October 2, 2013

Please Help Me, I’m Falling!

Posted in: Daily Living

by Joe Fontenot MD, CLVT and Marie Cafferty LPTA, SARPC

(Reprinted with permission from “The Magnifier”, a publication of MD Foundation.)

Common sense, as well as the Mr. McGoo cartoons, tells us that poor vision makes it more likely to fall. Medical studies bear this out.

Falls are serious and frequent events. According to a 2008 report by the Center for Disease Control (CDC), one third of those over the age of 65 have a fall every year, and one out of 10 falls results in a serious or even fatal injury. Falls are a major cause of death in people over the age of 65. Vision impairment is one of the major risk factors for falling.

Falls occur at any age, but have more serious consequences for older people. One fall, even if not serious, may predict more dangerous falls to come. You do not need to curtail your activities, but should consider fall prevention measures.

Macular degeneration and falls

People who have macular degeneration are particularly prone to falling. Those with macular degeneration tend to have problems with depth perception. One eye is frequently affected more than the other, resulting in loss of depth perception, a major risk factor for falls. Contrast sensitivity, the ability to see well in low lighting, and situations where there is little difference in colors and textures, is impaired. Blind spots (scotoma) are almost invariably present in macular degeneration, making it difficult to see small objects or obstacles.

Although macular degeneration by itself rarely causes total blindness, it may be compounded by glaucoma or diabetic eye disease. If this is the case, formal Orientation and Mobility (O&M) training by an Occupational Therapist may be needed. This could include use of the long white cane and possibly even a guide dog. However, this is rare if the only eye problem is macular degeneration.

What to do?

What should those with macular degeneration do to prevent falls and injury? Do not stop being active and getting out. Instead, consider the following adjustments:


Do not wear multifocal (bifocal, trifocal, or progressive) glasses while walking, especially in unfamiliar surroundings. The lower part of the glasses is designed to focus at a short reading distance, and anything further than that is out of focus and blurred. Anything on the ground or stairs will be difficult to see clearly. Wear distance prescription glasses or no glasses. The great Benjamin Franklin, inventor of bifocal glasses, has been the cause of many falls.

Home (where most falls occur)

Modify your home environment. More than half of all falls occur at home.

  • High risk areas include bathrooms, especially the shower and tub. Avoid reaching for the towel bar for stability it will not hold your weight. Instead, add grab bars and rails that are permanently installed into a wall stud. Invest in a bath tub bench that straddles the tub. Sit on the bench, and position yourself inside the tub. This saves energy by eliminating the struggle to regain your balance to get in and out of the tub. Avoiding loose rugs and wet, soapy floors can prevent many falls.
  • Stairs are another high risk area. If you fall down stairs, you may have a long way to go. It is like multiple falls. Always have at least one hand on the handrail. Do not carry things in both hands. Have good lighting, hand rails and mark the edge of steps to increase contrast. Never leave loose objects on stairs.
  • Do not store objects that you use frequently so high that you will need to climb on something to get them down. Store them at counter top height.
  • Add night lights or motion sensitive lights in areas where you may go at night-as, bathroom, kitchen, etc.
  • Do not run to answer the phone. Carry a cell phone with you at all times, so you can answer easily and can call if injured.
  • Think before you climb. Improvised stands or ladders, such as a chair, cause many falls.
  • Remove any and all loose objects on floors and stairs. Do not have loose or unattached rugs. Clear loose power cords.

In the community

  • If you have mobility or balance problems, use a cane or walker in unfamiliar areas. Make sure your aids are properly adjusted. An evaluation by a physical therapist would be best.
  • Beware of uneven terrain in your yard, up and down hills, curbs, and be mindful of unfamiliar stairs.
  • Consider installing motion sensor flood lights to the corners of your house to provide better illumination between dusk and dawn. Some creative folks string clear white Christmas lights around trees and bushes bordering their pathways to light the way.

Other measures

  • Join an exercise program. Strength and flexibility make it more likely that you will recover from a minor imbalance. Exercise and perform flexibility and balance training. Leg strength training is the most important, as it has been shown that leg weakness is a major risk factor for falls.
  • If you are dizzy or unbalanced on standing after lying down or sitting, ask your doctor to check you for a sudden drop in blood pressure (postural hypotension).
  • Do not walk in high heels or loose-fitting slippers, socks or slip-on shoes. Shoes should have non-slip soles and low heels. Do not have loose untied laces when walking.
  • Medication or alcohol may cause falls. Sleeping pills and antidepressants should be reviewed and discussed with your doctor, especially if you fall and were unusually unbalanced, or if you cannot remember the fall.
  • Medical alert systems can be considered. Having a cell phone with you at all times is an alternative.

Who can help or give advice regarding fall prevention?

1) Your local Area Agency on Aging may have a free all-prevention program, “A Matter of Balance”. This is currently available in 38 states. Contact them for free advice and local help. Call 1-800-677-1116 to locate your local Area Agency on Aging, or go to eldercare.gov.

2) The American Foundation for the Blind’s “Vision Aware ” program has tips and advice regarding fall prevention

3) Many local hospitals and home health agencies have fall prevention programs.

4) Orthopedists and other medical professionals such as Occupational and Physical Therapists are knowledgeable and helpful about fall prevention.

5) YouTube has a few good videos on fall prevention. To find them, search “Fall Prevention” on YouTube.

For additional information, view the audio/visual presentation, “Keeping Fit: Fall Prevention and Exercise for Older Adults With Vision Loss” by Anne Riddering, OTR/L, CLVT, COMS
Author Joe Fontenot MD, CLVT, is Medical Director of Community Services for Vision Rehabilitation in Mobile, Alabama.

Co-author Marie Cafferty LPTA, SARPC, is Health and Wellness Regional Coordinator at Area Agency on Aging in Mobile, Baldwin, and Escambia counties in Alabama.


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