Couple of questions before we get started:
- Are you an adult over the age of 65?
- Are you living with a disability due to brain injury?
- Are you a human being?
If you answered "Yes" to any of these questions - you are at risk for falls and should read this information!
Why does Falls Prevention Matter?
A couple more questions:
- Have you ever lost your footing on flat or changing level ground?
- Have you almost slipped on something wet, icy, or slick?
- Have you ever been in an elevated location, like a balcony or a ladder?
- Have you ever stumbled on something that was on the ground - either a rug, clutter, pet, or child?
- Have you ever rode a bike, electric scooter went skiing, running, or something that put you faster than zero miles per hour?
Falls are all around us, happening when we least suspect it. No one wakes up in the morning, anticipating a fall. Most falls likely have little to no serious consequences, making them seem like no big deal. However, just as quickly as falls happen, so too can a traumatic brain injury, or TBI.
What's a Traumatic Brain Injury?
An acquired brain injury, or ABI, is an injury after birth that is not hereditary, degenerative, or induced by birth trauma. When the head is hit or the brain is damaged, how the brain functions and communicates with the rest of the body may become changed. ABI is used as the umbrella definition for brain injury and can be further defined by how the injury is sustained:
Traumatic Brain Injury (TBI):
caused by sources outside the body - falls, motor vehicle accidents, violence, etc.
Non-traumatic Brain Injury:
caused by sources inside the body - strokes, aneurysms, tumors, loss of oxygen, etc.
With TBIs, a hit to the head can result in different severity of injury - mild, moderate, or severe. Mild TBIs are the most common form of brain injury, often presented as concussions. Despite the high prevalence, these mild TBIs can be difficult to detect for a lot of different reasons:
- Symptoms with mild TBI are often invisible to the outside eye, making them difficult to explain or understand.
- nausea, dizziness, vision disturbances, mood fluctuation, trouble sleeping, balance trouble, trouble with attention/memory, sensitivity to light/noise/movement, etc.)
- Some people can experience limited to no loss of consciousness (blacking out for a period of time)
- Detection can be difficult on first line neurological scans (for example - Computed Tomography, or CT, scans are often looking for bleeding or large structural damage within the brain). For those with injury like stretching or chemical adjustments, different tests may be required
- There can be a wide range of symptoms and severities even within this category. Majority of people have symptoms resolve within 1-2 months. However, for 10-15% of cases, long-term symptoms can be more difficult to manage.
- Treatment and access to treatment can be varied. For example, a person might be at a primary care physician's office, emergency department, urgent care facility, or go untreated or present as another condition (such as mental health, substance misuse, etc.).
Moderate and severe TBI are often less difficult to detect, often requiring hospitalization or inpatient rehabilitation. They can result in periods of blacking out/coma for more than 30 minutes and 24 hours respectively, and show up on neurological scans more overtly.
What is like after a Brain Injury?
Different parts of the brain are responsible for different functions a person can perform, such as a person’s movements, emotions, processing of the sounds/sights around, starting or holding a conversation, or being able to pay attention or remember information.
When the brain is injured, like after a big fall, tasks may be more challenging than prior to injury affecting daily life and relationships. There are different ranges and challenges that brain injury can present in various ways from person to person.
- For some people, it can feel like a TV with the wires in the wrong place – your thoughts and your actions can feel disconnected.
- For others it’s like being on slow WiFi – taking a long time to process and can feel frustrating to try simple tasks.
- Other people might get overwhelmed by a lot of stimulation like crowds, noises, or lights – feeling like a waterfall of senses that later results in this tired feeling or like they are driving through a dense, morning fog.
- They might have a tough time finding the right words or communicating with others, almost like their brain is a room filled with unorganized file cabinets and having to sift through every folder.
- For others, it might just feel like a car with the breaks and accelerator pedals switched related to their decision-making and emotions – looking like impulsivity or disruptive behaviors.
Though there can be a lot of negative aspects and changes after a brain injury, there are people that experience positive changes as well. Some people with depression, substance use, or difficult mental health challenges prior to injury, experience a peace, stronger relationships or spirituality, and less mental health challenges. It just depends on the person.
Repetitive training and strategies to help compensate for change in function can form new pathways within the brain to facilitate rehabilitation.
What's the Connection between TBI & Falls?
According to the CDC,
- One out of five falls causes a serious injury such as broken bones or a head injury.
- Over 800,000 patients a year are hospitalized because of a fall injury, most often because of a head injury or hip fracture.
- Falls are the most common cause of traumatic brain injuries (TBI).
- In 2014, falls accounted for almost half (48%) of all TBI-related emergency department visits. Falls disproportionately affect children and older adults:
- In 2015, the total medical costs for falls totaled more than $50 billion. Medicare and Medicaid shouldered 75% of these costs.
