Falls are the leading cause of injury among older adults and result in 2.8 million emergency hospital visits each year. Injuries from falls may be minor, significant, or even fatal.

Having one fall, even a minor one that does not result in injury doubles the risk of having another fall.  Falls without injury also increase the risk that a senior will become afraid of falling. The fear of falling that some older adults have may cause them to avoid doing certain activities or going to certain places. This fear of falling may lessen their physical health, emotional well-being, and overall quality of life.

Risk Factors For Falls

Certain conditions or medications may contribute to an individual’s risk of falling. Many of these risk factors may be controlled to minimize this risk. Some of these factors include:

• Poor vision – Many people experience decreased vision with increasing age. This may result in being less able to see potential fall hazards or navigate stairs.
• Foot problems – Injuries to the feet or conditions such as diabetic neuropathy may lead to falls. Improperly fitted shoes may also contribute to foot pain and fall risk.
• Difficulties in mobility or balance – Conditions that affect mobility and balance such as vertigo or arthritis may increase the risk of falling.
• A vitamin D deficiency – A vitamin D deficiency is common among seniors and may cause symptoms such as fatigue, back pain, and bone loss. These symptoms may lead to falls and injury.
• Lower body weakness – Weakness in the lower body may make it more difficult for an individual to catch themselves when they begin to fall.
• Medications – Certain medications such as sedatives or antidepressants may cause dizziness and affect balance. For some people, even over-the-counter (OTC) medications may have this effect.  
• Home hazards – Home layout concerns such as clutter or broken stairs may increase one’s risk of falling. Home modifications can make getting around the house safer. 

Injuries From Falls

Falls pose a significant risk of injury for seniors. For 1 out of 5 seniors who experience a fall, the result will be a serious injury. These injuries may be made worse by conditions such as osteoporosis (a condition that weakens the bones making them more susceptible to breakage) or by taking medications such as blood thinners.

Common injuries from falling include:

• Fractured (broken) hand, wrist, or arm
• Fractured leg or ankle, or a broken leg
• Pelvic fractures
• Hip fractures
• Knee fractures or broken knee
• Fractures of the spine
• Head injury

Head injuries from falls may not be immediately concerning, especially if a person does not lose consciousness or experience much pain. A head injury may lead to intracranial bleeding and to brain injury. Falls are the leading cause of traumatic brain injury in seniors. A senior who has hit their head during a fall should see a doctor as soon as possible to determine the extent of the injury.

Of the kinds of fractures caused by falls, hip fractures are the most significant. A hip fracture is the most likely kind of fracture to lead to other persistent health problems or to death.

It is reported that 1.6 million people worldwide will fracture a hip flexor each year. Less than half of all people who experience a hip fracture will ever regain their previous level of functionality. Many seniors whose fall results in a hip fracture are unable to live independently following the fall.

Treatment Of Injuries From A Fall

When a fall results in a serious injury such as a hip fracture, the course of treatment required may be intensive. Some fractures such as a hip flexor require surgery, medication, and rehabilitation. In some cases, an individual may not be considered a good candidate for surgery. This is likely to be the case if the individual was already unable to ambulate or is too ill to have surgery or anesthesia.

For individuals who sustain a stable fracture, bed rest may be ordered instead of surgery. This is due to the fact that in a stable fracture, the fractured bones are aligned in a way that may allow them to heal on their own without surgery. Individuals on a bed rest care plan for a stable fracture will need to be monitored closely for potential complications, such as pressure ulcers (also called bedsores) and pneumonia.

For many people who break a hip as a result of a fall, surgery will be required. Some common types of hip surgery include:

• Partial hip replacement – In a partial hip replacement, a surgeon will replace the damaged ends of a broken bone with a prosthesis (a metal or other synthetic replacement for a body part).
• Total hip replacement – In total hip replacement surgery, the upper femur and the socket of the pelvic bone are replaced with a prosthesis.
• Internal repair using screws – In this procedure, metal screws are placed in the fractured bone to hold it together during healing. A metal plate to assist in proper healing may also be used.

Care Needs For Fall Injuries After Discharge From Hospital

For an individual who has fallen and sustained a hip fracture, the fall recovery time may be lengthy. Many people are no longer able to care for themselves the way they used to. They may have significant trouble walking or even standing. This may result in a loss of functional abilities and in independence.

Even one year after falling and breaking a hip, studies show that:

• 90% of people who were previously able to navigate stairs independently are no longer able to climb 5 stairs.
• 66% of people will not be able to get on or off the toilet independently.
• 50% will be unable to lift themselves out of a chair.
• 31% will not be able to get out of bed by themselves.
• 20% will not be able to get dressed independently.

