- Evaluation – What increases a person’s risk of falling?
- Exercise – How does it help?
- Environment – What can I do to increase home safety?
- Education – How do I bring fall prevention into practice?
Falls are a significant health risk. Falls are the leading cause of injury related to hospitalization. Falls threaten a person’s health and their quality of life.
Adults with developmental disabilities have an increased risk of falling – 1 in 3 compared to 1 in 5 in the general population over the age of 65. In addition, they are more likely to experience an injury, such as a broken bone or head injury, after a fall. And, with each fall, the chance of falling increases.
People who fall, even if they are not injured, may develop a fear of falling. A fear of falling can cause a person to limit their daily activities, both social and physical. Again, the chance of falling increases.
Falls are preventable. As a supporter, you can help prevent falls by practicing the four “E”s:
Most falls are caused by a combination of personal and environmental risk factors. Personal risk factors include side effects from medication, underlying medical conditions, poor eyesight, unsteady gait and balance, and muscle weakness. Environmental factors such as poor lighting, unstable furniture, clutter and other hazards in the home, also contribute to falls.
Evaluation of personal risk of falling is the first step in planning for fall prevention. The more risks a person has, the greater their chance of falling. The risk of falling is increased for a person who:
- Has fallen before;
- Has difficulty walking;
- Has poor balance and muscle weakness;
- Has difficulty rising from a low chair or bed;
- Has poor eyesight or hearing;
- Gets dizzy or light-headed when standing or turning;
- Has a Vitamin D deficiency;
- Uses an assistive device such as a wheelchair, cane or walker;
Takes multiple medications;
- Uses medications such as tranquilizers, sedatives, antidepressants or antipsychotics;
- Takes medications, including over the counter medications, that cause drowsiness;
- Suffers from confusion, depression or memory loss;
- Has foot pain or wears improper footwear; and,
- Has a fear of falling.
Begin the evaluation by asking these simple questions.
✔ Did the person fall in the past year?
✔ Does the person seem unsteady when standing or walking?
✔ Do they worry about falling?
If the answer is “Yes” to any of these questions, further evaluation is needed. Complete the “Supporter Resource: Risk for Falling Checklist” to help identify personal risk factors.
The next step is to talk to the person’s doctor about the person’s fall risk. Start with the completed checklist. Discuss medical conditions such as epilepsy or osteoporosis that may increase a person’s risk of falling and injury. Urinary tract infections can cause disorientation and fatigue.
Treating osteoporosis with calcium supplements and weight bearing activities can help reduce the risk of injury. Ask the doctor about the need for supplements and what types of activities are best.
Talk to the doctor to understand how medications may affect a person’s strength and balance. A person taking four or more medications has more than twice the risk of falling.
Among other things, the doctor may recommend:
- Changing medications;
- Consulting with a physical therapist; and,
- Taking other tests.
Have an eye doctor check vision and renew eyeglass prescriptions each year. Poor vision makes it difficult for the person to walk up and down stairs, detect variations in surface elevation and see objects that may make them trip and fall.
Assistive devices such as wheelchairs, canes and walkers are meant to decrease risk. However, they may create an additional risk factor if not maintained or used properly. Make sure assistive devices are kept in good repair and are used correctly. Also, make sure the person has comfortable and proper foot wear.
Everyone can benefit from exercise. Physical activities – walking gardening, dancing, swimming, Tai Chi – can all help to increase strength, mobility and balance for all individuals, but especially those at risk for falling.
Exercise and physical activity help a person:
- Maintain and improve their physical strength and fitness;
- Improve their ability to do everyday activities;
- Improve their balance;
- Manage and improve diabetes, heart disease, osteoporosis and other diseases; and,
- Reduce feelings of depression and improve mood and overall well-being.
Explore the community. Go for a walk. Find classes offered through churches, parks and recreation services, or senior centers. All of these provide exercise classes specifically designed to increase strength and balance.
Getting people interested and committed to an exercise program isn’t always easy. Go4Life provides motivational ideas for both support staff and persons at risk. The site also provides activities and exercises specifically designed to help people build balance and keep from falling.
Work together to create a plan for safe physical activity (what, when, where) and do it. Everyone will benefit.
