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by Joon Nah   BScPT
Certified Vestibular Physiotherapist
updated June 18, 2022


Falls are one of the most common risks to health and safety, particularly as we age and become older adults. In fact, one in three seniors fall each year. Falls can lead to fractures, head injuries, emergency room visits, in-patient hospital stays and even a significant increase in death rate.

Falls also lead to more falls; it’s the number one predictor of future fall risk. So you can take even one fall as a clear sign that you should be doing something about it. See you doctor or physiotherapist to assess why you are more likely to fall and for help to identify your risk factors and core issues.

Fortunately, the majority of falls can be prevented. Here is a guide to help you reduce your risk of falling.

 

Identify the root cause of an increased fall risk

The best way to reduce your risk of falls is to find out why you are at risk in the first place. This helps to ensure that any changes you make will result in long term improvements in fall prevention. Falls may also be the first sign you have an underlying condition that you may not be aware of.

Here are some conditions that may be the root cause of your issue with falls:

Vision Issues

This may include worsening eyesight (visual acuity) that may require glasses or a change in prescription. It could also be other issues such as cataracts and optic nerve impairments that are common to older adults.

Hearing Loss

Better hearing can certainly alert you to issues that may compromise your stability, such as other people, traffic, and objects moving or shifting. However hearing actually helps your head better sense where you are in space through the detection of echoes and sound reflections.

Diabetes and Heart Disease

These are two of the most common ailments that affect our aging population. When they are not properly controlled, they can produce poor sensation in our legs and arms, intermittent dizziness and vertigo, an increase in fainting episodes, slower reflexes, muscle weakness and fatigue.

Side Effects from Medications

Dizziness, lightheadedness, drowsiness, confusion and blood pressure changes are among the side-effects listed on nearly every type of medication. The risk increases when you take more than one medication at the same time, or when dosages are incorrect.

Postural Hypotension

Also called Orthostatic Hypotension, this is a condition where your blood pressure suddenly drops when you change position (typically from lying to sitting and from sitting to standing).

Arthritis

Osteoarthritis can cause pain and joint instability. When this type of arthritis affects your feet and ankles, knees, hips or spine it can confuse your body’s natural sensation of position and can make you react inappropriately to motion.

Foot alignment

A foot that has an abnormally high arch or that is excessively flat can cause problems with your gait (the way you walk) and can also produce instability and pain.

Aging

As older adults, we all experience inevitable changes to our bodies that will affect our risk for falling. These include slower reflexes, weaker muscles, stiffer joints, higher levels of fatigue and poorer coordination.

Lifestyle and dietary habits

Certain behaviors and habits can have direct impacts on fall prevention. Some of these include alcoholism and drug use, missing meals, eating an unbalanced diet, dehydration and inactivity.

 

How to reduce your fall risk

1. Physiotherapy

Physiotherapists are trained to identify impairments of muscles, nerves and joints and develop a treatment plan to help you address those issues properly. A skilled physiotherapist can get to the root of your problem so that you’re fixing the issue rather than “managing” it. Addressing fall prevention properly usually starts here.

A physiotherapy assessment will involve a thorough history taking, so they can understand the progression of your condition and how it affects your life. Your physical therapist will then perform a number of tests to highlight areas that are contributing to your problem. This will include a gait assessment to observe the way you move and change position.

Physical therapy treatment will typically involve a home exercise program that targets the key areas that need strengthening, stretching and mobilizing and provide you with education on preventing falls.

2. Physical activity

This is our most importance piece of advice for fall prevention strategies. Increasing your activity level has a wide array of benefits that directly impact your stability. Among them are:

  • Increased strength and endurance
  • Improved sense of position (from our joints and from our inner ear balance system)
  • Faster reflexes and reaction time
  • Less confusion and improved head clarity
  • Improved heart and organ function improving blood flow

If you’ve already fallen, don’t let your fear of falling again stop you from being more active. In the long run, inactivity will only increase the chances you’ll continue to fall.

Here are suggestions for some helpful activities:

Walking

A free activity that virtually everyone can do, walking should be done as often as possible, for as long as you can safely handle. If you’re having some trouble getting started, we suggest using walking stick/poles to help with balance and endurance, particularly if your paths are uneven. Regular walking is the best activity for preventing falls.

Tai Chi

This is a Chinese martial art which can be performed alone or in a group. It focuses on slow, purposeful movements in specific patterns that challenge your balance and coordination. It has become immensely popular with older adults for fall prevention and you can find online resources and classes nearly everywhere.

Yoga

The coordination, strength, flexibility and focus that a good yoga session can provide is an enjoyable way for many to improve balance and stability. Again the online and community resources for this activity are plentiful.

Personal Training

Personal trainers can provide expertise and motivation to keep up with a specially designed workout that builds muscle strength, confidence in motion, endurance and bone density. Be sure to check that your personal trainer has experience working with clients that are older adults or are similar to you.

