resulted in one or more of the following: muscle atrophy, dehydration, and malnutrition and even altered mental status  An illness may cause decreased orientation and poor problem solving abilities which may be very dangerous.  Illnessess that can be easily treated by a prescription medication may become serious quickly if gone untreated.   Some illnesses are new ones or old illnessess that have suddenly worsened & caused physical limitations. Depression may be the primary or it may be the result of the physical limitation.  The condition can cause a fall and the medication side effects used for these conditions may cause the fall.

   6. Specific medication side effects are known to cause falls & taking more than three medications a day.  High fall risk medications:  diuretics, laxatives, sedatvies/hypnotics, vasodilators, antihypertensives and antidepressants.

Other medical conditions

   Some conditions are overlooked, unknown or not reported to family or a physician may be:

  • incontinence
  • drop in blood pressure or undiagnosed orthostatic hypotension
  • vitamin D deficiency.

Special Vulnerable Populations

 There are other factors that may be present that place patients in a special vulnerable population due to their risk of serious injury or even death from a fall.  This special population includes impaired mental status, newly disabled person, osteoporosis, post-operative, on anti-coagulants, and over 85 years old.  Most of these patients are not sent directly home or have previously been in a skilled nursing facility or a 24hour care residential home.   Patients that have had a recent orthopedic surgery or a newly disabling procedure will most likely undergo a rehabilitation period prior to being sent home. Home health care is continued if the patient needs nursing care or physical therapy and is home bound.  The common diagnoses that are placed  in special populations of fall risk categories are altered mental status, stroke with poor problem solving abilities or judgement, amputees, traumatic brain injury and brain syndromes such as Parkinson's, Dementia or Alzheimer's. 

If you feel like you or a family member is in the special vulverable population at risk for falls and needs more assistance in the home or intervention of some kind then you should get assistance for your self or your loved one immediately in the home to prevent a fall.  You may try a consult with a physician or contact your insurance to explore other options or placement for a safer environment.  You or your loved one may need to be somewhere temporarily until further safer arrangements are made for them at home where there is care more often at home to prevent falls or in an assisted type living setting.

 Now I know I am at risk...what do I do? 

If you have one or more of the common risk factors associated with falls then try to match the intervention or treatment up with the risk factors.

It seems simple and might be sometimes if you need minor changes in your home such as a grab bar.  But for some factors you must be diligent, resourceful, responsible, and you might have to ask for help from other people in your inner circle such as your family, friends, health care professionals, neighbors, and other people that are in your life in one form or another.  You may ask for help and that person may need your help in another way and then you can help each other.  I like to call helping each other the Partner Program. The partner program for safer adults can be any type of program you develop that includes contact daily with another person(s) and includes steps that help you be safer in your home.  The Partner Program should help keep you fall free and injury free for a long time. 

Let's get started!  See below some solutions to the fall risk factors that are common.  There are some solutions to your specific risk factor that might be difficult to get accustomed to or adjust to BUT will be worth it in the long run because you will be safer. 

Helpful resources: People  

Some of the people that can help you and some of the outlets that can help you are below:

  • Children, grandchildren, parents, spouse, siblings or other family members that are close or able to assist in one way or another.
  • Your physicians or specialists, pharmacists or other health care provider that you see on a regular basis.  Some others might be a counselor, patient liason or nurse, and group leader or mental professional.
  • Close friends, Church members or friends at church, pastors or community leaders.

These are just a few ideas of people in your life that can help you be safer at home.  Many people have stories, ideas and can contribute in different ways to help you make changes to a safer life.

Helpful resources: Services or Companies

Some companies provide help in your home to make it safe from falls & injuries.

  • Home safety assessments may be provided from local companies that offer professionals to evaulate the safety of your home. Home contractors or remodeling companies can make large remodeling to your home such as building a ramp or remodeling a bathroom to make it wheelchair accessible.   
  • Home health companies offer nursing services, physical therapy, occupational therapy and speech therapy.  Equipment needs may be addressed to help make your home safer and your daily tasks and living activities easier.
  • Hospitals in your local area may provide physical therapy near you or in your home to improve your strength and balance, order any needed equipment and give recommendations on needed changes to your home for safety.  Outpatient physical therapy clinics near you may also provide strengthening, balance training and assess any home needs.  Your physician may be able to order these services. 
  • Medical supply companies in your area can provide you with needed equipment.  Help you with what might be covered under your insurance & provide you with contact for new additions to your home such as a new ramp or shower unit. Your local hospital or your physician may be able to refer you to a professional to help you choose what you need.
  • Alert monitoring systems that provide emergency call monitoring that will contact emergency services if you fall.
  • Your local church may provide you with resources for equipment or help in the home.
  • Social workers or care coordinators may help you with services in the home.  Check your local phone book or a smartphone application for local city or state services if needed.

