Falls and Older Adults

Be Physically Active

Regular physical activity is a first line of defense against falls and fractures. Physical activity strengthens muscles and increases
 flexibility and endurance. Your balance and the way you walk may improve with exercise, decreasing the chances of a fall.

It's important to keep muscles strong. Strengthening muscles in the lower body can improve balance.
Work with your doctor or a physical therapist to plan a physical activity program that is right for you.

A supervised group program can help with balance and gait training. Strength and
balance exercises done at home can also reduce your risk of falls. This will help
improve your balance and strength.

Tai Chi is one type of exercise that may help prevent falls by improving balance and
control. This exercise uses slow, flowing movements to help people relax and coordinate
the mind and body. It can also boost your self-confidence. Dancing and other rhythmic movements can help as well.

Mild weight-bearing exercise -- such as walking or climbing stairs -- may help slow bone
 loss from osteoporosis. Having strong bones can prevent fractures if you do fall.

Your doctor or a physical therapist can check your walking and balance. They might do a "Get-Up and Go" test. This simple test shows
how steady you are when you get up from a chair. The test also is used to check your walking ability. 
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Have Your Medicines Reviewed

Find out about the possible side effects of medicines you take. Some medications might affect your coordination or balance, or cause
dizziness, confusion, or sleepiness. Some medications don't work well together, adding to your risk of falls.

Bring your prescribed and over-the-counter medicines with you when you visit the doctor. Also bring any vitamins, minerals, and herbal
products you are taking.

Ask if any of your medicines or over-the-counter products could increase your risk of falling. Never stop taking your medications unless
you talk with your doctor first.

Also, limit the amount of alcohol you drink. Even a small amount can affect your balance and reflexes.

Have Your Blood Pressure Checked When Lying and Standing

Some older people have normal or increased blood pressure while seated, but their blood pressure drops too much on standing. There is
no way to know unless you check. Tell your doctor if you feel faint or unsteady when you get up from sitting or lying down.
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Get a Vision Check-Up

Have your vision tested regularly or if you think it has changed. Even small changes in sight can make you less stable.

Wear your eyeglasses so you can see your surroundings clearly. Keep them clean and check to see that the frames are straight. When
you get new glasses, be extra cautious while you are getting used to them. If you use reading glasses or multi-focal lenses, take them off
when you're walking. They can distort your sense of distance and lead to a fall.

Choose Safe Footwear

Our feet have nerves that help us judge the position of our bodies. To work correctly, our feet need to be in touch with the ground and our
shoes need to stay securely with the foot as we take each step. Otherwise, falls may occur.

It's important to select your footwear carefully to help prevent falls. Wear sensible, low-heeled shoes that fit well and support your feet.
There should be no marks on your feet when you take off your shoes and socks.

Your shoes should completely surround your feet. Wearing only socks or wearing floppy, backless slippers or shoes without backs can
be unsafe. Also, choose shoes with non-slip soles. Smooth soles can cause you to slip on waxed or polished floors. 
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Six out of every 10 falls happen at home, where we spend much of our time and tend to move around without thinking about our safety.
Many falls could be prevented by making simple changes in your living areas, as well as personal and lifestyle changes.

Take steps to "fall proof" your home, both inside and outdoors. To make your home safer, you can

• remove or avoid safety hazards
• improve lighting
• install handrails and grab bars
• move items to make them easier to reach.

An important step toward preventing falls at home is to remove anything that could cause you to trip or slip while walking. Tripping on
clutter, small furniture, pet bowls, electrical or phone cords, or other things can cause you to fall. Slipping on rugs or slick floors can also
cause falls.

Arrange furniture to give you plenty of room to walk freely. Also remove items from stairs, hallways, and pathways.

Be sure that carpets are secured to the floor and stairs. Remove throw rugs, use non-slip rugs, or attach rugs to the floor with double-sided tape.

Put non-slip strips on floors and steps. Put non-slip strips or a rubber mat on the floor of your bathtub or shower, as well. You can buy these
 items at a home center or hardware store.

At home and elsewhere, try to avoid wet floors and clean up spills right away. Use only non-skid wax on waxed floors at home.

