Avoiding Falls: 8 Helpful Tips for Older Adults and Their Caregivers

If you’re a caregiver or just enjoy spending quality time with your parents or grandparents, these statistics may be cause for concern: Falls are a major problem among older adults (age 65 and up) and can lead to serious injury or death.¹ In fact, falls are the top cause of injury and death from injury among older adults in the U.S.²

Maybe most troubling of all? Many falls go unreported. Of the approximately 36 million falls reported per year, less than half of the older adults who fall tell their doctor about them.³ This is especially worrisome because falling once doubles your chances of doing so again.⁴

Thankfully, falls are preventable, for the most part, says Kevin Lazaruk, RPh. He’s a board-certified geriatric pharmacist and long-term care consultant based in Los Angeles.

What causes older adults to fall

Most falls result from a combination of issues — and the more risk factors you have, the greater your chances. Here’s what Lazaruk says can increase your chances of falling and what you or your caregiver can do to help keep you on your feet.

Risk Factor #1: Medications

As you age, the likelihood you will be taking multiple prescription medications tends to increase. The more medications you take, the greater the chance for side effects or drug interactions that contribute to falls.⁵ This is because there are certain medications with side effects that can interfere with balance, induce fatigue, and interact with other medications.

What types of medications are most likely to cause older adults to fall? Find out below.

Mental health, pain, and epilepsy medications: Drugs that affect your brain or suppress your central nervous system put you at the greatest risk of falling, says Lazaruk. This is because they often have side effects such as drowsiness, decreased alertness, sedation, dizziness, loss of balance, slowed reaction time, and decreased coordination.

These medications include:

• Antidepressants, particularly the tricyclic antidepressants, such as Elavil (amitriptyline), Tofranil (imipramine), and Pamelor (nortriptyline)^6,7
• Atypical antipsychotics, such as Abilify (aripiprazole), Zyprexa (olanzapine), and Risperdal (risperidone)⁸
• Benzodiazepines, such as Xanax (alprazolam), Klonopin (clonazepam), and Valium (diazepam)⁹
• Sedative-hypnotics, such as Ambien (zolpidem), Lunesta (eszopiclone), and Sonata (zaleplon)¹⁰
• Opioids, such as codeine, Vicodin (hydrocodone), Percocet (oxycodone), and Dilaudid (hydromorphone)¹¹
• Anticonvulsants, such as phenobarbital¹²

Blood pressure medications: Medications for controlling your blood pressure, such as Lopressor (metoprolol) and Norvasc (amlodipine),¹³ can increase your fall risk. Blood pressure medications can cause low blood pressure when you stand up. That can make you feel faint, lightheaded, or dizzy. This is called orthostatic hypotension, and it’s common in older adults.¹⁴

Diabetes medications: Low blood sugar can also contribute to falls in older adults. This means medications that decrease blood sugar are another potential culprit, including insulin and oral diabetes medications. When your blood sugar level drops, you may feel unsteady, lightheaded, and faint, which could lead to a fall. Which is why it is important to regularly monitor blood sugar and ensure your medication regimen isn’t excessively reducing your blood sugar.

Over-the-counter medications: Even medications you can buy over the counter aren’t harmless when you’re 65 or older. Lazaruk says products such as antihistamines like benadryl and decongestants can cause drowsiness, dizziness, confusion, and blurred vision.

Risk Factor #2: Health Conditions

If you’re suffering from certain chronic conditions or health-related factors due to aging, or simply not drinking enough water during the day, your fall risk may increase. Some examples include:

• Weakness in your lower body from aging, inactivity, and/or poor nutrition
• Impaired mobility, which can occur due to joint issues such as arthritis or conditions such as Parkinson’s disease
• Cognitive impairment, such as dementia or Alzheimer’s disease
• Vision problems
• Inner ear issues, which may cause vertigo and dizziness
• Urinary incontinence, which can lead to rushing to the bathroom at night in the dark
• Alcoholism
• Depression
• Pain
• Poorly controlled diabetes, which can cause numbness in the legs and vision issues
• Dehydration

Risk Factor #3: Environment

Environmental factors can also contribute to your fall risk, whether it’s the climate you live in or the condition of your home. For example, if you live in a cold climate, simply walking outdoors in the snow and ice can increase your risk of a fall. If you have unsecured rugs or slippery floors in your home — or a lot of clutter on the floor — you also might be at greater risk of a fall.

How to prevent falls in older adults

So the million-dollar question is, how can you (or your caregiver) help prevent falls? Aside from the obvious — having someone salt your icy sidewalk or keeping a bottle of water nearby to stay properly hydrated — Lazaruk says there are steps that you, your caregiver, and your health care provider can take to keep you safe.

Fall Prevention Tip #1: Do Routine Medication Reviews

It’s crucial to have your pharmacist regularly go over all your medications, says Lazaruk. This is especially true if you or your loved one keeps falling. This involves regularly going over all your medications and those used on an as-needed basis, and evaluating them for potential fall risk and other drug interactions, he explains.

It’s possible that your dose can be decreased, or you can stop taking a medication altogether (with your doctor’s input). The goal is to be on a medication regimen that provides the best response, while also minimizing side effects. Lazaruk notes that a review would also include over-the-counter medications and herbal supplements.

Fall Prevention Tip #2: Ask Your Doctor About Precision Medicine

Everyone reacts to medications differently. This is partly because of your genetics — what sets you apart from your neighbors and family members. Your doctor may be able to order a pharmacogenomic (PGx) test that can reveal how specific genes can impact your response to certain medications.

