Summary
Falls are often blamed on poor balance or muscle weakness—but those are only part of the story. In Part 1 of this Carelab episode, occupational therapists Emilia Bourland and Brandy Archie explore three overlooked reasons people fall: vision changes, environmental hazards, and dual tasking. They explain how subtle issues like reduced contrast sensitivity, poor lighting, cluttered walkways, or trying to do multiple things at once can significantly increase fall risk, even for otherwise healthy adults.
They also discuss why occupational therapists ask detailed questions after a fall. By understanding exactly what happened before, during, and after the incident, they can identify the true cause and recommend practical solutions that often reduce fall risk immediately. Rather than expecting people to adapt to their homes, Emilia and Brandy emphasize that homes should be adapted to meet changing needs as we age.
Key Questions Answered
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Why do people fall if they don't have balance problems?
Falls are often caused by factors beyond balance and strength, including vision changes, unsafe home environments, and attempting to perform multiple tasks at once. Addressing these underlying causes can often reduce fall risk more quickly than exercise alone.
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How can vision increase the risk of falling?
Aging can affect contrast sensitivity, depth perception, and the ability to adjust between light and dark. These changes make it harder to detect stairs, obstacles, and uneven surfaces, increasing the likelihood of a fall.
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Why is the home environment so important for fall prevention?
Many falls happen because of everyday hazards like clutter, poor lighting, loose objects, or poorly designed spaces. Small modifications—such as improving lighting, removing tripping hazards, and organizing walking paths—can dramatically improve safety.
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What is dual tasking, and why is it dangerous?
Dual tasking is trying to do two things at once, such as carrying laundry while talking or walking while focusing on a conversation. Because the brain rapidly switches attention rather than truly multitasking, awareness of balance and surroundings decreases, making falls more likely.
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Why do occupational therapists ask so many questions after someone falls?
Occupational therapists investigate exactly how, when, and where a fall occurred to identify its root cause. This detailed assessment allows them to recommend personalized solutions—such as environmental changes or habit adjustments—that can reduce fall risk immediately while also supporting long-term strength and balance improvements.
Transcript
Brandy Archie
Hi everybody, welcome to CareLab. We are here with a solo. Can we call it solo when it's just the two of us? An episode with no guest. Yeah, solo episode. No guest. so we're leaning into our occupational therapy-ness. And so today we're gonna talk about five reasons your loved one might be falling that don't have anything to do with balance, because we almost always think it has to do with balance or weakness.
Emilia Bourland
I think so. It's no guessed, yeah. Yeah.
Brandy Archie
And it doesn't always come to just the muscles, right? And so we got five different ones that we're gonna go through. And the first one is vision. People don't think about it very much. And actually you taught me this, Emilia. Like one of the things that caused the most falls is not using your bifocals well. And because the switching between distance and close
Emilia Bourland
Hm.
Yes, yeah.
Brandy Archie
is not always quite right for like the distance to your feet. And so that's just one of many reasons your vision could be impacting your ability to walk safely and to eventually cause- essentially cause a fall. One of the biggest ones I like to talk about is contrast sensitivity. So as we get older, the ability for us to dim and to and sometimes with certain conditions, you don't see contrast as well. And so while
Emilia Bourland
Mm, mm.
Brandy Archie
You could be standing at the top of the stairs and if they're carpeted and all the same brown color, if you don't notice the difference between each step, which can be really slight, you know, if there's not like an edger on each step, then that immediately triggers your brain to be cautious and more cautious, which actually ends up increasing your fall risk because you're unsure about the depth of each step and what you're doing. And so,
That's just like one way that vision can impact your risk for falls. And so just to assume that falling is only because of like balance and we need to, you know, increase our strength, it's really helpful to go backwards and really think about like what actually impacted this situation. When did the fall occur? I don't know about you, but I asked so many questions. When did you fall last? tell me about that. What were you doing? Like all the time.
