Preventing falls

An unexpected fall can lead to a lot of challenges  

When Navy Veteran Maxwell Bennett, 79, suffered two falls, injuring both of his shoulders, he knew it was time to do something to prevent falling again.

“I needed balance,” Bennett said, noting problems with his nerves, side effects of medication and a sedentary lifestyle brought on by the COVID pandemic. 

So, he turned to tai chi, offered through the Milwaukee VA’s Whole Health program. Tai chi and qigong are low-impact exercise routines especially helpful for older folks. The classes are offered in-person and virtually a few times each week, not only in Milwaukee but also through outpatient clinics.

Bennett’s been doing the classes for a couple of years, and they’ve helped improve his balance.

“It’s made a major difference,” he said. “It’s not perfect, but if I lean over, or I feel I’m about to fall, I know how to adjust my body, so I don’t fall. I’m a lot better. I’m proud of my balance.”

Falls: a growing problem

According to Milwaukee VA physical therapist Melanie Schultz, falls are a big problem for the elderly. The Centers for Disease Control reports that every year, 1 in 4 older adults (over age 65) experiences a fall, and that falls are the leading cause of injuries (fatal and non-fatal) among older adults.

While not all falls result in injuries, falls are the leading cause of injury-related death among older adults, according to the CDC.

Falls can do more than just cause physical damage: They can reduce quality of life, put more stress on the patient and family, and lead to lengthy hospital stays.

Why do so many older adults fall? There are numerous reasons, but one reason is overconfidence: A person feeling unsteady may think they can make it to the door or the bathroom, or don’t believe that a throw rug or dog toy on the ground poses a threat.

“Your balance gets worse as you get older, so it’s really important to work on that,” Schultz said. “But not everyone wants to hear that, so they don’t take the action needed to (prevent falling).”

Medications—as was the case with Bennett—can upset a person’s equilibrium or sensations in the feet and legs.

Changes in vision can also lead to a fall if the person doesn’t have the right prescription for glasses/contact lenses. Bifocal or progressive lenses can sometimes make things seem closer or farther away than they really are, according to the CDC.

Take action to prevent falls

“There are a lot of good programs out there that help with fall prevention, but you have to be willing to participate in them,” said Schultz.

Being physically active is key to preventing falls.

“As we age, it’s important to keep moving,” said Sue Kautz, falls performance improvement coordinator for the Quality, Safety and Value department in the hospital. “The worst thing we can do is just sit in a chair.”

Kim Gebauer, safe patient handling and mobility program manager, agreed. “One of my favorite phrases is: Movement is medicine,” she said.

And that’s where activities such as tai chi can be valuable. During tai chi, participants work on stability and shifting their weight from one leg to the other, said Stacy Olson, Whole Health program manager. “This helps prevent falls, with patients being more intentional and more aware of their movement,” she said. “And it helps strengthen the lower extremities and overall sense of balance.”

Being safe at home

To prevent falls in the home, Schultz recommends:

• Adding grab bars in bathrooms and railings for stairs.
• Making sure lighting is adequate throughout the home.
• Removing clutter, throw rugs and other tripping hazards.
• Placing colorful strips of fabric on the edges of stairs.
• Wearing shoes in the house because they protect the feet and give a person a better sense of landing.
• Having a chair in the bedroom for dressing.

She also said older people often need more time to adjust from lying down to sitting, or from sitting to standing. Falls often occur when someone is getting out of bed to go the bathroom, she said; they may be halfway to their destination when they suddenly feel lightheaded and fall.

Falls in the hospital

Patients admitted to the hospital are often at risk of falling as well because they don’t comprehend that they are “not at their normal level of function,” Schultz said.

And it’s easy for patients to overestimate their abilities, said Ruth Kunich, clinical performance and excellence coordinator, who’s part of the Milwaukee VA’s falls and mobility committee.

“One day in the hospital already starts the decline,” she said. “Plus, there’s a pride issue; people want control and want to be self-sufficient. They may say, ‘Oh, it’s only from here to the bathroom; I can make it,’ but they’re not the same person they were when admitted.

“But something as simple as a cold can decrease a person’s ability to get up and walk around, and that might even cause some mental decline, and then they don’t understand that they’re not at the same level as they had been before,” she said.

Keep moving

Most inpatients are encouraged to get out of bed and walk, if possible, even if it’s just a few feet to sit in a chair for a while. 

“That’s one of the most beneficial things you can do for people in the hospital,” Schultz said. “By sitting upright, you’re using a lot more muscles, and that helps everything function better.”

There’s also the STRIDE program, Gebauer said, which is designed to keep patients moving so they don’t lose their strength.

“During admission, we let patients know that they need to stay up and active as much as possible,” Kunich said.

“Falls is not a one person or one group committee,” Kautz said. “This is a system initiative. It is the duty of everyone who walks in a hall to help prevent falls. We’re not asking people to put their hands on people; we’re asking you to be aware of your surroundings and be willing to call for help.”

Learn more about VA’s Whole Health program.

This article was originally published on the VA Milwaukee Health care System site and has been edited for style and clarity.