Table of Contents
In this fall prevention guide, you will learn:
- Consequences of a fall.
- Systems that we use to stay upright and steady.
- Factors that influence our ability to balance and prevent a fall. These include medication, footwear, and strength.
- Steps you can take to improve your balance and reduce your risk of falling.
What is Balance?
The Oxford dictionary defines balance as:
“An even distribution of weight. This weight distribution enables someone or something to stay upright and steady.”
The Consequences of Falling
Falls occur at all ages.
Children don’t gain the confidence to walk without falling. Complete independent mobility can take many years.
Yet, with one fall, an older adult can lose their confidence and their independence.
As we age, our senses diminish, and our strength, agility, and coordination decrease. Many factors can impact the risk of falling.
A fall has consequences for older people. It often leads to an injury, sprain, strain, or fracture. It can also lead to a “fear of falling” or, worse, death.
Falls are the leading cause of injury-related death among adults age 65 and older.
The age-adjusted fall death rate is increasing. (1,2) Between 2012 and 2021, the rate of injury-related deaths among adults over 65 has gone up from 55.3 per 100,000 to 78.0 per 100,000. (3)
A fall and related injuries are a source of distress for:
- Partner or spouse.
- Other family members.
Falls should not be a “normal” part of aging. Instead, a fall is usually the result of unaddressed issues.
We will cover many of the things that can increase our risk of falling below. Let’s first discuss the systems we use to keep our bodies from falling.
How Our Bodies Stay in Balance
Keeping our bodies upright and steady involves several systems.
In this section, you will learn about these systems. By the end, you will understand:
Why do you sometimes lose your balance?
How you can improve your balance. Let’s start with the visual system and how it affects your balance.
The first system most people are aware of when it comes to balance is our visual system. Our eyes allow us to perceive, process, and interpret what we see. We rely on our eyes to keep us oriented toward the world.
Due to concerns about falling, most people look where they walk. Many people look down when the surface is uneven, or the terrain is unfamiliar and focus their eyes on one spot to maintain balance.
If we constantly rely on our eyes, the other systems become dull. The end of this guide will cover tips to protect your eyes and stimulate the other balance systems.
The second system we use is the vestibular system, or the inner ear.
The ear has three semicircular canals pointed in different directions. They are perpendicular to each other and give us position-sense when we move our heads. Fighter pilots and astronauts must train to avoid dizziness when doing their spins.
Children love to stimulate their vestibular systems. They roll around on the ground, hang upside down from monkey bars, and do other movements.
As we age, we tend to avoid stimulating our vestibular system. We find it unstable and disorienting. Clients tell me that they do the same walk every day. One day, someone comes up from behind and calls their name. Turning their head to see who it is, they fall.
Why does this happen?
Because that individual never worked on their balance with head turns. They lost their balance from a simple head turn. We provide tips at the end of this guide, hoping this never happens to you.
The third system we use in our body is the somatosensory system. The somatosensory system is part of our nervous system. It allows us to feel pressure and joint position, among other things.
Specialized nerves called proprioceptors exist in our muscles, ligaments, tendons, and joints. Proprioceptors relay information to our brains to let us know where our limbs are in space.
Cerebral vascular accidents, or strokes, cause trauma to the brain. This could lead to various problems.
Somatosensory System Example
A part of the brain receives information from the proprioceptors. Suppose an accident causes damage in that area of the brain.
That individual will not be able to interpret the data coming from the limb. As a result, they will not notice that their hand falls off the arm of the wheelchair when they lift themselves.
That individual then has to rely even more on their visual system. They must use their eyes to know where their hand or foot is.
With our central nervous system intact, we can train our proprioceptors. We do this by challenging our vestibular system or altering our visual system.
It is best to practice in a way that allows your proprioceptors time to succeed and does not overwhelm them. I have many exercises that will provide safe progressions in the tips below.
Factors That Influence Balance and Prevent Falls
Many factors influence our balance and help us prevent falls. We cover several of them in this section, starting with strength.