Emilia Bourland
I'm the most annoying.
I'm the most annoying. You tell me, like, we're gonna have a 20 minute conversation about it. But here's the deal at the end of that 20 minute conversation, we're probably gonna be able to dig down into exactly what the root cause of the fall was, and we're gonna be able to generate a solution for it. So, so next time your OT is asking you a million questions about.
Brandy Archie
Exactly.
Emilia Bourland
What time was it? Where did you fall? What were you doing? What was go like all of all of these things? try not to get too annoyed because they're actually gonna generate a a workable solution for you. And a lot of times, I think this is sort of the really maybe wonderful. Wonderful might not be the best word to use, but like the the good thing about the fact that there are all of these possible causes of falls besides just strength and balance.
Brandy Archie
Hm.
Emilia Bourland
Is that many of these things are things that we can impact very quickly? Right. We can we can accommodate for them, we can make an environmental change, we can make a a change to, you know, whatever that one little thing is, and all of a sudden, like magic, that fall risk is substantially lower. So, I mean, as much as it can feel like overwhelming that.
Brandy Archie
We can accommodate for them. Yeah.
Mm-hmm.
Emilia Bourland
That falls and the causes of falls are so multifactorial. The fact is, it actually gives us a lot of tools to intervene in ways that are really immediately effective versus only being reliant on increasing balance and increasing strength in order to prevent falls, which of course is something that we do and it is an important thing to do, but it takes a lot longer. And if you look at the science, it does not actually account for the majority of.
Brandy Archie
Takes longer though.
Emilia Bourland
Falls and fall risk. there's some really interesting research on there. Yeah.
Brandy Archie
Interesting.
Emilia Bourland
Mm-hmm. Mm-hmm. In fact, do you want to know what and this will lead us into? Wait, are we done with vision? No, we have more to talk about with vision.
Brandy Archie
I mean we could talk all day about vision, but I think the biggest thing is that like you pay attention to the fact that it could be your vision that's impacting your the risk for falls, even if you don't have like a low vision diagnosis particularly.
Emilia Bourland
We could.
Mm-hmm. Okay. All right. So, and I think, okay, so this is a good segue into the next of the five things, where we'll kind of tie vision in there too. But so, there's a really great research article. I can link it in the show notes actually for people who want to check it out. It's very eye-opening. It's this huge systematic review of like a gazillion studies about falls, fall risk, fall prevention.
Trying to identify what are the most common causes of falls and then how can we actually what types of interventions are the best at affecting the largest number of falls? And do you want to know what intervention prevents the largest number of falls, Brandy?
Brandy Archie
I one hundred percent do. Please tell me.
Emilia Bourland
I I'm gonna guess you 100% know already. And that is
that is environmental modification led by occupational therapists. Specifically, specifically, yes. let
Brandy Archie
Ooh, specific to that. Yes. So I've been saying all
this and it's actually true.
Emilia Bourland
It is it is legit science, well documented. Yeah. So okay, so environment. Why is the environment so important to how we to our fall risk? Well, because we are falling in the places where we live or out in the community, right? A fall is d is a is a is a relationship between you and the world that you are in. And so whether or not your environment
Brandy Archie
Exactly.
Emilia Bourland
is set up in a way that is accommodating to you and your skill level and your needs, both your sensory needs and your your your physical needs, is going to directly impact whether or not the high risk is your the far risk is higher. You can even think about it like, listen, you be walking around your house 35 years old, perfectly healthy, no issues at all.
But your kids left Legos all over the floor. You didn't see them. And now you're going down, right? Or at least it really hurts to step on Legos. Yeah.
Brandy Archie
percent you step on him and then you hurt and
now you're kind of, you know, wincing in pain, bouncing on the foot and then a fall happens. I mean that's not like ridiculous, right? Like
Emilia Bourland
Nope. It is it is it is not only ridiculous, it is it makes so much sense for why environmental risk factors are one some of the easiest things for us to change. Not always easy, right? But a lot of times we can make small changes that will significantly impact our fall risk in the environment. and two, why it's the why it is such a high, why it causes such a high number of falls is because
Brandy Archie
It's very plausible.
