Today September 22, is the start of the fall season and recognized as Fall Prevention Awareness Day. It’s important to highlight this public health initiative for a number of reasons. Falls should not be viewed as typical to the process of aging, and are preventable, yet they're the leading cause of visits to the emergency room as a result of injuries. Falls represent more than 3 million adults treated each year, and the experience of one quarter of Americans aged 65 and older. These tumbles have costs that are financial, social, physical and emotional.
Financial hardships, a lack of access to providers, inadequate health care coverage or even difficulties with transportation can create limitations for seniors and prolong recovery periods after a fall. This can further experiences of social isolation from friends and family especially in a pandemic period already requiring separation, as well as decrease community activities and independence, all impacting an individual’s quality of life.
Physically, the results of a fall can vary from minor bruising, to more serious injury such as fractures, broken bones, head injuries and confusion, or even death. Personalized care needs are an important consideration because as we age our bones become more brittle and susceptible to breaks, we also tend to notice some changes in our vision, our muscle strength and mobility, and some potential for decline in cognitive functioning.
As a mental health therapist, I’ve worked with hospitalized seniors and also those in community outpatient therapy, whose lives have been significantly altered by their own care needs or those of someone they love after falls and injury occur. In an inpatient setting, falls can impact a clients recovery time. Conducting ongoing risk assessments to determine contributing factors is an important part of patient care. Contributors to increased falls may include mental health diagnoses of depression, anxiety, mania, and psychosis. Clients with these conditions are often treated with prescribed medications including antidepressants, antianxiety, and antipsychotics. According to research, those who are using four or more medications, may be at increased risk for falls. The result of substance abuse impairments such as alcoholism which decrease clarity and mobility is also a known variable with injury and falls.
Medical conditions such as heart and blood pressure issues, diabetes, seizures, osteoporosis, declines in our vision, even arthritis may also present as risk factors for falls. Additionally important is the fact that these medical concerns can influence mental health outcomes, and vice versa mental health condition which may affect focus, and functioning can also increase likelihood of falls. I’ve observed patients who were formerly living independently or living at home with support, need to completely change their lives, transitioning to nursing homes, and unable to return home due to concerns about recurring falls. Such situations have life changing impact and can affect our sense of self, and trigger greater fears about falling again.
Some good news! Findings indicate that mental health treatment which utilizes an evidence based Cognitive Behavioral Therapy approach recognizing thoughts and feelings as affecting our behaviors, as well as the opportunity to build awareness of patterns, emphasize skill building in ways that create healthy options is an asset for learning to manage risk. A multipronged approach addressing emotional and physical health needs, social supports, and educational resources which prepare us for progressive life transitions offer the greatest options for success with fall prevention and health maintenance.
When considering environment, some specific factors that contribute to falls include those that exist within our homes. Issues such as uneven steps near entrances, or loose floor boards in our living spaces need to be repaired as soon as they’re noticed. Tasks such as clearing walkways of leaves that could be slippery or hide tripping hazards like rocks or debris should be regularly maintained. Other issues could be overhead tree branches, or wet and icy conditions with rain and snow. Various community organizations or private companies provide services for seniors that can help with yard maintenance on a rotating schedule, on a free or low cost basis.
As a therapist, my work focuses on holistic wellness with mental health counseling as well as home organization and decor which prioritizes our needs for a home that soothes and heals. How we live in our homes either increases or decreases our emotional and physical wellbeing, even our risk for falls. Even factors such as poor lighting prevent easy access to navigate stairs, limit our ability to notice hazards such as a loose rug, and inhibit our movement throughout our homes. Clutter is another concern. Creating identified spaces for categories of items, like books or cleaning products, decreases fall hazards, while also creating openness and visibility as we move throughout our space. When not addressed, clutter creates disorder and increases the likelihood of falls when items are not organized. Flexible solutions for storage can be created based on your personality and how you choose to use your space.
As an example, we may accumulate many more items over time than there is space for. By creating a process of storing memories in space efficient ways such as with the use of a digital photo album or scrapbook we can eliminate excesses that create those corner piles we've all had, and tripped over at some point. Prioritize keeping those items that are really precious to you and are associated with positive feelings versus simply holding onto things that no longer have a use or benefit to your life. Holding onto items or emotions that no longer function well for us also has the potential to foster behaviors such as hoarding, which has additional mental health implications, and creates an unsafe physical and emotional environment.
Those with higher risk factors for falls due to mental health, substance abuse, and or medical needs would benefit from continuous assessments that offer a holistic wellness approach assessing physical and environment hazards, medication needs, and opportunities for personal care education with tools necessary to improve areas such as strength and balance training. These strategies are important across senior care facilities, housing programs and within independent home environments with the support of personal and professional caregivers that can offer assistance. Even in circumstances where we need to maintain safety, there is hesitation.
Sometimes the reasons we don’t ask for help are easy to see. It can be hard allowing ourselves to be vulnerable and reaching out to others, especially if it may represent a perceived loss of independence or dignity, along with worries about mobility loss. We may seek to avoid the changing reality of our experiences. Sometimes barriers can also include a lack of awareness about what resources are available in our local community. These are areas where counseling can help create awareness of personal strengths and opportunities, available options for your health.
The following are also protective factors instrumental to decreasing your risk against falls:
Maintain communication with supportive people in your life
Participate in regular visits with your medical providers
Advocate for yourself, ask questions of providers and communicate your needs
Work with caregivers and organizations familiar with your specific needs to allow the best options for your care
Share changes to your mood, your sleeping and eating patterns
Utilize medical devices such as walkers, canes, and wheelchairs as prescribed and appropriate safeguards against continued falls
Keep a checklist of items to be done around the house, such as installing a shower grab bar or bench that family, friends, or professionals can help you complete to support safety and decrease the chance of falls.
Another important tool as we age is maintaining physical activity level where possible. Studies have found activities like TaiChi are very effective and can decrease fall rates by as much as 35%. Other exercises like yoga, walking outdoors, running, even standing in place on one foot promote balance and coordination, muscle strength and memory. Be sure to consult your medical provider in advance of any changes to your routine. Activities help us to improve motivation with practice, they also offer opportunities to set and accomplish personal goals, while creating enjoyment and chances to engage with others. We can create options for ourselves at any age.
Be willing to ask for help. At any age we all need it. Become familiar with the offerings available to you through organizations that offer services for seniors such as the National Council On Aging which offers a free check digital screener using a brief questionnaire to assess and help reduce your risk for falls. I hope that you'll find this information and these tools helpful as you either take care of your own wellness or continue care for others in your role as personal or professional caregivers.