Physical Therapy

RISK FACTORS FOR FALLING

BIOLOGICAL RISK FACTORS

Walking, Balance and Coordination Problems

Difficulties with walking are among the most common mobility limitations and can be the result of several factors:

• Weakness: muscle weakness can cause gait problems such as toe drag or foot drop and can also cause knee, hip or angle instability which in turn can contribute to falls. 
• Spasticity: spasticity refers to feelings of stiffness and a reduced ability to maintain smooth, controlled movements of limbs. The feelings may range from mild "tight" muscles to severe painful, uncontrollable spasms. Spasticity can occur in any limb, but is most common in legs. 
• Loss of Balance: balance problems typically result in a swaying or uncoordinated walking. 
• Dizziness and Vertigo: Dizziness may appear as the feeling of being off balance or lightheaded causing difficulty walking and contributing to falls. Less often occurring, but still contributing to falls, some experience vertigo - a situation in which one's surroundings seem to spin. 
• Sensory Deficits: numbness and other sensory disturbances such as tingling or burning sensations in the legs or feet may make it more difficult to walk as it may make it more difficult to be aware of the position of legs and feet in space - especially on uneven or unstable surfaces. 
• Tremors: Tremors are fine, rapid, back and forth movements on the limbs and head which can interfere with balance and coordination. 

Fatigue

Fatigue, differing from muscle fatigue resulting from exertion, but more the feeling of exhaustion that is unrelated to someone's level of activity.  When this type of fatigue is present, it can worsen all the other symptoms that contribute to walking difficulties which in turn increases the risk of falling.

Vision Problems

Double vision, blurring, poor contrast or loss of peripheral vision can cause dizziness and compromise a person's ability to walk safely - increasing the risk of falls. 

Cognitive Changes

While cognitive changes can range from the ability to focus to changes in organizational skills; however, as it relates to fall risks, cognitive changes that interfere with a person's ability to focus and perceive their surrounding environment are what can contribute to tripping. 

Bowel & Bladder Dysfunction

While dysfunction in our bowel and bladder systems do not directly affect mobility - the fact that one may be rushing to use the bathroom or getting up in the night while drowsy and unfocused, can be contributing factors to falls. 

Medications

All medications have side effects and everyone responds differently to medications.  Anyone taking medication that lists fatigue, weakness, dizziness should be particularly attentive to their mobility and the possibility for increased risk of falls. 

BEHAVIORAL RISK FACTORS

Inactivity

A sedentary lifestyle, for anyone, leads to deconditioning. Inactivity can result in the loss of muscle tone and weakness, as well as poor posture and impaired balance. Inactivity also results in decreased bone density, which increases the risk of fracture. Identifying problem areas with the assistance of an experienced physical or occupational therapist and developing an exercise routine can be effective in helping to reduce falls and fall-related injuries. 

Fear of Falling or Overconfidence

Falls and injuries from falls can be frightening. Fear is a natural, protective response, and the most common response is to try to avoid situations that produce fear. Although that kind of avoidance may keep an individual away from dangerous situations, it can also lead to inactivity and isolation, and lead one to severely curtail activities that they enjoy. On the other hand, overconfidence may result in behaviors that increase the risk of falling - rushing and being inattentive to possible hazards. A more effective approach involves recognizing factors that increase one's fall risk while actively seeking ways to reduce or minimize them in order to maintain involvement in enjoyable activities. Simple modifications to an existing routine or activity may be able to reduce risks. 

ENVIRONMENTAL RISK FACTORS

Eliminating hazardous conditions in the home and office is an important strategy in fall prevention. This may include removing clutter and reducing the risk of tripping by removing throw rugs; fixing poor lighting; or adding supportive features such as grab bars or handrails on stairs, in bathrooms, and in home entryways where there are steps. 

Public places are filled with potential hazards, including uneven pavement, potholes and ramps. Any of these can make it difficult to maintain safe footing, leading to slips, trips, and/or falls. Paying close attention to one's environment and navigating carefully are the most effective ways to prevent injuries. Wearing sturdy shoes with good traction is helpful. It may be necessary to use a cane or walker, especially on uneven ground or in unfamiliar surroundings.