Strength and Fall Prevention
Strength plays a critical role in fall prevention. The stronger you are, the better the chance that you could experience an injury from a fall.
Upper body strength improves our chances of catching ourselves in a fall. Lower body strength gives you the ability to withstand more significant perturbations. Core strength provides you with the stability to pull it all together.
Flexibility and Fall Prevention
Flexible ankles are both a curse and a blessing when it comes to falling. Flexible, strong ankles can withstand and correct slips and trips. While flexible, weak ankles are often the cause of a fall.
I encourage my clients to strengthen and improve the flexibility of their ankles.
A kyphotic posture or rounded upper back can cause balance issues and lead to a fall. In fact, research shows a relationship between kyphotic posture and loss of independence. There is also a correction with a higher death rate among community-dwelling older adults.
Let’s move to eyes, vision, and vision care.
Eyes and Vision Care
As we age, many people develop eye diseases. Some of these diseases will cause a degree of vision change, some of which is irreversible.
I am concerned when I assess an individual and it determines that their primary balance strategy is their eyes. This is a very common issue with most individuals over the age of 50 or if they have experienced previous falls.
Developing alternative balance strategies such as strength, agility, and our proprioceptors can help to keep us upright.
If you are over 65, have comprehensive eye examinations every 24 months.
If you are under 65 and have a family history of eye disease, do not hesitate to visit an optometrist. Changes in your vision are another reason to reach out to your optometrist.
Common visual changes that occur as we age include:
- Macular degeneration.
- Diabetic retinopathy.
- Mini-strokes that can affect the optic nerves.
Be sure to make regular visits to the optometrist part of your healthy aging process.
Many over-the-counter and prescription drugs can increase your risk of falling. Speak to your pharmacist about their potential impact on balance.
For example, the Tylenol bottle might state that you can take up to four grams daily. But the pharmaceutical company based the recommendation on testing with healthy, 25-year-old men.
The comparison is not useful. A young man has much more muscle content than we do as we age. The percentage of muscle, water, and body fat is very different between 25 and 65 years old. Despite this, the recommended dosage is the same for all adults.
The percentage of muscle, water, and body fat affects how long a medication stays in your body. It also determines whether it leads to toxicity faster.
The following common medications increase fall risk:
- Anticonvulsant medications.
- Muscle relaxants.
Fall Proof Your Home
When our balance is poor, hanging on to furniture to get around the house is dangerous. Just as having too much clutter can be dangerous. I provide suggestion if you find yourself in either or both situations.
Footwear and Fall Prevention
Footwear plays a critical role in balance and fall prevention. What we wear on our feet dictates the comfort, response, and support our feet feel for the task.
My husband says: “You can spot a physical therapist by their shoes.”
We generally wear sensible shoes: no high heels or floppy slippers. Below you will find all the qualities you should look for when shopping for shoes.
If you have specific shoe needs, seek help from a podiatrist or other foot specialist.
Choose shoe wear that reduces your risk of a fall and keeps your feet healthy. I suggest you follow these guidelines.
Slip On Shoes
Slip-ons make it life easier but not safer. I strongly encourage you to look for the following qualities in day-to-day shoes to reduce your risk of falling:
Low heel shoes are safer because you are closer to the ground.
Wide toe box to allow your toes to stretch out and help you respond to your environment.
Lace-up shoes are essential, but all my clients hate them because they have to lace them up. Instead, get lace-up shoes, but change the laces to elastic laces so you don’t have to bend down.
Use a long-handle shoehorn to slip your foot into the shoe, avoiding the need to reach down.
Foot Care and Preventing Falls
Our feet are essential for balancing. Studies show that the health of our feet is an integral component of fall prevention and balance.
Foot care has been an obsession of mine. Since I turned 50, I noticed that my balance was starting to change. I thought I could harness the power of my feet to improve my balance.
Foot care involves removing many unwanted items from your feet, including:
- Plantar warts.
- Ingrown toenails.
- And any other undesirable item.
From there, you want to add regular foot massage, toe stretches, and strengthening.
My YouTube shorts, below, demonstrate each of these.