While a fractured hip is the most severe fracture that generally results from a fall, other injuries may cause substantial limitations to an individual’s ability to care for themselves as well. Any broken bone may involve a long recovery time and physical therapy to return to its prior function. A brain injury as a result of a fall may also cause a sharp decline in an individual’s self-care ability.

This decline in function may leave people unable to care for themselves and perform activities of daily living (ADLs). They may need help to bathe, get dressed, toilet, or move and walk. An individual who has a serious injury from a fall may also find themselves unable to perform other daily tasks. These tasks, such as cooking, housekeeping, and financial management, are referred to as instrumental activities of daily living (IADLs).

Rehabilitation After A Fall Injury

After a significant injury from a fall, an individual will likely require rehabilitation.

In the case of a hip fracture, this rehabilitation will be started as soon as possible. Often, physical therapy begins within a day of surgery. This physical therapy will often be done at the bedside in a hospital room with a physical therapist working to ensure a patient does not lose ability from being in bed for too long. A patient in rehabilitation may be asked to sit in a chair for as long as they are able to tolerate it. This may reduce the risk of bed sores and blood clots.

While still in the hospital, patients will be asked to do strengthening exercises and to stand and walk with assistance and support. After walking is able to be accomplished safely, stairs may be attempted. A physical therapist at the hospital may also teach a patient to walk with a walker or cane or how to use a wheelchair. Occupational therapists will work with the patient to assist them in safely performing ADLs.

Depending on the surgery and the patient’s individual circumstances, more intensive rehabilitation after discharge from the hospital may be needed. In these situations, the hospital team will recommend an acute rehabilitation center. In these facilities, a patient will receive intensive therapy for up to six weeks.

Adaptive Equipment Used After A Fall Injury

After sustaining an injury from a fall, a person may need adaptive equipment to complete daily tasks. Some examples of adaptive equipment that may be needed include:

• Shower chairs or benches – Having a bench in the shower allows a person to sit while showering. This may prevent dizziness and falls.
• Shower handrails – A handrail in the shower to hold onto may assist people with the balance needed for showering.  
• Raised chair cushions – The difficulty of sitting and standing may be lessened when a chair is raised to a higher level.
• Raised toilet seats – Raised toilet seats help to reduce the difficulty of sitting and standing when using the bathroom.
• Front-buttoning or velcro tops and bottoms – Clothing with adaptive features such as velcro or front buttons may be easier for seniors to manage.

Physical therapists and occupational therapists will be able to recommend specific equipment that an individual will need. They may also be able to teach the individual how to safely use the equipment and work with caregivers to ensure it is being used safely and effectively.

Fall And Recovery: Care Provider Options

When an individual is seriously injured during a fall, options for care may need to be considered. An individual may no longer be able to care for themselves safely or may need extra help during the fall and recovery period.

When deciding on the best option for care when recovering from a fall, the following questions should be considered:

• Will the individual require extended therapy?

In many cases, due to the extensive therapy required to regain functional ability after a fall, a person may not be able to return home right away. They may need extended rehabilitation following their hospital stay or they made need therapy in a skilled nursing facility (SNF).

• Does the individual live alone?

Having a spouse, adult child, or another live-in caregiver may greatly assist an individual in their recovery. Many people who are not able to care for themselves with complete independence but who live with a caregiver are able to remain in their own homes with the assistance of home health services.

• How serious was the injury?

Injuries such as hip fractures and brain injuries may require significantly more care and recovery time than injuries such as a broken wrist or ankle. Knowing the prognosis of the specific injury may help individuals and their families choose the appropriate care.

• Is the individual’s home safe?

Since people who have fallen are at an increased risk of falling a second a time, ensuring that the individual will be returning to a home that is free from hazards is essential. Household layout issues such as poor lighting, cluttered walkways, or narrow staircases may lead to another fall.

• Does the individual have any additional health conditions that need to be managed?

Recovering from a fall may make handling other health conditions such as diabetes or heart-related conditions more difficult. A person may be overwhelmed during their recovery and unable to safely manage all of their health conditions.

• Does the individual have any memory or cognitive problems?

If an individual has dementia, Alzheimer’s, or another cognitive impairment, it may not be safe for them to stay in their home unless a caregiver is able to stay with them around the clock. Surgery may cause postoperative delirium, which may worsen memory loss and cognitive decline.

• Is the person able to perform IADLs such as cooking or driving?

Very often in the case of a serious injury from a fall, a person will not be able to cook or drive any longer. While they may regain this ability with therapy and time, they will likely need assistance with these tasks during their initial recovery from the injury. Individuals and their families may need to explore options such as meal delivery services and senior transportation services.