Matching your Risk to an Intervention or Treatment:

   Each fall risk below gives you several choices for intervention to help you correct your risk and possibley remove or lessen your risk for falls. 

      Environmental hazards: 

         Environmental hazards are any items in your home that may cause a slip, trip or other type of injury resulting in a fall.  Look around your home for fall hazards.  Begin by looking at your entrance to your home and see what may cause you to fall.  Is the walkpath to your front door or side door clear of debris or uneven terrain that may cause a slip or trip?  Are any stairs in poor condition or is there a handrail to hold for balance?  How is the lighting leading to the door and is the door or screen easy to open?  Then as you enter your home check every living area for other hazards that may cause a fall.  Some items of hazard may be small items in your walkpath such as shoes, rubs, furniture, clothing, cords, etc.  Other items of hazard may be water on the floor, broken flooring or raised flooring in a walking path, broken furniture or equipment, poor lighting, unsecured throw rugs or wrinkled carpet, stairs in poor condition or not made to standard and no handrails.  Look at your bath/shower area where many falls happen to check for safe grab bars and non-skid surface in the floor of the tub.  You should look in areas that you may spend time such as the garage, yard or a hobbie room of your home.  

      The following are intervention tools you may choose to help you make your home safer and free of environmental hazards.

  • Have a professional home safety assessment
  • Home health referral for physical therapy. 
  • Have your family or care giver remove fall hazards from your home by printing our checklists & making safety changes.
  • Contact a social worker to see if you may need assistance in making major needed changes to your home for safety. Your physician may be able to refer you to a specialist or order a home safety assessment or social worker consult.
  • Install an Emergency Response System in your home that provides monitoring 24 hours a day in the event you fall.  Many people chose to install these alert systems if they live alone and have had a recent fall or have one or more risk factors. 
  • You may need to hire a professional contractor to have specific areas of your home safer to move around.  Many common remodeling areas in the home that are needed for fall prevention are the bathroom to make the shower and toilet easier to use and adding a ramp to the entrance of your home.  Make needed repairs to uneven flooring or damaged flooring.  You may need to replace flooring or repair damaged stairs by a professional contractor or carpenter.
  • Consider rearranging your furniture in your home to make moving from one room to another easier & safer.  You may need to move a bedroom from the upstairs to the downstairs to avoid climbing stairs if this is a physical problem for you.  You may need to move your living room furniture in different places to make your walkpath more direct & to use sturdy furniture to hold while you walk to a chair or the bed. 
  • Sturdy rails & grab bars should be installed at all steps or uneven levels of your home inside at at entrance/exit AND in your bathroom near or in the shower/tub.
  • Have physical therapy evaulation for appropriate gait device to help you walk. You may need a wheelchair for long distances or to use you home.
  • Occupational therapy will evaluate for adaptive equipment in the home to perform activities of daily living easier and safer.
  • Consider organized group exercising such as tai chi, yoga, pilates, light weight training, walking or an aquatics class. It is safer to exercise with a partner or group.            

      Poor physical conditon:

       Poor physical condition or decondition may be the result of one or more of the following: musculoskeletal injury or neurological condition leaving you weak & with poor balance, recent fall or use an assistive device to walk or use of a wheelchair as primary locomotion.

  • Consult your primary care physician for possible referrals to the needed areas to get stronger or address other conditions.
  • See a physical therapist in the home or outpatient setting.  You may need a referral from your physician depending on the type of insurance you have or the state you live.
  • Referral to a nutritionist or dietition may help you change your diet to have more strength and get your recommended daily vitamins, minerals, and calories that you need.
  • See a professional exercise trainer if your physician clears to exercise. 
  • Get involved in physical activity with a partner or group and get involved in other social activities or hobbies to stay active.  It is recommended you discuss any new activity or exercise with your physician for your health safety.

  • If you have had a recent fall or live alone you should consider getting an alert monitoring system that will contact emergency services in the event you fall or are unable to be reached daily by the monitoring device. If you can not afford or do not want to get an alert system then you should begin a partner program with a family member or friend that you regulary keep in contact with on a daily basis for safety and your protection in the event you need medical attention. 

   Poor Vision

  • See your eye doctor or primary care physician to refer you to a specialist to help your vision.
  • You may need a special cane for poor vision or partial blindness
  • improve your lighting in your home to help your vision. 
  • place lighting at each end of hallway and stairs at top and bottom.  Use flourescent lighting which is brighter & less expensive.
  • place color strips & textured strips at areas where the terrain changes height to warn.
  • place furniture is easy places of your home so you may hold for a guide throughout your home
  • keep items off the floor especially in your walkpath and unnecessary furniture out of your main living areas.
  • If you have double vision you should see an eye doctor & special glasses or a patch may help during certain times of the day to help decrease the double vision when you need to be mobile.
  • If you drive and have vision problems you could be risking your safety and the safety of others.  Consider having a driving test that may be offered at rehabilitation centers near you. 

