Preventing falls one step at a time

University of Michigan Health System
Monday, 3 November 2003

U-M geriatric specialist recommends fall prevention techniques for older adults

Approximately 30 percent to 40 percent of senior citizens fall each year, which places falls as the leading cause of accidental death among older adults in the United States. Although it is impossible to prevent all falls, geriatric specialists from the Mobility Research Laboratory at the University of Michigan Geriatrics Center suggest both improving balance through exercise to avoid falls and employ "fall-proofing" behaviors in and around the home to reduce risks.

Falls are more dangerous for older adults than younger adults because serious emotional or physical injury can result from a single fall. Older adults become scared of falling again or fractures and pain discourage them to continue an active lifestyle, which usually results in a loss of independence.

"One to 2 percent of older adults will sustain a hip fracture per year resulting from a fall. Perhaps another 5 percent to 10 percent will sustain a major soft tissue or broken bone injury. There is also another percentage that becomes terribly fearful and restrictive in his or her activity because of a fall," says Neil Alexander, M.D., director of the Mobility Research Laboratory at the University of Michigan Geriatrics Center and associate professor of geriatric medicine.

Accidental falls and the paranoia that comes with them can be prevented through exercise and balance and through simple changes in behaviors while away and at home.

Exercise and the balancing act

Exercise, particularly balance exercise, works to strengthen and sustain the older adult during everyday activities. Balance exercises might provide the strength the older adult needs in order to catch himself or herself before falling completely.

This means adding muscle strength and control to be able to do the difficult transfer activities such as standing up, lifting oneself up out of a bed, chair or bathtub and also climbing stairs.

Exercise balance techniques:

• Stand on one foot


• Walk heel-to-toe


• Take a rapid step forward or backward


• Add challenges as you progress, such as using only one hand then no hands to stabilize yourself. Advance to closing your eyes while practicing balance techniques.


• Remember "anywhere, everywhere" exercises such as standing on one foot while doing dishes.

Alexander stresses the importance of having a stable support nearby, such as a kitchen counter or heavy chair—anything strong enough to prop you up while practicing balance techniques.

When balance becomes an issue, a specialist should be consulted to determine how to improve the situation.

"It's wise to go see a specialist who can evaluate your balance and walking to see if there is actually an underlying problem, such as a neurological problem, an arthritic problem, or particularly a problem that might be agreeable to physical therapy," says Alexander.

"Fall-proofing"

Although making the home safer and changing risky habits does not consistently prevent falls, "fall-proofing" is still a positive step to take in reducing the risk of accidents.

Fall-proofing the home:

• Remove unstable furniture that tests balance, such as a wobbly chair.


• Eliminate slippery or clustered rugs in the walkways. Only use flooring that is firmly attached or non-skid.


• Arrange furniture and other objects so they don't interfere with walking.


• Place grab bars by tubs, showers and toilets.


• Make sure to have tightly fastened handrails on staircases, porches and front walkways.


• Instead of wearing heels, slick soles or slippers when walking, wear shoes with traction or grip. But, be aware— the traction on the shoes can cause tripping, especially when moving from linoleum to carpet.


• Install adequate lighting in stairwells, hallways, bedrooms and bathrooms and make sure light switches are easily accessible. Use nightlights.


• Remove electrical cords and telephone wires from walkways.


• Have couches and chairs at a proper height for effortless standing up and sitting down.

Steer clear of high-risk behaviors:

• Avoid taking chances, such as walking on a freshly washed floor or a patch of ice.


• Instead of standing on a chair or table to reach something, try investing in a reaching tool to do the work.


• Be aware of carrying something while climbing stairs. If you must, try to have one hand on the object and the other on a sturdy handrail.


• Avoid talking while walking in unfamiliar territory. Curbs and cracks can be hazardous when not paying attention.


• Don't get up too quickly after eating, lying down or resting. Rapid changes may cause dizziness.


• Simplify activities. Multi-tasking usually means carelessness.

Alexander says, "With fall prevention one can never be completely safe from accidents. But to reduce fall risk, keep active. Focus on doing balance exercises and keep the environment as safe as possible."

For more information, or to contact University of Michigan Health System, see their website at: www.med.umich.edu