Most falls happen in the home. Falls are often due to hazards that are easy to fix – but also easy to overlook. Find and fix hazards in the home using the “Check for Safety: A Home Fall Prevention Checklist”. Look at floors, stairs and steps, kitchen, bathroom and bedrooms for:
- Poorly lit rooms, hallways and stairwells;
- Broken or uneven steps or other surfaces;
- Throw rugs that can be tripped over;
- No handrails along stairs or in the bathroom;
- Broken or unstable furniture;
- Wet slippery surfaces;
- Unexpected obstacles; and,
- Wires, cords and clutter.
Identify and then remove or fix all environmental hazards. Most things are simple fixes that can literally save a person’s life.
Also be aware of outdoor hazards such as uneven sidewalks, curbs, and slippery streets after a rain. Make sure people have shoes fit for the activity and weather.
Make fall prevention a priority and learn how to recognize risks for falls and prevention steps to take. Learn to identify, remove, or fix environmental hazards, or report problems as needed. And finally make sure you and persons at risk know how to prevent falls and what to do if someone falls.
SafetyNet Fall Prevention learning tools are designed to help you educate yourself and people at risk. (http://ddssafety.net/safety/fall-prevention/training-guide-fall-prevention)
Develop a fall prevention plan for every person identified as being at risk. Develop and implement the fall prevention plan with the person at risk and as needed, their doctor, physical therapist and others. Make sure everyone knows what to do. Include:
- A plan for regular physical activity that fits with the person’s interests and abilities;
- A plan for proper use and maintenance of assistive devices;
- An annual appointment with the person’s eye doctor to review vision;
- An annual visit with the person’s doctor to review medications and talk about medical conditions that increase fall risk; and,
- A plan for regular re-evaluation of personal and environmental risks.
Keep awareness high. Check for success. Meet the person at risk on a regular basis to discuss implementation of fall prevention plans. Review documentation from any falls. Talk about what worked or didn’t work for the individual. Make changes to the plan as necessary.
Continue to evaluate for personal and environmental risks. With some “frequent fallers,” causes of falls cannot always be identified. Instead, develop a plan of support to reduce as many risks of injury as possible.
Stay calm. Be aware that the person who has fallen may be shaken or even in shock. Carefully and quickly assess the situation.
1. Listen to what the person is telling you.
2. Observe the position of the person’s body and look for signs of bleeding, broken bones, or breathing problems.
3. Ask the individual what he or she is feeling.
4. Call 911 for emergency help! If a person appears to be seriously hurt, is bleeding badly, or complains of sharp pain, call 911. Do not move them.
5. Notify the person’s doctor and give them details of the fall - when, where and how the person fell.
6. Document what happened – both the fall and follow-up. Keep a running log of falls to develop a history of falls. The documentation should be completed after every fall and include:
- Previous falls - What is the person’s history of falls?
- Symptoms - What happened before the fall?
- Location – Where did the person fall?
- Activity – What was the person doing at the time of the fall?
- Time – What was the date and hour of the day?
- Incident - Was there an injury? Did the person receive treatment?
Falls can be prevented. As a supporter, you can help the people you support stay safe:
- Evaluate for personal risk factors. Identify persons at increased risk.
- Ensure people have vision checked annually and keep glasses updated.
- Have a doctor or pharmacist routinely check all medications, including over the counter medications, for increased risk of falls.
Exercise – Exercise – Exercise
- Promote healthy lifestyles including access to physical activity. Participation in a good balance or exercise program is key to fall prevention.
- Ensure home and community safety. Conduct onsite home safety checks and make necessary changes.
- Make fall prevention a priority. Educate yourself and people at risk as to its importance.
- Develop and implement individualized fall prevention plans for people at risk.
For recommendations on use and links to “You Can Prevent Falls” checklists, tip sheets, and fall prevention video for supporters, providers, and individuals, see:
- Supporter Article: You Can Prevent Falls
- Supporter Resource: Risk for Falling Checklist
- Supporter Resource: What to Do if Someone Falls
- Knowledge Check: Fall Prevention
Tools for Individuals:
- Tip Sheet #1 Check Your Risk for Falling
- Tip Sheet #2 6 Steps to Keep You From Falling
- Tip Sheet #3 What to Do If I Fall?
- Video: You Can Keep from Falling
For additional information on fall prevention go to:
- Check for Safety: A Home Fall Prevention Checklist
- Stop Falls
- Centers for Disease Control and Prevention - Stopping Elderly Accidents, Deaths and Injuries
- Go 4 Life