The Risks and Assessments
Falls are the most common cause of injury amongst older Canadians. Every year, it is estimated that 1 in 3 seniors aged 65 years and older are likely to fall at least once. In addition, the risks and negative health outcomes from having a fall increase in older adulthood. Being informed and knowledgeable about the risks of falling is a helpful way to address this.
Risk factors for having a fall:
- History of falling: Have you experienced a fall recently? Studies have found that experiencing a fall within the past 12 months is a risk factor for having another fall.
- Fear of falling: Are you worried or afraid of falling again? Fear of having a fall is a risk factor that can negatively impact your health and quality of life. For example, after experiencing a fall, you might go out less often to prevent a future fall. Being less active can weaken your muscles and make it more difficult to walk. Ultimately, these factors feed into a cycle of being at risk for another fall.
- Impaired balance and muscle weakness: Do you have trouble with your balance when you are getting up and/or moving? Do you experience fatigue and/or dizziness? These factors may also put you at risk for falling.
- Decline in senses: Have you had any difficulties with your vision or hearing? Do you have peripheral neuropathy? Being able to understand sensory information from your environment helps you navigate around obstacles. However, you may experience a decline in these abilities when entering older adulthood. Vision can also be affected by some types of arthritis. Older adults with vision loss are more vulnerable as they experience double the amount of falls compared to older adults without vision loss (Canadian Association of Optometrists, n.d). Hearing loss is also associated with falls, where people with mild hearing loss are “three times more likely to have a history of falls” (Lin, & Ferrucci, 2013, as cited in John Hopkins Medicine, 2012).
- Medication: What are the side effects of your medication? Certain types of medications, such as psychotropic medication and non-steroidal anti-inflammatory drugs (NSAIDs), may make you more vulnerable to falling. More importantly, studies have also found being on more than 4 or 5 medications is associated with increased falls risk.
Evaluation for being at risk for falls
If your healthcare provider is concerned that you may be at risk for falling, they may refer you to other services or healthcare providers for further evaluation.
A physiotherapist or occupational therapist can assess your risk of falls. Typically, this would involve instructing you to perform specific movements/actions or keep certain postures to see how well you can maintain your balance. A home safety assessment can also help decrease the risk of falling when you are at home. Home assessments are usually performed by occupational therapists who enter your home and evaluate the safety of your environment as well as how you interact with it. They will provide you with recommendations on how things can be changed at home as well as equipment that can help minimize the risk of falling.
After a home safety assessment, your occupational therapist may recommend you make changes to your home environment. This might include the following suggestions:
- Use a non-slip bathmat on a shower floor
- Consider installing a grab bar which will provide you with extra support when moving in and out of the shower or tub.
- Keep your home clean and clutter-free to prevent tripping.
- Secure loose rugs with double sided tape or a slip-resistant backing — or remove loose rugs from your home.
- Store items where they can be easily reached.
- Improve visibility in your space by installing extra light switches and nightlights so that hallways and stairways stay well-lit.
- Slow down your movement. This is especially important when you are transferring from sitting to stand and walking on unstable surfaces or different heights, such as going up ramps, stairs, into a car, or bus.
- Ask for help. When you feel that doing a task is not safe, such as reaching an item high up on a shelf, ask for someone to help get it for you.
You can learn more about these and other environmental modifications at the Government of Canada’s You CAN prevent falls! Resource.
Stay active. Whether this means starting an exercise routine at home, joining an exercise group, or going out for a walk, there are many ways you can engage in exercise. Exercises that help strengthen your muscles, such as using resistance bands or light weights, as well as exercises that improve your balance, such as Tai Chi are especially helpful for falls prevention. Learn more about exercises safe for people with arthritis in our Staying Active online learning module.
Understand the side effects of your medication. If you experience any issues with your medication, such as excessive dizziness that make you feel unsafe or concerned of falling, review your medication with your healthcare provider. Depending on your healthcare provider’s judgement from the medication review, they may make changes to your medication to help reduce your risk of falling. This may result with changes in drug dosage, switching to a safer alternative, or even stopping the use of a drug.
Assistive devices can help prevent falls. Making small adjustments with the everyday items you use can make a big difference. For example, wearing comfortably fitted shoes with appropriate traction and using a cane can help with improve your balance by providing you with stability when you walk outside.
- Using devices that help with your senses, such as glasses and hearing aids with the right prescription can help you be more aware of your surroundings. Scheduling regular checkups for your vision and hearing can help you monitor them over time. Identifying sensory problems early can give you the opportunity to get the appropriate assistive devices or other appropriate interventions to help prevent future falls.
For more information about assistive devices, visit our flourish article on Top Tools: Assistive Devices. If you are unsure about which assistive devices are right for you, ask your healthcare provider for recommendations.
There are many steps you can take to prevent falls, from modifying your space to keeping your muscles strong. You can learn more about other ways to improve your day-to-day life in our Daily Living online module.
Content created by Stephanie Au, MScOT, with expert advice from:
Dr. Alan Low, BSc. (Pharm.), Pharm. D., RPh, ACPR, RCHSP, CCD
Primary Care Pharmacist and Pharmacy Lead, BioPro Biologics Pharmacy
Clinical Associate Professor, Faculty of Pharmaceutical Sciences, UBC
Marlee Shloush, MScPT
Arthritis Rehabilitation and Education Program (AREP)