2022 HME Business Handbook: Patient Safety

Keeping Patients Safe And Ensuring They Don't Take A Tumble

Patient SafetyTwo separate parties walk into an older movie theater; a 25-year-old with friends, and a 68-year-old on her own. Both trip and fall due to torn spots in the carpet while getting to their seats. Neither are injured. Both enjoy their movie, returning home after the show.

That evening, each of them reports their fall to their family. The 25-year-old states, “I was a total klutz today at the movie and tripped over the carpet and dropped my popcorn.” The 68-year-old tells family, “First off, I’m okay. I had a fall today when I was at the movies.” The younger person’s family has a good laugh, while the older individual’s family immediately starts to discuss their loved one’s future: “You can’t go places alone anymore. Maybe you need a cane or a rollator?”

Why the difference? The World Health Organization reported in 2021, “Older people have the highest risk of death or serious injury arising from a fall and the risk increases with age. For example, in the United States of America, 20-30 percent of older people who fall suffer moderate to severe injuries such as bruises, hip fractures, or head trauma.” To a younger person, a fall is usually just an embarrassing moment with maybe a couple of bruises. To an older individual, it may be a lifealtering event.


Falls can be classified into two different categories: Mechanical and Organic. Mechanical Falls are falls caused by an interaction between an individual and their environment. Examples: Tripping over a throw rug, leaning against a non-stable item, slipping on a wet or cluttered surface. While these types of falls can be experienced by all ages, the higher injury rate of older individuals makes their risk much more concerning.

However, these types of falls can be decreased substantially by a speedy change in, or interaction with, the offending environment. 1) Tacking down or getting rid of throw rugs. 2) Assuring the stability of items such as tables, chairs, sofas, etc. 3) Immediate clean-up of any item on the floor such as liquids or food spills that can cause a fall. Identify the problem and solve.

The second type is Organic Falls. These are caused by a person having a body system failure that precipitates a fall, such as standing up too quickly and becoming lightheaded or losing balance due to loss of sensation in a limb.


While it is quite simple to remove a trip hazard, affecting causal factors in Organic Falls is somewhat more complicated. Light-headedness upon rising, known clinically as Orthostatic Hypotension, can be experienced by those who have been seated/standing for an extended period, or can be due to vascular damage; both might result in a fall. When gravity leads to blood pooling in the lower extremities, our bodies utilize the “Calf Muscle Pump” to move the blood up the body. Each time the calf muscle (gastrocnemius) is actuated, it contracts against veins in the area and blood is moved up the body via the opening/closing of valves in the veins.

Conversely, any activity that limits that calf movement causes blood to remain in the lower legs. The result of arising too quickly can result in a fall due decrease in blood availability to the brain. For those individuals without vein disease, simply moving their feet in a foot pump action before arising can limit the number of episodes of orthostatic hypotension.

But what about individuals with chronic venous insufficiency (CVI) and incompetent valves? Is there anything that can be done to lower the risk of an Organic Fall for these individuals?


A 2018 study has shown compression can help. This study examined individuals wearing medical compression stockings (MCS) and the effects on somatosensory function (ability to interpret bodily sensation). A decrease of this function has been associated with an increased risk in Organic Falls. (We have all experienced a decrease in somatosensory messages with having our foot “fall asleep.”) Wearing of MCS has previously been shown to assist the veins in moving the blood up the leg, decreasing orthostatic hypotension falls; this study shows that an additional value is gained from MCS wear by increasing of proper interpretation of the necessary motion needed to retain one’s balance. (Woo, Davids, Liukkoen, Chow, & Jaakaola, 2018) Not as simple as wiping up a spill to stop a fall but this medical compression stockings are readily available from your trusted medical device provider.


To reduce Mechanical Falls:

  1. Remove trip hazards in the home and be extra aware of hazards when out. Always use handrails.
  2. Avoid shiny floors, which are often slippery with even a bit of moisture.
  3. Wear well-fitting shoes or slippers
  4. Put nightlights in rooms and halls.

To reduce Organic Falls:

  1. Move feet up and down three or four times and slowly rise from a seat nose-over-toes.
  2. Wear medical-grade compression stockings as prescribed.
  3. Different environments can lead to different injury outcomes from an organic fall. Choose safe environments.

This article originally appeared in the May/Jun 2022 issue of HME Business.

About the Author

Robyn "Redd" Smith is an Occupational Therapy practitioner, Lymphedema & Wound Therapist and owner of Allez Group, a medical education company. You can read more from her at fromtheclinic.com.

HME Business Podcast