Falling should not be considered a normal part of aging, but falls and the injuries and deaths they cause are a serious concern for older adults. According to the Centers for Disease Control and Prevention (CDC), one in four adults over the age of 65 falls each year, and falls are the leading cause of injury-related deaths for that age group.
Falls that cause injuries and deaths are prevalent in Wisconsin communities. Data from the Wisconsin Department of Health and Human Services shows more people over the age of 65 die from falls in Wisconsin than in any other state, with 182 deaths per 100,000 among people 65 years of age and older. Milwaukee County leads the state with 322 deaths due to falls in 2020.
Medications That Increase Your Fall Risk
A fall can be tied to multiple risk factors, including medications that can affect your balance and coordination. Most medication side effects are mild and temporary, but certain medications may cause you to feel faint or dizzy or to experience blurry vision or impaired judgment. These are all important side effects to note and discuss with your pharmacist when you pick up your prescription. In some cases, it may not be one medication causing the side effect; it could be interactions between multiple medications.
“If you feel faint or dizzy when transitioning from sitting to standing or laying down to standing, this could be due to your medications,” said Kylie King, PharmD, pharmacist with the Froedtert & the Medical College of Wisconsin health network. “Be cautious and aware of how you feel when you change positions. Take it slow until you figure out why you are feeling this way. If you think it could be due to side effects of your medication, speak with your doctor immediately.”
Types of medications that can increase your fall risk include:
- Sleep medications
- Depression and anxiety medications
- Mood and psychosis medications
- Seizure disorder medications
- Allergy medications
- Muscle relaxers
- Blood pressure medications (low blood pressure can make you feel tired or dizzy)
Your pharmacist can help you understand how the medications you take may affect your risk of falling. They can review the dosage, alert you of potential interactions with other medications and counsel you on the potential side effects.
“We recommend you fill all of your prescriptions at the same pharmacy, especially if your physicians are affiliated with different health systems,” King said. “This gives the pharmacist an accurate record of all of your prescriptions.”
In addition to certain medications, other risk factors for falls include:
- Muscle weakness
- Problems with gait and balance
- Vision changes
- Foot pain and improper foot wear
- Home hazards (stairs without handrails, poor lighting)
- Community risk factors (uneven sidewalks, icy surfaces)
The leading cause of hospital admissions at the Froedtert & MCW adult Level I Trauma Center at Froedtert Hospital is falls. In 2020, falls made up 32% of trauma admissions. On average, 1,400 people are admitted to the Trauma Center each year for fall-related injuries serious enough to require hospitalization. Most often, these injuries are traumatic brain injuries or hip fractures.
It is especially important for older people to be assessed in a trauma center after a fall-related injury. If evaluation is limited to the injury without consideration of underlying medical issues, the extent of the injury’s impact can be underestimated. The initial evaluation affects outcomes — even for patients who have survived 60 days after their injuries.
“The good news is that falls are often preventable,” said Kim Lombard, BS, CHES, injury prevention and outreach coordinator for the adult Level I Trauma Center at Froedtert Hospital. “There are several prevention strategies to reduce your risk or your loved one’s risk of falling.”
1. Talk to Your Primary Care Provider About Your Fall Risk
It is important to have a conversation with your primary care provider if you have a fear of falling. Fear of falling can be a risk factor for falls because it can lead a person to be less active, which increases the likelihood of muscle weakness and isolation.
If you have fallen before, sharing the circumstances and any related injuries or conditions due to the fall can help you and your provider make a plan to identify fall prevention strategies.
“If you have not had a recent vision exam, your provider may refer you to an optometrist,” Lombard said. “If you are concerned about muscle weakness, your provider may refer you to a physical therapist for help with strength and balance exercises. There are also many community-based fall prevention programs and workshops to consider.”
The adult Level I Trauma Center at Froedtert Hospital offers a seven-week workshop on fall risk and fall prevention through Stepping On, a national, evidence-based program. Research shows that Stepping On participants have a 31% reduced risk of falls.
2. Ask Your Pharmacist About a Medication Review
If you or a loved one are taking multiple medications, and you are concerned about the risk of falls associated with the side effects of those medications, a medication review with a pharmacist can be helpful to evaluate all current prescriptions.
“Be prepared to discuss your current medications, prescriptions and over-the-counter medications,” Lombard said.
For older adults in particular, the CDC recommends stopping medications when possible, switching to safer alternatives if available and reducing medications to the lowest effective dose.
“A pharmacist is an important part of the care team for Froedtert & MCW patients,” King said. “When a pharmacist at one of our clinics does a medication review, they will have access to all of your health records and can connect with your primary care provider or specialists to make recommendations about changes to your prescriptions.”
3. Reduce Home Hazards
Most falls happen in the home because it is where we spend most of our time. Clutter, poor lighting, stairs without handrails and slippery surfaces can all increase your fall risk at home. There are ways you can reduce certain hazards at home to prevent falls.
“Install grab bars where you may need them, such as in the tub, near the toilet or in the shower,” Lombard said. “Consider brighter lightbulbs at home or adding lamps to dim areas. Make sure stairwells have handrails on both sides. Carrying a cell phone is the best way to ensure you can call for help if you need it.”
4. Talking to a Loved One About Falling
It might feel uncomfortable or shameful to talk about falling. If you are concerned about a loved one’s fall risk, approach the conversation in a nonjudgmental way. Try to engage in a discussion about what they might consider as risk factors for falling.
What To Do After You Fall
If you fall, knowing the steps you can take to help yourself up can make the situation less stressful.
Call for Help
If you cannot get up, but you have access to a phone, call 911. If you are injured, paramedics can provide medical care and take you to the hospital. Even if you are not injured, they can help you up from the ground.
“I recommend keeping a cell phone on you at all times and keeping phones lower to the ground in the home,” Lombard said. “Also, consider other emergency response systems. Medical alert systems are helpful. Some people carry whistles or have a friend or neighbor check in on them daily. Whatever your situation is, be proactive and have a way to call someone if you need help.”
If help is not available, assess the situation, and try not to panic. Take a few deep breaths. Without moving, decide if you are injured. Rest for a few moments before you try to get up.
Get up Slowly
If you are able to move, attempt to bend both of your knees and lay on your side. Once there, get up on one elbow while using the opposite hand to push yourself up — your legs should remain on the ground but your upper body should be raised.
From there, try to move into a kneeling position on both your hands and knees. Crawl toward a chair or a step, and put your hands on the surface to support you as you get up slowly into a sitting position. If you cannot crawl, scoot backwards toward the surface. If you are not close to a surface that can support you, you can try pushing your back up against a wall and using your legs to get into a standing position.
“We generally do not recommend a person pull you up from the ground because that could cause an injury to them or to you,” Lombard said. “They can still assist by moving a sturdy chair close to you for support.”
Go to the Emergency Department, and Follow up With Your Doctor
While most bumps and bruises do not require medical attention, symptoms of an injury may not be immediately apparent. If you are in pain, go to the emergency department for evaluation. Be sure to schedule a follow-up appointment with your primary care provider.
Learn more about fall prevention tips and resources.