What is Fall Risk?

Falls are a common risk among older adults that has been steadily increasing. According to the CDC, 1 in 4 people over the age of 65 fall every year. With falls being so prevalent, it is no surprise that they are the leading cause of both fatal and non-fatal injuries in adults 65 and older (Commandeur et. al 2018).

What are the Risks?

Falls are notoriously hazardous, causing damage to physical, mental, and financial health. In a study by Jung and colleagues, the most common consequences of falls include physical injuries, psychological impairments, lengthened hospital stays, and financial burden (2018).

The most prevalent injuries from falls include fractures of the wrist, hand, pelvis, hip, and humerus.

When it comes to the various types of risks attributed to falling, there are two main categories: intrinsic and extrinsic risks. The CDC lists them as follows:

Intrinsic

  • Advanced age
  • Previous falls
  • Muscle weakness
  • Gait & balance problems
  • Poor vision
  • Postural hypotension
  • Chronic Condition including arthritis, stroke, incontinence, diabetes, Parkinson’s, dementia
  • Fear of falling

Extrinsic

  • Lack of stair handrails
  • Poor stair design
  • Lack of bathroom grab bars
  • Dim lighting or glare
  • Obstacles & tripping hazards
  • Slippery or uneven surfaces
  • Psychoactive medications
  • Improper use of assistive device

Fall RiskHow to Know if You’re at Risk

If any of the above risk factors apply to you, you may be at risk for falling. But fear not, for physical therapy can help!

How Physical Therapy Can Help

We can assess the risk of falling in our very own clinic. According to our clinic director and senior physical therapist Amanda Scharen, “There are standardized tests we can do in the clinic to predict fall risk”. She further explains how we can use those results to educate patients on how to reduce their risk through their daily routine like “using an assistive device such as a cane, and doing balance training under PT supervision.” To ensure risk of falling is reducing, the same standardized tests can be used to measure improvement over time.

Because there are many factors that contribute to fall risk, there are various techniques used in physical therapy to improve these factors.

Several studies support the use of strength and balance training to reduce fall risk. Weak muscles used during walking have been found to contribute to falling, specifically when tripping over obstacles (Caetanoa et al. 2018).

Amanda expressed how “Many times, elderly patients are afraid to get down on the floor because they don’t think they’ll be able to get back up.” In the clinic, this is something important to practice under PT supervision because if you happen to fall, it is critical to be able to get back up safely if no one is around to help. “I have been able to help patients learn how to get up and this helps improve their confidence with daily activities at home” Amanda explained.

Other modalities we focus on in our clinic are standing balance exercises, stretching of lower extremities, and strengthening with sitting to standing movements, all of which help improve physical strength and balance, as well as confidence in daily activities.

What You Can Do at Home

Common risks found in homes include dim lighting, absence of handrails, poorly designed stairs, obstacles that can cause tripping, and slippery/uneven surfaces. Assessing your home for these hazards is a great first step to protecting yourself against falling.

The CDC provides a detailed brochure that includes a safety checklist for fall hazards in your home. The list includes risks that may appear in all rooms of your house including your kitchen, bathroom, and bedroom. It is suggested that each room be checked for tripping threats such as uneven surfaces and objects on the ground, as well as sufficient lighting, and handrails to help with balance.
You can find the online brochure here.


References

Commandeur, D., Klimstra, M., Macdonald, S., Inouye, K., Cox, M., Chan, D., & Hundza, S. (2018). Difference scores between single-task and dual-task gait measures are better than clinical measures for detection of fall-risk in community-dwelling older adults. Gait & Posture, 66, 155–159. doi: 10.1016/j.gaitpost.2018.08.020
Jung, H., & Park, H.-A. (2018). Testing the Predictive Validity of the Hendrich II Fall Risk Model. Western Journal of Nursing Research, 40(12), 1785–1799. doi: 10.1177/0193945918766554
Fact Sheet Risk Factors for Falls . (2017). Retrieved February 19, 2020, from https://www.cdc.gov/steadi/pdf/STEADI-FactSheet-RiskFactors-508.pdf
Make STEADI Part of Your Medical Practice. (2019, January 31). Retrieved from https://www.cdc.gov/steadi/

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