The Ultimate Guide to preventing slip and falls

It was a Monday afternoon. Virginia had gone into her local grocery store to pick up a few things for an anniversary dinner she was planning to make. While looking at the top of the aisle for a special sauce, Virginia’s right foot slipped out from under her. She fell back and hit her head on the ground.

Virginia’s case is not unlike many other fall victims. The goal of this guide is not to scare you. It is not to cause older adults to hide in fear or wear bubble wrap everywhere they go. It is not to make caregivers or children feel like they need to watch elderly relatives all the time. The goal is to help you enjoy life, be less fearful, learn ways to prevent falls from occurring and be ready for what is to come when there is a fall.

The more you know, the better prepared you will be to protect yourselves and your loved ones. This guide provides facts about falls, things to be mindful of, and tips to help you recognize fall hazards and prevent them from creating the next fall victim.

Facts About Falls

The World Health Organization defines a fall as “an event that results in a person coming to rest inadvertently on the ground or floor or other lower level.” Fall-related injuries are common and may be fatal or non-fatal. Most fall-related injuries, while non-fatal, result in considerable health care needs and are a major cause of long-term pain and disability among older adults.

Falls account for over 2 million hospital emergency room visits and over a thousand deaths, according to the Centers for Disease Control and Prevention.

Falls are responsible for half of all accidental deaths in the home. OSHA’s Fall Prevention Campaign and the Bureau of Labor Statistics report that falls are the most common cause of lost workdays, cause several hundred workplace deaths, and account for 5% of the job-related fatalities for women compared to 11% for men. After death, fractures are the most serious consequence of falls. Ultimately, medical treatment for slip and fall incidents exceeds $50 billion; wage loss is another $30-50 billion.

A Third of All People Over The Age of 65 Fall Every Year

Slips and falls are the leading cause of occupational injury for people 55 years and older. Over a million people over 65 will fall yearly—nearly one of every three persons over 65 will fall. Falls account for almost 90% of all fractures among people over 65. For people aged 65-84 years, falls are the second leading cause of injury-related death; for those aged 85 years or older, falls are the leading cause of injury-related death.

Not all falls will cause an injury, but when it does, the injuries are usually severe. They make it difficult to get around, perform activities of daily living, and live independently. Falls commonly break bones in the wrists, arms, ankles, and hips. Given the disproportionate impact on the elderly, it is no surprise that hip fractures and the consequences of hip fractures cause the most significant personal impact. Half of all people over 65 who are hospitalized for hip fractures cannot return home or live independently afterward. The sad part is that falls represent 40% of all nursing home admissions, and over 60% of nursing home residents will fall each year. It creates a never-ending cycle.

Head injuries are also a major problem—falls are among the most common cause of traumatic brain injuries. These are especially dangerous because many older people are taking blood thinners and other medications that can exacerbate the impact of the fall. Hitting your head while on blood thinners can cause a brain bleed. This could lead to permanent impairment or death.

Who is at Risk for Falls?

All people who fall are at risk of fall-related injuries, but certain factors increase the type and severity of injury.

One way to help understand why some people are at higher risk for falls, beyond obvious risk factors, is to view falls from the lens of fall consequences. Experts who study falls and fall prevention tend to categorize falls by the injuries they cause, but the categories overlap and will not serve our purpose. Therefore, for our guide, we’ve developed five categories of falls based on the consequences:

1. Non-injury fall requiring no medical treatment.
2. Falls resulting in any minor consequences, including cuts and bruises, requiring minimal medical care.
3. Severe falls resulting in serious injuries such as hand, wrist, arm, ankle, or leg fracture, requiring minimal medical care with minimal long-term consequences.
4. Serious falls resulting in severe injuries such as head trauma and hip fracture. This includes other fractures that require medical treatment and have long-term consequences.
5. Serious falls resulting in death.

These categories feature increasing severity, which corresponds to statistics on age and gender.

Age is one of the key risk factors for falls. Children are at high risk for fall-related injuries. This is because of their rapidly developing mobility, innate curiosity, and lack of knowledge about dangers. Thankfully, this group often only suffers from Category 1 and 2 falls. People over 65 have the highest risk of death or serious injury from a fall. Some older people suffer from Category 1 and 2 falls, but the majority suffer from Categories 3, 4, and 5 falls. Unlike toddlers, older people’s risk is partly due to declining physical abilities, decreased sensory perception, and slowing cognitive faculties.

Does Gender Affect Fall Injuries?

• Men and women are equally at risk for fall-related injuries; however, men are more likely to die from a fall, while women are more likely to suffer increased injury severity. Other general fall risk factors include:
  occupations at elevated heights;
• unsafe environments;
• overcrowded housing;
• alcohol or substance use;
• underlying medical conditions, including poor mobility, cognition, and vision;
• physical inactivity and poor muscle tone.

