Fall Prevention for Older Adults with a Physical Disability

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What puts you at greater risk of falling?

What can you do to prevent falls?

References and Resources

 

Older adults with a physical disability are at greater risk of falling than older adults without a physical disability. Falls typically occur while you’re doing everyday activities such as walking, getting up from a chair, or bending down. There are both physical and emotional consequences from falling. 

Physical consequences may include:

  • Mild cuts and scrapes
  • Broken bones such as hip or femur fractures
  • Traumatic brain injury (TBI)

Accidental falls are the leading cause of injury-related death in older adults.

The fear of falling is very powerful and you may not even realize how this fear is limiting your daily activities.  Fear of falling can result in:

  • Staying at home more and decreasing outings to see your friends and family. Limiting your social activities can put you at greater risk for anxiety, depression, and other mood disorders. 
  • Spending more time sitting and being inactive. Lack of physical activity leads to further loss of muscle strength and, in turn, will increase your risk of falling.

Injuries and fears caused by falling can reduce your overall health, increase your health care costs and reduce your ability to take care of yourself and be independent.

What puts you at greater risk of falling?

Some risks factors listed below are preventable and others are not, but knowing the factors can still help you assess your level of risk. 

  • If you live alone or have a small social circle, you are at higher risk of falling because you are less likely to have help when you need it.
  • A history of falling, even if you have only had one fall, will increase your risk of falling again. 
  • Muscle weakness caused by a physical disability, such as multiple sclerosis or post-polio syndrome, and/or due to inactivity.
  • Poor balance, coordination, or walking (gait) problems.
  • Poor vision.
  • Cognitive (thinking) problems that affect your ability to focus and pay attention while you’re walking.
  • Not using assistive devices or mobility aids when and how you should. Tips or falls in wheelchairs account for a lot of fall-related injuries for wheelchair users. 
  • Wearing poor or unsuitable footwear.
  • Some medications or the combination of multiple medications can have side effects such as fatigue or dizziness that may increase your risk of falling.
  • Poor diet or not drinking enough fluids (water).
  • Alcohol use.

Your physical environment also affects your risk of falling.

  • If handrails on stairs or grab bars are missing or not properly/securely installed.
  • Poor stair design or stairs in disrepair such as small stair width, uneven stairs or stairs of different heights. 
  • Dim lighting may reduce your ability to see obstacles or tripping hazards. 
  • Obstacles or tripping hazards such as power cords, throw rugs that move, or even your pet cats or dogs that are always underfoot. 
  • Slippery or uneven surfaces.

What can you do to prevent falls?

Exercise to improve your strength and balance

Exercise is the single most effective way to prevent falls.

  • Try a strength training program to increase your muscle and core strength. 
  • In addition to strength training, other exercises can help you improve your balance and coordination, such as swimming, yoga, Tai Chi or exercises using exercise balls or BOSU balls (half-dome exercise balls).
  • A trained physical therapist can help you improve your balance, strength, and gait through exercise. They might also suggest an assistive device or change of devices—and provide guidance on how to use these aids.
    • Poorly fit devices can increase the risk of falling.
  • Enroll in a fall prevention program. Several of these are available nationwide and are often at your local community center, hospitals, Senior Center, or YMCA.
    • National Council on Aging’s (NCOA) Center for Healthy Aging has a list of Community Programs (see Resources on last page). 

Improve your safety at home

Use a falls prevention check-list around your house to improve its safety:

  • CDC’s Check for Safety: A Home Fall Prevention Checklist for Older Adults
  • Occupational therapists can work with you or your family to look at your home for hazards and evaluate you for limitations that contribute to falls. Recommendations often include:
    • Improving physical abilities to safely perform daily tasks.
    • Changing daily activities.
    • Modifying your home.
  • Simple home modifications that can help prevent falls include:
    • Adding grab bars next to the toilet or inside the bathtub.
    • Adding handrails for stairs or walkways.
    • Using contrasting colors to make it easy to see stairs and walls.

Out and about safety – things you can do while you are on-the-go

Consider your energy level and plan for fatigue.

  • Know your limits and look for signs of fatigue such as catching your foot as you walk so you know when you need to stop and rest.
  • If you are an occasional user of assistive devices, bring your devices with you and have them ready. If you’re an occasional user of a wheelchair, make sure you have it on hand for longer days when fatigue may become a problem.
  • Use footwear that is suitable for the weather and conditions. 
  • Sometimes the safest route is not always the fastest route. Play it safe and avoid steep hills, cracked sidewalks, and uneven surfaces.
  • Pay attention of the surface and obstacles in front of you when you are walking so you have more time to react. 
  • Stop walking or rolling when you’re using your mobile or smart phone.

Talk to your health care provider to prevent falls

Support from your family and friends

As you age with a disability, your care assistance needs will grow and change as well. Get your family, friends, and other caregivers involved in fall prevention. 

Make sure the people helping you have the knowledge, training, and support they need. Some caregiver resources include:

Resources

Center for Healthy Aging’s Links to Community Programs

CDC’s Check for Safety: A Home Fall Prevention Checklist for Older Adults

The Good News About Fall Prevention, produced in 2008 by nursing students at Seattle Pacific University featuring Dr. Elizabeth Phelan

Homemods.org is a University-based, non-profit with resources for Home Modification

Fall prevention information and resources provided by the University of Washington

References

Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, Lamb SE. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2012 Sep 12;9.

Matsuda PN, Shumway-Cook A, Bamer AM, Johnson SL, Amtmann D, Kraft GH.  Falls in multiple sclerosis. PM R. 2011 Jul;3(7):624-32.

Peterson EW, Ben Ari E, Asano M, Finlayson ML. Fall Attributions Among Middle-Aged and Older Adults With Multiple Sclerosis. Arch Phys Med Rehabil. 2012 Nov 28.

Disclaimer

This information is not meant to replace the advice from a medical professional. You should consult your health care provider regarding specific medical concerns or treatment.

Authorship

Content is based on research evidence and/or professional consensus of faculty at the University of Washington Aging and Physical Disability Rehabilitation Research and Training Center. This factsheet may be reproduced and distributed freely with the following attribution: Verrall, A. (2013). Fall Prevention for Older Adults with a Physical Disability [Factsheet]. Aging and Physical Disability Rehabilitation Research and Training Center. NIDRR/U.S. D.O.E. grant #H133B080024. University of Washington. http://agerrtc.washington.edu/