Fall Prevention for the Elderly: Safety Strategies and Tips

In-home nurse helping senior man walk through his hallway

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Falls are the leading cause of injury in adults 65 and older – with reports showing about 14 million adults fall each year, according to the Centers for Disease Control and Prevention. Not only are falls common among older adults, but they can also lead to more serious injuries when they occur.

Falls can lead to severe health conditions like traumatic brain injuries, bone fractures and even death. According to the CDC, falls are also the leading cause of injury-related death in the 65-and-older population – and the fall death rate is growing.Here’s what to know about what increases risk for falls in older adults, and get familiar with fall prevention tips and safety measures that can help reduce the risk.

Key Takeaways

  • Falls are the leading cause of injury in adults 65 and older – with reports showing about 14 million adults fall each year.
  • Among seniors, almost 80% of falls in the home occur in the bathroom.
  • There are steps you can take to prevent falls, such as removing trip hazards like throw rugs, keeping track of your medications and building muscle strength.

What Causes Falls in Older Adults?

Anyone can slip and fall, but older adults are more prone to falling than younger people.

“That’s because aging affects our muscle strength and flexibility, making it more challenging to maintain balance and stability. Older adults are also more likely to have chronic conditions that can affect their mobility, coordination and overall stability,” says Dr. Esiquio Casillas, senior vice president and chief medical officer for the AltaMed Health Services Program of All-Inclusive Care for the Elderly, or PACE, in the Los Angeles area. “Plus, age-related vision changes and hearing loss can make it harder to navigate and identify potential hazards.”

Some areas of the body in which age-related changes can increase your fall risk include:

  • Eyes, such as partial or total loss of vision.
  • Nerves, including decline in or loss of nerve function, such as sensations in the feet.
  • Bones, such as reductions in bone strength.
  • Muscles, including muscle loss or impaired muscle function.
  • Brain, including challenges with brain coordination.

Diagnoses like Alzheimer’s disease and other dementias, which can develop in older adults but are not natural parts of aging, can also increase risk of falls in older adults due to the disease impact on memory and thinking.

How to Prevent Falls in Older Adults: Health Tips

You can take steps to support your health to improve your balance and reduce your risks of falling. Health tips for preventing falls include:

Regular exercise can keep your body fit and agile so that you’re more capable of balancing and avoiding falls and also more capable of catching yourself if you start to fall.

“Keeping active and regularly exercising muscle groups that are important in walking, bending and balance can help avoid future falls,” Casillas says.

The CDC recommends older adults exercise for 150 minutes a week using moderate-intensity exercises, like brisk walking, or 75 minutes a week of more intense exercise like jogging or hiking. The agency also recommends devoting two days a week to strengthening muscles.

Some people may also benefit from physical therapy to work on strength and balance, says Dr. William Buxton, a board-certified neurologist and the director of neuromuscular and neurodiagnostic medicine and of fall prevention at Pacific Neuroscience Institute in Santa Monica, California.

In a balance-supporting physical therapy routine, Buxton says exercises tend to be focused on leg and core strengthening. Core strengthening can be crucial in relieving tension on other parts of the body, like nerve pressure in the legs or bone spurs in the back, that can impact overall health and fall risks.

Working on balance, posture and even treating niche conditions in the body like ear issues can help with reducing fall risks too, Buxton adds.

A healthy brain and heart can support the body’s ability to balance, so keeping them strong is essential in reducing fall risks.

Taking care of the brain and heart can include managing blood sugar levels and treating conditions like diabetes and prediabetes, which can lead to nerve damage impacting balance, Buxton says.

Healthy vitamin levels support balance. In particular, long-term deficiencies in vitamin B12 may increase fall risks by causing nerve dysfunction in the feet. Evaluating B12 levels is part of the routine workup for assessing balance problems, Buxton says. Your doctor may also suggest you get tested for a B12 deficiency if you are experiencing other unexplained nervous system symptoms like numbness or tingling in your arms or legs, weakness or balance issues, or if your standard blood tests suggest you may be experiencing a type of anemia.

In these cases, taking a vitamin B12 supplement may be a good idea. However, people who are not deficient in vitamin B12 do not need to take a vitamin B12 supplement.

“It’s not something everyone needs to take, but if somebody is having problems with balance, getting B12 tested can lead to an easily correctable factor,” Buxton says.

Certain medications can alter your alertness and make you more prone to losing your balance. For example, antihistamines like Benadryl have anticholinergic properties and can be sedating. Drugs with anticholinergic properties can block the neurotransmitter acetylcholine, which plays a role in involuntary muscle movements. When blocked, the body may be slower to react during certain events, like catching itself during a fall.

If someone who has recently taken Benadryl starts to fall, their brain may not respond as quickly as needed, which can increase the risk of a collision. These drugs can also make people more sleepy during the day, increasing risks of falling asleep – and falling over, Buxton says.

Letting your doctor know about all the prescription and over-the-counter medications you’re taking when discussing your worries about falling enables them to effectively help with fall prevention strategies.

In addition to a single drug that can impact alertness, Casillas explains that polypharmacy, or using five or more drugs at one time, can increase risks for falls.

“Falls often are related to side effects and drug interactions of people taking too many medications,” he adds. “If you are taking five or more medications, speak with your doctor to discuss the risks of polypharmacy and the option of reducing or eliminating unnecessary medications.”

Alcohol can impact alertness and affect balance. Health professionals often advise against alcohol use in older adults, or recommend decreasing alcohol consumption if you are unable to give up drinking.

“Anything more than a drink a day significantly increases risks of falls,” Buxton says.

