Risk Reduction Strategies for Fall-Related Injuries

According to a 2018 Cochrane systematic review, about a third of community-dwelling adults ages 65 and over will fall at least once annually (Hopewell et al., 2018). While most of the injuries are minor, more severe falls that result in fractures can significantly impact a person’s health, ability to live independently and enjoy good quality of life. While the debate continues regarding optimal strategies for healthcare providers to offer persons at risk of fall injuries, there is general agreement as to intrinsic and extrinsic risk factors. Many risk reduction strategies, including exercise, vision and hearing evaluation, gait and balance improvement, as well as identifying environmental hazards are simple enough to implement outside of a formal program. Following is a summary of those factors identified in medical literature to have the greatest impact on an older adult’s risk of suffering a fall-related injury.

Physical Health

There is no doubt that remaining physically active can reduce the risk of falling by helping to maintain bone density and muscle strength. Women can lose up to 20% of their bone density following menopause, particularly if they are sedentary. According to research by the National Council on Aging, up to 50% of women and 25% of men will experience a bone fracture due to osteoporosis at some point in their lifetime (NCOA, 2022). Resistance exercise (strength training) is particularly effective for maintaining bone density, as is any type of weight-bearing exercise, including walking. Aerobic exercise (walking, swimming, stationary cycling) is also beneficial for maintaining good cardiovascular health, since poor cardiovascular health, particularly postural hypotension (low blood pressure upon standing) also increases the risk of falling. Other areas to work on are maintaining an efficient gait and balance. See the exercise area on this website for balance and strength exercise videos.

Vision and hearing loss are also linked to increased fall risk. According to the American Speech-Language Association, one in three adults ages 65 and older experiences hearing loss, so the organization recommends annual hearing evaluations (Tri Health, n.d.). Similarly, the American Optometric Association recommends annual vision exams for persons over age 60 (AOA.org, n.d.).

External Risk Factor

Trip-and-fall hazards inside the home are easy to overlook such as throw rugs that may bunch up or slide when stepped on, stairs without railings, bathtubs without grab bars, poorly lit outdoor passages and garage areas. In terms of hazards outside the home, the best strategy is to be proactive. If you are planning to be in an area with uneven walking surfaces (dirt path, uneven paving stones etc.), or if you find yourself having to walk outside in inclement weather, consider a cane as a protective measure. A four-prong cane is most stable, but even a simple cane is helpful.

The Cochrane study also cited improper footwear as a cause of falls. If there is a walking specialty store in your area, consider paying a visit for a gait analysis and footwear recommendation. Properly fitting shoes with good support make it easier to balance and less tiring to walk. During the winter months, look for shoes with no-skid soles. If you need to navigate through ice, Yaktrax are removable cleat systems for improving traction on snow and ice. If you are fortunate to have a flexible schedule, particularly during the winter, try to schedule outdoor activities in mid-day when lighting is optimal, and the weather is warmer. Also, check out this Senior Living article on food delivery for seniors, as an alternative to grocery store trips when the snow is falling.

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