Beyond Balance: 5 Hidden Reasons Older Adults Fall Part 2

Summary

In Part 2 of this CareLab series, occupational therapists Emilia Bourland and Brandy Archie wrap up their discussion on hidden causes of falls by exploring two often-overlooked risk factors: medications and footwear. They explain how polypharmacy—taking five or more medications, including over-the-counter medications and supplements—can increase fall risk through side effects and drug interactions. Rather than stopping medications on your own, they encourage regular conversations with your healthcare provider and pharmacist to ensure every medication is necessary and working safely together.

The episode also highlights how the shoes we wear can either support or sabotage our mobility. The right footwear should provide stability, proper fit, secure fastening, and enough ground feedback to help maintain balance. Throughout the conversation, Emilia and Brandy emphasize that preventing falls often comes down to making small, proactive changes before an injury occurs. They remind listeners that our bodies naturally change over time, and adapting our habits, homes, medications, and footwear is one of the best ways to stay independent and safe.

Key Questions Answered

Transcript

Emilia Bourland
Hey, welcome back to this part two of our CareLab series on five things that are highly impacting your fall risk that are not balance or muscle weakness. Brandy, are you ready to jump right in here?

Brandy Archie
So like

Let's jump in. And if you didn't hear part one, that's okay. Listen to this whole one, but then go back and listen to part one so you get the other three.

Emilia Bourland
Yes, because I promise you there are at least a couple things in there that are going to surprise you that you have that you didn't know about before and that you had not thought about it. So it's definitely worth going back to listen to. Okay, so today we're gonna start off with talking about medications. Now, y'all know Brandy and I are occupational therapists. we're not medication experts, we don't prescribe. However, it is absolutely

Brandy Archie
Yeah.

Emilia Bourland
True that medications impact people's fall risk. and they can do that in a couple ways. One of the ways, first way I want to talk about here is something called polypharmacy. So polypharmacy used to be defined as like someone being on 10 or more medications. Now I believe polypharmacy is actually defined as five or more medications. So if you think about it, that's a lot of folks, right? I mean, a lot of

Brandy Archie
Yeah, it impacts a lot of people. If you especially if you include like

vitamins and other things.

Emilia Bourland
And technically, polypharmacy does include over-the-counter supplements, non-prescription drugs that you might be taking, things like Tylenol, ibuprofen, that kind of stuff. So if you're taking five or more medications a day, technically that's polypharmacy. And so, why does this increase fall risk? Well, essentially, the more medications that we have on board, the higher risk there is for either interaction or duplicate effects of these medications. and so

medications that when they work together can make you dizzy, can affect your blood pressure, things like that. When they're working together, those effects are amplified. And the more medications that we throw into the mix, the more complicated it all becomes. And so the higher that risk becomes. Of course, individual medications can also impact fall risk on their own, things that affect your level of alertness, things that affect blood pressure.

you know, those kinds of issues as well. So here, here's the real deal here. What does this mean? This does not mean that you should go stop taking all your meds. That is not at all. Please don't do that. That is not what Brandy and I are saying. you're you're probably on

Brandy Archie
Please don't do that.

Cause even that could cause

fall risk and among other things, right? Like stopping medications without titrating down, like that's all risky.

Emilia Bourland
I absolutely, absolutely. Medications are complicated, y'all. So the here's the thing to do. You want to have regular conversations with your doctor, with your doctor's nurse, if that's someone who's more easily available to access, and with your pharmacist. never forget about your pharmacist as being a great resource. Talking to them about the medications that you're on.

Brandy Archie
Yeah.

Emilia Bourland
being aware of of saying like, hey, are there po any possible interactions between any of these? Are any of these doing the same things? so making sure that all the meds that you're on are things that you actually need to be on, having regular conversations about that, and utilizing the people who are experts on medication in your healthcare team, your pharmacist, your doctor, your nurse.

To talk about these things to make sure that everything that you're on is appropriate and that there's not an unnecessary risk that's being involved there. And doing that on a regular basis, right? Because people's meds can change all the time. Maybe you have a primary care doctor, and then you also have a specialist. Your specialist adds some meds on, but they didn't know about all the other things. But your primary care doctor does. You can see how this can get out of control really fast. So

having that conversation regularly to make sure all of your meds are appropriate, or if you do need to stop something that it's being stopped appropriately, I cannot overstate the importance of that.