Knowing you are at an increased risk for a fall or fall-related injuries can be stressful, but we will now transition to factors that increase your risk for falls. Again, the goal is to increase your knowledge so that you can be more prepared to avoid falls or limit the severity of injury.

What Increases Your Risk for Falls?

Not to sound the alarm bells, but there are a lot of things that increase your risk for falls. Some are obvious, some are obscure, and some are imperceptible. Most are out of your control, but the more you know, the better prepared you will be.

Fall risk factors come in two flavors:

• Extrinsic: outside factors that originate from external sources.
• Intrinsic: inner factors that arise from internal sources and are often specific to the person that fell.

Extrinsic Risk Factors

Extrinsic risk factors can be more dangerous than intrinsic risk factors because they are outside your control and cannot be predicted. They can be obscure and imperceptible. Extrinsic factors that pose the greatest risk for falls include:

• Slippery surfaces.
• Liquids on smooth surfaces
• Loose or wrinkled carpets.
• Uneven walking surfaces.
• Unexpected changes in elevation.
• Poor lighting.
• Staircases with defective or absent handrails.
• Unsafe environments that have distractions, cluttered floors, or tripping hazards.
• Poorly designed bathrooms.

The vast majority of workers’ compensation claims are due to employees slipping on slick floors, so the government creates programs to prevent work-related slip and fall incidents. OSHA and DOL also promulgated rules to decrease distractions, clean up tripping hazards, and prevent falls from elevated surfaces. Very little is done to protect customers visiting businesses or the elderly in nursing homes. Floors are not being made less slippery. Businesses are not spending more money to clean up messes before someone falls. People have tried to change this with little success.

Intrinsic Risk Factors

Intrinsic risk factors can also be dangerous, but they can be more predictable and controllable. Our guide focuses a lot of attention on older adults since they are at increased risk for falls and fall injuries, but the following intrinsic risk factors can apply to all ages:

• Factors that impair your ability to walk:
  • Poor muscle tone.
  • Lower extremity weakness.
  • Impaired balance.
  • Loss of sensation in legs or feet.
• Decreased reaction time.
• Impaired vision.
• Decreased cognition.
• Decreased memory.
• Underlying medical conditions, such as neurological, cardiac, or other disabling conditions.
• Side-effects from medication.
• Behavioral factors, including:
  • Not paying attention to your surroundings.
  • Not looking where you are stepping.
  • Engaging in risky behavior, like standing on unstable surfaces or objects.
  • Rushing around.
  • Not quickly cleaning up a spill or fixing a defective carpet.
  • Not using brighter lights.
  • Wearing clothes that impede your ability to walk safely.
  • Not using handrails.
  • Not using walkers or other assistive devices.
  • Incorrectly taking your medication.
  • Not wearing prescription glasses or not keeping them up to date.
  • Alcohol or substance use.

Analyzing the extrinsic and intrinsic risk factors lead to numerous ideas for decreasing fall risks and maybe even decreasing the severity of injury. In other words, there is hope. By identifying fall risk factors, you have the potential to prevent the first fall from ever occurring.

Determine if Intrinsic or Extrinsic Factors caused a Fall

You might need to ask many questions before you understand why someone fell. Sometimes the injured person will not remember what triggered the fall. They might be embarrassed that they fell, or afraid that family members will require additional supervision. Some possible questions:

• Were you using an assistive device?
• Could you see where you were walking?
• Were you wearing your glasses?
• Was there something on the ground that you were trying to get around or over?
• Did you notice anything on the ground that you might have tripped or slipped on?
• Were you rushing to get somewhere?
• Did you lose your balance or feel dizzy before you fell?
• Did you feel like your legs were weak, gave out, or just became uncoordinated?
• Were you taking your medication as prescribed?
• How did you feel right before the fall? Did you notice anything different? Have you felt this way before?
• Are you confident you can walk around safely?

These questions are not meant to be exhaustive; They are intended to remind you that there are extrinsic and intrinsic factors, both of which might have caused a particular fall.

How do I Prevent Falls?

Whether you are old or young, fall prevention is fairly similar, it involves education and proactive measures. For older people, the proactive measures include:

• Exercise. Think about building muscle tone, increasing strength and flexibility, and improving balance. This exercise might include weightlifting, cardiovascular exercises, meditative methods, and yoga.
• Environmental changes, like restricting access to dangerous areas.
• Ensure adequate supervision.
• Health maintenance and modifications.
• Multifactorial interventions, like individual fall-risk assessments followed by tailored interventions, home modifications, and appropriate medical referrals to address identified risks.