Mm-hmm.
Emilia Bourland
very few of us have environments that are actually set up in a way that is thoughtful for for preventing falls. but kind of tying back into that vision thing, one of the things that we can think about in our environment to help prevent falls, besides just removing clutter and tripping hazards hazards, is lighting.
Brandy Archie
my gosh, yes. Yes. Lighting is so important. Because 'cause this is what the lighting is doing for you. Is we're not saying you can't see, but what we're saying in in that you like your eyes need more light all the time. It's like a band-aid essentially for your environment. If we put some more light on the scene, then the things that are like not usual, like the Legos on the floor or the dog toys in the way or the whatever you know, a pillow fell off the bed and is actually in your walking space, the things that are not normal
are illuminated to you so you can avoid them, right? I think the biggest excuse or statement that people say often to me is like, well I've lived in this house for 30 years. Like I can go through this house with my eyes closed. And I don't disagree with you. That could be true. But there are so if you have if somebody else lives with you, if you have a pet, if you have grandkids coming over or children running around, like
Emilia Bourland
Mm-hmm.
Brandy Archie
And if you just like happen to be more tired when you went to bed than you were before and you did something slightly different than you normally do, that means there could be something happening in your pathway at night when you get up to go to the bathroom or wherever. that's not usual. It's usually the things that are not usual that cause the fall that's that that are happening in the environment. And adding additional lighting can help you avoid that.
Emilia Bourland
Yeah, I like your point about because I've also heard this probably a hundred million times over, you know, treating however many gazillions of of patients I've treated at this point, specifically for for falls who are who are seeing me because they've had a fall. you know, either well, just saying I'm not going to fall, or I've I've done it this way for 30 years. I've lived in this house for 30 years, whatever it is. you know.
Brandy Archie
Mm-hmm.
Okay.
Emilia Bourland
I I know this really well. Here's the thing that has changed. Maybe your home has not changed in 30 years, but guess what has? You.
Brandy Archie
Your body, your vision, your muscles, your reaction time, your accommodation time with your eyes, how much how quickly you switch from like dark to light situations, all that has changed.
Emilia Bourland
Your body. Mm-hmm.
That's right. So the environment that worked for you 30 years ago may just not work for you anymore. Now that doesn't necessarily mean that you need to get up and sell your house and move somewhere else, right? But it does mean how can we make thoughtful changes to the environment that work better for the person you are now? Because you probably you probably got that house in the first place because it worked for you and your lifestyle as a at then at that point, right?
Brandy Archie
Right.
Then
Emilia Bourland
There is there is nothing wrong. No, people don't like to change. No one likes to change. Myself included, right? No one likes change. But there's nothing wrong with with adapting your environment to meet your needs rather than expecting yourself to constantly adapt to your environment. Who's who's your house working for? Who's it working for? It's working for you. Not the other way around. Yeah, exactly.
Brandy Archie
Totally.
Supposed to work for you. Yeah, so make it work for you. Yeah.
Yeah. that's such a good point. Okay, we sh we should bet we should try one more maybe.
Emilia Bourland
We should try one more
and then I think and then I think this is gonna be a two parter. I think you'll have to tune in for the next episode to get the last the last couple. Mm-hmm.
Brandy Archie
You're gonna have to wait a couple days for the next ones. Yep, that's right.
okay. I think one of the other top reasons, so we've had two so far, vision and environment, is dual tasking. So doing more than one thing at a time. Because what is like literally your brain can't do more than one thing at a time. Okay. So when you are doing more than one thing, you're doing both of them kind of badly. And I am
Emilia Bourland
Hmm.
Ooh.
Wait, hold
on. But wait, Brandy, what about multitasking? Don't we all multitask? She says.