PGx testing looks at many different classes of medications, including antidepressants, antipsychotics, anticonvulsants, and opioids — all of which increase your risk of falling.¹⁵

Here’s how it can help you: Let’s say you’re experiencing side effects from your medication, such as drowsiness or dizziness. A PGx test can indicate a more optimal medication (or dosage) for you that may reduce your risk of falling.¹⁶ Additionally, Genomind’s precision medicine software uniquely allows clinicians to check for potential drug-drug and drug-gene interactions all in one place. This can help clinicians evaluate prescribing options less likely to result in adverse events, such as factors that can cause falls in elderly. Fewer side effects may also make you more likely to take your medication regularly, notes Lazaruk. More good news: Some PGx tests are covered by Medicare, including one of Genomind’s.

Fall Prevention Tip #3: Fall-Proof Your Home

Safety measures in your home are just as important as medication reviews, says Lazaruk. He emphasizes that the bathroom is a particularly important place to make fall-proof. Install grab bars in your shower, by your toilet, and in your tub. Place fall mats on the floor and think about installing a shower chair.

Lazaruk also suggests removing clutter from your floors and stairs, securing loose rugs to the floor and cords to the baseboards, and installing a railing (or railings) leading up your stairs. Make sure you have good lighting, and place lights (or nightlights) along your path to the bathroom. Fall mats can also be placed next to your bed.

Fall Prevention Tip #4: Wear Secure Shoes

“I cannot emphasize enough the importance of footwear,” Lazaruk says. He recommends wearing no-slip, closed-toe grip shoes with plenty of support, even around your home. Avoid slippers and flip-flops — “you don’t want to be stubbing your toe and then take a tumble,” he explains.

Fall Prevention Tip #5: Have a Flashlight Handy

You don’t need to walk around with a hefty flashlight everywhere you go, but there are safe and easy alternatives. For example, you can use the flashlight on your smartphone when you’re walking in or outside in the dark. Or you could simply clip a small flashlight onto your keychain. “Keep a flashlight handy to illuminate your path if you’re walking in the dark,” Lazaruk says. “It’s easy to miss a curb or step into a hole when you can’t see well.”

Fall Prevention Tip #6: Take Your Time

If you suffer from orthostatic hypotension — a drop in blood pressure when you stand up — Lazaruk advises sitting up for a minute or two before you get out of bed. This can help your body adjust to the pressure so that you can stand up without feeling faint.

Also, make a point of slowing down and focusing when you’re walking around, especially up or down stairs. “Don’t be preoccupied looking at your phone or thinking of something else,” Lazaruk says. “Look at each step and take your time, because a missed step could lead to an injury.”

Fall Prevention Tip #7: Don’t Rule Out Walking Aids

You may need a cane or walker to help you get around safely, notes Lazaruk. Ask your doctor about getting an evaluation. If you already use one or the other, check with your doctor to make sure you’re using it correctly.

Fall Prevention Tip #8: Check Your Lower Body Strength

Do you have trouble stepping up to a curb or walking upstairs? Lazaruk advises talking to your doctor about an evaluation of your lower extremity strength. He also recommends strength and core training. (You’re never too old to go to the gym.) Strength training can beef up your muscles to help you get around better. Core training, such as yoga and tai chi, can boost your balance and stability.

Sometimes, the fear of falling can feel worse than an actual injury. But by taking these steps, you’ll feel steadier inside and out.

Sources:

1. Falls lead to injury or death: Centers for Disease Control and Prevention (2017). “Important Facts About Falls”
2. Top cause of injury and death in the U.S.: Centers for Disease Control and Prevention (2020). “Keep on Your Feet—Preventing Older Adult Falls”
3. 36 millions falls per year: Centers for Disease Control and Prevention (2020). “Keep On Your Feet—Preventing Older Adult Falls”
4. Risk of falls doubles after first: Centers for Disease Control and Prevention (2021). “Facts About Falls”
5. Increased risk of side effects or interactions. Centers for Disease Control and Prevention (2020). “Keep On Your Feet—Preventing Older Adult Falls”
6. Info on antidepressants and risk of falls: Harvard Health Publishing (2021). “Medications that increase your risk of falling”
7. Info on types of antidepressants: Mayo Clinic (2019). “Tricyclic antidepressants and tetracyclic antidepressants”
8. Info on atypical antipsychotics and risk of falls: University of Michigan Health (2020). “Antipsychotic Medicines”
9. Info on Benzodiazepines: Mayo Clinic (2019). “Tricyclic antidepressants and tetracyclic antidepressants”
10. Info on sedative-hypnotics’ side effects/falls: U.S. Food and Drug Administration (2019). “Sleep Disorder (Sedative-Hypnotic) Drug Information”
11. Info on opioids: Harvard Health Publishing (2021). “Medications that increase your risk of falling”
12. Info on anticonvulsants: HealthinAging.org (2019). “Tip Sheet: Alternatives For Medications Listed In The AGS Beers Criteria® For Potentially Inappropriate Medication Use In Older Adults”
13. Info on blood pressure medications and falls: Centers for Disease Control and Prevention (2008). “Are Your Medicines Increasing Your Risk of a Fall or a Car Crash?”
14. Orthostatic hypotension common in older adults: Clinical Medical Journal (2021). “Orthostatic hypotension in older people: considerations, diagnosis and management”
15. Info on pharmacogenetic tests: MedLine Plus (2021). “Pharmacogenetic Tests”
16. Info on PGx testing: Genomind (2021). “Some PGx tests are covered by Medicare“