by Robin Burroughs, Risk Control Director, CNA HealthPro

As people get older, not only are they more liable to slip and fall, but they are also more likely to suffer serious injury from a fall. To protect against this danger to life and limb, it is necessary to understand what causes falls and to take certain common-sense preventive measures.

CNA HealthPro insures healthcare organizations, including nursing homes and other long term care facilities. To help our clients, we have closely studied the question of what individuals and institutions can do to reduce fall-related injuries. This article summarizes the findings.

These guidelines are only a starting point in creating your own fall-prevention plan. It is by no means a complete treatment of this important subject. Talk to your doctor and other caregivers for more detailed and specific advice about staying healthy by staying upright.

Common Causes of Falls
Illness – Certain diseases produce symptoms that can greatly increase the risk of falls. This means it's important to discuss all aspects of your illness with your doctor, and to know what symptoms to expect or to anticipate. Also, talk to your doctor about arranging assistance to evaluate and manage possible fall-related symptoms.

Here are just a few of the common illnesses that can increase your falling risk:

• Parkinson's disease, multiple sclerosis and other neurological illnesses, which may affect balance, muscle tone and gait, can be helped by such assistive devices as braces, canes, walkers and wheelchairs.
• Heart disease and blood pressure problems may cause sudden dizziness, which can substantially increase the risk of falling. Alert your physician if you feel such symptoms, which can be alleviated by proper medication.
• Arthritis can cause pain and stiffness, which can result in unexpected weakness or loss of balance. Assistive devices (see above) may increase safety in such cases.
• Diabetes can produce sudden alterations in blood sugar, which in turn can cause symptoms such as weakness or dizziness. If you are diabetic or suffer from low blood sugar, take special care to follow your prescribed diet and medication regime.
• Depression, anxiety, memory loss, senility and Alzheimer's disease can impair awareness and judgment and thus increase the risk of falls. Be sure to take medication as directed, and be realistic about your capabilities.

Medication side effects. Prescription drugs, while invaluable in treating disease and illness, can produce side effects or interactions with other medications that may increase your risk of falling. Always talk to your physician or pharmacist about medication risks, including possible allergic reactions. Call your doctor immediately if you experience any of these symptoms after taking a drug:

• anxiety or agitation
• confusion or memory loss
• depression
• excessive drowsiness
• dizziness, lightheadedness or weakness
• shaking or tremors
• impaired balance
• disturbances of vision, such as blurring or double vision
• iapid or irregular heartbeat

If you are taking your medications independently, these tips can help reduce the danger of drug interactions or other problems that could result in physical weakness and falls:

• Be sure to take your medications exactly as directed, and have a system in place to prevent double-dosing.
• Keep a current list of all your medications and provide it to the doctor whenever new medications are being ordered. Include all over-the-counter (non-prescription) pills or supplements, as well as prescribed medications.
• Purchase your medications from the same pharmacy whenever possible. Your regular pharmacist is a good resource for identifying potential drug interactions.
• Read the explanatory material that comes with your prescriptions, and note any warnings.
• Store medications properly, as instructed on the container.
• Prepare your medications in a well-lit area, and reread the labels carefully before each dose.

If you receive assistance when taking your medications, be sure that you know the name of each medication you are taking and what it looks like, as well as dosage, medication schedule and the reason it was prescribed. Question any medication that is not provided at the correct time or that looks different from previous doses. Be alert to any changes in routine, as mistakes do occur.

Other risk factors. Certain behaviors and conditions increase the odds of injuring yourself in a fall. These include the following:

• Smoking. Smoking not only may decrease bone strength, but it also increases the risk of home fires – another serious safety concern. It's never too late to quit; talk to your physician about how you can kick the habit.
• Alcohol. Even a small amount of alcohol may be dangerous if you are suffering from some diseases or taking certain medications. Be sure to discuss with your doctor whether or not you can safely drink any alcoholic beverages, and, if so, how much and how often. Excess alcohol intake may decrease bone strength as well as impair judgment, decrease balance and slow reaction times. Many falls, automobile accidents, medication mistakes and fires are associated with alcohol use.
• Vision or hearing loss. Always wear glasses and hearing aids as prescribed. Keep these implements nearby when you're in bed and put them on before getting up.
• Bowel and bladder dysfunction. The urgent need to use the bathroom can increase your risk of falls. If you experience bowel or bladder urgency or incontinence, speak to your doctor about possible treatment. Be sure your path to the bathroom is always clear and well lit. And remember that some drugs, such as diuretics and blood pressure medications, may cause frequent urination, so you will need unimpeded access to the bathroom after each dose.

Home Safety Issues
Most falls occur in the home. You can create a safer, less fall-prone living space by following these simple safety tips:

Lighting. Dim lighting and dark shadows invite missteps. Make sure that the following areas are well lit, and that light switches or pull-cords are easily accessible:

• house and garage entrances
• outside walkways and paths
• stairs and hallways
• closets
• medication storage and preparation areas

Be sure to have extra light bulbs of varied wattage on hand and to replace burned-out bulbs immediately. Bedrooms, bathrooms and kitchens should be equipped with night-lights to prevent late-night trips and falls.