3. Modify your home environment

Tidy Up

Remove clutter from areas where you would commonly walk. Boxes, books/magazines are tripping hazards. Gather and tie up loose cables and cords. Avoid falls by cleaning up any spills or messes immediately.

Reduce tripping hazards

Secure the edges of rugs and mats with carpet tape (double-sided tape). Make sure that the transitions in flooring from one room to another or in doorways are level. Prevent falls by moving furniture to keep paths wider.

Lighting

Brighten up the dim areas of your home with more light fixtures or brighter bulbs. Add night lights to hallways and bathroom and clear a path in front of light switches. Make sure that your bed lamp is in easy reach and keep a flashlight easily accessible for power outages.

Bathrooms

Use non-slip mats in showers and bathtubs. Purchase a bath/shower seat to sit in while bathing. Install grab bars near the toilet and in the bath. Install a raised toilet seat.

Other suggestions

Add a handrail to both sides of the stairway.
Keep commonly used items in cabinets and drawers that are easier to reach.

4. Gait Aids

We highly recommend the use of a cane or walker if you are at risk for falls. You may not even require the help all day, every day. They can be a great tool for helping you get up from a seated position or for use on longer walks, or in areas where surfaces may be uneven or challenging. A physiotherapist can help assess whether you need a gait aid, what type is best for you, ensure that it’s fitted to your body size, and provide advice on how to use it.

5. Medication check

Double check that you are taking your medications as they’ve been prescribed. Sometimes even properly prescribed drugs can have a negative affect as your conditions change over time, especially if you are taking multiple medications. If you suspect that this is the case, make an appointment with your physician or your pharmacist. Remember, it’s also important not to mix alcohol with your medications.

6. Have your eyes and ears tested

We highly recommend that you seek an assessment from a qualified optometrist. At a minimum, you should be assessed every two years, as some vision problems can be caught early before they result in much larger problems.

Hearing tests should also be performed by an audiologist if you are having hearing complaints. If you’re unsure, ask a family member, as it’s usually more obvious to those around you than to you yourself.

*And remember to always wear your glasses and your hearing aids.

7. What you wear

Footwear

We encourage you to wear well-fitting shoes in the house. Soles should be non-slip or rubberized and you should only wear low-heeled shoes. Stocking feet and slippers sure are comfy but should be avoided.

Clothing

Avoid loose fitting clothing, especially pants or dresses that touch the ground when you’re standing. Use cross body bags and purses rather than handheld ones to keep your hands free and ready to help steady yourself when needed.

8. What you eat and drink

Limit your alcohol as even one drink can affect your body’s ability to balance and be stable.
Keep your blood glucose levels in check by eating healthy and avoid missing meals.
Better nutrition means more strength, better balance and decreased risk of conditions that can worsen your stability. It’s no surprise that we recommend fruits, vegetables, and lean meats as an indirect way to prevent falls.

9. Winter Hazards

Be proactive and check weather reports often to prepare for snow and ice. Then make sure that you salt and de-ice before storms start. If you’re able, clear snow from walkways, driveway, and entry areas. If not, many communities have volunteer snow removal programs for seniors that are free of charge, or come with a small fee. The City of Toronto provides snow clearing services at no cost for elderly or disabled individuals. Check if your town or city has a similar service to help you prevent falls in the winter.

10. Pets

Cats and dogs can get underfoot and be particularly hazardous in the dark. A collar with a bell can be a great way to alert you that they are nearby when you can’t see them.

11. Manage pre-existing conditions

Your ability to stay on top of a chronic medical condition can gradually wane over the years or your long-term problem may worsen over time. In either case, it could have a direct impact on your balance, stability and mobility putting you in danger of falling. Ensure that you are mindful of your symptoms and speak with health professionals regularly to prevent a worsening of your condition. Some chronic conditions in older adults that could lead to falls include:

 

How likely are you to fall?

There are tests that a physiotherapist can do to determine your risk of falling.
However, if you are someone that has been diagnosed as having a high falls risk, here are some further tips:

  • practice getting up from the floor.
  • when getting up from a lying position, sit up first and wait for a full count of 10 before you slowly rise into standing (even if you think you feel ok when you first sit up).
  • always have your phone with you or wear an alert device that can automatically call for help.
  • make plans with a friend or family member who can do a check in call with you once a day.

It’s important to report any fall to your doctor. Even a small fall that you blame on a mistake can be a sign of something more serious and will help you prevent future falls.

NOTE:  Vertigo is NOT a normal sign of aging. It’s often related to an inner ear condition that can be easy to treat by a vestibular physiotherapist. Click here to learn more about BPPV (Benign Paroxysmal Positional Vertigo).


Cornerstone Physiotherapy has physiotherapists experienced in the assessment and treatment of patients who have balance, gait and stability issues. Whether it’s a matter of deconditioning, joint osteoarthritis, or a dizziness issue, we can help. If you’re uncertain whether we are the right health professionals for your condition, we offer a free 10 minute phone consultation. Contact us today!

About the author

Joon Nah

Co-founder, Physiotherapist Learn More about Joon Nah

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