A Falls Prevention Checklist

Why is Falls Prevention Important?

With falls being the leading cause of injury in older adults, it is imperative that rehabilitation practitioners have the knowledge needed to help patients reduce their risk of falls. In Canada, 20-30% of seniors living in the community fall each year. Falls can result in fractures and brain injury, which negatively impact the quality of life and increase the mortality rate. Furthermore, a history of falls may increase one’s fear of falling, leading to decreased physical activity, which in turn exacerbates the risk of falls. This blog will provide you with falls prevention strategies to help you educate your patients on how to prevent falls in the home and community, and information on exercise-based falls prevention programs.

Strategies for Falls Prevention

At Home

6 out of 10 falls occur in the home. Luckily, there are small changes that you can suggest to your patients to decrease their risk of falling at home. Consider going through the checklist below with your patient so that they can implement some of these suggestions to “fall-proof” their home.

Living Room/Dining Room

Clutter (ie. slippers, blankets, pillows, books etc.) should be off the floor.
Electric cords should be tucked away.
Ensure that rugs are non-slip or are fastened down with double-sided tape.
Arrange furniture so that it is not in the way when walking.
E.g. Chairs at the table should be tucked in.
E.g. A coffee table should not be in the middle of the room, or, the walking space around the coffee table should be wide enough to get through with a gait aid (if you use one).

Bedroom

Keep a phone within reach, next to your bed for emergencies.
Have a nightlight on in case you need to get up at night.
Keep glasses (if you wear them) within reach in case you need to get up at night.
Keep your shoes/non-slip slippers and gait aid (if you use one) next to the bed.

Bathroom

Use a non-slip mat in the shower/bath.
Keep the floors dry. Be careful after taking a shower/bath.
Install grab bars in the shower/bath and next to the toilet. A towel rack is not a substitute.
Consider purchasing/installing a shower chair or bath bench if needed.
A handheld showerhead can make showering less challenging.

Kitchen

Place commonly used items within arms reach.
Avoid stepping on stools/chairs to reach for things. Ask for assistance instead.
Keep the floors dry. Be cautious of leaky faucets or spills after washing the dishes.

Hallways/Stairs

Clutter (ie. slippers, blankets, pillows, books etc.) should not be on the floor/stairs.
Ensure railings are sturdy and use railings when on the stairs.
Place the coloured tape on the stair edges to see where one step ends and another begins.
Ensure you have a light switch at the top and bottom of the stairs.

Outside your residence

Install rails on outdoor stairs.
Ensure the stairs are even.
Use salt on icy driveways/sidewalks.
Ask for help if needed to shovel snow, keep the yard clean and remove protruding roots.

Miscellaneous

Good lighting throughout the house is key to help you see any obstacles.
Turn on outdoor lights at night.
Consider using a medical alarm if you are concerned about falling.

If your patient requires larger costly home modifications, (e.g. installing grab bars, ramps, a stairway lift) to create a safe environment, there are government and community organizations that offer financial assistance to make homes safer for seniors and individuals with disabilities. Examples in Ontario, Canada include March of Dimes Home and Vehicle Modification Program.

In the Community

Walking outdoors in the community has additional fall risks. Use the following tips to help your patient address them.

Wear appropriate walking attire when walking outdoors, including good shoes, sunglasses/glasses (avoid bifocals/transitions glasses as they can distort your view).
Use an appropriate gait aid if needed.
Be aware of your environment including cracks, curbs, poles, ice.
Walk on grass instead of ice or cracked sidewalks.
Look for a rail to hold onto when boarding or getting off a bus/subway.
Sit close to the door on a bus/subway.
Ask for help if you require assistance.
Slow down, there is no rush.

You can share the above checklists with your patients by subscribing to Embodia and sending your patients an education tool on this topic.

Exercise Program for Falls Prevention

In addition to using the above strategies to improve your patient’s safety in the home and community environments, it is important to implement an exercise program for fall prevention. This program should include balance training, resistance training and aerobic training.

Balance and Resistance Training

Research has found that balance training, especially one that incorporates typical daily activities, greatly reduces the risk of falling. You can guide your patients through exercises to improve their balance and/or refer them to a fall prevention program that incorporates balance training.

