Worried about falls in an older parent or relative? If so, do you know if their doctor has considered the most useful fall prevention approaches?
Fall risk can be reduced, but it generally takes some thought and effort. That’s in part because most older adults have multiple factors making them vulnerable to falls.
In a related article on this site, I’ve explained that best fall prevention plans involve identifying an older person’s particular risks — especially risks related to health conditions — and trying to counter those.
So for instance, if an older person has diabetes and is having frequent moments of low blood sugar (also known as hypoglycemia), then to reduce falls, addressing the hypoglycemia is as important, if not more, as starting an exercise program.
In other words, I always recommend that aging adults and families learn to tailor their fall prevention plans. You want to focus on what are the most important modifiable risk factors for that individual person.
That said, over the years I’ve noticed that there are four approaches that I find myself using over and over again, in almost all my patients who have had repeated falls.
These four approaches are used often by geriatricians, but much less often by busy primary care doctors. Unless, that is, a proactive family asks about them.
My Four Most-Used Fall Prevention Approaches
They are:
- Medication review, followed by reducing medications that increase fall risk.
- Checking blood pressure (BP) sitting and standing.
- This to make sure that BP isn’t overall on the low side (e.g. sitting systolic BP less than 120), and also that it’s not dropping a lot when the older person stands up.
- Gait, strength, and balance evaluations, often in collaboration with physical therapy.
- An evaluation often confirms that an older adult has poor balance and diminished leg strength. Doing exercises specifically designed to improve balance and strength, such as the Otago program, can counter this.
- Home safety assessment and modification, in collaboration with occupational therapy when possible.
- An occupational therapy evaluation usually needs to be ordered by a health provider, as part of skilled home health services.
- The Occupational Therapy Geriatric Group at the University at Buffalo also offers an excellent free home safety workbook here: Home Safety Self-Assessment Tool (HSSAT)
You can hear me explain these four approaches in the related podcast episode embedded below. (Click the magnifying glass for a searchable transcript.)
What about Vitamin D for fall prevention?
I do still recommend that most older adults take a vitamin D supplement, however, I no longer particularly recommend it for fall prevention.
Vitamin D used to be my fifth general recommendation for fall prevention. Even though it seemed the effect on falls reduction was small, at least it’s an easy thing to implement, and a daily dose of 800-1000 IU/day is extremely unlikely to cause harm.
However, the accumulating research evidence has been suggesting that Vitamin D supplementation has no benefit, when it comes to preventing falls. (At least, not in “community-dwelling” adults over age 65, which means older adults who are not in the hospital or in nursing homes.)
In 2018, the US Preventive Services Task Force recommended against Vitamin D supplementation to prevent falls in community-dwelling older adults.
Caveat: they say “Recommendations apply to community-dwelling adults not known to have osteoporosis or vitamin D deficiency.”
That is actually a fairly large group to exclude, given that both osteoporosis and vitamin D are fairly common.
Since vitamin D is unlikely to cause harm and may help some older adults, I still recommend it, just not specifically for fall prevention.
For more, see Vitamin D: the Healthy Aging Dose(Plus Answers to 7 FAQs).
Review your fall prevention plan if you’ve fallen or been concerned!
Perhaps the most important strategy to apply is to be proactive in getting help with falls.
Research has found that older adults often don’t report falls to their health providers. Worse yet: when they do, health providers often fail to provide adequate evaluation and management in response.
So, although it’s good to tell your doctor if you’ve fallen, it’s even better to do a little homework and be ready to ask about the four fall prevention approaches I’ve listed in this article:
- Medication review, followed by reducing medications that increase fall risk
- Checking blood pressure sitting and standing
- Gait, strength, and balance evaluations, often in collaboration with physical therapy
- Home safety assessment and modification, in collaboration with occupational therapy when possible
Here are some related articles to help you:
- 8 Things to Have the Doctor Check After an Aging Person Falls
- Preventing Falls: 10 Types of Medications to Review if You’re Concerned About Falling
- Why Older People Fall & How to Reduce Fall Risk
If you want to equip yourself to be even more proactive, you can learn more about how your health providers should be addressing falls on the CDC’s STEADI website.