Brandy Archie
We all do, but we don't
do but your brain's not you think you are doing it. And I am speaking to myself because I am a great offender of this. You think you are doing two things at one time, but you're just doing two things and splitting them up. This is what this is what your brain is basically doing, right? It's like I'm doing this, it's
Emilia Bourland
Ha
It's it's task switching. So what we call multitasking
tasking is actually attention switching and task switching, right? We just do it really fast. Mm-hmm.
Brandy Archie
In a short amount of time. Yes.
Exactly. And you really wouldn't like encourage a student to learn that way, would you? You wouldn't be like, We're gonna talk about math and reading right now. Like, here's your paper for math and here's your paper for reading. Like you don't do that. You have time for reading, then you have time for math, like when you're trying to learn something new, right? It makes sense because your brain needs to focus on one thing. So even though our lives seem to require us to do this, we're not very good at it. And so
well we just talked about before, which is yes, maybe you were able to carry the laundry basket up the stairs and holler at your kids twenty years ago and not have any problem getting up and down the stairs. But things have changed. Maybe those stairs didn't change, but you have changed. And so the ability to like hold this basket with two hands and step up the stairs and not use the railing and then also be like avoiding the cat as it's coming down is actually a very like
multi step process that then your brain has to try to accommodate for and doesn't always do it as quickly as it used to, which leaves a air leaves a gap for challenges to happen. And so I literally had a client one time tell I was like asking all the twenty questions about the fall, right? And she was like, you know, I was just like going up the stairs and my teen like my son, he's in his twenties, was home and I was hollowing up the stairs to him.
And then I fell. And I was like, Yeah, like your attention switched off of you paying actually kind of a lot of attention to your balance as you carried that basket up the stairs to yelling for him to do something or whatever. And it distracted you and then your body wasn't able to like manage that and like you slipped and fell. And all a lot of that's happening in the background. Like you're not consciously aware of how hard your brain is working at that moment, but it was and it impacted you.
Emilia Bourland
Yeah, I actually think the the example of like walking and talking at the same time is a is a great example of dual tasking. Because when we're having a conversation with someone else, we are mostly paying attention to that conversation. But guess what we're not doing? We're of course, to your point, we're not paying as much attention to our or our brain maybe isn't doesn't have the same amount of focus dedicated to.
Brandy Archie
Mm.
Emilia Bourland
subconsciously picking our feet up or, you know, moving in a certain way. But guess what it's also not doing? We're not necessarily visually scanning it as much, right? So we're not looking around for obstacles in our environment or changes in our environment. we're not attending to the things around us as much. Instead, we're attending to that conversation because that's an important thing to do. So, you know, if you are someone who is having more trouble
with balance who is maybe ha feeling a little bit more unsteady, trying to maintain focus on that single task of getting from one place to another, versus trying to accomplish all of the same things that you would have done before at this at the same time. is it's an important consideration to have. I think also what I wanna say here because I'm sure there's someone who's listening who's like, well you guys are saying
You're y'all talking about these things, and you're saying that this has nothing to do with you know balance and weakness, which is not what we're saying. balance and weakness are important. We do want to address those things, right? But what we're saying is that it's not the only piece of the puzzle. And when we and when we address these other pieces of the puzzle, we can have
More immediate impact on fall risk, like almost instantaneous sometime to make people safer. And holistically, the overall fall risk is gonna go significantly down if we're considering these things alongside making sure that someone is getting the other intervention that they might need for balance or strength in addition.
Brandy Archie
Exactly. we've got two more really good ones coming up. But we're gonna leave you here and you're gonna have to listen to the next episode, to get that to get that content. So make sure you subscribe so that you can know when the next episode comes out and you can get these other two things that don't have to do particularly with balance or strength that cause falls. All right, we'll see y'all next time.
Emilia Bourland
We sure do. Yeah, we'll see you all next time. All right. Bye.
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