Brandy Archie
And I that's like so it's so important. But I also feel like that's like a big higher level thing that you're like, I gotta have an appointment, I gotta go talk to them about it, and you should on a regular basis. Maybe you even trigger yourself to do that every year or every six months. But one micro thing that you can do is I think almost every time you pick up a prescription from the pharmacy, they ask, Do you have any questions? And I almost always say, No, I don't have any questions. But one thing you could do at that moment is say,

Emilia Bourland
Mm-hmm.

Brandy Archie
Does this medication have any side effects that affect like my risk for falls? Because you know, like you see the medication commercial and then they run off this whole long list of side effects. And that's important because you need to know all of them, but also it's like kind of going over your head because it's such a long list. And if you are have had a fall, are worried about falls, have noticed changes in your ability to move, then just asking that simple question can help them

Bring that one side effect up to you because some of the other side effects might not impact you at all. Like if it's about pregnancy or about breastfeeding or s other stuff that's not going on in your life at this moment, and let's weed out the noise and just say, like, are there any is there any risk for me having a fall because I'm taking this medication? Just so you can be aware. It's not saying that you are doing it, that it will happen to you. But if one day you wake up feeling a little lightheaded and dizzy, you might originally think,

Emilia Bourland
Mm-hmm.

Brandy Archie
Go back to bed or whatever. Or if you've actually asked this question and they said, you know, sometimes it could affect your blood pressure and you might feel lightheaded and dizzy, you'll be like, yeah, maybe it's this medication. I'm gonna keep an eye on that. If it happens multiple times, I might go back and talk to my doctor and say, You know, that medication you put me on, I spent five out of the last seven days I felt lightheaded and dizzy for a while in the morning time. Can we talk about that? 'Cause they don't know what to change for you if you don't give them any feedback, right? 'Cause there is a long list of side effects.

Emilia Bourland
Mm-hmm. That's right.

Brandy Archie
They don't know if it's impacting you or not. And you kinda don't know either because lightheadedness can be dehydration or any number of things, right? But if you're tuned in, it can really help.

Emilia Bourland
Yeah, absolutely. I think that the the like best point there of many amazing points is that your providers need your feedback really truly, like for healthcare to work, there has to be a partnership there because they're the expert maybe on that medication, but you are the expert on you and your daily experience with it. And it is impossible for your provider to adjust things for you as an individual.

Brandy Archie
Exactly.

Emilia Bourland
without knowing what you as an individual are experiencing on a day-to-day basis. So don't be, don't be shy about talking to that person with a white coat and really telling them, you know, what's up. I promise you, the vast majority of providers are not only going to be open to hearing it, they're gonna be happy to hear it because it makes it so that they can care for you more effectively. last thing before we move on to the to the second

item for fall risk that we're going to address today. we have some great episodes with a pharmacist that are really worth going back and listening to. so we will link those in the show notes so you can go check them out once you are finished with this series of part one and part two on on fall risk factors that have nothing to do with balance or muscle weakness. So make sure that you're checking those out.

Brandy Archie
Yes, yes.

That is right. And I just want to add one more thing about medications. One I know you tried to wrap it up. I know you tried too. But this thing came to my mind because I have heard it so many times, is that when I push maybe people to go have that conversation with their physician, they say, you know, I I just thought that they prescribed the right thing for me. And I'm like, it was the right thing to their knowledge, but if they don't have any feedback

Emilia Bourland
Mm.

Brandy Archie
Then they don't know that that's that's just the one they do the most often. And it seems like it should work with what you're doing. You know, so it's not like they're doing a bad job. This is not about them not choosing the right thing. It's that it's complicated and they need your input. So feel like confident in doing so. So just want to throw that in there before we switch over to our last one for today, which is

Emilia Bourland
Yeah.

Footwear.

Brandy Archie
That's right, footwear. I think this goes a lot, it ties a lot into environment, mostly because of the same thing we brought up in the previous episode, which is I've had these shoes for 10 years and it wasn't a problem. Just like my house, I've lived in it for the last 30 years and it hasn't been a problem. Footwear choices have a lot to do with the changes that your body has encountered, right? I was working with a lady who had she was noticing the size of my feet.

Let's start there. Because I have I wear big shoes and have big feet. And she noticed because I know I wear size eleven in women's. and she noticed because she also wears a size eleven in women's. And so so, you know, no shade there. She just really was noticing and she was like, I have all these shoes that I don't wear anymore because they it's harder to walk in them than it used to be.

Emilia Bourland
Ha ha

Yo, Brandy's tall. Brandy's tall.

Okay.

