Preventing Falls—One Step at a Time

Do you know what a "fall" is? Most of us believe we do. How many times have you heard someone say, "I didn't fall, I just slipped?"

In 1987, the Kellogg International Working Group on the Prevention of Falls in the Elderly defined a fall as "unintentionally coming to rest on the ground, floor, or other lower level from a standing, sitting, or horizontal position in a movement not caused by a seizure, stroke, fainting, motor vehicle accident, or risky behavior, such as skiing, roof repair, or drug overdose."

Since then, much research has been done on falls among older adults. Unfortunately, despite a quarter-century of attention on falls prevention, national and local data continues to be alarming. According to the U.S. Centers for Disease Control and Prevention:

  • One-third of Americans aged 65+ fall each year.
  • Every 15 seconds, an older adult is treated in the emergency room for a fall.
  • Every 29 minutes, an older adult dies following a fall.
  • Falls are the leading cause of fatal injury and the most common cause of nonfatal trauma-related hospital admissions among older adults.
  • Sixty percent of fatal falls occur in the home.
  • In Washington state, falls result in over 12,000 hospitalizations each year (compared to 2,600 hospitalizations due to motor vehicle accidents).
  • Fifty-four percent of older adults are discharged to skilled nursing homes after hospitalization for falls.
  • Only 22 percent of people hospitalized for falls are able to return home.
  • The financial toll for older U.S. resident falls is expected to increase as the population ages and may reach $54.9 billion by 2020.

The impact of falls

The truth is, falls with or without injury can heavily impact quality of life. There can be serious social and psychological consequences for older adults, such as fear, loss of confidence, and self-limited mobility—leading to decreased strength and balance—which in turn increases the chance of falling again. Falls often lead to further physical decline, depression, social isolation, and feelings of helplessness.

What causes falls

Be aware that there are many individual and environmental fall risk factors.

  • Individual risks include muscle weakness; a history of falls; use of a walking device; problems with vision; arthritis; depression; and age (80 and older).
  • Environmental risks can involve wet and slippery surfaces; uneven, cluttered surfaces and/or floors (often due to throw rugs); stairs and curbs; inadequate lighting; improper shoes and/or footwear; pets; and poorly fitted assistive devices for walking.

What you can do to prevent falls

The good news—falls are preventable! Studies show that fall rates can be reduced by incorporating fall prevention strategies. The Centers for Disease Control and Prevention recommends four things you can do to reduce falls:

  1. Make your home safer. Remove clutter and throw rugs. Install handrails, grab bars and night lights.
  2. Have your health care provider review your medications on a regular basis.
  3. Have your vision checked annually.
  4. Begin a regular exercise program. Walking is good exercise. Be sure to also include exercises that focus on increasing balance and strength. It's a good idea to wear sturdy, nonskid shoes at all times.

The importance of exercise

You might ask, "Why is exercise so important?" The research is clear—a regular exercise program that includes strength and balance components is the single most effective strategy to prevent falls. Regular exercise also improves balance, health (arthritis, diabetes and high blood pressure), mood, walking, strength and flexibility. The Surgeon General recommends 30 minutes of moderate exercise, five times a week, which can also be done in 10-minute sessions.

At senior centers across the U.S., evidence-based programs like A Matter of Balance, Enhanced Wellness, and Stay Active and Independent for Life (SAIL) help older adults gain the strength, improve balance, and confidence to help them live healthier lives and preserve their independence. For more information about falls prevention classes in King County, see King County Rallies to Prevent Falls (AgeWise King County, September 2012).

The Fall Prevention Clinic at Harborview Medical Center

The Fall Prevention Clinic at Harborview provides a comprehensive assessment for clients that may include:

  • Fall risk factors
  • Identification of strengths, risks and deficiencies
  • Medical history
  • Balance assessment
  • Medication review
  • Vision evaluation and treatment
  • Lower limb joint testing
  • Neurological function testing
  • Cardiovascular status, including checking for orthostatic hypotension
  • Environmental safety

Following the assessment, specialists work with patients to develop a management plan for identified risk factors, balance and gait training, exercise recommendations and environmental modifications.

Dr. Elizabeth Phelan directs the Fall Prevention Clinic. She serves on the Seattle-King County Advisory Council on Aging & Disability Services and speaks of the often deleterious, life-altering effects of falls, spreading the word about the importance of falls prevention.


HomeStretch is an innovative in-home exercise program for older adults developed by Dr. Anne Shumway-Cook in partnership with Aging and Disability Services (ADS), the Area Agency on Aging for Seattle and King County. The program goal is quality of life enhancement, management of chronic conditions through regular physical activity, and falls prevention.

Initially the six-week program used an intergenerational model that coupled physical therapy graduate students with homebound elderly case management clients. From 2002–2007, the program was associated with improvements in measures of physical function along with improved self-efficacy (The Effects of a Home-Based Exercise Program on Physical Function in Frail Older Adults).

To offer the evidence-based program year-round, ADS collaborated with Wesley Homes in Des Moines. In 2010, a pilot program was offered to long-term care case management clients living in south King County. A Wesley Homes physical therapist visited clients six times in their homes, each time for approximately one hour. Due to the successful pilot and ongoing interest in the program, HomeStretch has been extended to eligible long-term care clients throughout the Seattle area.

State and local agencies collaborate to prevent falls

The Washington State Senior Falls Prevention Coalition meets quarterly and works to reduce falls among seniors through professional development, public education, advocacy, networking, resource development, and referrals. Publications include Older Adult Falls (an excerpt from the Washington State Injury and Violence Prevention Guide, January 2013). For information about joining the statewide coalition, contact

Aging and Disability Services planners Mary Pat O'Leary and Karen Winston have been involved in falls prevention for more than a decade. For more information about falls prevention activities in King County, contact them at or