We all want to protect our parents, grandparents, and loved ones. Falls cost over 31 BILLION, yes BILLION, dollars a year for the healthcare system. Most of that is the hospital admission alone. It can cause serious injury, and have long lasting effects on our function and ultimately, our confidence. Not to mention that mortality increases after a fall.
We can’t just talk about the HOW to stop it, we have to discuss the WHY do people fall.
If we do not understand the WHY we cannot begin to focus on the HOW to stop it.
So WHY do people fall? As the founder and lead Occupational Therapist at Aurora Independence, a mobile outpatient therapy practice in Philadelphia. I notice that there are often three reasons people are falling. They are: Environmental factors, Personal/Physiological factors, and Psychological factors. These three factors interplay off each other with the impact of each changing by the day, the hour and sometimes the minute.
Environmental factors include the physical space we live, work, and play in. This includes hazards found in and around the home and in public places. Some of these factors may have varying levels of significance for some individuals . For example, stairs may be more of a hazard or obstacle to overcome, if you are missing a limb, or if you have sensation deficits from previous conditions. Whereas, for someone with vision issues it could be the amount of light that is available.
You can begin by asking yourself: What does the home look like? How many stairs are there to enter, how many stairs to access the most used portion of the house? What are the floor conditions like? How wide are the doors? How big is the bathroom? What is the lighting like? Is the elevator to access public buildings? Does public transportation have accessible entrances?
These physical factors tend to be the easiest to address, and often the focus of MOST fall prevention strategies outside of balance training. However, they are not the end all be all. You can have a first floor, handicap accessible house, with well paved sidewalks in all your public spaces including ADA accessible everything and STILL have a fall.
There are many other factors in play.
Personal and Physiological Factors are those that are related to your physical body. Simply put, these are the parts of you that make you! Generally speaking we can observe these, test these, or measure these factors in some way.
It can be straightforward such as age, weight or it can include some more abstract examples such as lab results and medication side effects at molecular level. Usually I break these Physical factors into smaller categories such as the body, the brain and the chemistry because there are a lot of things to consider.
For the body we want to consider individual characteristics including deficits or abilities that relate to our muscles and their natural aging process such as: strength, coordination, sensation, or flexibility.
Questions you may want to ask are:
What is sensation like in our toes? Can we see? How many limbs do you have? When was the last time we went to a doctor? Have we had a stroke or heart attack and are any body parts weaker because of this? What chronic conditions do we have, and what are their impacts on our body?
For our brains we want to consider previous injuries, cognition deficits or decline and other aspects of our central nervous system such as neurological conditions.
Questions you can consider are: Have we had a stroke or Brain injury previously? How is our attention? Are we forgetful? Do we have a nagging concussion we just never felt better after? What types of support are we already getting for things like medication management and cooking tasks? What is our memory like?
Lastly, we want to consider chemistry. Our body is a sensitive system and while it is highly adaptable, it can be thrown out of whack easily. Especially as we age. Chemistry can be affected by unbalanced nutrition, dehydration, medication side effects, or the use of alcohol.
Questions to consider are:
How much do we drink? How often? Do we get blood work regularly? Do we suffer from UTI’s? Do any of the medications we take have side effects? If so, what are they? Do any of them increase our risk of falls?
Or I can It may also be beneficial to discuss the length of time these physical factors have been a consideration. Is it a newly acquired physical attribute? Or is it chronic?
For example: someone who is missing a limb will have different physical factors than someone with all four limbs. However, A person who was born without a limb, may have different balance, or adaptability than someone who just lost their limb to a traumatic event, or a chronic medical condition. In the other regard, if you were just diagnosed with Diabetes, you may not yet have sensation deficits in the extremities, but someone who has been trying to manage it for years may.
Physical factors are HIGHLY personal, and they can become quite complex involving a multitude of factors that often require a medical professional to help guide you.
elements of your personality that limit or enhance the ways in which you engage with your world. Personality and emotional factors can make a task really easy, or seemingly impossible.
The largest psychological factor I find is the FEAR of falling. How confident are you that you can perform a task safely? Often, if you are afraid of falling, you will increase your risk of falling. It’s important to reflect honestly, and ask yourself or your loved one questions about comfort and confidence in daily tasks. Place it on a scale of 1-5 with 5 being so scared you won’t perform it, and 1 being so confident you don’t even think about it.
Additionally psychological factors can go the opposite way. We may feel OVERLY confident that we can perform a task, and mentally we can, however other factors are getting in the way (see environmental and physical factors.) Such as balance deficits we are not away of because of cognitive deficits, or that pesky carpet corner that won’t stay down in the middle of the night with little light as an environmental hazard we just keep ignoring.
Bringing it together
As a whole we need to consider how all the different factors discussed above come into play. If you or a loved one have had a fall, then my guess is one or more of the above factors was at play. And if you or a loved one has not had a fall, NOW is the time to consider those types of factors. So how do we keep grandma from falling?
First we assess their risk facts in each of the above sections. Then, we prioritize them in order of what can be changed, and what can’t. For some people, reversing time to NOT have a stroke is desired, but not a feasible option. So why can't we change the physical presentation? We CAN address the environmental and psychosocial factors to reduce our falls.
Enlist a professional to help you, and PLAN ahead, don’t wait until you are caught with your pants down, or you’ve been admitted for a fall.
The biggest mistake I see in the continuum of care, is isolating the problems into separate compartments when in actuality they are interrelated. Under the guidance of a professional you will learn exercises unique to your or your loved one deficits and needs. You are an individual and your interventions should reflect that.
Under your doctor/ pharmacists you can discuss the medication side effects that may be influencing balance and cognition.
With a PT you can address deficits with walking, nagging injuries, balance, surgical recovery.
With an OT you can get help with dressing, shopping, engaging in social activities both in/out of the house.
For more information on how to address a VERY specific environmental factor check out this blog The #1 thing you can change right now to reduce falls and reach out to professionals if you have a fear that you, or someone you love is a fall risk.
You deserve to live in the world confidently.