Balance training may include resistance exercises that target specific muscles that are important in maintaining balance, such as the quadriceps, hamstrings, gluteals, calf, core and back muscles. Some examples of resistance exercises for these muscle groups are:

½ squats
Hamstring curl
Calf raises
Hip extensions
Hip abductions
Bird dog

Balance training also includes exercises that focus on directly challenging and improving balance. Ideally, these exercises should incorporate some of your patient’s daily tasks. Some example of balance challenging exercises are:

Tandem standing
Single leg stance
Clock single leg balance
Backwards walking
Walking and turning around
Navigating obstacles while carrying groceries
Stepping on and off of a curb with a gait aid

If you would like to prescribe any of the above exercises to your patients, subscribe to Embodia to access 1200+ exercises from Embodia’s exercise library. You can easily share exercise videos with your patients to increase their adherence to a falls prevention exercise program and ultimately improve their functional outcomes.

The Otago Exercise Program (OEP) is a famous cost-effective balance training program that is used in the USA, UK, Australia and New Zealand and has been shown to reduce falls in older adults by 35%. The OEP includes five strengthening exercises, 12 balance exercises and a walking program. Exercises can be progressed as appropriate. For more information on how to implement the OEP, review this manual. For more information on fall prevention programs in Ontario, visit https://www.ontario.ca/page/exercise-and-falls-prevention-programs.

Walking/Aerobic program

Cognitive decline is associated with increased falls. Evidence shows that aerobic exercise improves cognitive function, thereby reducing the risk of falls. Based on this evidence, it is imperative to incorporate aerobic exercise into a falls prevention exercise routine. To learn more about this topic, check out Embodia’s online course about the impact of exercise on cognition and physical activity in older adults by Dr. Theresa Liu-Ambrose.

It is recommended that older adults partake in 30-60 minutes of moderate-intensity aerobic exercise 3-5 days/week. This could include a walking program that can be divided into minimum 10-minute bouts throughout the day. While participating in aerobic exercise, ensure that your patient follows the suggestions in the checklist above for walking in the community safely. Encourage your patient to walk with a partner to support this healthy habit.

In conclusion, although older adults have an increased risk of falls, there are many ways that rehabilitation practitioners can help their patients reduce this risk. Incorporating some of the suggestions outlined in this blog can help promote a safe environment and a stronger, healthier individual in order to avoid falls.

References

https://www.canada.ca/en/public-health/services/health-promotion/aging-seniors/publications/publications-general-public/safe-living-guide-a-guide-home-safety-seniors/facts-seniors-injury-canada.html
https://www.nia.nih.gov/health/fall-proofing-your-home
Clemson, L., Fiatarone Singh M.A., Bundy A., Cumming, R. G., & O’Loughlin, P. (2012). Integration of balance and strength training into daily life activity to reduce the rate of falls in older people (the LiFE study): randomized parallel trial. BMJ, 345:e4547. DOI:10.1136/bmj.e4547
Campbell A.J., & Robertson M.C. (2003). Otago Exercise Programme to prevent falls in older adults. New Zealand Accident Compensation Corporation.
Stark, S. L., Roe, C. M., Grant, E. A., Hollingsworth, H., Benzinger, T. L., Fagan, A. M., Buckles, V. D., & Morris, J. C. (2013). Preclinical Alzheimer's disease and risk of falls. Neurology, 81(5), 437–443. https://doi.org/10.1212/WNL.0b013e31829d8599
Erickson, K. I., Voss, M. W., Prakash, R. S., Basak, C., Szabo, A., Chaddock, L., Kim, J. S., Heo, S., Alves, H., White, S. M., Wojcicki, T. R., Mailey, E., Vieira, V. J., Martin, S. A., Pence, B. D., Woods, J. A., McAuley, E., & Kramer, A. F. (2011). Exercise training increases the size of hippocampus and improves memory. Proceedings of the National Academy of Sciences of the United States of America, 108(7), 3017–3022. https://doi.org/10.1073/pnas.1015950108
American College of Sports Medicine. Acsm Guidelines for Exercise Testing and Prescription. 10th Edition. Lippincott Raven; 2017.

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Blog Writers: Bella Levi, MScPT Student; Debra Posluns, MscPT Student; and Linnea Thacker, MScPT Student