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Taking fall prevention outside

Falls aren’t just a major cause of injury. They can also result in chronic pain, reduced mobility, disability and even death. In fact, one-third of all hospital admissions for injuries are fall-related. The Public Health Agency of Canada reports that falls result in $2 billion per year in direct healthcare costs. The best way to address falls is to try to prevent them from happening – at home and outside.

“Historically, the whole notion of preventing falls has focused on home safety” says Azeena Ratansi, Occupational Therapist with the Centre for Osteoporosis and Bone Health at Women's College Hospital. “That approach comes from research that looked at elderly individuals, who spent a significant portion of their time at home because that was their environment.”

However, Public Health Agency of Canada data from the last five years show that in Canadians ages 65 and over who sustained an injury due to a fall, 46 per cent of those falls happened while walking. In this group, fallers were more likely to be female and more likely to be older (i.e., 85+).

“More and more data are also showing that falls in middle-aged adults, particularly active ones, are a lot more prevalent than we realize,” says Ratansi. “Those individuals don’t fall at home. They fall primarily outside.”

For many people in midlife, and even for active older adults, the risk of an outdoor fall may be greater than the risk of a fall at home. Making small changes can help reduce that risk.

Watch your step

A number of studies have found that many falls happen when people are walking. A 2014 study in the American Journal of Public Health differentiated between utilitarian walking (walking with a specific purpose or destination, such as walking to the drugstore to pick up a prescription) and walking for leisure or recreation. Utilitarian walking was associated with greater fall risk.

The study also found that falls on sidewalks, streets and curbs were more likely to result in an injury than falls in recreational areas. Older adults had two times the risk of falling while walking out of necessity and four times greater risk of injury from a fall on a sidewalk, than in a recreational area.

“When you have a destination in mind, you’re less likely to be paying attention to your surroundings, you may be rushing, so the falls risk may be higher,” Ratansi says. “Whereas if you’re simply going on a walk for leisure or recreation, you’re more apt to pay attention to your surroundings because it’s not about the destination, it’s about the process.”

The most obvious approach to reducing fall risk outdoors is to pay attention: be alert for possible tripping hazards such as curbs, obstacles and uneven sidewalks. Given the frequent use of electronic devices, things like texting while walking can prevent you from noticing physical barriers and unevenness in the ground that may cause you to trip and fall. Try to do one thing at a time.

If you take public transit, be alert to the position of your feet when standing, especially on a moving vehicle such as a bus or subway.

“Your foot position determines your stability,” Ratansi says. “Your feet should be shoulder-width apart, or even wider.”

If your feet are close together when the bus stops suddenly or the train lurches, it is almost impossible to keep your balance, even if you are holding onto something.

“I’ve told patients this, and had them come back at their next appointment and say it made a big difference,” Ratansi says.

Hands free

Don’t just watch your step, though. Your hands are important, too.

“One of the most important things – and this is for outside and inside – is to keep your hands free at all times,” says Ratansi. Try to keep your hands out of your coat pockets in winter, and avoid holding things in your hands. She notes that many women find this a challenge, because they often carry a handbag, and are often carrying other items, whether it’s a gym bag, briefcase or groceries.

“We’re always schlepping stuff, and this is such a big risk factor because your hands are your protective gear,” Ratansi explains. “The problem is when you trip or fall, you have no way to break your fall. So if your hands are busy carrying a cup of coffee or a bag and your foot catches on some unevenness in the sidewalk, your righting reactions are compromised and therefore, your options are limited.”

It may not be realistic to suggest never carrying anything, but there are ways to carry items that don’t occupy your hands. A backpack or a cross-body bag can free up your hands. If you do carry a handbag, or are carrying groceries, Ratansi suggests carrying it over your forearm, in the crook of your elbow, or on your shoulder, rather than in your hand.

Falls are preventable

“Falls usually happen because of the combined effects of a number of factors, such as a loss of balance, inattention, muscle strength, impaired vision, and environmental hazards,” explains Ratansi. It’s important for people of all ages to evaluate their individual falls risk and behaviours, as it could stop them from experiencing an unnecessary and potentially, serious injury.


Which month has the highest rate of admission to the emergency room because of a fall?

November. Why? Because that’s when people are more likely to be on ladders to clean out their eavestroughs and put up Christmas lights.


This information is provided by Women’s College Hospital and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition. This document was last reviewed on: March 9, 2016

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