   "Dizziness" that falls under vestibular problems such as vertigo

  • See a specialist for your vertigo or vestibular problems.  Your primary care physician can refer you to a physical therapist, neurologist, or an ear nose & throat specialist(ENT) to check your ears.  You may be dizzy due to other reasons such as inner ear infection that may clear from a prescription from your physician.  You may have low blood pressure or certain medicines may be causing your dizziness and seeing a physician may help you find out what the cause may be.
  • If you are diagnosed with vertigo then you should see a physical therapist for vestibular rehabilitation.  Check with your local physical therapy clinics or your physician may be able to refer you to a vestibular clinic.
  • You should avoid the movements that cause the dizziness such as quick position changes or turning your head quickly to the side that causes the dizziness.  Move slower when changing positions.  You may be unsafe during walking or driving if your vertigo becomes worse.  You do not want to decrease your activity due to the fact you could become weaker but you do not want to be unsafe during your activities.  You should consider using an assistive device, move slower when changing positions and avoid turning your head quickly unless you are on a firm surface or lying down. Do not drive if you have been experiencing vertigo during driving. Vertigo typically occurs if you turn your head too fast to one side or change positions too fast.  During walking or driving you may experience vertigo which may cause a fall or harm to yourself or others. 
  • You may perform exercises for your vertigo if prescribed by your phsyician or physical therapist but only if you are in a safe environment with very little chance of falling or you have assistance of another person. 

 

   Muscle atrophy, dehydration, and manlnutrition

   These three conditions may be brought on by an acute illness.  An acute illness may be due to a new medical condition or long standing medical condition that has suddenly worsened or exacerbated.  Illnesses may physiological such as a bacterial infection or it may be psychological such as clinical depression.  Any type of illness that goes untreated, rather it is physical or mental, may lead to severe problems such as muscle atrophy, dehydration, and malnutrition. A person may have depression by itself or their physiological conditoin may lead to depression, either way the resulting physical condition increase their risk for a fall. 

  • You should address any illness immediately by seeking medical attention. 

  • Family and/or care giver intervention should be present at all times to help prevent another illness and monitor signs of another illness beginning.

  • Medications that are used to treat illnesses may increase your chance of falling also and make sure you know the side effects and if you should stop taking them if serious side effects occur such as an allergic reaction.  Medications may need to be addressed by physician or pharmacist.

   Medications: three or more medications may be a warning sign of being a fall risk.

  •       check the list of medications and their known side effects and discuss peak times of medication with your nurse to know when to take them safely.  Taking medicines should always be done according to your physician's prescribing dosage amount and frequency and at the same time of day.  Sometimes your physicain or pharmacist can give you suggestions of when to take a medicine so it doesn't increase your chances of falling.
  • See if your medications fall in the high fall risk category such as diuretics, laxatives, sedatvies/hypnotics, vasodilators, antihypertensives and antidepressants.

Special Vulnerable Population for fall risk

 Any medical condition that has resulted in decreased mental alertness, decreased memory or orientation, poor problem solving abilities. Some of the medical conditions that may have these mental or cognitive problems are stroke, traumatic head injury, brain hemorrhage, Parkinson's, Dementia, or Alzheimer's.  There are also psychological problems or chemical imbalances that increases a person's fall risk due to the medication side effects. 

  • This population of fall risk should be supervised & may need several treatment interventions from several different areas of medical care such as physician consult, nursing care, physical therapy, occupational therapy, home assessment and family education.
  • Equipment needs should be addressed such as hip protectors, helmets and beds should be lowered to decrease injury from a fall.
  • Medications should be addressed by physicians and/or pharmacist to check side effects or interactions and supplements if needed.
  • Home safety assessment done and physical therapy evaluation if needed for strengthening and education to family/care giver on transferring, ambulating and keeping person active.

 

 ***No matter what your situation is in your home you should have daily contact with someone.  If you live with family or another person let them know what you are doing & have a phone with you. If you live alone then you should have daily contact with someone so you are monitored and that someone will call for medical attention or check on you if they are unable to reach you by phone or door contact.  An accident may happen in your home and if you live alone you may not be able to get to a phone to contact someone for help.  If you are on an anti-coagulant and have a head trauma then you may have a serious injury  Time is crucial if you have had a serious injury and the quicker you get medical attention then your chances of recovery are greater.  Make a program or begin a routine to have daily contact with someone and more than once a day through one or more of the following: family member(s), church, social outing groups, neighbors, or other form of contacts such as a life alert system. 

   

   


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