Why Did My Loved One Fall?

As we age, we do assume additional risk factors that contribute to falling, however, falls are not a normal part of aging. Your loved one can stay on their feet and avoid the risk of a fall.

Many things can cause a fall

Most falls are caused by a combination of factors, both internal to your loved one (happening within them) and external to them (happening in their environment). A fall rarely occurs due to just one cause or reason.

Internal causes (physiological)

• Poor eyesight, especially in areas with low lighting

• Poor hearing, which is usually accompanied by balance issues

• Slower reflexes that happen as we age

• Chronic conditions that can affect sensation and balance, such as diabetes, vascular diseases (heart disease, peripheral vascular disease), and foot problems

• Cognitive impairment (mild cognitive impairment, dementia, Alzheimer's)

• Depression

• Age-related loss of muscle mass (sarcopenia) or generalized weakness

• Vitamin D deficiency or osteoporosis

• Drops in blood pressure from sitting to standing (postural hypotension)

• Behavioral hazards, such as not modifying daily activities or routine exercises to account for new or increasing difficulties (examples are continuing heavy lifting or using a stepladder)

• Incontinence is also not a normal part of aging

External causes (environmental)

• Polypharmacy (taking 5 or more medications daily), especially certain medications

• Joint replacement surgery, which usually increases risk only temporarily

• Home safety hazards

  • Low lighting

  • Lack of support, such as walking aids or grab bars

  • Use of walking aids (yep, this is both a help and a hindrance!)

  • Slick or wet flooring

  • Loose rugs or frayed carpeting

  • Wires and cords

  • Cluttered walkways

  • The ambient temperature is too high

  • Ill-fitting or painful footwear

  • Pool and hot tub decks

• Community safety hazards

  • Uneven ground

  • High curbs and steps

  • Lack of railing, fences, or benches

  • Multiple obstacles to navigate, especially in the city

  • Icy surfaces

  • Pool and hot tub decks

What can I do?

Check your loved one's home for trip and fall dangers and help make the home safer. Start by eliminating as many of the external risk factors and hazards as possible. Make sure they have good-fitting footwear with non-skid soles, remove obvious tripping hazards, repair damaged stairs and walkways, add lighting to stairs and walkways (simple nightlights can help), carpet over slick floors and make sure all other carpet is in good shape, remove excess rugs and ensure mats placed on tile or other hard surfaces (bathroom and kitchen) are non-skid or otherwise secured, place non-skid surfaces in bathtubs/showers and on pool or hot tub decks.

Consult an occupational therapist for home modification recommendations individualized to your loved one.

Take a walk with your loved one to see how stable they are and report your observations to their primary care provider. Also, watch for changes in their strength or balance. Likewise, listen without assumption to any worries your loved one expresses about feeling dizzy, weak, or unsteady, and see that they get help.

Discuss the internal risk factors with your loved one's healthcare team, such as chronic conditions, medication side effects, and cognitive impairments, and have their feet checked. Ask their provider about a Vitamin D supplement.

Encourage your loved one to get regular vision and hearing exams. Also, encourage them to stay physically active, especially in activities that strengthen leg muscles and improve balance. Consider nighttime urine containment methods such as bed pads, briefs, and bedside commodes. Most falls occur at night in the bathroom or on the way to the bathroom.

Note that a fall may be a warning sign

A fall might be an indicator of a new or worsening health condition. New, and often temporary, health conditions that can cause falls include:

• constipation

• infection — bladder, urinary tract, or respiratory

• dehydration

• sudden confusion (sometimes called delirium)

Your loved one should always speak to their primary care provider if they've had a fall.

The CDC has an excellent Stay Independent brochure that includes a fall risk questionnaire.