Home Health Care After A Fall

If an individual is able to live at home safely after a fall but needs additional assistance with personal care and ADLs, home health care may be a good option.

A home health care agency will allow an individual to receive physical and occupational therapy at home. Therapists will work with the patient at home, helping them navigate their surroundings and home. Therapists may also be able to ensure that the home is safe and that risks of future falls are minimized.

When using home health care, nurses will also come to the home. Nurses will assist with treatments, medications, pain management, and any needed post-surgical care such as wound care. Home health aides will assist with ADLs such as dressing, toileting, and showering.

Other professionals such as dieticians, social workers, speech therapists, or respiratory therapists may also come to the home depending on the individual and their specific needs and plan of care.

When recovering from a fall, an individual and their family should meet with several home health care agencies to assess which one best suits their needs. Some home health care agencies are able to provide services such as meal preparation, transportation management, and housekeeping. If an individual is in need of these services, they should ensure the agency they select offers these services and ask about any additional costs that may be associated with them.

Inpatient Facilities For Recovery From Fall Injuries

While recovering from a fall, it may be necessary for an individual to stay in an SNF. Stays in an SNF are generally meant to be short-term and for acute needs. The length of stay will be determined by an overseeing doctor with the input of a therapist.                

For example, if a person sustained an injury after a fall, they may need to stay in an SNF until they are able to safely walk using a walker and until their pain is successfully managed with medication. A doctor may also want to see that a surgical wound is fully healed or ensure that a patient is no longer at risk for conditions such as pneumonia.

At an SNF, health care staff will work with the individual to help them recover from their injury. Occupational and physical therapists will work with the individual at the bedside and in therapy rooms. They will ask questions about how the individual’s home is set up so they can help the person plan for safe discharge home. A doctor will oversee this care and nurses and nursing assistants will provide treatments, medications, and assistance with ADLs.

Before an individual enters an SNF, it may be helpful if a family member or caregiver visits several facilities with available beds. This will give an individual a better sense of each facility and assist in the selection process. If visiting multiple facilities is not possible, researching different facilities online may also help an individual and their family learn about different SNFs and make an informed choice.  

If an individual is not able to return home following a stay in an acute rehabilitation facility or SNF but no longer needs a skilled level of care, they may consider moving to an assisted living facility (ALF).

In an ALF, staff will be present around the clock to assist an individual with care needs and medication management. ALFs usually include services such as housekeeping, meals, transportation, and activities as well.

While most ALFs do not have physical therapists or occupational therapists on staff, home health agencies may be able to work with the ALF to provide therapy as needed. If an individual who already lived in an ALF sustains an injury after a fall, they may be able to use the services of a home health agency when they return to the ALF.

Some ALFs and SNFs are part of larger communities known as continuing care retirement communities (CCRCs). In these communities, many levels of care are offered on one campus. A CCRC allows a person to stay in a familiar environment as their care needs change. A person may start in an ALF, sustain a fall, receive therapy and skilled care in the SNF, and then return to their room in the ALF. This allows for continuity of care, familiarity, and a sense of security for an individual.

Selecting A Care Provider After A Fall Injury

Once the choice about what type of care is needed has been made, the choice about who will be providing that care needs to be made. Some important considerations when selecting a specific care provider include:

• What is the rate of falls at the facility or with the agency?

Most facilities and agencies keep data about the number of falls their patients have had. Asking to see these numbers may give individuals and their families a better sense of the safety of the provider.

• Is there a falls protocol or specialized care plan in place?

In some facilities, individuals who are at a high fall risk are given specialized precautions. Staff should be trained in those precautions and a fall prevention program.

• Are clients or residents encouraged to be as active as possible?

Activity after a fall is important. Individuals who have experienced an injury may have a fear of falling and engaging in certain activities; however, being more active may actually decrease one’s risk of additional falls.

• How does the staff interact with clients or residents?

Watching how the care staff interacts with current clients or residents will give an individual a sense of how they will be treated by care staff. If possible, an individual considering an inpatient facility should visit and observe staff and resident interaction during various times of the day.

By making an informed choice, an individual and their family will feel more confident in the care and assistance that the provider offers. Recovering while in the care of trusted professionals may make a significant impact on an individual’s quality of life and on their ability to regain previous abilities.

Financial Considerations Related To Fall Injuries

All types of long-term care have associated costs. An individual who needs long-term care after a fall may need to apply for Medicaid, sell their home, use a reverse mortgage policy, take out a loan, or pay premiums on long-term care insurance. This may be financially and emotionally stressful.

