I speak with elders on a regular basis about falls and how to prevent them. Starting out, many elders (and their caregivers) have mistaken beliefs about falling. First, they think that falling is an important issue for older people but not for them. If I fall, I just get up and brush myself off.  I never hurt myself. No big deal.

• The good news is that most falls do not result in injury. Only about 10% of falls experienced by older people will result in physical injury. However, when falling over and over again, the risk of injuring oneself is greatly increased. Falls can lead to hip fractures, spinal cord trauma, brain injury and other serious injuries, which can reduce one’s quality of life and ability to live independently. Falling is not limited to physical injury but can include social withdrawal, psychological trauma (i.e., fear of falling) and increased dependence requiring long-term nursing care. The bottom line? Falls are not benign!  Falls are a big deal!

Second, too many elders still think that if they do fall, the best way to stop falling is to avoid physical activity, as much as possible.

• As a temporary fix, guarding against falls by avoiding activity may work, but over the long run this strategy often fails. Why? Because inactivity actually increases the risk of falling! With any cutback in activity, leg muscles quickly become weak and, as a result, the ability to keep balance and avoid falls diminishes greatly.   

Because of these of false beliefs, fewer than half of all elders see a doctor after a fall. This is not good. Those who decline medical attention are far less likely to find out why they fell and, more importantly, to engage in preventive activities that that might prevent them from falling again.

For elders and their caregivers, falling should be a teachable moment; an opportunity to find out why the fall occurred and how to prevent another fall from happening. As well, it’s good time to address issues surrounding fears over another fall and what to do to in the event of a fall.

Finding the Source of Falling

Falling can be a sign or symptom of an underlying health problem; one that you may not even know about. For this reason, determining the cause of a fall begins with a visit to the doctor, even if no injury as occurred.

The Story of Your Fall

Your doctor will want to know the details of your fall so that he/she can understand what is causing them. To prepare, think about your last fall.

• When was the fall (date/time of day)?
• Where did the fall occur? Outdoors or indoors? If at home, in the bedroom, bathroom, kitchen, etc.?
• What were you doing before the fall?  Walking, bending over/picking up something from the ground, reaching up, getting up from bed/chair or toilet, etc.?
• How did you feel just before you fell? Dizzy, weak, faint, etc.?
• How long were you down on the ground for?
• Did you experience any injuries?
• How did you get up? By yourself? Need assistance?
• Are you afraid or fearful of falling again?
• Have you experienced other falls in the past 3 months? If yes, try to supply descriptions about these events as well. 
Additionally, the doctor will test your balance, vision, strength/flexibility and coordination, mental clarity, and medications. The results will determine your risk of falls and help design a specific plan to avoid falling again.

Avoiding Fear of Falling

Since the fall, are you afraid of falling again?  Have you cut down on your activities as a result?  If the answer is yes, you are not alone. Being fearful of falling and possible injury is a rational or ‘protective’ reaction, which tells us to me more cautious in our everyday activities. However, avoiding activity in hopes of avoiding a fall is not a rational response and, as stated previously, may contribute to the risk of balance loss and falling.

Fear of falling is typically associated with lack of confidence in accomplishing everyday tasks, such as getting in and out of the shower/bathtub, climbing stairs, walking to the bathroom at night, etc. Fear of falling can be minimized by:

• Engaging in exercises that increase muscle strength/balance and build confidence. Physical therapists are a good resource to help with a program that is appropriate for you.
• Using a cane or walker to support unsteady balance.
• Modifying unsafe environments. For instance, if the fall occurred in the bathroom while getting into the bathtub, installing grab bars and placing non-skid rubber strips on the tub bottom helps   support balance/restore confidence. 

What To Do If You Fall

Despite the best efforts to avoid falling, falls are unfortunately going to happen. Here are some tips if you fall:

• First of all, don’t panic. Try to remain calm/assess the situation. Take a few minutes to determine if you are hurt. Do not attempt to get up if you feel you are injured. Try the ‘wiggle check to ensure that you’re okay. While you're down, without moving your arms and legs, wiggle your fingers, then your toes. If you can't wiggle all your fingers/toes or if it's painful to do so, there could be some kind of nerve or bone injury.
• If you live alone, a fall alarm or PERS (Personal Emergency Response System) may be useful. This is a device worn as a neck pendent or wristwatch. In an event of a fall and inability to get up from the ground, the PERS can be used to send a signal to a family member or emergency service for help (I’ll have more to say about PERS in future blogs). Cell phones, with easy speed dial, can be used as an alternative to PERS. 
• If you feel you are not injured and are able to get up, crawl to a strong and stable piece of furniture, like a chair, that you can use as a support to help pull yourself up. 

Click here to get more information on Fall Prevention.

Rein Tideiksaar Ph.D., PA-C (or Dr Rein as he is commonly referred to) is the president of FallPrevent, LLC, Blackwood, NJ, a consulting company that provides educational, legal and marketing services related to fall prevention in the elderly. Dr Tideiksaar is a gerontologist (health care professional who specializes in working with elderly patients) and a geriatric physician's assistant. He has been active in the area of fall prevention for over 30 years, and has directed numerous research projects on falls and has developed fall prevention programs in the community, assisted living, home care, acute care hospital, and nursing facility setting. To learn more, check out the Dr’s professional profile on LinkedIn: http://www.linkedin.com/pub/dr-rein/6/759/592 If you have any questions about preventing falls, please feel free to e-mail Dr. Tideiksaar at drrein@verizon.net.

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