Staying Safe and Grounded: Tips to prevent falls at home and around town.

Stephens, Stephanie

Neurology Now:
doi: 10.1097/01.NNN.0000459067.66693.c0
Departments: Living Well
In Brief

Tips to prevent falls.

Jerry Lewis did it right, but most of us don't want to do it at all. Falling is no laughing matter. And people with neurological problems are at greater risk.

Even elderly patients with mild to moderate neurological impairments have a three times higher incidence of falls than people without neurological challenges, according to a 2013 study in the journal British Medical Journal Open.

In its 2008 guideline for assessing patients for risk of falls, the American Academy of Neurology cited increased risks for falls among people diagnosed with stroke, dementia, and gait and balance disorders. Patients with Parkinson's disease, peripheral neuropathy, lower extremity weakness, sensory loss, and substantial vision loss also have a higher risk of falling, the authors of the guideline wrote.

The risk is not only associated with a neurological condition. According to the National Council on Aging, one in three people over the age of 65 in the United States fall unintentionally every year. Nearly 2.5 million nonfatal falls occurred among older adults in 2012, resulting in emergency department treatment and followed by hospital admissions for more than 722,000 of them. Nearly half of these people had not told their health care providers about the fall because they feared losing their independence.

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TIPS TO PREVENT FALLS

The good news is that there are things you can do to reduce your risk for falls, whether you've already had an injury from a fall or just want to make sure you don't fall in the first place.

“I remind patients and families that they really can prevent falls,” says Michael Okun, MD, a professor of neurology, neurosurgery, and neuroscience at the University of Florida College of Medicine's Center for Movement Disorders and Neurorestoration. Dr. Okun, the national medical director of the National Parkinson Foundation, is also a Fellow of the American Academy of Neurology. But knowing when to ask for help is an important first step, he says.

1. Consult your doctor. When a person falls two or more times within a year or has an injury caused by a fall, they probably need an evaluation by a doctor, says geriatrician Jane Mahoney, MD, a professor of medicine at the University of Wisconsin School of Medicine and Public Health, who is also the director of the University of Wisconsin Health Mobility and Falls Clinic. “At the Wisconsin clinic, a team of professionals work together to identify the reasons why people are falling and then help them do what they need to in order to reduce their risk,” Dr. Mahoney says.

That may mean using a three-pronged cane or a walker when moving about in and outside the home.

The Wisconsin clinic sees people who have had a stroke, Parkinson's disease, traumatic brain injury, and cognitive impairment. Other common causes for falls include vision problems, arthritis, and fluctuations in blood sugar caused by diabetes. High blood sugar can cause dehydration and lightheadedness. Low blood sugar can cause confusion and faintness.

“We also see falls related to poor judgment and poor safety awareness,” says Dr. Mahoney, “such as when people don't use their cane or walker at home or out and about.”

2. Maintain good vision. Vision problems can increase your risk for falls. “If you can't see, you can't identify a fall risk and avoid it,” says Mindy Renfro, PhD, a licensed physical therapist at the University of Montana in Missoula. “Bifocals are especially troublesome when you look down at the floor and it's out of focus.” Make sure your prescriptions for glasses and contacts are up-to-date, and schedule an annual eye check-up, she advises.

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þ A Checklist for Preventing Falls

OUTDOORS

* Clear all steps and sidewalks of debris, clutter, and slick surfaces.

* Install textured surfaces on stairs, walkways, porches, and decks; put railings on both sides.

* Make sure doorways have low thresholds.

* Install or update outdoor lighting on entrances and in other high-traffic areas.

* Position the mailbox within easy reach.

INDOORS

* Use non-skid floor wax.

* Remove scatter rugs from tops of stairways and high-traffic areas.

* Secure all rugs so they don't slip and so feet can't “get under” a corner.

* Don't leave clothes, shoes, and bags on the floor.

* Paint a contrasting color on top edges of steps.

* Evaluate all rooms for sufficient, uniform lighting, including lights at tops and bottoms of stairs.

* Designate a special place for a first-aid kit and emergency phone numbers.

* Consider wearing an alarm device that alerts another person when you've taken a fall.

BATHROOM

* Install secure grab bars to help get in and out of the tub and shower safely.

* Clean off soap scum and use non-slip strips on tub and shower floors.

* Use adjustable-height shower heads.

* Secure bath mats so they can't slip.

KITCHEN

* Store frequently used items within easy reach to avoid climbing.

* If you must climb, use a quality, solid step stool with a top bar to hold onto.

BEDROOM

* Keep a lamp and telephone by the bed.

* Place nightlights along paths you take to and from the bed.

3. Exercise regularly. The old adage, “Use it or lose it,” holds true for preventing falls. “The more you keep physically active, the better. Play golf, walk, or go dancing—do whatever you can to stay fit,” Dr. Mahoney says. Most importantly, exercise can help people maintain their balance and strength. That advice is especially true for those with neurological conditions. At the 2014 American Stroke Association conference, for example, researchers reported that tai chi, a slow-moving, choreographed martial art, reduced falls among stroke survivors. A tai chi course that has been modified for people with balance problems is a good option, Dr. Mahoney says. The YMCA often offers these modified classes. The National Association of Area Agencies on Aging can also help identify programs near you.

A physical therapist can also help develop an exercise plan for people with neurological conditions, especially those who are very frail or who were not active before. Exercising safely and with good form—and under professional supervision—is important, says Dr. Renfro.

4. Take stock of your medications. Certain medications can cause dizziness or drowsiness and can affect balance. Analgesics, sedatives, and antipsychotics, for example, can throw you off balance and increase your risk for falls. Make sure your pharmacist, primary care provider, and other specialists have a complete list of all your medicines, including over-the-counter medicines and supplements. Ask them to identify medications that may cause drowsiness and dizziness, and have them recommend the safest options for you.

5. Do a home assessment. Ask your doctor to recommend a physical or occupational therapist to evaluate your home for falling risks, sooner rather than later, Dr. Renfro suggests. “Many people say, ‘I don't need to do this—my disease or condition isn't that bad.’ If you wait until your condition gets ‘too bad,’ living at home may no longer be an option. I have seen too many cases where a person has a serious fall, and it is determined that their home is no longer safe for them to return to,” Dr. Renfro says.

“Don't try to do the assessment by yourself,” she advises. There are plenty of do-it-yourself resources for adapting the home online. But a professional can help ensure that the grab bars in the hallways or bathrooms are properly placed and at the right height, that the floors have the right kind of non-skid surface, that the lighting is appropriate and well-placed, and that the doorways are wide enough to accommodate a wheelchair or a walker, for example.

Being proactive instead of reactive can reduce significant physical, emotional, and financial costs, Dr. Okun says. But, he acknowledges, sometimes people are reluctant to follow advice or make the changes necessary to ensure their own safety. Hearing advice from more than one person helps. So, too, does framing the message in a positive way. For people who may bristle at being told that they must use a cane or walker, for example, consider a friendlier message: A cane or walker isn't a defeat—the larger defeat is not using it. “Remind the person that they're not giving up, they're being smarter about staying safe.”

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FOR MORE INFORMATION

* Neurology Now article on preventing falls: bit.ly/Falls_NN

* Neurology Today article on preventing falls: bit.ly/NT-falls

* National Council on Aging resources on preventing falls: bit.ly/falls-ncoa

© 2014 American Academy of Neurology