In older adults,
- Each year, 3 million older people are treated in emergency departments for fall injuries.
- Common locations for elderly falls:
- 60% of falls happen inside the home
- 30% of falls occur outside the home, within a community setting (for example, while shopping or walking on the street)
- 10% in a health care center such as a hospital, clinic, or nursing/rehabilitation facility
- Types of falls:
- 43% at ground level or first-floor falls (not from a height)
- 14% on or from stairs or steps
- 11% on curb or sidewalk
- 9% from a chair, bed, or furniture
- 4% involving the bath, shower, or a toilet
- 26% “Other” (including unspecified types)
- 30-65% of people with brain injuries reporting balance challenges at some point during rehabilitation.
- Fifty percent of the people who experience stroke are at
risk for falling.
- 50-60% of injuries reported in people with Intellectual Developmental Disability (I/DD) are due to falls.
- Injury due to falls represents one of the leading causes of liability claims against group homes and other care providers.
Who's Most at Risk for Falling & How can They be Prevented?
Safety and prevention starts with you. You are the only one who can choose to live safely in order to live a long, independent, and full life. A quick and easy “what not to do” is likely found by watching America’s Funniest Home Videos – a constant video loop of people falling… Real falls prevention is like a word search - challenging to see the words through all the seemingly randomized letters. But with some extra time and awareness, you start to make words out of that sea of jumbled letters. There are a lot of little ways and steps that you can take to prevent falls, that when done all together create an atmosphere of safety as a habit – whether preventing a first injury or another one. The table below discusses what characteristics might lead to increased fall risk and some prevention strategies.
|Age: higher falls risk for those 65 years or older||more frequent health checks after age 60|
|History: half of people who fall will fall again in the next 12 months||seek a falls assessment if you've fallen with primary doctor or physical/occupational therapist|
|Fear of Falling: May relate to being anxious, preoccupying attention, or reducing activity||seek fall prevention or balance/strength programs, identify any home modifications, counseling or relaxation strategies|
|Muscle Changes: decreased or altered strength, tone, flexibility and balance||seek strength, core, and exercise activity as well as adapted tools|
|Polypharmacy: 4 or more prescribed medications increases risk||contact your pharmacist or doctor to learn about any interactions, side effects, or concerns|
|Visual, Spatial, or Vestibular Disturbances: blurred/double/distorted vision, dizziness, balance trouble, numbness||get regular vision, hearing, & balance checks, wearing any devices as prescribed; address any balance, dizziness, pain, swelling, or numbness in the foot or leg|
|Cognitive changes: slow processing, impaired executive functions (attention, multitasking, etc.), self-awareness||avoid multitasking often and take breaks to prevent feeling overwhelmed or fatigued|
|Mood: depression/low mood or related medications may affect activities of daily living and mobility||seek counseling, social support, or relaxation strategies|
|Incontinence or other chronic conditions: i.e. TBI, Stroke, Multiple Sclerosis, Dementia, diabetes, pain/arthritis||follow or seek out pain, nutrition, or other chronic management programs|
|Short Term Factors or Effects: medication side effects, malnutrition. dehydration, alcohol intake||address any medication side effects, reduce or abstain from alcohol and substance use, & keep hydrated; focus on nutrition, seeking guidance when needed|
|Activity Related: highly active opportunities (i.e. walking, stairs climbing, footwear)||seek ways to make activities safer (proper shoes, stabilizer, rails, helmets, etc.)|
|Environmental factors: i.e. poor lighting, bad kitchen organization, carpets and rugs, clothing||secure rugs/clutter, improve lighting (motion/smart active), add grab bars/railing, functional storage|
When is a Fall more than a Fall?
What does it feel like after a concussion? Some people experience physical changes that are easily noticeable like a swimming, 3D-like, blurred, or double vision. They might have significant head pain or are overstimulated by lights, sounds, or motion. They might feel really tired, nauseous, or overall really dizzy or unbalanced. Other challenges that might show up within or after 24 hours might be trouble sleeping, altered thinking or processing, or fluctuating mood.
Any of these symptoms after falling or hitting your head could be a sign to seek medical attention.
Concussion Signs Observed
- Can’t recall events prior to or after a hit or fall.
- Appears dazed or stunned.
- Forgets an instruction, is confused about an assignment or position, or is unsure of the game, score, or opponent.
- Moves clumsily.
- Answers questions slowly.
- Loses consciousness (even briefly).
- Shows mood, behavior, or personality changes.
Concussion Signs Reported
- Headache or “pressure” in head.
- Nausea or vomiting.