This guide does not aim to provide health care advice. Always inform your health care providers about your health, environment, and concerns about falls. The first two measures benefit everyone, but mostly the elderly. We focus a lot of attention on them because these two measures could decrease fall injuries by many magnitudes.

Exercise is the Best Way to Prevent Fall Related Injuries

The Mayo Clinic reports the 7 benefits of regular physical activity include:

1. Weight control;
2. Combats health conditions and disease, like cardiovascular disease, diabetes, depression, anxiety, arthritis, etc.;
3. Improve mood;
4. Boost energy;
5. Sleep better;
6. Increased intimacy; and
7. Socialization.

Admittedly, the last two will probably not directly prevent falls, but they likely contribute to increased mood and better proprioception. Proprioception is your body’s ability to sense movement, action, and location. Current recommendations are to engage in at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity per week, spread out over the course of a full week. Greater health benefits and weight loss are experienced by increasing up to 300 minutes per week. However, as with most things, speak with a health care professional to make sure it is safe to engage in any exercise program. The U.S. Department of Health and Human Services also recommends strength training exercises for all major muscle groups at least two times a week.

Defining Levels of Aerobic Activity

“Moderate aerobic activity” includes brisk walking, biking, swimming, and anything that gets your heart rate to 64-76% of your maximum heart rate (i.e., maximum = 220-YourAge). “Vigorous aerobic activity” includes running, high-intensity activities, and anything that gets your heart rate to 77-93% of your maximum heart rate. “Strength training exercises” include using weight machines, resistance against your own body weight or resistance bags, or activities such as rock climbing. Again, consult a health care provider before starting any exercise program or modifying your program to ensure it is safe. People of advanced age or limited physical ability could benefit from beginning efforts like walking up and down ramps and stairs while holding a railing, simulating the transition between sitting and standing, and Tai Chi.

So how does exercise reduce falls or the impact of a fall?

Increasing strength and flexibility has the side-effect of improving balance, coordination, and overall physical wellbeing. This also leads to faster reflexes and better awareness of how your body reacts to changing environments. Increasing upper body strength will assist with holding on to objects to keep you from falling. Increased muscle mass will help absorb the forces of a fall. Additionally, the increased circulation and oxygenation will improve brain function, which has the effect of increasing attention to your environment and quickly analyzing situations as they arise.

Starting an exercise program can be scary. It can also be very frustrating because it takes time to see results. Don’t give up. Find a friend or family member to exercise with you or use a professional to guide you. The long-term benefits are far too great to give up prematurely.

Environmental Changes Help Reduce Falls

People tend to spend a majority of their time in their home; therefore, it is no surprise that the home environmental factors cause many falls. Indeed, 55% of fall related injuries occur inside the home with an additional 23% of injuries occurring just outside the home on curbs and sidewalks. It is estimated that between 35% and 40% of falls result from environmental-related factors. The environment is interactive with other intrinsic and extrinsic risk factors; therefore, it is a prime element for modification.

Most older adults prefer to age in their homes and surrounded by a familiar environment. As they age and become less stable on their feet, the elderly fail to modify their environment to accommodate age-related changes. Research shows that home modifications can improve physical function, provide a sense of security, and lead to continued socialization versus isolation.

Books have been written and professionals specialize in home modification to reduce various risks, including the risk of falls. This guide is insufficient to determine what makes a safe living environment, so it is imperative that you hire a professional to conduct a home assessment and develop a plan. The plan should factor in the environment, health status, and behavioral patterns of the occupants, as well as outside-the-home risks like curbs, sidewalks, and patios. This is not a one-size-fits-all endeavor. Everyone interacts with their environment differently so an individualized assessment and plan should be obtained.

What are some of the typical fall hazards in the home?

The Centers for Disease Control and Prevention (CDC) published a Checklist to help you find a fix in-home fall hazards.

You can read the CDC’s checklist, but the main takeaways are:

• Floors, create clear pathways for walking around the house, keep floors free from debris, avoid using rugs that can slip, and affix wires and cords to the wall.
• Stairs and Steps, keep objects off steps, fix loose or uneven steps, ensure there is good lighting over the stairs, make sure carpeting is firmly attached to each step, and make sure all elevation changes are accompanied by secured handrails.
• Kitchens, keep frequently used items on lower shelves and, if you use a step stool, make sure it has a handrail.
• Bathrooms, avoid using rugs that can slip, have grab bars in the tub and next to the toilet, and we also recommend ensuring tubs and showers have rough non-slip surfaces.
• Bedrooms, ensure lighting is easy to control from the bed, and we also recommend having low-profile nightlights that light the floor from the bed to the toilet.

Beyond the CDC’s recommendations, if your doctors recommended you use assistive mobility devices, like a walker, cane, or wheelchair, use them. All the time. Without exception. If you have not had a health care provider recommend an assistive mobility device, but you think you might benefit from one, get one. At a minimum, this will increase your confidence level and reduce anxiety.

