A fall is rarely the first sign that something has changed. Often, there are subtle warning signs weeks or even months beforehand.

For Fall Prevention Awareness Month, we asked Covell Care and Rehabilitation, SRC’s onsite physical, occupational, and speech therapy partner at our Adult Day program, what they wish older adults and families knew about fall risk.

Their message is an important one: Falling is not an inevitable part of aging, and you don’t need to wait for a fall to ask for help.

Pay attention to changes in everyday life

Some of the earliest warning signs may show up during ordinary routines.

Perhaps someone has started reaching for furniture or walls while walking. Their steps may be shorter or less even, or they may shuffle or have more difficulty lifting their feet. Standing up from a chair may take more effort, or they may seem unsteady when turning.

Near-falls matter, too. Catching yourself on a counter, stumbling without going down, missing a step, or frequently brushing off an incident as “I’m just clumsy” may be an early warning sign.

Another important sign is fear of falling even if a fall has never happened.

Someone may begin avoiding stairs, showers, uneven surfaces or community outings. They may become reluctant to walk without another person nearby. Over time, doing less can lead to decreased strength and endurance, social isolation, and even greater fall risk.

These kinds of changes shouldn’t automatically be dismissed as “just getting older.”

Fall risk is about more than rugs and grab bars

Making the home environment safer is important, but physical and occupational therapists look at much more when considering someone’s risk of falling.

Changes in strength, balance, endurance, posture, walking speed and reaction time can all matter. So can dizziness or faintness, pain and joint stiffness, foot problems, numbness or decreased sensation.

Vision and hearing changes can also contribute to fall risk. Difficulty with depth perception, contrast, or adjusting between light and dark spaces can make it harder to navigate the environment. Hearing loss can affect awareness of what is happening nearby, communication, attention, and the ability to respond quickly.

Physical therapists (PTs) and occupational therapists (OTs) may also consider medication side effects or recent medication changes; dehydration, nutrition, fatigue or illness; frequent nighttime trips to the bathroom; and changes in memory or attention.

Sometimes the clues are found in daily activities. Is it becoming more difficult to bathe, dress, cook or use the stairs? Is someone struggling with footwear, pets, oxygen tubing or mobility equipment? Have they become less confident or withdrawn from activities they used to enjoy?

Together, these changes can tell a larger story about a person’s safety, mobility and independence.

“Small changes can prevent falls: keep walkways clear, use good lighting, wear sturdy shoes, and keep your cane or walker close. Encourage daily strength and balance exercises, and remind your loved one to move slowly when standing. Fall prevention starts with awareness!”
Leah Goodrich, OTR
Covell Care and Rehabilitation

What can families do?

Start by noticing.

Watch what happens during everyday routines:

• Is your family member using their arms to push up from a chair?
• Are they holding onto furniture as they walk?
• Is it taking longer to reach the bathroom?
• Have they started avoiding the shower or stairs?
• Do they lose their balance when turning, carrying something, or talking while walking?

Everyday observations like these can provide useful information without asking someone to attempt an unsupervised balance test, which may not be safe.

And ask about confidence as well as physical ability. Someone who has quietly stopped doing things because they’re afraid of falling may be telling you something important.

You don’t have to wait for a fall

A fall or near-fall is a good reason to talk with a physical or occupational therapist, but it isn’t the only one.

New fear of falling, changes in walking or balance, dizziness, weakness, difficulty with everyday activities, increased reliance on furniture, or withdrawal from usual routines can all be reasons to consider an assessment.

Early evaluation can help identify factors that may be contributing to fall risk and help an older adult remain safe, active, confident and independent.

For participants in SRC’s Adult Day program, partnerships with therapy providers such as Covell can also make that support easier to access.

“Our relationships with Covell and other outside partners allow us to really provide holistic support. One participant recently graduated to no longer requiring a walker while attending activities. Covell was able to work with him while he was already here onsite. His care partner did not have to arrange for separate offsite physical therapy, and Covell’s support has helped him engage in our activities in new ways.”
Buffy Fox
Director of Services, Seniors Resource Center

The goal isn’t simply to prevent a fall. It’s to help people keep doing the things that matter to them.

Special thanks to Covell Care and Rehabilitation, SRC’s onsite physical, occupational and speech therapy partner at our Adult Day program, for contributing their expertise to this article.

[Experience the Difference: Explore Adult Day →]