What each home health care provider, SNF, ALF, and CCRC will accept as payment varies. Factors such as the level of care needed may increase costs in certain facilities.

More detailed information on the options for covering long-term care costs may be found here, but some general guidelines regarding payment for different options are noted below:

• Home health care –  Medicare will pay for 100% of the costs of home health care as long as the agency is Medicare-certified and as long as the doctor ordering the care certifies that there is a skilled need. Medicare will cover the cost of services needed on a part-time and temporary basis (less than 8 hours a day for 21 days or less.)

Medicare will not pay for services to assist with IADLs such as housekeeping, transportation, or meal preparation. Different agencies accept different forms of payment; however, common payment options include Medicaid, private pay, and long-term care insurance.

• SNFs – Medicare will cover 100% of the costs for up to 21 days as long as there has been a qualifying hospital stay. On days 22 through 100, Medicare will pay a portion of the costs and the individual will be responsible for a copay amount. After 100 days, Medicare will no longer cover the costs of care in an SNF and the individual will be responsible for the entire amount. Most SNFs accept payments such as long-term care insurance, Medicaid, and private pay.
• ALFs and CCRCs – These facilities are not considered medical care and are not covered by Medicare. The cost of these facilities will need to be paid for by private pay or long-term care insurance. Staff at an ALF or CCRC may be able to assist an individual and their family determine the best payment option.

Legal Considerations Related To Fall Injuries

Because of the stress associated with making some of the financial decisions discussed above, It may be helpful to set up a power of attorney who may be able to take care of these financial decisions for the individual or at least help them with some of these choices.

If an individual does not already have a living will, they should consider putting one in place before starting long-term care. A living will is used to protect an individual’s wishes in the case of an emergency medical event. While planning for long-term care and fall recovery, an individual may also want to set up a funeral trust to begin prepaying for funeral costs.

Effects Of Fall Injuries On Caregivers

Falls may have a serious impact on caregivers as well as the individual who has fallen. Falls are associated with greater caregiver burden and with higher stress. They may feel overwhelmed at the additional care needed or guilty that a fall occurred.

The National Coalition On Aging (NCOA) recommends that caregivers take the following steps to prevent future falls:

• Assess the risk of falling and take steps to make the home safe.
• Have family or friends look at the layout of the home and check for hazards.
• Discuss the health conditions that the caregiver and the individual who has fallen have.
• Note any cognitive problems the individual who has fallen is experiencing.
• Make sure the individual who has fallen has regular eye checkups and that all prescriptions are current.

FAQs About Recovery From Injury After A Fall

1. Why should a person report all falls to their doctor?

All falls, no matter how minor they seem, should be reported to a doctor. A doctor may want to do tests to make sure no injury has occurred. They may also want to talk about a fall prevention program and look into anything that may have caused the fall. In the event that the fall was caused by medications, weakness, poor eyesight, or other physical conditions, a doctor may be able to begin a treatment plan to address the cause.

After an older adult falls, they are at a much higher risk of having a second fall. A doctor may be able to lower this risk, but only if they are aware that a first fall occurred. Sometimes seniors may feel embarrassed about their fall and may not want to talk about it. By discussing their fall protection program with a health care provider, they may be able to prevent a more serious and potentially life-threatening fall in the future.

2. Why do hip fractures sometimes lead to death?

A hip fracture is a complex injury that may significantly impair an individual. While many people do recover and are able to live independently, approximately 21% of all seniors who fracture a hip will die within a year. Some reasons for this include: 

• Surgery carries increased risks in seniors.
• Bedrest may lead to infections such as pneumonia.
• A hip fracture may lead to depression and lower quality of life.
• Hip fractures may aggravate other pre-existing conditions.

3. Why does osteoporosis make falling more dangerous?

When a person has osteoporosis, they have lost bone mass causing their bones to become more brittle. This may cause bones to break more easily than the bones of a person without osteoporosis. A person with osteoporosis should take extra precautions and make sure their home is free from fall hazards. They should exercise and eat a healthy diet. These things may reduce the risk that a fall will result in a serious fracture.

4. What is the most dangerous type of fall?

In seniors, all types of falls may lead to severe injury. Even a fall from walking or a slip may be fatal. All falls produce some trauma to the body. Seniors are less able to recover from this trauma than younger people due to the aging process. In the U.S., an older adult dies from a fall every 19 minutes. Among women over 65 years old, a fall that results in a hip fracture leads to more deaths than breast cancer. 

Since the risk of serious injury and death following a fall is so significant, it is important that older adults and their caregivers take every precaution for a fall protection program.