A final thought on safety around the home.

Do not underestimate the potential trip and fall hazards. Even the slightest discrepancy (e.g., half an inch) between two adjoining surfaces presents a tripping hazard. This hazard is not uncommon on sidewalks, tile patios, and hardwood floors. You need to ensure walking surfaces are as even as possible to optimize safety.

Your health, safety, and independence are important. We suggest you use as many of the strategies and suggestions included in this guide as possible. While they might not prevent all falls or all fall injuries, they should positively impact your life, lifestyle, and longevity.

What are the Legal Considerations After a Fall?

There is nothing more embarrassing than being out in public and falling over. Whether you’ve fallen out of a chair or simply lost your footing and fell, you may have experienced a sense of public humiliation. If you are lucky, that was the only fall related injury you suffered. On the other hand, if your fall caused significant injuries, you may want to contact a personal injury attorney.

In many states, property owners are required to remove any dangerous condition or warn visitors about the dangerous condition. When property owners fail to do one or the other, they may be liable for the injuries caused when the dangerous condition causes someone to fall. Neither liability nor compensation is guaranteed.

Generally, when the injury victim is successful in holding the property owner liable for their fall injuries, the average settlement is between $20,000 and $50,000. Court litigated cases tend to settle in the upper end of this range. Most injury lawyers work on a contingency fee, so the injury victim does not incur fees or costs unless they win. Premises owners can expect to incur, although paid by their liability insurance company, around $50,000 in fees and costs. Virginia’s case was not an average case. Please note, actual settlements and costs depend on numerous factors.

Here are some common questions our clients ask:

What do I do after a fall?

1. Check for Injuries
   Do not try to get up right away. If you have a head injury, you might fall a second time. Make sure you can move your arms and legs. Check if you are bleeding.
2. Seek help
   Find someone to get a staff member or manager as soon as possible. They should be able to assist you with getting to a safe spot, cleaning up anything that needs to be cleaned up, and contacting emergency medical services if necessary.
3. Documentation
   Report the incident to management to document what happened. Make sure to include any witness statements and contact information. Obtain a copy of the report and make a note of all staff involved in the reporting process (Names, positions, and contact information if possible). Take pictures of where you fell and what caused you to fall. Request to see the video of the fall, if available—most stores will not give you a copy of the video, but this will put them on notice to save it and you might be able to record the video with your cell phone. Gather the names and contact information for any witnesses. This type of documentation is essential for your claim. You want to memorialize as much information as possible.
4. Contact Gage Mathers: (602) 258-0646
   For us, the sooner we can begin representing you the better for your case. Whether from the scene of the incident, at the hospital or a short time later, call us so that at the very least we can inform you of some of the processes and options that you have. Let one of our Intake Representatives guide you through this complicated time, and if possible, allow us to apply over 50 years of experience to your advantage.

How soon should I get treatment?

Preferably immediately after the fall. You want to make sure you do not have any significant fall related injuries. If you do have significant injuries, you need to make sure that they are addressed right away. You should follow your health care providers’ advice and contact them if there is any change in your condition. Do not assume you are okay, even if you do not have any cuts or bruising.

Who pays for my treatment?

Use your own personal health insurance. This recommendation is backed by our 50+ years of collective experience. No one can guaranty you will get a financial recovery for your fall injury, so if you fail to use your health insurance then you might be stuck having to pay your medical bills with your own money. The use of health insurance also helps prevent bills from going into collections and counting against your credit. Ultimately, if you are compensated for your fall related injuries, then any settlement or jury verdict may be used to reimburse your health insurance company and pay any outstanding medical bills.

What if I have co-pays and deductible?

Pay them or work out a payment plan with the provider. The last thing you want is for your providers to send any outstanding bills to collections. Most premises liability claims will take at least 6 months to resolve, depending on the circumstances.

How much does it cost to hire a slip and fall lawyer?

Hiring Gage Mathers to fight for you will cost you no money up front and we are only paid if your claim is successful. When it is successful, we are paid a contingency fee (usually one-third of the total recovery) with reimbursement of our claim-related costs after that.

Why do I need an attorney? Can’t I do it on my own?

There is nothing preventing you from handling your claim on your own, but there are two sayings that may apply: (1) you get what you pay for, and (2) a [person] who represents himself has a fool for a client. Why handle your own claim, and potentially mess it up, when you can have a highly respected and experienced attorney handle it for you? Hiring Gage Mathers would relieve you of the burden and stress of your claim and allow you to focus on your health and rehabilitation.

Call us at 602.258.0646 and let us handle the headache of insurance companies so you don’t have to.