“I’ve fallen and I can’t get up!” How many
times have we heard comics deliver that line
from a now-famous 1980s TV commercial?
The truth is that a dangerous fall is no
laughing matter. It’s a real worry — for
those who suffer from balance dysfunction and
for the family caregiver.
Just the fear of a parent, spouse or other loved
one falling is enough to give a caregiver
chills. And the statistics bear that out.
The National Institutes of Health says that
falls are the leading cause of fatal and
non-fatal injuries in people 65 and older.
And The New England Journal of Medicine reports
that if you’re elderly and are injured by a
fall, there’s a good chance you’ll end up in a
skilled nursing facility, such as a nursing
Hip fractures alone are a serious problem.
The American Academy of Orthopaedic Surgeons has
estimated that 90 percent of the 352,000 hip
fractures recorded in the U.S. each year are the
result of a fall. Only a quarter of hip
fracture patients make a full recovery.
About 40 percent will require nursing home care,
half will need a cane or walker and another
quarter over age 50 will die within a year of
the injury. In fact, the rate of hip
fractures begins to increase at age 50 and
doubles every five to six years. Women
over 50 suffer such fractures at two to three
times the rate of men.
Fortunately, there are a series of steps that
the caregiver and patient can take to reduce the
risk of dangerous falls and increase the safety
of maneuvering at home. If balance
dysfunction appears to be an issue, both should
visit the family doctor for a discussion of the
symptoms and possible treatments.
A typical solution will be for the doctor to
refer patients to a fall prevention program.
Today, there are both traditional and advanced
programs available on an outpatient basis and at
home. Home therapy programs can offer some
distinct advantages over treatment at an
- Patients who have balance problems or who have
already fallen may not be able to travel to a
rehab facility, and it may be inconvenient or
impossible for the caregiver to provide
- Home treatment allows the patient to progress in
a familiar environment, while institutional
therapy can sometimes require a patient to learn
movements all over again when he or she gets
back to the house.
- Home therapy allows a patient to remain among
family and friends.
- Home programs typically involve individual
one-on-one therapy focused on a speedy recovery,
while institutional rehab may treat patients in
a group setting.
- Those patients who still have an active career
find it easier to work at home and keep in touch
with the office while they’re recovering.
Traditional home fall prevention methods have
typically involved “gait training,” which is
essentially teaching someone to walk. The
patient also gets general strengthening
exercises and instruction on how to use an
assistive device, such as a cane or walker.
The challenge with these basic programs is that
they sometimes leave the patient coping with
certain limitations when they could actually
achieve a higher level of mobility through more
To guide patients toward the most successful
recovery, newer, more advanced therapy programs
have emerged to deal proactively with the root
causes of balance problems. The causes
might involve vision, inner ear or other
balance-related issues. Sensation and
coordination problems could be factors.
There might be pain or numbness in the feet.
A patient’s lack of strength or flexibility
could be the cause. Or a person’s living
area and environment could reveal hazards which
increase the likelihood of falls.
These newer programs examine the potential
causes through a detailed evaluation.
Working with the physician, specially trained
therapists then develop and launch treatment
plans that are customized for each patient.
The success rate is high. Sponsoring home
health organizations have begun to document
patient outcomes demonstrating the ability of
such programs to relieve pain, increase
sensation and reduce the risk of dangerous
As part of any fall prevention program, a
therapist can make recommendations to the
patient and caregiver about improving safety in
a home environment. The caregiver can
follow through on these and other possible
- Keep floors clear and reduce clutter.
- Ensure that floors are clean and not waxed.
- Use non-skid throw rugs.
- Install handrails or grab bars in stairways or
- Make sure the home is well lit.
- Use a sturdy step stool or ladder to reach high
- Excellent do-it-yourself fall prevention
information can often be found on Web sites of
state or local health departments, and through
local or regional fall prevention coalitions.
Balance programs can help to change the lives of
patients and allow them to live more
independently at home. A Florida woman
resumed her walking regimen and said that her
life was worth living again. An
87-year-old pharmacist was able to return to
work. Even a 100-year-old Hurricane
Katrina survivor was made mobile enough to
return to relatives in New Orleans. These new
balance therapies can also help to reduce stress
for caregivers and help them sleep at night,
knowing that an older relative is safe from fall
injuries that could send them to the hospital –
The message is clear: there’s no reason
for patients or their caregivers to suffer from
a fear of falling when solutions are just a
phone call away.
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