Floors. These measures can reduce the likelihood of slipping and tripping:

• Remove small throw rugs from every room and hallway.
• Check that bathroom rugs have rubber non-skid backing, and replace bathroom rugs when the backing wears out.
• Ensure that all carpeting is well-secured and that edges are flat.
• Keep hallways and other walkways clear of furniture, boxes or other items.
• Clean up spills immediately; keep all floors clean and well-swept.
• Use only non-slip floor wax or no wax at all.
• Keep electrical and telephone cords off the floor and away from walkways.

Stairs. Honestly assess your ability to climb up and down stairs. If stairs present a hardship or a hazard, consider single-level housing or moving your bedroom to the first floor. If stair-climbing is part of your daily routine, you can decrease the risk of accidents by following these stairway safety tips:

• Keep stairs well lighted and free of any clutter.
• Use non-skid stair treads or low pile carpeting.
• Install and maintain sturdy handrails on both sides of the staircase and at each landing. Handrails should extend the full length of the stairway.
• Wear appropriate footwear. Don't walk up or down stairs in socks, stockings or smooth-bottomed slippers.
• Keep outside stairs clear of debris, leaves, snow and ice. Outdoor stairways and inside stairways both need handrails.

Kitchen. The important thing is to store utensils and cooking supplies at counter level or lower for ease of access, and to keep frequently used items within easy reach. If you can, avoid stepstools, but if you must use one, make sure it is sturdy, well-balanced and equipped with hand-rails.

Bathroom. The bathroom is the scene of many serious injuries. It requires special safety measures, such as the following:

• Install and use handrails in the tub and shower and around the toilet.
• Install a high toilet seat to make sitting and standing safer and easier.
• Use non-skid strips in the bathtub to prevent all-too-common shower slips.
• Remember not to lock the bathroom door, in case you should fall and require assistance.

Furniture. Arrange your furniture to allow for wide walking spaces, especially if you use assistive devices, such as a cane or walker. Beds, chairs and tables should be adjusted to the height that allows you to sit and rise easily. They should be secured to prevent slipping or sliding during use.

Footwear. For maximum traction and stability, wear low-heeled shoes with non-skid soles that fit snugly. Avoid footwear with thick, heavy soles that can catch on uneven surfaces. Check shoelaces to make sure they're tied. It's best to avoid walking in the house wearing socks and stockings, which are slippery.

Wellness and Fall Prevention
Keep active. Staying physically fit can reduce your risk of serious injury from falls and other accidents. Talk to your doctor or physical therapist and find the right activity for you. Moderate exercise provides health benefits for people of every age, including the following:

• stronger bones and slower loss of muscle mass
• increased flexibility, mobility and balance, resulting in more confident movement
• reduced joint pain and stiffness
• more positive outlook and increased enjoyment of life

To prevent exercise-related injury, don't overdo it. Stop when you're feeling depleted and make sure you have the proper attire and equipment for your activity.

Eat a balanced diet. All seniors, especially post-menopausal women, need to maintain bone health to reduce the occurrence of fractures. You can prevent osteoporosis, a gradual weakening of the bones, by regular intake of adequate amounts of calcium, vitamin D and other essential nutrients pursuant to the advice of your health care professional. If you are not sure of the foods that constitute a healthy diet, and whether you need nutritional supplements, ask your nutritionist or doctor.

In Case You Fall …
Despite taking all reasonable precautions, there's still the chance you might fall. It's important for all seniors to consider the risk of falling while unattended, and to take necessary safety measures.

Many seniors have fall alarm pendants or emergency systems in their homes. Others arrange to get daily phone calls from family or friends, alerting the caller to possible trouble if the phone goes unanswered. Talk to your family, friends and caregivers and decide upon the approach that works best for you.

In its brochure, "Don't Let a Fall Be Your Last Trip," the American Academy of Orthopedic Surgeons recommends the following steps if you fall:

• Don't panic.
• Assess whether you have been hurt.
• Slide or crawl along the floor to the nearest couch or chair and try to get up.
• If you can't get up, call for help.
• If you are alone, crawl or slide to the telephone and call 911 or relatives.

Falls will always be a risk as we get older, but it's possible – and not very difficult – to significantly reduce the odds of accident and serious injury. By taking just two simple steps – talking to your doctor about fall prevention and examining your home for possible hazards – you can begin the process of creating a safer, healthier and more confident lifestyle.
This article was published by CNA. It is for educational purposes. It is not legal or medical advice. CNA makes no representations as to its correctness or completeness and accepts no liability for any injury or damage that may arise from its use. Specific legal or medical questions should be referred to a competent attorney or medial professional.

CNA is a registered service mark of CNA Financial Corporation. © 2005 Continental Casualty Company. All rights reserved.