What are some ways to prevent falls?
Because falls account for 95% of bone fractures, it's important to find ways to prevent them. When people fall in their homes, others may wonder how that can happen in a familiar environment. But you can fall anywhere, including your own home where you may have walked the same floors for half of your life. You may have medical conditions that contribute to a loss of balance. You may be rushing to answer the phone or get to the bathroom. Or you may trip on that piece of carpet you've been meaning to tack down for a long time. (Table 18 lists ways of preventing falls.) There are things you can do now to help you take control and prevent falls. It's not just the new lamp with a long cord that can trip you. If you
Table 18 Preventing Falls
are placed on a new medication or you develop a new symptom such as fever or dehydration, you are more likely to fall. So it's particularly important to be aware of any change in your personal circumstances as well as any changes in your environment.
The more risk factors you have for falling, the more likely you will fall. Risk factors for falling include:
• Age > 65
• Poor balance or poor vision
• Alzheimer's disease or any condition that impairs thinking or memory, including depression
• Weakness or numbness in the feet or legs
• Medications such as those used to treat depression, psychosis, and high blood pressure
• Medical conditions such as arthritis, vitamin D deficiency, stroke, Parkinson's, infection, dehydration, fever, sudden blood pressure or pulse changes
• Previous fall
While you may not have any control over some of your medical conditions or the medications used to treat them, you do have some control over exercise. Increasing your strength, balance, and coordination can reduce your risk of falling. Tai chi has been shown to reduce the risk of falling in frail older people, reduce the rate of bone loss, and also reduce the number of fractures, possibly due to fewer falls from improved balance. Don't underestimate the importance of the improved balance, coordination, and flexibility that results from exercise.
If you or a family member has many risk factors for falling, you may want to invest in a medical alarm to alert medical and rescue personnel if you or a family member falls. Bed rails are available for non-hospital beds. Getting up in a dark room may make falls more likely. Be sure to have a well-lit path to the bathroom. If you don't want to wake your partner with extra light, keep a small flashlight next to the bed.
If you are on a number of different medications, it's important to make sure that you are taking the correct dosage at the appropriate time every day. Using a pillminder allows you to stock each compartment with your daily allotment of pills. That makes it less likely that you will take too much of any of your medications, some of which might lower your blood pressure and make you drowsy or dizzy, causing you to fall. You should also avoid the use of alcohol and discuss any over-the-counter medications with your clinician prior to taking them.
My clinician has advised that I use hip protectors. What are they, and why should I use them?
Your clinician is concerned that you are at risk for falling. If you do fall, hip protectors, which are thick cushioning pads that fit over the hips, may prevent you from fracturing your hip.
Hip protectors are available in different styles and sizes. Hip pads that fit into washable underwear cushion the blow of a fall, but these pads are not washable. Another style has pads sewn into the underwear in the space over the hips and is fully washable. A third style of protector fits over regular underwear but under your clothes. A belt-type hip guard can be worn outside clothing. Figure 13 shows two different types of hip protectors. There is also a style designed specifically for men. If you also have urinary incontinence, some styles allow for the use of pads.
Studies evaluating fractures in people using hip protectors have conflicting results; some show a benefit
Figure 13 Styles of hip protectors. Courtesy of HIProtector® Fall Prevention Devices.
and others do not. Although hip protectors can absorb up to 75% of the impact of a fall, one of the biggest problems with assessing their effectiveness in reducing fracture risk and probably the biggest barrier to their effectiveness is getting people to actually use them.
If your clinician suggests hip protectors, it's not something that will hurt you, so go ahead and use them. A number of medical-surgical supply companies carry hip protectors, and they are available on the Internet. It's important to measure yourself accurately so that the protectors don't slip around or dig into your hips. Because hip protectors can be expensive, shop around.
-  A protective pad worn on the hip.