Brandy Archie
And so we were talking about that. And I was like congratulating her essentially that she paid attention to that and that she was okay with changing that, right? And like not wearing those shoes anymore. They were like heels or wedges. Some of them were flip-flops that just didn't have like backs to them. And that extra effort of like flipping the shoe up is another thing that your brain is doing. Used to be automatic and you didn't think about it at all. And now maybe not so automatic. and she was just like, you know what? This is not worth the effort. I'm not wearing none of these shoes no

Emilia Bourland
Mm.

Brandy Archie
And I think while that might feel strong, it's also keeping you from having a fall. And like what's tell me tell me the balance between a hip fracture and being in the hospital and like switching from a pair of shoes that you've already had for 10 years to a pair that is you just got. Like buy yourself some new shoes, people. It's okay. And make sure that your footwear is supporting you and not causing you more work than it is worth.

Emilia Bourland
Yeah. I I wanna highlight what is sort of the question that you asked there because we can apply that this across so many fall risk factors that are things that require us to make some kind of change in our lives that often people do not want to make those changes. And it is so important to ask yourself if this thing that

that you want to do this certain way or you like to have it look this certain way, is that thing worth the risk of potentially having a fall where you end up with a life-changing injury? Because that is what it is, right? and and the more of these things we combine, the higher the risk of having that life-changing injury injury goes up. And the other thing that I'll say is

Brandy Archie
Mm-hmm. Mm-hmm.

Emilia Bourland
Once someone begins to fall, unless some intervention is made, unless some changes, like whatever it is, unless we do something about it, that person is unlikely to just magically on their own stop falling. That's not the way it works. What is going to happen is that person is going to fall until they are injured. Maybe someone has fallen 10 times in the last year, but they didn't get hurt. And and I can Brandy, you've probably heard this.

Brandy Archie
Yeah.

Emilia Bourland
a a bunch of times too. Yeah, I fall all the time, but I but I haven't gotten hurt. It is a zero-sum game, folks. Yes, yeah. Well I I haven't gotten hurt yet. Exactly. But the fact is if you are falling, it's a zero sum game. Eventually one of these times when you fall, you are going to get hurt. It's it's like getting in a car accident, you know, over and over again. Let's say you get in half a dozen fender benders and you're, you know,

Brandy Archie
Yes.

So it becomes less important almost in their mind.

Emilia Bourland
The car's not badly damaged, you haven't gotten whiplash, anything like that. Well, eventually, if you keep getting car wrecks, you are going to get hurt. It is not different for a fall. So it is so important to ask yourself that question. Is it is it worth the risk for me to not make this change? Am I willing to accept the consequences of not making a change that I know I can and maybe?

probably ought to make versus I'm willing to accept the possible consequences so that I do not have to have a change. You have to weigh that question for yourself, but you do have to ask it and answer it honestly to you. And I when when posed in that way, I have very, very rarely had someone say to me, well, yeah, I would rather be in the hospital with a head injury or broken hip rather than change out my shoes.

Brandy Archie
Yes. It's change is hard for everybody. Nobody likes to do it. But you know what you know what's changing all the time? You. Your body is changing all the time without your permission, right? And then we get rigid about changing everything else around us. but if your body's changing, you gotta change too in order to make sure you're well supported with the current function. We do this for kids all the time. Like all the time. 'Cause we know that they're like first they're babies, they can't do anything, then they're toddlers, they need a little bit of freedom.

Emilia Bourland
Change is hard. Mm-hmm. No one likes to do it.

We think of them as changing. Mm-hmm.

Brandy Archie
You think of

them as changing and so you support them appropriately as they change. And I think we kind of forget that when we get to be adults because we don't see the change as rapidly as we do when we're children. But stuff is changing literally all the time with you. And so and not just after sixty five, like throughout your whole life. And sometimes you change things intuitively because your lifestyle has changed. You work instead of going to school and you need to sleep differently and you know, like you do this to be more functional, but

I think we drop off at when we get to like retirement age because like, you know, I'm chilling. I'm retired. I I can move at my own pace. I don't have to think about these things. But actually it's a lot of stuff still changing at that time frame too. And it's okay. It's okay to t to change a few things. And you know, the other thing that's really important. The more willing you are to change a few small things earlier on, the less change you will have to have in the future.

Emilia Bourland
Bingo. There you go. That's it. That's that's the sound bite from today. If you take away nothing else. That said, we should actually talk about what good footwear looks like since we're giving this. Let's talk about that a little bit.

Brandy Archie
we left that part out. I just assumed

in. Okay, so good footwear supports your feet and makes you feel comfortable. Okay. so that could mean you need support for your arch. it could mean that they're on securely. So that's with laces or with velcro if we can't manage the laces very well, or plenty of shoes that look really great and are not velcro but don't require tying. it needs to have a back to it.

