by G. Kent Stewart

As babies, we learned to crawl; in childhood, we played on the floor; and in adolescence, some of us played sports that often found us on the ground or floor. Playing on the floor, taking spills from bicycles, chasing a ball on the hardwood or gridiron are no longer fun ways to while time away. Now that we have reached our 70s and 80s and some of us our nineties, falling to the floor is an unexpected catastrophic event, often with dire results. Actually, there are two broad kinds of falls-those that occur outdoors while engaging in some activity we enjoy such as gardening; and those occurring indoors, sometimes caused by traps we unconsciously set for ourselves. Let’s talk for a few moments about falls and falling.

First, be aware that I am not expert or schooled on falls or fall prevention. I am just a 90-year-old guy who has fallen a lot of times beginning in my teenage years and extending to as recently as only a few months ago! I was never clumsy; perhaps just a little too physically active for my own good. So thanks for letting me share some experiences from which others may profit.

Falls Outdoors While Doing What We Like Doing

If you are aging, but still like to fish the pond behind Bramlage, walk the trails, venture into the woods, and work a garden plot, you may have the stage set for an occasional fall. That’s why at age 90, I used a walking stick when afield or fishing and hiking whether alone or with a friend. If I do fall, and occasionally I do like some other individuals who spend a lot of time outside, before getting up and resume activity, I remain down long enough to satisfy myself that I am not hurt. Hiking, fishing, bird watching, hunting, shooting, and land scouting has its hazards, such as exposed tree roots, uneven ground, slippery gravel, hidden rocks, fence wire, and vines. Watch out for them! If you are contemplating a risky step, don’t take that step; choose an alternative. Enjoy your outings, but be careful. Move slowly, look carefully, assure yourself that you are balanced, and take extra care not to stumble. Walk slowly, move carefully, be alert, observant, and use your walking stick as a third leg, thus enjoying the safety and rigidity of a triangle.

Falls From Traps We Set Ourselves

If I must fall, I prefer to fall outdoors rather than inside my home. In-home falls too often include striking some solid object like wood furniture, doors, cabinetry, bathroom fixtures, kitchen appliances, stairs, walls, and hard floor surfaces. Older adults who have never fallen in their homes, are among a fortunate minority. Falls do not necessarily accompany old age; but the natural infirmities that accompany aging do tend to contribute to imbalance and unsteady gait. The danger we seniors face from falling, especially indoors or on concrete, is the risk of fractures and head injuries. Plainly, following a fall, it is really good judgment to seek medical evaluation of our well-being.

Falls, particularly those occurring at home, seem fairly prevalent among elderly individuals. Yet, propensity for falling as a characteristic of old age is indeed debatable. Some in-home falls result from traps we unconsciously set for ourselves. We cannot eliminate all the traps, but we surely can be cognizant of them and reduce their prevalence. First, be once again aware that your author is not a falls expert; and realize that this little story is just an introduction to fall prevention. The Internet is replete with detailed strategies to prevent falls. Take advantage of this marvelous technological resource, and by all means, talk with your physician and other medical experts about falls and fall prevention. Here are some indoor fall prevention strategies. Incidentally, they may be good conversation starters.

•  An often-overlooked fall prevention strategy shared with me by an ophthalmologist is to simply turn up the lighting. That is, install brighter light bulbs in your light fixtures! We spend decades illuminating our homes with indirect and soft lighting contributing to a relaxing and subdued ambience. Visual acuity diminishes with age and propensity to fall increases, so use additional lighting to reduce that potential.
•  Watch out for rugs, big thick ones and little slippery ones. They are dangerous. As we age, we tend to almost shuffle rather than raise our feet as we walk. Shuffling into the edge of a rug is a near guarantee of a fall.
•  If your home features hardwood floors, you are well-advised to avoid walking in slick stockings. Walking safely on hardwood requires we wear non-slip footwear.
•  Pets, God love the furry companions, have caused many a fall among elderly people. Don’t get rid of kitty-cat or doggie, but do know where they are in reference to your feet. The furry little creatures, especially cats, love to rub our ankles.
•  Many homes still popularly feature multiple interior floor evaluations. There may be a step up or a step down to walk from one room to another. For example, some homes may have a step up or a step down to get from the kitchen to the dining or living area. Even one step is a hazard, and installing a stair railing or a ramp for one step may be impractical. So, install a vertical grab bar on the door casing to hold when going from one elevation to another. Using a walker or Rolator is a lot less costly than medical treatment for a fall that could have been avoided.
•  For those who live in two-story homes with bedrooms upstairs, the safest alternative, other than relocating a bedroom to the main level, to negotiating the stairs is to install a stairway chair lift. Today’s top brand chairlifts are well-engineered safety devices. Again, keep a walker or a Rolator on each floor. 
•  Before moving with your walker or Rolator, take a moment to assure yourself that you are comfortably balanced—not too forward or too far back, but just standing comfortably and naturally before starting to move. It is also good practice to be positioned so as to avoid having to step backwards.
•  The kitchen and the bathroom are fertile places for serious falls. Both rooms are replete with equipment, appliances, and cabinetry dangerous to fall against, and both usually feature hard floor coverings. Install grab bars strategically and always wear non-slip shoes when entering these rooms; or walking on any hard, potentially slippery floor surfaces.
•  Probably the most overlooked fall prevention strategy is to be well-exercised. Upper body strength is basic to easing the impact of a fall, and lower body strength helps us maintain balance and facilitates mobility. Exercise regularly, then exercise some more. An exercised body is a stronger body and a great deterrent to falling.
• Keep your cell phone charged and nearby at all times. If you live alone, an electronic alert device worn around your neck or on your wrist is a good investment and a good companion.
• When transferring from walker to walker, walker to Rolator, or Rolator to Rolator, be sure the Rolator brakes are set. Position the device you are using so as to move laterally or forward to the awaiting device, not backwards. Again, avoid walking backwards when using any mobility assistance device, whether it be a simple walking stick or a sophisticated Rolator.

Summarizing quickly, if you engage in outdoor activities, you can expect an occasional but hopefully not serious fall. If you are sufficiently strong and agile to engage in outdoor activity such as hiking and gardening, you may be strong enough to survive an outdoor fall. While a person might expect an outdoor soft ground fall, it is far better to avoid an occurrence. Be alert and exercise judgment and forethought. Just because a fall occurs outdoors, does not mean it is not potentially serious.

The inherent dangers (so-called traps) of in-home falls can be mitigated by being sensitive to home features that contribute to accidents. Be alert and consult the Internet for fall avoidance and medical professionals for guidance. Maintain good in-home lighting, avoid slippery footwear, and install grab bars strategically. Consider installing a hand rail on the corridor wall because it’s a fall deterrent, and it’s greatly helpful for regaining footing if you do find yourself down. Realize the importance of regular exercise, and keep your cell phone easily accessible.

Note: These guidelines were developed from general reading and personal experience of the author, and should not be substituted for professional or medical advice. GKS