Falls and Imbalance

General Information
Falls are a major cause of both disability and death in senior citizens. They occur frequently. More than one third of people over age 65 have at least one fall each year. After a fall, elderly patients frequently voluntarily restrict their activity because they fear another fall. The occurrence of falls is a strong predictor of nursing home placement. Reduction in exercise leads to further weakness that, in turn, increases the risk of another fall, a vicious circle. Older patients need protection while walking after a fall to allow them to retain an adequate level of physical fitness.

Injuries sustained in a fall may range from trivial bruises to life-threatening trauma. Head injuries and fractures of long bones lead the list of serious outcomes. There may be a delay in the onset of the effects of head injury.

Several medical problems may predispose a patient to suffer a fall. Visual changes that decrease visual acuity, particularly at night or in the dark, increase the chances of a fall. Neurologic problems that cause weakness or affect stability and balance also set the stage for a fall. More serious medical problems, such as stroke, seizures, bleeding with associated anemia, and heart disease, particularly abnormalities in heart rate and rhythm, can lead to falls. Any medical problem that causes debility is a factor. With these serious diseases the prime focus of concern is the major health problem, but a fall can immeasurably compound these problems. A fall adds to the acute problem and prolongs recovery.

Important Points in Treatment
All falls merit some degree of evaluation. If there has been a health risk, your physician should be involved in the evaluation and any needed treatment. If health and limb remain intact, there is still a concern about why the fall occurred and how to prevent any more falls. Your physician can help evaluate health-related causes, but you must evaluate environmental causes in the home.

The environment is responsible for more than one third of all falls. Improper lighting, inadequate handholds, unstable furniture, loose rugs, and uneven floors all pose risks. Just as it is possible to childproof a house for a toddler, it is possible to fallproof a house for yourself. The shortest route from one place in the house to another may not be the safest. Always take the safest route. Remove hazards even if they are heirlooms. Rugs, throw rugs, and furniture are all avoidable hazards. Stairs should be supplemented with handholds for safety. Make sure that light switches are available at the doors or, if possible, outside the doors to dark rooms. Use night-lights freely. Adjust lighting so that it is even and bright enough to reveal obstacles.

Furnishings should be sturdy and stable to permit them to provide necessary support if they are leaned upon. The bathroom has the potential of being particularly hazardous. Nonskid mats are important inside and outside the bath. Towel racks do not substitute for handrails. Leave the bathroom door unlocked or at least openable from the outside.

Time and other efforts spent in maintaining safe mobility are more than compensated by savings in pain and disability and by an improved quality of life.

Notify Our Office If

• You have a fall. All falls merit some degree of evaluation. If there has been a health risk, your physician should be involved in the evaluation and treatment indicated.
• You have any sign of confusion after a fall. There may be a delay in the onset of the consequences of head injury.

FALLS:  PROPER SHOES

General Information
With advancing age the risk of a fall increases. A fall may not only produce an injury but may also result in limitation of activities that will impair the quality of life and the ability to engage fully in the ordinary activities of living. Selection of footwear is an important factor in the prevention of falls.

It is a common observation that well-fitting athletic shoes or sturdy, well-fitting leather shoes provide safer, surer footing than scuffs, slippers, or slip-ons. Careful study has shown this not to be true. Most falls occur to people who are soundly shod. It is true that well-fitting shoes firmly laced are important preventives. Loose, floppy, or ill-fitting footwear adds to the risk of instability, which may lead to a fall.

Important Points in Prevention
Equally important or perhaps more important is the selection of shoes with soles that are safely usable in your own environment. Soles must be matched to the floor surface on which they tread. Shoes with smooth soles—leather, rubber, or plastic—may be equally slick and unsteady on carpet or bare floor. Shoes may come with smooth soles or the soles may be worn smooth. Shoes with lug soles, particularly rubber lug soles, do well on smooth floors but may catch in fibers of the carpet nap, particularly if the carpet has a thick pile. Many well-constructed, expensive athletic shoes feature such a lugged construction. Shoes with a textured rubber or composition sole are a better compromise for steady footing.

Many athletic shoes, particularly those designed for running and active sports, have a rubber toecap. These toe caps are designed to provide traction as the athlete pushes forward at a run. They also tend to catch in carpet pile and may prompt a spill. This is a particular problem with patients who have difficulty picking up their feet as they walk and as a result shuffle. Shoes designed for walking as exercise often offer the best balance of a sole designed for nonslip traction without lugs or caps that trip you up.

Lace-up shoes will permit a careful adjustment for a snug but not restrictive fit. This is of importance with feet prone to swelling or with deforming arthritis. Laces can be hard to handle. Velcro closure or elastic laces are available and offer the compromise of permitting adjustment when needed without the need for retying every time you put on your shoes. Elastic laced shoes may be slipped into with the aid of a long-handled shoe horn.

Notify Our Office If ...

• You have a fall. All falls merit some degree of evaluation. If there has been a health risk, your physician should be involved in the evaluation and treatment indicated.
• You have any sign of confusion after a fall. There may be a delay in the onset of the consequences of head injury.