Hazards in the environment are estimated to play a role in one-third to one-half of falls. Typical hazards include inadequate lighting, clutter, electrical cords across pathways, small rugs or rugs on top of carpets, uneven surfaces, slippery surfaces, raised thresholds, low chairs, and soft chairs. Most falls occur indoors: in the bathroom, bedroom, or kitchen. Ten percent occur on stairs, with walking downstairs causing more falls than walking upstairs. The most common outdoor hazards are steps and curbs.
A person’s likelihood of falling increases in proportion to the number of internal risks (such as poor vision and neuropathy) and external risks (such as stairs and rugs) present.
Some people may not report a fall to their family, friends, or even doctor due to a misperception that falls are a normal part of aging, or they may withhold the information because they feel embarrassed or fear losing their independence. But falling is not normal, and it can lead to serious injury and loss of independence. By letting someone know that you have fallen, and seeking help to address the cause of your fall, you are taking an important step toward preventing future falls and maintaining your independence to the greatest degree possible.
The American Geriatrics Society and the British Geriatrics Society issued joint guidelines for fall prevention in 2010, in which they recommend an annual doctor’s assessment of fall risk for older people. You can ask for this assessment if your doctor does not raise the subject of fall prevention with you. To evaluate your fall risk, your doctor should ask whether you’ve ever fallen and, if so, under what circumstances. He should ask if you have any mobility problems, if these are not already known. If your risk of falling is deemed to be high enough based on these answers and your overall health status, your doctor may refer you to an occupational or physical therapist for individualized help. Sometimes it is possible to get a fall-risk screening done at a community health fair or through a senior center or seniors’ organization.
Ask your doctor to check your prescriptions for drug interactions or other factors that may increase your risk of falling; your pharmacist may also be able to help you with this. Also ask your doctor whether it would be beneficial to get your vitamin D and B12 levels checked out. Let your doctor know about any episodes of hypoglycemia you’ve experienced and what the circumstances were. If your HbA1c level is below 7%, you may want to discuss the possibility of “loosening” your blood glucose control, especially if you’re experiencing frequent hypoglycemia.
An occupational or physical therapist can do a safety assessment of your living space (a nurse may also be able to perform this service) and evaluate your functional mobility. Screenings typically last about an hour. At your home, a therapist will look at your typical daily activities and evaluate your balance, your posture, and any difficulties you have with each activity. He will guide you through a problem-solving process to identify and prioritize changes that can be made throughout your home. You should feel free to discuss any activities that have been affected by your diabetes or any other chronic condition you have so that the two of you can work out solutions that improve your quality of life. A physical or occupational therapist can suggest environmental adaptations to improve your ability to care for yourself independently, such as adaptive equipment for dressing, grooming, toileting, and showering. Some difficult tasks may have simple alternatives, such as using no-tie expanding shoelaces in place of regular ones.
Physical therapists can also teach you exercises to improve your strength, balance, and posture and help you plan for other physical activities. If needed, they may focus on your walking patterns to help you improve your gait.