Community partnerships are at the core of successful initiatives. I am fortunate to partner with many amazing and talented people who are leaders in addressing the importance of falls prevention.
In outlining falls prevention, I think it helps to outline it in the framework of Professor Gary Rolle and colleagues (2001) which includes three simple questions—What? So what? Now what?
What? September 22 is National Falls Prevention Day. In recent years, this recognition was expanded to Falls Prevention Week to increase awareness about falls, health, and injury prevention. This nationwide effort raises awareness that falls are preventable, and this year’s theme is “Strengthening Community Connections in Fall Prevention”.
So what? Older adults—especially those with chronic medical conditions—may take medications that can contribute to their fall risk. Various common medications can cause dizziness, fatigue, blood pressure changes, or even disorientation. Some mental health conditions—and their treatment medications—can also contribute to a greater risk of falling and injury. Vision and hearing loss can also contribute to increased risk.
According to a Centers for Disease Control report on Older Adult Fall Prevention, one out of five falls (20 percent) results in a serious injury. Injuries from falls can include broken bones—for example, wrist, arm, ankle, and hip fractures. Falling is the most common cause of traumatic brain injuries (sometimes called TBIs). But also, fear of falling can cause a person to become less active, reducing their normal everyday activities and becoming isolated. This reduced activity cycle can then increase their chances of falling.
Aging and Disability Services prioritizes interdependence and independent living for older people and adults living with disabilities. Sometimes mobility aids are needed for someone to remain independently mobile. The right tool or device can empower us to move about our (accessible) environment more easily. Canes, crutches, and walkers assist with stability and balance. Scooters and wheelchairs—with and without power—can safely provide mobility when the ability to walk is limited or impossible. Proper use of these mobility aids can help prevent falls.
Sometimes, these same aids can be the cause of a fall. Improper fit, model, construction, or use of a mobility aid can be the cause of serious injuries. When canes, crutches, or walkers are borrowed or gifted from friends, for example, they may not be the right height or type, and may not be used properly.
Environmental factors such as uneven or blocked sidewalks and pavement and lack of (or obstructed) curb ramps can also cause someone to fall. Inadequate lighting along pedestrian routes can also cause unsafe conditions that result in falls.
Scooters and both manual and power wheelchairs are all common, independence-supporting mobility devices. However, each can cause significant fall risks. Even an experienced user can forget to set brakes or turn off power assist devices or take a spill due to uneven ground surfaces or obstacles. All wheelchair users understand the greatest risks come with transfers, especially unassisted.
Now what? As the wise saying goes, “an ounce of prevention is worth a pound of cure.” There are many easy things people can do to reduce their risk of falling, starting with taking good care of their health:
- Be sure to get annual vision and hearing exams, unless otherwise directed by your health care provider.
- Wear good footwear—sturdy shoes that offer your feet the necessary support and toe protection.
- Stay active—include exercise that increases strength and balance.
When using mobility aids, talk with your doctor or a physical or occupational therapist to make sure you have the right equipment and know how to safely use it. Practice until you become comfortable with the equipment, even in unfamiliar environments. Maintain good safety habits such as setting brakes, turning off power assist devices, and taking care with transfers.
Take care with medications, and if experiencing any disorienting symptoms, practice “SRA”—Stop. Rest. Ask for assistance, if necessary. If fear of falling makes it difficult for you to move about your home or community, reach out to a medical professional, social worker, or an evidenced-based fall prevention program, like Matter of Balance, Otago, or Stay Active and Independent for Life (SAIL) for support.
Governments, businesses, communities, and individuals can also help mitigate fall risks. Advocate with local transportation agencies to install and maintain sidewalks with curb cuts—especially where the weather can cause debris, snow, ice, or flooding that increases pedestrian falls. Communities can emphasize with landowners, businesses, and residents to keep these passageways clear and safe.
Report poor or non-existent street lighting, cracked sidewalks, and other unsafe pedestrian conditions to the proper authorities. In many cities, you can call 311 to report issues on municipal properties (read “What is 311 and When Should I Use it?”). In Seattle, many residents report issues using the Find It, Fix It app on their smartphones.
Medical staff should be vigilant when serving patients using mobility aids to ensure they are appropriate and safe, and that patients and family members know how to use them properly. When assisting patients with vision and or hearing loss, discuss how this may impact mobility and safety. Will they have difficulty seeing in the dark and could benefit from carrying a flashlight? Is there a safety need for hearing assistance when outdoors or in crowded environments, for example? When prescribing medications, both doctors and pharmacists should educate patients on any side effects that could increase their risk of falls.
Fall prevention is both an individual and a community responsibility! Everyone can play a part by ensuring safe environments, supporting health education, and being part of active, aware, and empowering communities.
Contributor Mary Pat O’Leary, RN, BSN is a senior planner in the Seattle Human Services Department’s Aging and Disability Services division. She thanks a former colleague, Deborah Witmer, for contributing to this article.