Be careful when walking outdoors, and avoid going out alone on ice or snow. A simple slip on a slick sidewalk, a curb, or icy stairs could result
in a serious injury.

During the winter, ask someone to spread sand or salt on icy surfaces. Be sure to wear boots with good traction if you must go out when
it snows. Better yet, don't take chances walking on icy or slippery surfaces.

Poor lighting -- inside and outdoors -- can increase your risk of falls. Make sure you have enough lighting in each room, at entrances, and on
outdoor walkways. Use light bulbs that have the highest wattage recommended for the fixture.

Good lighting on stairways is especially important. Light switches at both the top and bottom of stairs can help.

Place a lamp within easy reach of your bed. Put night lights in the bathroom, hallways, bedroom, and kitchen. Also keep a flashlight by your
bed in case the power is out and you need to get up.

Have handrails installed on both sides of stairs and walkways. If you must carry something while walking up or down stairs, hold the item in
one hand and use the handrail with the other. When you're carrying something, be sure you can see where your feet are stepping.

Properly placed grab bars in your tub and shower, and next to the toilet, can help you avoid falls, too. Have grab bars installed, and use them
every time you get in and out of the tub or shower. Be sure the grab bars are securely attached to the wall.

You might find it helpful to rearrange often-used items in your home to make them more accessible. Store food boxes, cans, dishes, clothing,
and other everyday items within easy reach. This simple change could prevent a fall that might come from standing on a stool to get to an item.

If you have fallen, your doctor might suggest that an occupational therapist, physical therapist, or nurse visit your home. These health care
providers can assess your home's safety and advise you about making changes to prevent falls. 
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Appropriate use of assistive devices can prevent harmful falls. These devices may include canes, walkers, and reachers. A physical or occupational therapist can help you decide which devices might be helpful and teach you how to use them safely. Talk with your doctor about having a physical therapist or occupational therapist assess your device needs.

A cane or walker may help you feel more stable when you walk. Different types of canes are available. Some have grips made of foam or that fit the shape of your hand. Many canes can be adjusted, but some cannot.

A physical therapist can advise you about which cane to choose. Be sure the length fits you well. Your elbow should be at a comfortable angle. A cane that's too short may make you unsteady. A cane that's too long is harder to use. If you use a cane, be sure to learn how to walk with it the right way. A physical therapist can help.

If you're at risk of falling, your physical therapist might suggest using a walker. A walker will help you stay balanced by giving you a wide base of support. Be sure to choose a walker that fits you and gives a level of stability that is best for you.

Different types of walkers are available. Some walkers have two wheels so the walker shouldn't roll away from you. These walkers work well if you need to put weight on the walker when you move. Other walkers have four wheels and brakes for going down inclines.

You can add a basket, tray, or pouch to some walkers to carry items. These accessories will make it more convenient to use the walker.

If you use a walker, be sure it's the right type for you. Also, learn to use it properly. A physical therapist can help you select the right walker and show you how to use it. Four-wheeled walkers can be used if you don't need to put your weight on the walker for balance. Those with two tips and two wheels can roll, depending on where you place your weight. Walkers with tips only are quite common and will not roll.

A reacher, or grabber, can also help prevent falls. This simple tool lets you take lightweight items from high shelves and other places and pick up objects from the floor so you do not have to bend over. Use a reacher rather than standing on a stool to get something from above or bending down to pick up something from the floor.

Another helpful device is a portable telephone. Carry the phone with you from room to room. When it rings, you won't have to rush to answer it. Not rushing could avert a harmful fall. Never rush to answer the phone or door. 

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Falls are a common reason for trips to the emergency room and for hospital stays among older adults. Many of these hospital visits are for fall-related fractures. You can help prevent fractures by maintaining the strength of your bones.

Having healthy bones won't prevent a fall. If you fall, though, having healthy bones can prevent hip or other fractures that may lead to a hospital or nursing home stay, disability, or even death.

Osteoporosis makes bones thin and more likely to break. It is a major reason for fractures in women past menopause. It also affects older men. If bones are fragile, even a minor fall can cause fractures.

At any age, you can take steps to keep your bones strong. Be sure to consume adequate amounts of calcium and vitamin D. People over age 50 should consume 1,200 mg of calcium daily by eating calcium-rich foods and taking calcium supplements.

