Falls are the leading cause of injury for adults aged 65 and over, affecting move than 14 million people annually, according to the U.S. Centers for Disease Control and Prevention. Wheelchair users are at even higher risk, says disability and fall expert Laura Rice, a professor of health and kinesiology at the University of Illinois Urbana-Champaign. Rice's research focuses on fall prevention and management, particularly among wheelchair users. She spoke with News Bureau biomedical sciences editor Liz Ahlberg Touchstone about the risk factors of falls, how to reduce those risks and how to best brace oneself for a fall. Video by Andy Savage.
How common are falls among the elderly or people with a disability?
Falls are very common among people with a variety of different health conditions. Falls can have a significant impact on daily life, both from physical injuries and also from developing concerns about falling. Falls are something to take very seriously and work to prevent.
My work mainly focuses on people who use wheelchairs. Depending on the specific population, we see fall frequencies anywhere from about 60% of people experiencing at least one fall per year all the way up to about 75% or 80%. Among older adults who ambulate, it's a little bit lower: About 30% to 50% of older adults will experience at least one fall per year.
What kinds of risk factors might increase the chances of falling?
It depends on the health condition. However, the population that is studied the most are older adults who ambulate. Some of the risk factors for falls in that population are things like impaired balance or taking multiple medications. A history of falls is very predictive of future falls. That's one of the biggest questions that doctors will often ask. Cognition can play a role as well.
People - a lot of health care providers included - often think that when we provide a wheelchair to a person, their risk of falling goes away. However, as we've seen from our research, this isn't true. The risk of falling is actually higher among wheelchair users. We haven't been able to do as many large-scale studies, but in our research, we found that some of the common circumstances in which people who use wheelchairs fall include transferring, or moving between a wheelchair and another surface; pushing or driving the wheelchair over rough terrain, such as gravel or wet leaves; reaching for an item; and wheelchair malfunction, like a loose or broken caster.
Are there any strategies to mitigate some of these risks?
One big thing is being smart about your environment. It varies depending on whether you walk or use a wheelchair, but in general, if you have a lot of clutter in your home, think about clearing away some things: getting rid of the clutter, moving throw rugs out of the way, just making it easier to navigate your home.
There are several evidence-based programs that a person who may be having trouble with falling could join. I'm currently working on a program for people who use wheelchairs. It's called iROLL, "Individualized Reduction of Falls." We look at a variety of different factors that influence falls and try to teach people not only how to prevent falls from occurring, but also how to manage the aftermath of a fall.
What are some of the most common or biggest complications of a fall?
When people fall, the consequences can fall into two different buckets. The first one is physical injuries, something we most commonly think of after a fall. A person could have bruising, a cut, a fracture or a significant injury like a head injury.
The second category is developing concerns about falling. We don't think as much about someone becoming overly concerned about falling, but it can lead to people restricting the activities that they do, both in their homes and their communities. It also can result in physical downgrade as well. If they're not doing as much activity, they might get deconditioned. It can spiral out of control quickly.
What should someone do if they feel themselves falling?
There's a real science on how to fall properly - again, depending on your health condition. In general, what I would recommend is, as much as possible, to avoid sticking your hand out to try to break your fall. Instead, try to bring your limbs in and curl up into a ball as much as possible. This will help to prevent upper extremity fractures or injuries and let the forces be taken by areas of your body, like your back or your sides, that are a little bit more tolerant of those forces. If you do use a wheelchair, tucking your chin to your chest will help to prevent any injuries to your neck and prevent your head getting hit, especially if you're falling backwards.
What kinds of resources or plans do you recommend families have in place to help someone who is at risk of falling?
Communication is the key. If you have a family member who is susceptible to falls, developing a daily check-in program is very important. You might make a quick call or send a text, just to make sure that your family member is doing okay. Research shows that if a person falls and they cannot get back up, this can have some pretty significant consequences. The longer someone stays on the ground, the greater the risk of death or admission to a hospital or a long-term care facility.
There are a lot of automated fall detection devices on the market as well. One good example is the Apple watch, which has a fall detection system built into it. However, those detection systems aren't very accurate for people who use wheelchairs. My team has found that when people fall from a seated position, such as being in a wheelchair, the acceleration down to the ground is different. A lot of the commercially available fall-detection devices that are designed for ambulatory populations don't pick up those falls. My team is now working to develop an algorithm that would be able to detect those falls from a seated position. So, hopefully soon, there will be a nice resource available for people who use wheelchairs as well.
