Senior Safety: Intervention or Treatment for Fall Risks

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 possibly remove or lessen your risk for falls.

Environmental hazards

Environmental hazards are any items in your home that may cause a slip, trip, or another 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 walking path 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 walk path 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 on the floor of the tub.  You should look in areas that you may spend time such as the garage, yard, or a hobby 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 caregiver 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 walk path 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 entrance/exit AND in your bathroom near or in the shower/tub.
  • Have a physical therapy evaluation for appropriate gait devices to help you walk. You may need a wheelchair for long distances or to use your home.
  • Occupational therapy will evaluate adaptive equipment in the home to perform activities of daily living easier and safer.
  • Consider organized group exercising such as tai chi, yoga, pilates, lightweight training, walking or an aquatics class. It is safer to exercise with a partner or group.

Poor physical condition:

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 in.
  • Referral to a nutritionist or dietitian 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 regularly 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 refer you to a specialist to help your vision.
  • You may need a special cane for poor vision or partial blindness
  • to improve your lighting in your home to help your vision.
  • place lighting at each end of the hallway and stairs at top and bottom.  Use fluorescent 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 walk path and unnecessary furniture out of your main living areas.
  • If you have the 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 an 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 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 physician or physical therapist but only if you are in a safe environment with very little chance of falling or you have the assistance of another person.

Muscle atrophy, dehydration, and malnutrition

These three conditions may be brought on by an acute illness.  An acute illness may be due to a new medical condition or a 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 condition may lead to depression, either way the resulting physical condition increases their risk for a fall.

  • You should address any illness immediately by seeking medical attention.
  • Family and/or caregiver 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 the physician or pharmacists.

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 physician 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, sedatives/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 increase 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 pharmacists to check side effects or interactions and supplements if needed.
  • Home safety assessment is done and physical therapy evaluation if needed for strengthening and education to family/caregiver on transferring, ambulating, and keeping a 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 anticoagulant 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 another form of contact such as a life alert system.