Fall Prevention

Some things that can increase the risk for having a fall include:

• Having obstacles like rugs, cords, clutter, or loose steps in the home
• Changes in vision
• Decreased strength or sensation
• Dizziness or unsteadiness
• Medications or use of other substances
• Being sleepy
• Blood pressure changes
• Not wearing the most appropriate footwear for an activity
• Not using an assistive device (like a cane) correctly
• Being on unsteady or slippery surfaces

Individual risk factors

• Difficulty with walking and balance
• Lack physical or mental exercise
• Poor eating habits, eating unhealthy foods, or not drinking enough water
• Various medical conditions and medications may increase the risk of falls.
• Stroke, arthritis, or vestibular problems
• Blood pressure medications

A fear of falling can make people less active, which can lead to weakness and a higher risk for having falls. The good news is that there are things you can do to prevent falls, including:

• Remove clutter and obstacles in your home.
• Secure rugs in the home.
• Keep your home brightly lit so you can see clearly and use lamps and/or nightlights.
• Add grab bars and non-slip mats in the bathrooms to increase safety with slippery surfaces.
• Use handrails on the stairs and install non-slip treads on steps.
• Find out the side effects of any medication you are taking and let your doctor or pharmacist know if your medication makes you feel dizzy.
• Let your medical providers know all medications and supplements you are taking.
• Limit alcohol use.
• Get enough sleep.
• Stand up slowly if you have any lightheadedness or unsteadiness when getting up from a chair or bed.
• If you use an assistive device, like a cane or walker, make sure you have been trained on how to use it properly. Your doctor or physical therapist can make recommendations about appropriate devices and help fit the device to you.
• Wear supportive, non-skid footwear.
• If you are losing your balance, having falls (or near falls), or are worried about falling, let a medical professional know. Tell your doctor about any falls you have had, even if you caught yourself or did not get injured.
• Ask your doctor about receiving a fall risk assessment if you have noticed changes with your balance or walking.
• Ask your doctor about being referred to physical therapy if you are having dizziness, unsteadiness, have had stumbles or falls, or have changes in strength or sensation.

Additional fall prevention tips

• Physical exercise: Better strength and balance can lower risk of falls. Walking, body weight exercises, and weightlifting can help improve your strength. Yoga, Pilates, and Tai chi are great ways to work on balance and flexibility. A physical therapist (PT) and occupational therapist (OT) can help you create an exercise routine.
• Exercise your mind: Sometimes not paying attention can cause a fall. To sharpen your mind, work on more than one task at a time. A speech therapist or OT can give you things to do at home.
• Nutrition and health: Eating too little or unhealthy foods can lead to weakness and bone loss, making it easier to fall or cause more injury after a fall. A dietician can help. Keep up with annual physicals and ask your doctor about taking Vitamin D to improve bone, muscle, and nerve health. Make sure to drink enough water.
• Medications: Talk with your health care team about your list of medications and supplements. Some medications can make you feel off balance, drowsy or lightheaded, which could lead to a fall.
• Diabetes management: Keep your blood sugar at a stable level to prevent feeling faint. In the long run, it can prevent damage to eyesight, weakness, or losing foot sensation.
• Vision: Follow up with yearly vision check-ups and be sure to have eyeglasses checked. Brain injury or stroke may affect your ability to judge distance, ability to see clearly, and deal with changes in lighting. Work with a neuro-optometrist, a specialist in vision after brain injury and occupational therapist (OT) to help with individual vision challenges.
• Ear disorders: After a head injury, sudden changes in head position or certain activities may trigger dizziness, vertigo, or loss of balance. It is important to talk with an ENT doctor and a PT for treatment.
• Dizziness: Blood pressure can drop when you go from lying down to sitting up, or from sitting to standing making you feel dizzy, lightheaded, or weak. Do not walk if you feel dizzy and drink 6-8 glasses of water each day—unless you have been told to limit your fluid intake. Talk with your doctor about what you can do.
• Foot care: Foot pain or poor footwear can increase risk of falls. Do not wear slippers and socks or go shoeless. Make sure shoes fit well, have good support, and have thin, non-slip soles. See a foot specialist and PT. Always wear the recommended foot braces or orthotics for weakness or decreased sensation in the feet.
• Always wear helmets: When riding bikes, skates, skateboards, motorcycles, all-terrain vehicles, and horses or when playing contact sports such as football, softball, or skiing, make sure to wear a helmet.
• Assistive devices: Your physical therapist (PT) can recommend the right walking device such as a walker, cane, or wheelchair. Make sure they are fitted to your size and replace worn out or broken parts such as tips of walkers and canes.
• Choose a safer way to do things: Leave big jobs like gutter cleaning or painting the house to the professionals. Keep everyday items within easy reach, take your time, and pay attention. Avoid walking on wet surfaces, clean up spills, and don’t rush. Ensure all rooms are well-lit and bedside lights are within easy reach. Use night lights in the bedroom and/or bathroom.
• Transfers: If you are helping someone move from a chair/couch, bed, or car, make sure you have been trained by a professional to use good body positioning. A physical therapist (PT) can teach you how to transfer others safely.
• Home modifications: Most falls happen in the home. Speak with your PT and OT and review the home safety section for ideas on home layouts. Keep stairs and floors clutter-free and remove cords. Remove loose rugs or use double-sided tape to keep the rugs from slipping. Put railings on both sides of stairs. Keep items you use often in easy reach without needing to use a step stool or chair. For bathrooms, add grab bars and non-slip mats in and outside of tubs, showers and next to the toilet. Add brighter lighting to home and stairs, use motion-activated nightlights, and keep flashlights handy. Lampshades and frosted bulbs help with glare.
• Depression: Symptoms of depression can make you less aware of your surroundings and slow your ability to react quickly. A psychologist or counselor can help with strategies.
• Speak up and talk openly: Speak with your loved one and their healthcare providers about fall risks and prevention. If your loved one has fallen, if they seem unsteady, or are worried about falling, tell a medical provider. Keep a cell phone close with programmed emergency numbers or use a medical alert system monitoring service.

