Fall Risk- It adds up
What does it mean to be a high fall risk? So many times I sit down and have a conversation with a client or caregiver and I start with the question, “Have there been any falls at home?” The quick answer is oftentimes, no. My skepticism runs high because everyone of all ages has had an experience of falling for many reasons. We are quick to find a line of defense here but the intention of this question isn’t to bring upon shame. I’d rather identify possible issues and correct them BEFORE the fall and injury.
There are plenty of reasons a person can be at high risk of falling and age isn’t the only factor. Yes, if you are over 65 years of age, we consider this an increased risk factor. The reality is that someone’s environment (pets, stairs, thick carpeting, throw rugs, lack of anti slip material in showers) plays a significant role in tripping hazards. Medications can always have side effects, particularly increased lethargy, changes in blood pressure or sometimes even the time of day that medication is taken is affecting the person negatively. If someone is taking several medications including a sleeping aid, pain medication or even a diuretic, that could lead to effects like blood pressure changes and create a greater opportunity to fall.
Many people are already aware of certain diagnoses leading to greater instability like Parkinson’s Disease, neuropathy, chronic pain conditions or a stroke but there are many hidden disorders that you may not be aware of which is why screening and doctor appointments are so important. Another item to consider is someone with a history of depression due to the correlation with lack of activity, motivation and overall health condition.
Fearfulness of falling is something many do not consider but it can also impact your risk. If we have increased anxiety and fear that this event could occur, it tends to limit our physical activity and participation in social events in which now we are losing strength and influence our balance negatively.
When we make a mental checklist of these things that may apply to our loved ones, we normally think about a grading system: no, low, or high fall risk potential. In my clinical practice working with mostly those who are 65 and over, most hit the high mark of fall risk. Of course, I’m also conducting other assessments to get to this conclusion but when having an interview with a client, I am often adding up the factors I’ve mentioned.
Age 65+
3 or more coexisting diagnoses
Prior history of falls
Incontinence
Visual deficits
Impaired walking or ability to dress self (due to fear, pain, sensation issues, poor safety)
Environmental issues (clutter, pets, difficult home entrances)
4 or more prescribed medications
Pain
Cognitive impairments
If any of these apply, 4 or more are considered at greater risk for falls.
So what can we do? It’s important to recognize the risks present even if there isn’t a history of falling. Being confident about balance and strength isn’t necessarily a bad thing but lack of awareness can be harmful. Making appropriate changes to make a home safe by lifting the throw rugs, making one-story setup changes to reduce stair use, and recognizing changes from medications or side effects to look for, are all good starting points in self-awareness. It is critical to improve confidence to live a healthy and steady day-to-day lifestyle while also practicing cautiousness. Yes, as a physical therapist, my ideal scenario is to have a chance to do a balance assessment and identify opportunities for improvement early. The reality is I’m more often coming into the situation AFTER the fall has happened with an injury. Looking for ways to live a safe lifestyle complimented by regular PCP visits, vision checks, therapy screens and overall awareness of any changes puts you and your loved ones at an advantage to stay ahead of the worst F word. Falling.
Written by Kayla Fluder, DPT