If you still do not know if you have healthy feet, then have a foot assessment. Pedorthists and podiatrists are foot care experts. They know foot orthotics and orthopedic footwear well.
You don’t have to go see them because you want an orthotic. See them for the health of your feet.
Flexible Strong Feet
Studies and my clinical observation tells me that taking care of your feet is critical when it coms to reducing your risk of a fall. I recommend that you begin with some foot care. You can get the help of a professional for corns, calluses, hammer toes and bunions.
I recommend that you start with some basic foot massage that you can do yourself and other important foot care strategies that you will find here.
The video below is a sample of several exercises to improve your balance. A more comprehensive series of (ad free) balance and fall prevention videos is available on my site.
The fastest way to improve your balance is to practice. The videos in this balance exercise series will help you quickly regain your confidence.
Fall Prevention Tips
These tips will help reduce your chance of a fall.
Take Care of Your Eyes
Get your eyes checked. Make sure your eyeglass prescription is up-to-date.
Request a low vision exam if you have any vision difficulties. The right tools can ensure you can see important things. This is especially true if you are dispensing the medication at home.
Glasses are an essential consideration in vision care. However, bifocals and progressive lenses impact our ability to perceive depth accurately. You need be cautious when managing steps.
Slow Head Turns Exercise
Head movements stimulate your vestibular system. To train your vestibular system while working on your balance, start with little head turns. As you get more comfortable, add more prominent head turns. The speed and angle at which you turn your head can make a big difference in your ability to stay upright.
Train Your Proprioceptors
Practice balance exercises that do not involve focusing your eyes on one spot. Begin with moving only your eyes without turning your head. Start moving them slowly from side to side, then up and down.
There are many examples of in the Beginner Level Balance Exercises in my book, Exercise for Better Bones. Be sure to explore all the variations.
The strength of your legs, core and arms play a role in fall prevention as we discussed earlier. The strength training guide will provide you with a greater understanding of the benefits of being strength training and help you find the right resource for you. View our strength training guide.
The flexibility of your ankles play a role in fall prevention as we discussed earlier. The flexibility guide will provide you with a greater understanding of the benefits of flexibility and help you find the right resource for you. You can start with the blog that covers both ankle and toe stretches.
Posture has been shown to influence your balance. The posture guide will provide you with a greater understanding of the benefits of flexibility and help you find the right resource for you.
Talk to your pharmacist whenever you get a new prescription or a change in dosage. Specifically, ask if any of the medications increase your risk of falling.
Fall Proof Your Home
When our balance is poor, hanging on to furniture to get around the house is dangerous.
Suppose you move around your home using your furniture for stability. In that case, you certainly will benefit from some assistive device. There are many great options to keep you safe, depending on your situation and your home layout.
Please get in touch with a Physical Therapist. They can assess your balance and have you try different devices until you find the one that suits your needs. They can also customize a strength and balance program. When you regain strength and improve your balance, you can try the exercises on this site and build up to not needing an assistive device.
Home Safety – Top Three Tips for the Spaces in Your House
- Never use a chair to climb up to reach into a cupboard.
- Keep often-used items in easy-to-reach places.
- Clean up spills straight away.
- Install grab bars.
- Consider a shower chair.
- Use non-slip mats.
- Keep a phone close by in case of emergency with preprogrammed numbers.
- Ensure lamps are easy to reach.
- Use motion sensor plug-in night lights.
- Remove clutter, keeping the path free from obstacles.
- Use non-skid rugs and carpets with secured edges.
- Remove any cords or wires.
- Keep them free of clutter.
- Install full-length handrails.
- Attach non-slip treads mark step/stairs edges.
Indoors and Outdoors Stairs
- Ensure adequate lighting, including sensor lights.
Consult an Occupational Therapist
Occupational Therapists can do home safety checks and provide detailed reports in most larger cities.
In the meantime, please keep yourself safe. If your safety or that of someone you love is a concern, please check with your local hospital or doctor. Attend a fall screening event in your town or look for a local fall prevention clinic.