• After a fall, do not move the person until it is determined that the fall did not cause any serious injury that needs immediate medical attention.
• Check their head, neck, and spine movements. For people with previous head or brain injuries, notify a healthcare provider right away.
• Check to see if they are alert and ask questions to make sure responses are accurate. For example, ask a few simple questions they should know, such as “What is your full name?” or “What is your address?”
• Make sure they can move their whole body and look for obvious broken bones or joint dislocations.
• Make sure there is no heavy bleeding.
• If serious injury is noted or suspected, do not attempt to move the person, because this could cause more harm. Instead, call 911 for emergency medical assistance.
• If there is no sign of serious injury, make a plan for getting up safely from the floor.

How to help someone get up from the floor depends on how much assistance the person usually needs for transfers.

• Highly functioning people will often be able to get up without much help by using their environment.
• Someone who is more dependent on others for movement may need to be lifted off the floor with either a mechanical lift or with a two-person lift method.
• If it is safe to try to get up, check the surroundings for safety and to decide what can be used to help with a safe transfer.
  • Using a solid surface to pull to or push from can help make moving from the floor easier. Solid surfaces commonly found in the home include a table, bed, sofa, or coffee table.
  • You could even use a locked wheelchair for support.
  • Avoid grabbing onto things that could tip over or break free and possibly cause another fall. For example, tables that only have a center base, towel bars in the bathroom, rolling or unsteady chairs.

Steps for getting up

1. Move into position next to the solid surface support.
2. Get onto your hands and knees next to the surface.
3. Place hands up onto surface and move knees round to be fully facing surface.
4. Step one foot forward so you are in a half-kneeling position.
5. Push down with arms and forward leg to get up onto feet.
6. Ask for help if you do not feel that you can safely get yourself or someone else up on your own, even if you have to wait.

If someone needs a great amount of help to get up from the floor, a mechanical lift should be used. This will decrease the risk of injury to everyone involved.

Being able to get onto the floor can be helpful for performing a home exercise program, including getting onto the stomach for stretching of the front of the hip and trunk, which can get tight with long-term wheelchair use. This type of transfer might also be needed if a person ends up on the floor unintentionally, such as sliding out of the bed.

Moving to the floor

• Place the sling in the appropriate position and secure the loops to the lift.
  • If using the manual lift, you will need to use the V-bar.
  • The base of the lift should be in the widest position.
• Raise the person up in the lift and away from the surface.
  • Person’s legs should be off to one side of the vertical post.
• Slowly lower the person to the floor, allowing them to lay in the middle of the lift base.
• Once on the floor, unhook the sling from the lift and move the base of the lift from under the person.
• Skin needs to be protected while the person is on the floor.
  • Pillows, padding, and position changes should be used as needed to prevent pressure areas.

Moving from the floor

• Place the sling appropriately under the person on the floor.
• Widen the base of the lift and carefully move it into position around the person so that feet and legs are toward the center post and over the base of the lift.
• Lower the lift bar so that the loops of the sling can be secured to the hooks.
• After connecting the sling, raise the person up from the floor and move them to the bed or wheelchair.

If a mechanical lift is not available, a two-person (or more) lift technique can be used.

• Plan for how the person on the floor is going to be moved.
  • Make sure the path is clear for everyone between where the person is now and where they will be moved.
• Position the person on floor into partially reclined position with arms crossed across chest, leaning back up against one assisting person.
  • From behind the person on the floor, one assistant wraps their arms around the person’s sides and grasps onto the opposite forearms in a bear-hug position. The second assistant wraps their arms underneath the person’s knees, keeping knees and hips bent.
  • In a coordinated effort, the assistants lift the person to a firm surface. Communication is key for a safe and successful lift with the least amount of effort or risk of injury. Use a countdown such as 1, 2, 3, lift for an easier and more coordinated effort.