Right before Thanksgiving, Sharon, 80, was home alone when she slipped on some flour that had spilled on the floor. Her daughter, Sally, arrived a short time later and found her sitting in a chair in an odd posture, shaken by the event and not wanting to be left alone. A subsequent trip to the doctor was unrevealing, but the after effects of the fall were dramatic. Sally said her mom “seemed mentally stunned and unresponsive,” needing help with most daily activities for weeks.

Several months later, it happened again. Sharon’s family had installed monitoring cameras and was alarmed when they saw Sharon fall backward onto the stove, where she got stuck.  

“Thankfully I had turned off the gas a few weeks previously or she might have set herself on fire,” Sally said.

Soon after that Sharon moved into a long-term care facility.   

Unfortunately, Sharon’s experience of falling is common. Last year, Senate Minority Leader Mitch McConnell made headlines when he tripped during a dinner event at a Washington, DC, hotel. He sustained a concussion and rib fracture that landed him in the hospital for several days followed by treatment in a rehabilitation facility. While his accident garnered national attention, most falls go unreported, according to the Centers for Disease Control and Prevention (CDC).

The risk of falls is significant, especially as we age. More than 1 in 4 older adults fall every year, leading to an estimated 3 million emergency room visits and over 800,000 hospitalizations. CDC research cites annual medical costs of more than $50 billion. Yet many people underestimate the risk of falls. By increasing awareness of falls and taking specific actions to prevent them, home healthcare providers can help elders avoid injuries, healthcare costs and even deaths.

Mary Ann Gonzales, MD, a physical medicine and rehabilitation physician and brain injury medicine specialist, says she sees patients with falls “at least once a week.” Impaired balance, weakness, poor vision, heart rhythm problems, and dizziness increase fall risk as we age. Gonzales also notes that taking multiple medications, or polypharmacy, can make someone more likely to fall. Some combinations of medications may contribute to orthostatic hypotension, a drop in blood pressure when moving from lying or sitting to standing, which can lead to falls, she said.

The CDC reports that the fall death rate increased 30% between 2007 and 2016. In 2020, falls were the leading cause of injury death in adults 65 and older and accounted for 36,000 deaths. According to the World Health Organization, falls are the second leading cause of unintentional injury deaths worldwide.

Individuals and home care provider actions

Annual fall risk assessments are recommended by the CDC and the American Geriatric Society for all adults 65 and older. The CDC’s Stay Independent brochure includes a series of questions for older adults and their care providers to assess fall risk.

CDC’s STEADI algorithm was developed to support healthcare providers by outlining the process for screening, assessing and intervening to reduce falls.

Specific recommendations for individuals include:

  • Staying active: Exercise can improve balance, strength and overall fitness.
  • Identify and address visual and hearing concerns.
  • Improve home safety, including removal of tripping hazards, slippery rugs and clutter.
  • Review medications with a doctor or pharmacist to weigh benefits against potential fall risks.

Home care providers can further aid seniors aging at home to prevent falls by:

  • Working with their insurance plan to obtain the right medical equipment/support to help maintain an active lifestyle. 
  • Getting involved in physical therapy to improve balance and strength to reduce fall risk.
  • Setting up weekly/monthly calls with family members to discuss any assistance needed for continued independence to maintain and even improve quality of life. 
  • Making a plan to ensure they have the systems and supports needed to thrive as they age in place.

Gonzales also recommends keeping pathways well-lit, using a cane or walker when needed, and installing grab bars near the toilet and shower in the bathroom. For those who live alone, an alert system or a smart watch can be a way for someone to get help if they fall, she said.

In Sharon’s case, an underlying medical condition, frontal lobe dementia, contributed to her balance problems. To help compensate, her family made sure she had supports to hold onto throughout the house. They encouraged her to use a cane, though she was resistant. Ultimately, they had to move her to long-term care because she couldn’t live alone safely.

Government actions to reduce falls

According to a 2022 report by the U.S. Government Accountability Office (GAO), nine federal programs are aimed at reducing falls in older adults or people with disabilities. They include programs that provide home safety assessments and modifications, such as ramps and rails, as well as exercise classes for certain populations. While these initiatives may be helpful for those they serve, high-risk groups, such as adults 45-59 years old who have disabilities, may be left out. In addition to expanding program scope to include younger individuals who might benefit, better information-sharing is needed between federal agencies to coordinate program administration and outreach efforts.  

Tech-enabled solutions

Innovative programs that draw on technology to support high-risk individuals, their home health providers and other care team members can reduce falls and associated injuries and lower costs.

In one such program, an evidence-based screening tool is used to identify adults who are more likely to fall and who could benefit from extra support. Occupational therapy assistants work with these individuals and their care partners to identify hazards — poor lighting, loose rugs, lack of guardrails — and take corrective action.

Other risk factors, like vision and hearing problems, excessive medications, or mobility concerns, are also identified and addressed. High-risk individuals may be referred to their doctor to discuss medicine adjustments or to a physical therapist to improve strength and balance. Older adults and their families are empowered to take important steps to improve home safety and quality of life.           

Often, fall risk factors go unnoticed and unaddressed until it is too late. As our population continues to age, a proactive, multi-pronged approach to fall prevention is vital to address this important public health problem.  

Lisa Doggett, MD, MPH, FAAFP, is a family and lifestyle medicine physician and senior medical director at Sagility, a global leader in business process management and optimizing the member/patient experience.