- Balance problems or dizziness, or double or blurry vision.
- Bothered by light or noise.
- Feeling sluggish, hazy, foggy, or groggy.
- Confusion, or concentration or memory problems.
- Just not “feeling right,” or “feeling down”.
If you do sustain a concussion, you might feel like you can get right back to normal activity but it’s important to get the right amount of rest and scaling back activities so that symptoms don’t arise or get worse.
- Start slow, avoid doing too much or practices that could hinder recovery like caffeine, smoking, alcohol/substance use, or physically demanding activities.
- See if a family member or friend can come by to help for a few days or do specific chores like grocery shopping or laundry.
- Listen to your body and don’t be afraid to ask for help.
Other symptoms might be an indication of a more serious problem and should be taken seriously. Seek medical assistance as soon as possible with any of these symptoms, particularly with worsening symptoms or intense head pressure.
- One pupil larger than the other.
- Drowsiness or inability to wake up.
- A headache that gets worse and does not go away.
- Slurred speech, weakness, numbness, or decreased coordination.
- Repeated vomiting or nausea, convulsions or seizures (shaking or twitching).
- Unusual behavior, increased confusion, restlessness, or agitation.
- Loss of consciousness (passed out/knocked out). Even a brief loss of consciousness should be taken seriously.
Stopping Falls in their TRACKs
- TALK to your doctor or other professional about your falls risks, medications, assistive technology/mobility aids, eyewear or hearing devices, proper nutrition and hydration, and the best footwear for you.
- High heels, floppy slippers and shoes with slick soles can make you slip, stumble and fall. Heavy boots can lead to trouble lifting the feet high enough. Walking in your socks or bare feet on slick flooring can also be dangerous. Instead, wear properly fitting, sturdy shoes with nonskid soles. Sensible shoes may also reduce joint pain.
- REMOVE hazards from your home and workplace that could lead to falls - clutter, unsecure rugs, broken/uneven flooring or steps, etc. Also try to avoid carrying heavy loads or multitasking when moving.
- Remove boxes, newspapers, electrical cords and phone cords from walkways.
- Move coffee tables, magazine racks and plant stands from high-traffic areas.
- Secure loose rugs with double-faced tape, tacks or a slip-resistant backing — or remove loose rugs from your home.
- Repair loose, wooden floorboards and carpeting right away.
- Store clothing, dishes, food and other necessities within easy reach (not always grabbing the step stool or using less safe means to reach).
- Immediately clean spilled liquids, grease or food.
- Use nonslip mats in your bathtub or shower. Use a bath seat, which allows you to sit while showering.
- ADD space modifications such as lighting, grab bars, organization, stair railing, ramps, secured bathroom rugs (to reduce excess water), and more!
- Place night lights in your bedroom, bathroom and hallways (these could be motion sensored).
- Place a lamp within reach of your bed for middle-of-the-night needs.
- Make clear paths to light switches that aren't near room entrances. Consider trading traditional switches for glow-in-the-dark or illuminated switches.
- Hand rails for both sides of stairways
- Nonslip treads for bare-wood steps
- A raised toilet seat or one with armrests
- Grab bars for the shower or tub
- A sturdy plastic seat for the shower or tub — plus a hand-held shower nozzle for bathing while sitting down
- CONNECT with exercise programs available to increase strength, balance, and coordination. Learning how to get up from a fall or what to do in case of a fall can help prevent further injury.
- With your doctor's OK, consider activities such as walking, scaled exercises, water workouts, Bingocize, or tai chi.
- A physical therapist can create a custom exercise program aimed at improving your balance, flexibility, muscle strength and gait.
- KEEP up with annual physicals, eye/hearing exams, and prescription medications. Some medication side effects may put someone at greater falling risk.
- Make a list of your prescription and over-the-counter medications and supplements, or bring them with you to the appointment. Your doctor can review your medications for side effects and interactions that may increase your risk of falling.
- Let your doctor know if you've fallen in the past year.
- See medical advice should you experience any concussion symptoms.
Falls Prevention Exercises
Where can I find more Resources?
- Free Falls Checkup (National Council on Aging)
- Mayo Clinic Falls Prevention
- Falls Safety Checklist (CDC)
- STEADI Resources
- Medication Risk Resources (CDC)
- Falls Prevention Resources (Stop Falls)
- Fall Prevention Program Guidelines (CDC)
- Evidence-Based Falls Prevention Programs (NCOA)
- North Carolina Falls Prevention Coalition
- Healthy Aging NC
- Healthy Eating
- Choose My Plate
- Balance Problems after Brain Injury (Model Systems Knowledge Translation Center)
- MSKTC TBI Factsheets