• Diminished strength
• Poor nutrition
• Decreased vision
• Vestibular changes
• Loss of balance control
• Improper use of a walker or cane
• Substance abuse
• Change in walking style (gait) due to physical impairment or arthritis
• Poorly controlled blood pressure
• Foot problems or lack of foot care

Fall risks related to changes in cognitive status:
Loss of judgment
Impairment in awareness of surroundings
Decreased ability to perceive fall hazards in their environment

Fall risks related to medications:
Interactions of medications which cause side effects such a confusion, poor motor coordination or weakness
Interaction of medications which cause one medication to have an effect not intended by the physician
Irregularity in taking medications as prescribed, missing doses or taking the same medication twice
Some medications cause dizziness, drowsiness, confusion, poor motor coordination or weakness
Medications have been prescribed by a physician who is not aware of the unique dosages appropriate for the elderly

Fall risks related to environmental conditions:
Throw and scatter rugs without non-skid backing
Lack of grab bars and no slip bath mats in the bath or shower
Water spills on the floor
Clutter on the stairs
Inadequate lighting
Electrical cords and extension cords which interfere with walkways
Insufficient night lighting
Outside stairs in poor repair
Wall to wall carpets are torn or worn out

There are some steps you can take:
1. Encourage your parents to request their physician to review their medications to be sure there are no medication interactions, side effects or counter indications for older adults
2. Begin discussion with your parents about their concerns, worries and the challenges they face in remaining independent
3. Arrange for an environmental/ home safety assessment with a geriatric care manager to identify potential hazards and to obtain suggestions for changes to the home which can maximize independence and limit risks
4. If you have observed memory loss, confusion or impaired judgment, arrange for a memory screening or a cognitive assessment. A Geriatric Care Manager (GCM) can assist in making these arrangements. Locate a professional GCM at www.caremanager.org or in New England you may use the local chapter site at www.gcmnewengland.org.
5. Participate in a visit with your parent's physician, arrange for consent forms to facilitate communication with the physician and the physician's office
6. Consider making arrangements for your parent to begin care with a geriatrician. You can identify geriatricians, or primary care physicians certified in geriatrics through:
American Board of Family Medicine (geriatric medicine) www.theabfm.org.
American Board of Internal Medicine (geriatric medicine) www.abim.org
American Geriatrics Society (physician referral service) www.healthinaging.org
7. Encourage your parent to participate in regular exercise. Utilize Service Link 1-866-634-9412 for information and referral or a Geriatric Care Manager to help you find group exercise programs convenient to your parent's home.


"Balance is a use-it-or-lose it function. Consequently, no matter your age, consistently challenging your balance will keep you healthier." Michael Bearer, Executive Director of Fall Prevention Clinics of America as quoted in "Flagging Falls, Jennifer Mellace, Aging Well, November-December 2009.

The high cost of falling has been well documented.
But looking beyond direct costs and the high number of fall related fatalities, a most compelling concern remains. Elders who have a history of falling develop fears which will ultimately cause them to reduce their level of physical activity and therefore further compromise their mental and physical health by becoming more isolated. The impact on their potential to remain independent is very high. If you buy into your loved one's denial about the seriousness of their falling, you may be contributing to their eventual loss of independence.

You can become proactive by:
Insisting on an honest discussion
Learn about your parent's activities or reduction in activities
Seek help in developing a plan of action

If you need help in getting a discussion stated, a consultation with a Geriatric Care Manager will help you plan how to break the ice.