The Fall Prevention Alphabet

By: Brandi Singleton, PT, DPT, CCI

You have probably heard at some time or another that falls are a problem. Maybe you even heard it referred to as an epidemic.  Well, neither of these declarations is an overstatement. When this topic arises among healthcare professionals, it is met with an unfortunate familiarity. Aging adults and their loved ones face this subject with fear, apprehension, or unpleasant memories that would rather be forgotten.

When we look at falls from a statistical standpoint, the numbers are alarming.  Each year 30% of adults over the age of 65 experience a fall.  Of these, 20% require visits to the emergency room to treat fall related injuries.  Even more alarming is the number lives lost as a result of falls.  Falls are the leading cause of death from injury in older adults, a number that has increased 30% between 2007 and 2016. In total, medical treatment and care related to falls in the United States cost a staggering 30 billion dollars each year!

Aside from the undeniable statistics, consider the “forgotten falls” that are undocumented. And what about the “fear of falling”, which is often not considered because the tangible evidence is less overt than injuries and 911 calls. But fear of falling is a major contributor to morbidity among older adults. The psychological impact often leads to inactivity and social isolation. This results in an even higher risk for falls due to weakness and immobility related to this crippling fear. Other medical issues soon follow because a person fearful of falling often takes in less fluid in order to minimize the need to walk to the bathroom. This can lead to incontinence, urinary tract infections dehydration and confusion to name a few. The end result of these mounting issues is decreased quality of life.

So, what can we do to prevent falls and to help those with a fear of falling conquer their fears?  First, we must understand that this is not only an issue to be tackled by healthcare providers.  As friends, family, and neighbors of aging seniors, we all play a role in recognizing risk factors.  For so many other illnesses and ailments we know the signs and symptoms, and what to do when we see those signs.  Symptoms of fall risk should be no exception.

So, what are the signs and symptoms that may alert us that we are dealing with a person who is at high risk for falls?  Consider this simple screening process using the Fall Prevention Alphabet. 

Apprehension: Has the individual decreased participating in activities they once enjoyed? Are they less mobile than they used to be?  Do they seem fearful when they are up and moving about?  Do you notice them reaching for furniture and/or walls as they walk around? If you notice these behaviors, you have likely discovered a person with a fear of falling. If these behaviors are ignored, this person is likely to continue to become less active and subsequently less mobile. 

Balance: Does the individual seem to be unsteady when walking around?  Do they lose their balance from time to time?  Have they had any recent falls?  If a person is demonstrating balance issues there is a good chance that they would benefit from interventions to address these issues to improve their safety and mobility.

Cognition: Does the individual have difficulty negotiating the environment safely? Are they less aware of safety hazards?  Do they demonstrate impulsiveness or impaired decision-making?  Do they trip over items that are in plain sight? Cognitive changes often result in an inability to recognize and respond appropriately to hazards.  If you are noticing issues with a person’s memory and decision-making it may be time to take action to improve their safety.

Dysfunction: Has the individual experienced an illness or physical ailment that has affected their mobility? Do they have visual changes or nerve injury that affects sensation and awareness of body position? Is there a pulmonary or cardiac issue that limits endurance? Health care professionals can often help older adults improve mobility and by recommending appropriate compensatory strategies and/or equipment to improve safety and function after illness or injury.

Environment: A common occurrence in the home of an aging adult, is a cluttered environment.  Though this is often a tough topic to discuss, it is critical that it is addressed, because this poses a very large fall risk.  Other environmental factors to consider include: bed height, chair height, thresholds, throw rugs, doorway width, flooring type and condition. 

As we acknowledge National Fall Prevention Awareness Month, remember today and every day the important role you can play in fall prevention for aging adults around you. If you have gone through the fall prevention alphabet and have raised red flags in one or more areas, it is a good time to consult with medical professionals to evaluate and develop a treatment plan. A holistic approach is important to ensure that all risk factors are addressed. Falls are often not prevented just by addressing one risk factor alone, such as balance. This is often one piece of a larger puzzle.  With the Fall Prevention Alphabet, reducing falls can be as simple as ABC!   

Also, to learn more about fall prevention strategies, check out my course with Summit Professional Education here!