The impact of falls on quality of life

We all recognize that our risk of falling increases as we age, but do you know the impact that just one fall can have? How about the impact that it has on increasing one’s risk of death? Let’s look at some facts to help you develop a vested interest to create a daily approach to help your loved one avoid falls. 

Facts and Numbers

According to the research obtained by the Centers for Disease Control in the publication Deaths from Older adult falls, falls have been increasing as a significant death risk for those that are over 65. 

Fall death rates among adults age 65 and older increased about 30% from 2009 to 2018.

The fastest growing rate was among adults aged 85 and older (about 4% per year). 

Their research further reveals that of the 800,000 hospitalizations that occur each year, 300,000 of them are a result of hip fracture. In my clinical experience as an OT, working in acute care, hip fractures are usually a result of a fall. I have seen so many lives drastically changed by the result of a fall due to the change in mobility and sharp decline in basic self care independence.

My observations are supported by research.  Take for example the findings by Dr. Cheng at the University of Rochester, in the research publication For elderly, even short falls can be deadly.

Cheng’s team found that approximately 4.5 percent of elderly patients (70 years and above) died following a ground-level fall, compared to 1.5 percent of non-elderly patients. Elderly patients remained in the hospital and the intensive care unit longer and only 22 percent were able to function on their own after they left the hospital, compared to 41 percent of non-elderly patients.

You might be wondering what you should be doing right now to help your loved one stay clear of falling. 

Major contributing factors leading to falls

Weakness- core, arm and leg strength are needed for safe transitions from sit to stand and ambulate safely.

Medications- sometimes causing dizziness, lightheadedness, confusion, blurred vision

Hypotension- low blood pressure and changes in blood pressure when transitioning from sit to stand

Afib - the irregularity of the heartbeat that can elevate to a rapid rate leading to lightheadedness and shortness of breath and even passing out

Balance deficits - equilibrium issues, effects from a stroke or other neurological impairments as well as not using an appropriate device to supplement a balance deficit consistently or using the wrong one. 

Urinary incontinence- in efforts to get to the toilet quickly while experiencing incontinence, safety is often compromised 

Vision- low vision, depth perception deficits, sensitivity to light

Cognitive deficits impacting safety awareness - impulsivity or limited attention, poor awareness to surrounding risks, problem solving difficulties 

Environmental risks - spaces that are too narrow for balance devices, such as a walker, to fit. Uneven flooring, scatter rugs, poor lighting, cluttered areas/walkways, are all examples of environmental risks 

Let’s take a closer look at two of the listed factors and the strategies you can use every day to minimize fall risks. 

Contributing factor: Weakness

The activation of muscle activity is something that you can improve everyday by optimizing functional movement and self care tasks. Use functional mobility, transfers, and standing activities as a strengthening and balance program. Every little bit of movement is valuable and that value is enhanced with focus on quality, frequency and duration.  

Moving against one’s own body weight through the environment can be enough of a challenge for aging folks. When increased time and frequency of the opportunity to perform the activity is made, natural strengthening occurs. 

Think about the activation of muscles that you use when getting dressed, standing at the sink to wash up,  to take a shower, or use the toilet. Is your loved one completing these basic self care tasks in the same way? Have they stopped doing some of these daily self care tasks or need more physical assist?

Imagine your muscle strength and endurance after 2 weeks of not completing your daily routine with your current level of independence. You would be weaker right?  Those tasks would be more challenging and then, over time, eventually become dangerous to complete.

The therapeutic approach-  Make sure that your loved one is doing as much of their self care and mobility with their greatest level of independence every day with the greatest utilization of their best posture, strength and endurance.  Consider this equation: 

Activity + neuromuscular activation + duration + frequency = strengthening 

If they need help due to physical limitations, such as limited range of motion (ie: shoulders, knees, hips), focus on filling in the gaps for them but avoid doing too much for them . Focus on facilitating their independence.  In the beginning, this may take extra time.  Consider this an investment with great return. 

For example, you can help them get a foot into their pant or underwear leg opening and then step back.  Give them time to problem solve, reach forward with their arms, move their legs closer to their torso, and utilize every muscle they can to be successful.  Focus on being a stand by assistant instead of  them being a full recipient of care. 

Contributing Factor: Balance

Insufficient balance seems to creep up on us as we age. It can also occur all of sudden with the onset of something like a stroke. . Here are just a few areas that lead to loss of balance: 

- decreased foot clearance from the floor (aka shuffling feet)

- uneven gait pattern (aka limp)

- one side of the body weaker than the other 

- using the wrong type of balance device (using a cane when a walker should be used)

- not using a balance device at all when one should be used

- edema (excessive fluid/swelling of the legs) 

- poor sensation of the lower legs

- back pain

There are interventions that can be used which not only prevent falls, but build strength, confidence and opportunity for greater mobility

The therapeutic daily approach- Make safe mobility a daily priority and support the foundation of mobility with all that is necessary (walking device, compression socks if needed, adequate strength throughout the body). 

Whenever there is an opportunity to walk, stand vs sit, and get out of the house, engagement in those opportunities can be life changingConsider the impact of consistently using proper footwear to support the foot and help with good foot clearance. If a brace or other support is needed, make sure they can get it on and use it regularly. The mobility of ankles and toes is often overlooked yet needed for balance and proper foot clearance on all surfaces as well as for ascending and descending any rise/threshold/step. 

Far too often, people avoid using a balance device (cane, walker of varying types) because of the stigma of seeming “old”. Consider this analogy that I share with my patients, 

 “Improve the quality of your walk so you can walk further, with more confidence, more frequently and watch yourself get stronger and go further. You wouldn’t drive your car with summer tires in the Winter right? Think of yourself that way. Put on the Winter tires and move forward with confidence.”   

One of the most important things that one can do to improve balance is to challenge it by moving more with the right support. Not by walking less without any support at all. Increasing opportunity for the body to respond to environmental changes like flooring types and outdoor surfaces will help to ward off gradual decline of balance.  

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 If an uneven gait pattern is present, working toward strengthening the weak areas with focus on postural alignment. Using opportunities to work on sitting upright, away from a chair back, standing with shoulders and hips level, knees well spaced apart and head aligned while engaged in a self care tasks such as brushing teeth, combing hair or while eating a meal. These simple postural changes alone improve balance by allowing the body to carry weight more squarely. This can be practiced several times a day in several areas of the daily routine.

The most important thing, in my opinion from decades of clinical observation, is that those who move as much as possible every day while doing basic self care, focusing on maximizing their independence at all times, are at less risk for falls. Experience the life changing effects of consistently strengthening with a daily approach of using a self care and mobility routine that optimizes independence.