Good dietary sources of calcium include

• dairy products such as low-fat milk, yogurt, and cheese
• orange juice, cereals, and other foods fortified with calcium
• dark green, leafy vegetables such as broccoli, collard greens, and bok choy
• sardines, salmon with bones, soybeans, tofu, and nuts such as almonds.

Vitamin D helps your body absorb calcium. Exposure to sunlight causes your body to make vitamin D. Many older people don't get enough vitamin D this way, though. Eating foods with vitamin D and taking supplements can help.

As you grow older, your need for vitamin D increases. People ages 51 to 70 should consume at least 400 international units (IU) of vitamin D daily. People over age 70 should consume at least 600 IU daily.

Herring, sardines, salmon, tuna, liver, eggs, and fortified milk and foods are good sources of vitamin D. Vitamin D supplements may also be needed. Talk with your doctor about how much vitamin D you need. Taking too much may be harmful.

Physical activity is another way to keep your bones strong. Try to get a total of at least 30 minutes of physical activity a day. Find time for activities like walking, dancing, stair climbing, gardening, and weight-lifting.

Talk with your doctor about having a bone density test. This safe, painless test assesses your bone health and risk of future fractures. Medicare and many private insurers cover this test for eligible people. Women over age 65 and all men over 70 should have a bone density test.

Your doctor can also advise you about whether you should consider taking prescription medications to improve bone health. These medications can slow bone loss, improve bone density, and lessen the risk of fractures.

Other ways to maintain bone health include quitting smoking and limiting alcohol use. Smoking and heavy alcohol use can decrease bone mass and increase the chance of fractures. Also, maintain a healthy weight. Being underweight increases the risk of bone loss and broken bones.

You're never too old to improve your bone health. A diet that includes enough calcium and vitamin D, and physical activity can help prevent bone loss and fractures. You can also have your bone density tested and ask your doctor about supplements or other medicines to strengthen your bones if needed. 
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Whether you're at home or somewhere else, a sudden fall can be startling and upsetting. If you do fall, stay as calm as possible. Take several deep breaths to try to relax.

Remain still on the floor or ground for a few moments. This will help you get over the shock of falling. It will also give you time to decide if you're hurt before getting up. Getting up too quickly or in the wrong way could make an injury worse.

If you think you can get up safely without help, roll over onto your side. Rest again while your body and blood pressure adjust. Slowly get up on your hands and knees, and crawl to a sturdy chair.

Put your hands on the chair seat and slide one foot forward so that it is flat on the floor. Keep the other leg bent so the knee is on the floor. From this kneeling position, slowly rise and turn your body to sit in the chair.

If you're hurt or can't get up on your own, ask someone for help or call 911. If you're alone, try to get into a comfortable position and wait for help to arrive.

If you have problems with balance or dizziness, be sure to discuss these with your doctor. If you are often alone, and at increased risk of falling, consider getting a personal emergency response system. This service, which works through your telephone line, provides a button or bracelet to wear at all times in your home.

If you fall or need emergency assistance for any reason, a push of the button will alert the service. Emergency medical services will be called. There is a fee for medical monitoring services, but it may be worth the cost.

Carrying a portable phone with you as you move about your house could make it easier to call someone if you need assistance. You might also put a telephone in a place that you can reach from the floor in case you fall and need help.

Be sure to discuss any fall with your doctor. Write down when, where, and how you fell so you can discuss the details with your doctor. The doctor can assess whether a medical issue or other cause of the fall needs to be addressed. Knowing the cause can help you plan to prevent future falls.

Many older people who have fallen are afraid of falling again. Even if a fall doesn't cause injury, the fear of falling again might prevent you from doing activities you enjoy or need to do. Fear of falling also might cause you to stay at home away from your friends, family, and others.

Your muscles and bones can weaken over time without the physical activity that comes with doing daily tasks or exercise. As a result, you could become more -- not less -- likely to fall.

After a fall, your doctor might refer you to other health care providers who can help prevent future falls. A physical therapist can help with gait, balance, strength training, and walking aids. An occupational therapist can suggest changes in your home that may lower your risk of falls. 
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