The Importance of Fall Prevention

Author: Dr. Aaron Bass, PT, CSCS

Falls may seem harmless most of the time. However, the importance of fall prevention in older populations cannot be understated. Falls are the leading cause of injury-related death and non-fatal injuries among adults ages 65 and older, and the prevalence is rising.^1,2 Falls often cause a litany of non-life-threatening injuries such as hip, wrist, and shoulder fractures that can lead to serious complications and often require surgery to resolve. The aftermath of these types of injuries is often activity restriction that results in a sedentary lifestyle that can have serious detrimental affects on health and quality of life.^3,4 Sedentary lifestyle can increase risk of cardiovascular problems, certain types of cancer, cognitive decline, dementia, Alzheimer’s, recurrent falls, weakness, and decreased independence.⁴ Even the falls that do not result in immediate injury can have long term affects. Adults who fall and are not injured often report an increased fear of falling that can lead to a decrease in activity and an increased risk of falling again.³

The point of this article is not to scare you into walking on egg shells out of a constant fear of falling. In fact, the aim of this article is to do the opposite, to encourage regular movement and activity and stress the importance of fall prevention. You should be aware of which risk factors are present that may increase the risk of falling and take steps where possible to address them. There are certainly factors that may not be in your control or are much more difficult to address including vision problems, multiple medications, neuropathy, COPD, hypertension, and urinary incontinence.^1,5 However, there are many other risk factors that can be addressed more simply such as lower body weakness, vitamin deficiencies, alcohol consumption, improper footwear, and home hazards.^1,5 Home hazards include poor lighting, cluttered floors, thick rugs, multiple changes of surface, lack of quality hand rails, and slippery surfaces. 

So, what can you do to address these risks? Simply being aware of the risk is a great start. Fall prevention education has been shown to lead to positive results regarding awareness and decrease of fall risk due to behavior change.⁶ Considering cognitive impairment significantly increases risk for falls, participating in activities that can improve cognitive function could be helpful. Puzzles, memory games, strategy games, reading, changing daily routines, socializing, or learning new skills are excellent options. Developing new skills requires your brain to create and/or strengthen neural connections that can improve overall brain health and function. 

Participating in regular physical activity is also one of the most important steps towards fall prevention. Exercise does not have to be complicated. You do not need to go to your nearest Crossfit gym and learn how to throw hundreds of pounds around (unless you want to, in which case, more power to you). You can simply start a weekly routine that includes some combination of cardiovascular, strengthening, and balance activities. Low intensity cardiovascular activities could include walking, swimming, stationary bike, or elliptical. Ideally, most of these activities would involve standing to promote joint and bone health as well as balance. If walking makes you nervous, start in a controlled environment with flat surfaces and minimal tripping hazards. Strengthening can be as simple as practicing multiple repetitions of standing up from a chair and sitting back down, stepping up and down on your stairs at home, squatting, or bending over to pick-up an item and placing it back down. For those who thrive in a group setting or when following a specific exercise plan, there is no shortage of exercise classes or strengthening programs you can subscribe to or join. 

So how can you know the extent of your fall risk? Many tests and measures have been developed specifically for assessing fall risk in older adults. Most of these should be performed with a certified professional to ensure safety. However, there are some simple informal tests you can do yourself. How difficult is it for you to stand up from the floor? How difficult is it for you to stand up from a chair without using your arms? Are you able to stand with one foot in front of the other with heel touching toe? Are you able to stand on one foot? These tests may not be perfect, but they can be effective in giving you a general idea of your own fall risk. If any of these are difficult for you, you may want to consider physical therapy to promote fall prevention and help ensure your own safety, health, and quality of life. 

1. Centers for Disease Control and Prevention. (n.d.-b). Older adult falls data. Centers for Disease Control and Prevention. https://www.cdc.gov/falls/data-research/index.html 
2. Get the facts on falls prevention. Get the Facts on Falls Prevention. (n.d.). https://www.ncoa.org/article/get-the-facts-on-falls-prevention/ 
3. Centers for Disease Control and Prevention. (n.d.). Facts about falls. Centers for Disease Control and Prevention. https://www.cdc.gov/falls/data-research/facts-stats/index.html 
4. Cunningham C, O’ Sullivan R, Caserotti P, Tully MA. Consequences of physical inactivity in older adults: A systematic review of reviews and meta-analyses. Scand J Med Sci Sports. 2020 May;30(5):816-827. doi: 10.1111/sms.13616. Epub 2020 Feb 4. PMID: 32020713.
5. Ha VT, Nguyen TN, Nguyen TX, Nguyen HTT, Nguyen TTH, Nguyen AT, Pham T, Vu HTT. Prevalence and Factors Associated with Falls among Older Outpatients. Int J Environ Res Public Health. 2021 Apr 12;18(8):4041. doi: 10.3390/ijerph18084041. PMID: 33921355; PMCID: PMC8070134.
6. Ong MF, Soh KL, Saimon R, Wai MW, Mortell M, Soh KG. Fall prevention education to reduce fall risk among community-dwelling older persons: A systematic review. J Nurs Manag. 2021 Nov;29(8):2674-2688. doi: 10.1111/jonm.13434. Epub 2021 Aug 26. PMID: 34331491; PMCID: PMC9291009.