Emilia Bourland
Mm-hmm.

Brandy Archie
So that you're not flipping up a sandal. and if you need it, it needs to support your ankles too, like to give you the level of support you need. And then heels are essentially walking on a toothpick, and they've never been easy to do. And so if your balance is challenged, the higher the heel, the more challenging. So I'm not saying you can't wear any heels ever. You gotta judge this for yourself. But the flatter shoe,

Or at least the flatter to the ground and the more, you know, solid the base of your shoe is, the better you're gonna be supported.

Emilia Bourland
I want to add to that like the the type of sole that is on the shoe can be really important. So having a non a non-slide sole, that's something that's not going to be slick on a surface and cause you to slip or slide is really important. Making sure that the shoes fit you properly, the size shoe that you wore 10 years ago may not be the same size shoe that you need right now.

Brandy Archie
Hm.

Emilia Bourland
And particularly if if you're diabetic, then making sure that you have shoes that fit you properly are really, really important, not just for fall risk, but also for the health of the skin on your feet, which of course, you know, if someone does have diabetes, if you get a wound on your foot, that can lead to all kinds of negative consequences that you that you don't that you don't want. No one wants that. No one needs that. so making sure that your shoes have a non slip slip.

Brandy Archie
You don't want you don't want it. Mm-hmm.

Emilia Bourland
sole and that they fit properly are really really important. And then the last thing that I'm gonna add to that is a lot of times people think that getting like really thick, cushy soles on like their athletic shoe or whatever it is is the thing to do for fall risk because they're like, well this is more supportive. Here's the deal though, y'all. And your the sole of your your shoe does need to be supportive. You want to have good arch support.

But when your the sole of your shoe is so thick that you cannot feel the ground beneath you, that actually increases your fall risk. So going with a thinner soled shoes that allows you to kind of be more in touch with the floor beneath you so that you can feel that ultimately, and you can get that that feedback from from your foot helps to improve.

Your balance and reduces and reduces your fall risk. Your balance is not just made up of your muscular strength. It's also made up of your vision, combined with your inner ear, combined with this thing that we call proprioception, which is knowing where your body is in space, combined with your sensation, literally the feedback that you're getting through your feet. And so if we cut off the feedback that you're getting through your feet,

we've eliminated a really important part of balance. So thinking about the thickness of your soles, making sure that they're supportive and that they're protective, but also maybe that they're not so thick that that it's like you're walking on a boat and you have, you know, no real connection to the ground beneath you. That can be another important consideration.

Brandy Archie
And if that feels too nebulous to be like, what is feeling the ground? The ground is the ground. I it's the difference between I leave from the tiled kitchen floor into the carpeted bedroom in which I need to pick up my feet a little more 'cause it got thick, shaggy rug, right? or the difference between I'm at the edge of the s of the last step, so half of my foot is on and half of it's not, and I'm on a full step. or I'm on the ground. Those are things that often happen.

Emilia Bourland
Mm.

Brandy Archie
very automatically and your body adjusts to that new surface because it got that feedback from your feet. And if you don't feel that and you're not looking because you're carrying a basket of laundry, you could totally miss some of that. So that's what she's meaning by like having a soul that allows you to have those sensations is really important because if some of your other senses have changed and are not as sensitive, you might really need that feedback in order to have your body make those decisions automatically for you.

Emilia Bourland
Yep, those are great actual functional examples of that. anything else that you want to add before we wrap this this part of the episode up?

Brandy Archie
I don't think so. This is like really important stuff to be thinking about. If it feels overwhelming, this is a great reason to see an occupational therapist to actually talk through your situations and do some testing so you can understand that maybe one thing is a little worse than other things and that we should accommodate by having thinner soled shoes or whatever it is. There's lots of factors here. We gave you two whole episodes of five different

Emilia Bourland
Mm-hmm.

Brandy Archie
large things that all have individual factors. So if that feels like a lot, an occupational therapist is a great person to come talk to to help figure that out.

Emilia Bourland
Yeah, and we have lots of content on falls, on environmental modifications. So if you have not, please make sure that you like and subscribe. Go check out some of those earlier episodes where we really dig down into these topics as well. if you have a question, please leave it in the comments. We would be happy to address questions that the audience might have or that you might have. and please, if you found this episode to be helpful, take some time to to give it a rating or review. That is the best way for us to help other people find this content and ultimately help people live the lives they that they want to live. All right, y'all, thanks you so much for listening. We will see you right back here next time on CareLab. Bye.

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