Preventing Falls

Falling is a significant problem for people with arthritis. “Not only are people with arthritis 20 to 30 percent more likely to have a serious fall but they also experience more severe consequences when they fall than people without arthritis,” says David Geier, MD, an orthopedic surgeon and expert in injury prevention.

In a study of more than 10,000 adults 20 to 87 years old, 20 percent reported a notable fall in the previous year. However, in a separate study of people with rheumatoid arthritis, nearly 40 percent reported a fall. Another study published in the journal Arthritis Care and Research found that people with rheumatoid arthritis are at a high risk for falls regardless of age or sex. Adults with osteoarthritis in their lower body were more likely to have a fall, with the risk rising as the number of joints affected increased. Those with one joint with OA had an increased fall risk by 53 percent; those with two joints with OA had a 74 percent increased risk, and those with three or more OA joints had an 85 percent increased risk of falls, according to a separate study published in the journal Arthritis Care and Research.

Why Falls Are Worse for Arthritis Patients

Falls are a leading cause of injury worldwide but patients with arthritis have a higher risk of being injured and having worse injuries, Dr. Geier says. More than half of all the falls endured by people with arthritis resulted in injuries, most commonly head injuries and fractures, with 15 percent requiring a doctor’s care and 8 percent requiring emergency care, according to the study of RA patients in Arthritis Care and Research.

Hip fractures are one of the most devastating consequences from falling, as they have a great impact on your overall health and mobility, Dr. Geier says. Having any type of arthritis can increase your risk of hip fractures, according to a study published in the Journal of Rheumatology. People with rheumatoid arthritis were three times more likely to break their hip while people with osteoarthritis were twice as likely to have a hip fracture.

Osteoporosis, Arthritis, and the Risk of Falls

There is a strong link between osteoporosis (thinning bone and bone loss) and rheumatoid arthritis. Glucocorticoid medications — commonly used to treat flares in people with inflammatory arthritis — can cause osteoporosis. A lack of exercise due to pain or fatigue among arthritis patients can also increase the risk of osteoporosis.

And osteoporosis further increases your risk of falling and increases the risk of having a fracture from the fall.

When it comes to the relationship between osteoarthritis and osteoporosis, the relationship is less clear but these conditions often occur together and may influence the health impact of the other, according to a study published in the Journal of Bone and Mineral Metabolism.

Fall Culprits: How to Identify the Sneaky Reasons for Falls

A loose rug, a missed stair, a slippery shower floor — you’d think figuring out why you slipped and fell would be easy. However, the immediate trigger of a fall is rarely the root cause, Dr. Geier says. And identifying that root cause is step one in learning how to best prevent slips and falls in your particular situation so it’s important you figure out your personal risk factors, he says.

Medications

The first thing you should look at are your medications, he advises. Many drugs commonly used to treat arthritis can impact balance and/or cause brain fog, two side effects that increase your risk of falling, he says. Pain medications are a common culprit; people taking opioid pain meds were 2.5 times more likely to have a serious fall, according to a study published in the Canadian Medical Journal. Both disease-modifying antirheumatic drugs and biologics, two classes of medications commonly used to treat arthritis, list dizziness as a common side effect. In addition, any medication that acts on the brain or that affects your cardiovascular system can increase fall risk — which includes medications not specific to arthritis but commonly prescribed to patients with arthritis, such as antidepressants, blood pressure medications, diuretics, and sleeping pills, according to pharmacist Mark D. Coggins.

Gait Changes

Biomechanical problems are another main cause of falls in patients with arthritis, Dr. Geier says. This can include gait or balance issues due to painful and swollen joints (particularly those in the lower body), poor posture due to fusions and cartilage loss, and imbalances due to weakness on one side of the body.

Many arthritis patients report feeling like their joint “just gave way,” likely due to general weakness or bone loss, according to the Arthritis Care & Research study of people with RA. These biomechanical causes tend to be very specific to each patient, so Dr. Geier recommends making an appointment with a physical therapist who specializes in mobility to help you pinpoint your issues.

Fatigue

Lastly, fatigue — especially the crushing, persistent fatigue many arthritis patients experience — makes you more vulnerable to falls, he says. When you’re physically and mentally exhausted you’re less mindful of your body and your environment and more likely to get hurt.

How to Protect Yourself Against Slips and Falls

“Prevention is everything when it comes to falls, and it’s something I always discuss with arthritis patients,” Dr. Geier says. “Making small changes now can lead to greatly improved health later on.”

Do the Right Exercises

Posture exercises

Exercises that help stabilize and improve your posture can improve your ability to see and avoid hazards around you, says Tom Ryan, a physical therapist who works with arthritis patients at the Panorama Orthopedics Center with locations in Denver, Colorado.

Core exercises

Similarly, exercises that strengthen your core will make it easier to regain your balance after a slip, Dr. Geier says. These should include exercises that target not just the abs you can see but the front and back of your torso and your pelvic girdle.