I’ve also recently compiled a Fall Prevention Resource Guide, click the link below to get your free copy of this PDF resource. It’s short and lists my top recommended online fall prevention resources, so that you have a way to find them fast.
With some gentle reminders from you and others, your health providers will do a better job helping you reduce falls.
Questions or comments? Post them below!
This article was reviewed and minor updates were made in Sept 2023.
Charles Tart says
I’m 86, a semi-retired psychologist, who has spent much time in life observing my own mind. I haven’t had a fall of concern yet, but sometimes have moments of feeling off balance, like I may fall. Two things make these moments more frequent, getting too rushed and getting too absorbed in my thoughts instead of paying attention to my walking. For me at least, being more mindful, something I’ve advocated in my books over the years, lessens my chances of falling.
As a backup, when possible I walk close enough to some supporting structure so I could grab on with a hand when I feel off balance. I’ve had some handrails attached to the wall in the places in my home where there is no other thing I could grab if I get an unbalanced feeling.
And thanks so much for your advice on all issues regarding aging!
Nicole Didyk, MD says
Deep thinking and self examination are good activities, but can be distracting! I’m glad you haven’t had a concerning fall.
By the way, we call grabbing onto household structures instead of using a cane or walker (or another gait aid) “furniture walking”!
cj says
I fell 8 times in 2 weeks – hospital discovered I had a urinary infection. Treated for it.
Was a year ago and haven’t fallen!
Nicole Didyk, MD says
That’s a great example of how a fall can be a sign of another problem! I’m glad you have stayed fall free!
Sun says
I might add vision, especially when wearing progressive eyeglasses. My ophthalmologist says single vision lenses help prevent falls.
Nicole Didyk, MD says
Multifocal glasses (bifocals, progressives, or multifocals) have lenses with different strengths, whereas single vision lenses don’t. Mulitfocals can cause some distortion at the place where the lenses change, or can make some objects appear blurry if seen through the incorrect lens.
I found this article about single lenses, and it does seem as though single lenses are better at preventing falls on those who do a lot of outdoor activity. The article goes on to indicate that for those with a low level of outdoor activity, multifocals might be better.
So, for sure, getting vision assessed is important , and based on your needs and lifestyle, your optometrist should be able to help you decide which lenses are best.
Frank says
At some afternoon or early evening deal with the issues on your mind and write what you have and will do for resolution: put the notes away and do your yoga or breath exercises
And relax
Nicole Didyk, MD says
This is great advice for a lot of conditions that affect older adults. Relaxation can promote better concentration and attention, both of which are important for balance and stable walking.
Stan Goldberg, Ph.D. says
These are excellent ideas. However, I didn’t see anything about training the body not to fall. In Parkinson’s the body’s ability to consistently execute automatic behaviors (e.g., walking down the steps) is disrupted. I have found that I can retrain my muscles to execute volitionally by using the research found in memory and learning. Not as good as not having to think about going up or down steps, but definitely preferable to falling.
Nicole Didyk, MD says
I’m glad you found the suggestions to be excellent!
Exercise or training of any kind is an important part of falls prevention. It sounds like you’re using cognitive training, which is very interesting, and absolutely preferable to falling. Thanks for sharing your success.
Joan Good says
Thank you doctor for being there for us older folks. Old age is not for sissies as someone most wisely said.
I will be seventy-nine in December and am very pro-active about health. We walk a couple of miles every
day, eat a very healthy diet and supplement based on our doctor’s recommendations. My insomnia is severe and is taking a mental toll, so my doc recommended yoga. I found a very informed teacher who is analyzing my issues, stemming from a ski accident at age fifteen to being rear ended by a truck at a stop sign in my thirties. The common sense comment made by one of your readers makes a lot of sense such as avoiding the wrong shoes and not attempting to cross or be involved in slippery surfaces! Thank you for being here for us.
Nicole Didyk, MD says
I’m so glad you found someone to help with your insomnia without using medications!
It sounds like you have some very healthy habits and I would encourage you to carry on with exercising and eating well. You’re right that common sense can go a long way to keeping a person well.
Thanks for sharing your feedback.