Alcohol both directly and indirectly increases fall risks in the long term. Indirectly, the drug contributes to damage in the nerves and feet, “which decreases the ability of our feet to give our brain feedback to know where legs are in space, which can throw off balance,” Buxton says. Directly, it is a toxin to the brain, causing harm to the cerebellum – “the balance center of the brain,” he adds.

Drinking alcohol is also sedating in the short term, so it can increase your risk for unintentional injuries like falls. According to the National Institute on Alcohol Abuse and Alcoholism, older adults may be more susceptible to these risks than younger adults as aging can lower the body’s tolerance for alcohol.

Fall Prevention: 7 Steps to Prevent Falls at Home

In addition to taking care of the body, taking care of your home can help reduce your risk of falling.

This can include taking steps to:

Keeping a safe living environment can mean keeping a clean living environment – and decluttering appropriately. Casillas explains that stray or unnecessary items, including decorative furniture, can increase people’s risk for falling in the home.

“At times we save things that have sentimental value or gather items to give to loved ones,” Casillas says. “Other times we’ve become so used to having these items, that we don’t even notice the clutter around our home.”

Getting rid of these items can be emotionally difficult, especially if they hold meaning in your life, but it can be extremely beneficial for your health, he adds.

“This not only lowers your risk of falling or tripping, but it also makes it easier to move around your home – especially if you use a walking assistance device, like a cane or a walker,” Casillas says.

Some furniture or home items to get rid of or store away include:

  • Floor lamps.
  • Boxes.
  • Any item that can obstruct your walkways.
  • Throw rugs.

Casillas emphasizes the importance of removing throw rugs and making sure carpets are firmly fixed to the floor, as these can carry sneaky risks for the older adult population.
“Falls caused by loose rugs and unsecured or damaged carpets are a major cause of injury in adults age 65 or older,” Casillas says. “Over time, both rugs and carpets can bunch or bulk up, making them a trip hazard. While no-slip strips can help keep area rugs in place on tile and wooden floors, they only last so long. Plus, they can easily get caught in a person’s walker.”

Remove clutter from the floor: In addition to clearing household items, Casillas encourages getting in the habit of picking up and putting away stray items that you might trip on, like:

  • Bags.
  • Mail.
  • Loose papers.
  • Laundry.
  • Shoes.
  • Pet accessories and toys.
  • Electric cords.

Preventing falls in the home isn’t solely dependent on removing items – adding helps too. Items to add may include adaptive equipment, like handrails, which can provide you support around the home if you start to lose your balance.

Casillas particularly encourages the use of adaptive equipment in the bathroom, which is one of the most common places for falls. According to the CDC, among seniors, almost 80% of falls in the home occur in the bathroom.

In the bathroom, adaptive equipment items can include:

  • Shower chair.
  • Raised toilet seat.
  • Grab bars in the shower.
  • Grab bars near the toilet.

Straining to reach an item from a high shelf could increase your risk of falling. Keep frequently used items within reach, to avoid the need for a footstool. Keeping the items you regularly use on a lower level where they are accessible can help reduce fall risks.

“Keep routinely used items within reach, at waist or counter–level,” Casillas recommends. “Avoid using step stools and ladders, and do not stand on a chair or table to reach something that’s too high.”

To grab something up high, he recommends using a reach stick or asking for help.

Wearing a fall detection device or programming your Apple Watch to act as a life-alert device can provide you with support if a fall occurs. Fall detection is available in more recent versions of the Apple Watch. To turn on life alert features on the watch, go to Emergency SOS under the My Watch tab and select Fall Detection, then turn on Fall Detection – or ask a loved one to help do this for you.

Wearing a fall detection device can be particularly helpful if you live alone, as they “oftentimes can give the individual, their family members and their doctors comfort in having an added level of security,” Buxton says.

Your ability to see where you are going can impact your ability to safely get from one place to another without falling. In the dark of the night, this is easier said than done. Setting up supports like a night light can help you find your way if you need to get somewhere – for instance, the bathroom – during the night.

While fall-proofing your home can do wonders in your living space, it won’t keep you safe in unfamiliar environments, like someone else’s house. Buxton recommends having a plan for traveling and being aware that fall risks can be higher in unfamiliar places.

“The risk is oftentimes higher in unfamiliar environments because people don’t know what to watch out for,” he explains. “So it’s important to be vigilant always in terms of things that could cause somebody to fall.”

If traveling to see family or friends, you may want to request that they have good lighting turned on and clear pathways before you arrive. On the flip side, if an older relative is visiting your home, be mindful of how you can make your home more safe.

Shoes linked to higher risk of falling include those with high or narrow heels, loose shoes that lack laces, straps or buckles, and shoes with smooth soles. High heels, floppy slippers and shoes with slippery soles can make you trip and fall. So can walking in your socks. Instead, wear properly fitting, sturdy, flat shoes with nonskid soles.

What to Do If You Fall

Falls can lead to serious consequences. So, if you lose your balance it’s important to seek help.

If you fall, the National Institute on Aging recommends taking the following steps:

  • Take deep breaths. This can help you relax.
  • Before you get up, decide if you are hurt. Don’t get up too fast if you are hurt.
  • If hurt, stay put and call for help. You can do this verbally, or through a life-alert device or smart watch if you’re wearing one. Dial a loved one on the phone if accessible or call 911 and wait for help.
  • If you are OK to move, move slowly. The NIA recommends slowly rolling to your side, resting then crawling on your hands and knees to a sturdy chair. When getting onto the chair, put your hands on the chair first and position your body in a kneeling position with one knee down and one foot flat on the floor, before slowly rising yourself up to the chair.


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