Yoga

The combination of stretching, strengthening, and balance work is ideal for many patients with arthritis, Ryan says. If regular yoga feels too difficult, experiment with different types of yoga like “yin” or resting yoga.

Individualized exercises

The best exercises are going to be ones that address your particular problem areas, Dr. Geier says. A physical therapist or occupational therapist can help you determine where your weak spots are what exercises will best strengthen them. This should include practicing everyday movements — like standing up from a seated position or stepping into a bathtub — that cause you to lose your balance frequently, Ryan adds.

Slip-Proof Your Environment

Use rug anchors

If you have rugs on slick surfaces like tile or wood, then you know how easily they can move underfoot and become a serious slip hazard. Solve this problem by using rug anchors, Ryan says. These rubber or Velcro tabs attach underneath each corner and keep the rug anchored in place to the floor.

Put step treads on all your stairs

Stairs are a major cause of slips and falls. They require a certain level of agility, coordination, and focus to navigate, Ryan says. One way to help make them safer is to use step treads, he says. You can get large ones that cover the entire surface of the stair or adhesive strips that attach just to the front edge. There are types for carpet, tile, or wood; indoors or outdoors. Whichever type you pick make sure they are securely attached so they don’t add to the slip potential.

Install a shower chair

The number-one piece of adaptive equipment you should add to your bathing routine is a shower chair, says Lisa Folden, an occupational therapist and naturopathic lifestyle coach at Healthy Phit Physical Therapy & Wellness. These waterproof seats can take the pressure off achy knees and hips as well as help keep you stable while you scrub, she says. If space is an issue you can have a wall-mounted shower seat installed that folds up when not in use.

Add a non-slip bath mat

Taking a slip in the shower is a risk for anyone but people with arthritis often are a greater risk due to balance issues, slower reflexes, and brain fog. This is why a grippy mat placed in the bottom of your bathtub or shower stall is a must, Ryan says. A good non-slip bath mat should cover the entire bottom surface (avoid “sticker” types), adhere well to the bottom, and be antimicrobial, he says.

Install grab bars

Grab bars — sturdy metal bars mounted to a wall and used to help you stand up or sit down — are useful in many places in your home, Ryan says. Put one by your toilet, by your shower, next to your bed, or any other place you need help standing or sitting. Grab bars work best if they are permanently mounted, rather than using suction that can slip, and have a surface that is easily gripped.

Buy a portable standing assistant

A lightweight portable metal frame gives you a handle to use to stand up from your bed or couch without risk of falling. When the portable stand assist is not in use, it folds away out of sight. “You have to have quite a bit of hip and knee mobility to sit without falling and then stand up again, which is something many people with arthritis lack,” Ryan says. Having something to hold onto, like this rail, can be invaluable for preventing injury and maintaining proper form, he adds.

Install a bed rail

For people for whom a grab bar doesn’t provide enough assistance, the solution may be a sturdy, adjustable bed rail that tucks under your mattress to give you a firm grip to sit or stand. As a bonus, it comes with a pouch to keep your glasses, phone, and other essentials at arm’s reach. “This is a great tool for preventing falls early in the morning and at night, when people are most vulnerable,” Ryan says.

Use a Mobility Aid

Canes

For people who feel mostly stable but are just a little unsure on their feet, a cane can be an invaluable tool, Dr. Geier says. They’re discreet, lightweight, and very affordable, providing a little boost to your balance as you move.

Walkers

If you always feel off balance or if you’ve already experienced numerous falls, it may be time to use a walker, Dr. Geier says. Walkers provide stability while moving with you so you have support exactly where you need it. He recommends having your physical therapist show you the proper way to use one as improper use of walker can make some arthritis issues worse.

Wheelchairs

“Wheelchairs are a two-edged sword and I’m generally hesitant to recommend them unless they’re necessary,” Dr. Geier says. “Using mobility aids that keep you on your feet, doing weight-bearing activities, are preferred as they can help reduce stiffness and help prevent osteoporosis while improving balance.” Unfortunately, once people become reliant on wheelchairs, it can be difficult to stop using them, which can significantly reduce your quality of life and worsen your symptoms, he says.

However, there are some people for whom there is simply no other option. In this case he recommends only using the wheelchair only as much as necessary and working closely with your doctor and physical therapist.

Adjust Your Treatment Plan

If you are noticing that you are feeling more off-balance, dizzy, or foggy than usual; or if you have been experiencing an increased amount of slips or falls, talk to your doctor about what changes you can make to your treatment plan to address this issue before you endure a serious fall, Dr. Geier says.

This may mean changing medications, getting a referral to a physical or occupational therapist, changing your exercise routine, or altering your daily routine, he says. And don’t feel silly bringing it up. “It’s so important to get ahead of this one, your doctor will certainly want to hear about these symptoms,” he adds.

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