How To Prevent Falls
This blog was originally published in the New York Times.
It’s that time of year again when safety-conscious organizations issue cautionary tales about preventing falls and, failing that, protecting against serious injury when suddenly descending unintentionally from the vertical.
Even if you think you already know everything you need to know about falling, you’d be wise to read on. Many of us can use a periodic kick in the pants to help keep us safe. I know, because I’m one of those prone to doing something foolhardy even while thinking how dumb it is.
Case in point: Having just read a ream of background information about the risks of falling and its exorbitant costs, both personal and financial, I did something utterly stupid. I stood on the edge of the bathtub in my slippers to clean the top of the surrounding tiles. I got away unscathed this time, but I’ve promised myself never to try that again. As a much younger friend reminded me, a little household dirt never killed anyone, but landing hard on bathroom fixtures is a common cause of fall-related injuries and even deaths among people of all ages, and especially those in and beyond their seventh decade.
In much of the country, fall injuries rise during the winter months when walkways become slippery and trip hazards are obscured by snow, ice or, in some areas, by leaves. Senior citizens, being less agile and more fragile, are especially at risk. A map of fatal falls in the United States, published last April in the AARP Bulletin, provides graphic testimony: Wisconsin and Minnesota, two of our coldest states, led the nation in deaths from falls among residents 65 and older.
Given the season, let’s start with how to avoid slips, trips and falls outdoors when sidewalks can sometimes resemble hockey rinks.
Step one: Check your footwear. Shoes and boots should have slip-resistant soles (rubber or neoprene, not plastic or leather). Or equip them withexternal traction cleats, sold under brand names like Yaktrax.
Step two: Take smaller steps, bend forward slightly, go slow and walk as flat-footed as possible when it’s icy or snowy. Check the steps and sidewalk for black ice before going out in the morning, even if only to pick up the paper or mail. Do likewise when stepping out of a vehicle. Although the air temperature may be above freezing, dew or fog can freeze on a colder surface.
Regardless of the season, scan the path six or more feet ahead of you for trip hazards. Avoid carrying items that block your ability to see the ground in front of you. I once tripped and landed hard on an irregular sidewalk while carrying two shoeboxes in my arms. Even when empty-handed, be sure to pick your feet up to avoid catching a shoe.
Now for the most common place for falls: Your home. Most dwellings contain a catalog of trip hazards, including piles of papers, loose carpets or floorboards, extension cords and clothing carelessly dropped on the floor, not to mention water or grease on the kitchen or bathroom floor. Remove as many of these as possible and wipe up all spills as soon as they happen.
While important at any age, these precautions are critical for the elderly. Falls are the No. 1 cause of injury to seniors, one in three of whom can expect to fall each year. Too often the result is a debilitating fracture, loss of independence or death. Nearly three times as many people die after falling (some 32,000 a year) than are killed by guns in the United States. Even when the injury from a fall is minor, it can create fear that prompts people to avoid certain activities lest they fall again.
When walking indoors, always wear shoes or slippers with nonskid soles — not barefoot (unless you want a broken toe), and never just socks unless they have nonslip grips on the soles. My slippers, which are really shoes with rubber soles, reside next to my bed so I can slip directly into them when I get up.
Always use a handrail when going up and down stairs. Consider installing a railing on stoops that lack them. If the item you want to carry is too big to hold in one hand or arm, ask someone to help. Bathrooms are particularly dangerous, especially for the elderly, who can benefit greatly from safety bars in the tub or shower and next to the toilet. Nonskid mats in the shower and tub and on tile floors are a must for all ages.
Among other steps to take that can reduce the risk of falling is to maintain physical strength and balance as you age. If you’re uncertain of your stability or agility, consider some sessions with a physical therapist and practice the recommended exercises regularly. Higher levels of physical activity have been shown to protect against falls in a study of Canadian men and women 65 and older.
Think before you climb. Always use a safety stool — not a chair or ledge — when trying to reach a high-up item. I now ask a tall customer or store clerk to help retrieve a grocery item on the top shelf, instead of standing on the edge of a lower shelf to reach or knock it down.
At home, move all frequently used items to lower shelves, or purchase a cabinet that sits on the floor to store them in.
Some experts recommend learning “the right way to fall.” In the Netherlands, physical and occupational therapists even teach classes on the art of falling. The advice tends to focus on minimizing the risk and extent of injury by landing on soft tissue as gently as possible. It includes trying to stay relaxed as you fall; the stiffer you are, the more likely an injury. As you land, try to roll like a football player.
When falling forward, the instinct is to stick out one’s hands to break the impact, which often results in broken wrists instead. If possible, try to twist as you go down to land on a side and then roll over to your back.
When falling backward, tuck your chin to your chest to avoid hitting your head, which can result in a concussion, and keep your arms in front of you.
In all honesty, these measures are more easily described than executed. Several friends of a certain age who have fallen maintain that there was nothing they could do to mitigate an injury in the split second between being upright and lying flat on the ground. But consider mentally reviewing scenarios in which you “practice” falling more safely by visualizing the measures described above.