By RICK WEBER
Falls kill.
Those two words aren’t designed for shock value—they’re an increasing reality. Falls among adults 65 and older caused over 38,000 deaths in 2021, making it the leading cause of injury-related death for that group, according to the Centers for Disease Control and Prevention (CDC). In 2021, emergency departments recorded nearly three million visits for older adult falls.
It couldn’t happen to you? If you’re in that age group, there’s a 25% chance you will fall this year.
Elizabeth Templeton’s passion is to do something about it. Templeton, DPT, GCS, WCS, CEEAA, is a physical therapy professor in Florida Gulf Coast University’s Department of Rehabilitation Sciences.
She believes falls in older adults are preventable when risk factors are identified early through proactive screening. Early detection and intervention are critical, not only for traditional physical risks like balance and strength deficits, but also for often-overlooked contributors such as continence issues and pelvic floor function.
“From my clinical experience, I have observed that older adults are unaware of the importance of fall prevention, while others may resist seeking help due to stigma,” she says. “There is strong evidence that demonstrates individuals may resist seeking help due to denial or self-perception, and that sedentary lifestyles are associated with persistent inactivity and increased fall risk.
“By broadening our understanding of fall risk, we can create more comprehensive and effective prevention strategies.”
Fall rates can decrease by approximately 23–24% in high-risk groups when older adults are evaluated for fall-risk factors—such as a history of falls, balance or gait impairments, medication side effects and potential hazards in the home—and receive personalized interventions such as exercise programs, home safety modifications or medication adjustments, according to the Journal of the American Medical Association (JAMA).
The American Geriatrics Society and British Geriatrics Society advise that all adults over 65 should be screened annually for a history of falls or balance impairment. Screening involves asking about previous falls, balance problems and related symptoms. If risk is identified, a multifactorial fall-risk assessment is performed, which evaluates the circumstances and frequency of falls, associated injuries, medications (including over-the-counter), comorbidities, activities of daily living, use of assistive devices and fear of falling.
Screenings can be accomplished through self-reported prescreen questionnaires or through an intake interview. The CDC has identified a group of objective screening tools that can be done quickly and safely by a medical professional such as a physical therapist, including gait speed measurement and the Timed Up and Go (TUG) test.
Templeton says primary care providers can screen for falls during an individual’s Annual Wellness Visit, which is typically reimbursed by Medicare. Community-based programs, senior centers and public health initiatives may also offer fall-risk screening using validated tools such as the STEADI Stay Independent questionnaire, which was part of research Templeton conducted at FGCU.
“Based on the frequency of falls in older adults, they should take the results very seriously—gait speed isn’t just a predictor for falls but also for mortality and frailty,” she says. “Depending on the deficit identified, some recommendations may be to increase lighting their home, such as installing motion lights or nightlights, or removing throw rugs.
“If we identify a patient may be at risk for falls based on polypharmacy (taking five or more medications daily), as a doctor of physical therapy, I will recommend that the individual see their prescribing provider to review their medications and their effect on falls. If we are assessing the individual at a community event, we may recommend they seek out formal physical therapy or occupational services.”
Templeton’s initial clinical passion developed through specialized training in pelvic floor rehabilitation following graduate school. The pelvic floor—a complex group of muscles within the pelvis—plays a vital role in bowel and bladder control, sexual function and overall pelvic stability.
“Because it sits at the body’s center, where the pelvis is connecting the upper and lower extremities, I quickly realized that the pelvic floor cannot be treated in isolation because it influences nearly every aspect of movement and function,” she says.
Several years into her career, while working in Cherry Hill, New Jersey, as a geriatric clinical specialist across multiple assisted living facilities, she began noticing a pattern: Many resident falls occurred when individuals were walking to or from the bathroom. This observation became the bridge between her two areas of focus.
Drawing on her background in pelvic health, she started incorporating pelvic floor muscle training and practical behavioral strategies, such as limiting fluid intake a few hours before bedtime and reducing bladder irritants like caffeine and alcohol, into her fall-prevention programs.
“This integrated approach deepened my commitment to both pelvic health and fall prevention, recognizing how closely these systems are connected in promoting safety, independence and quality of life for older adults,” she says.
Through her work with the Shady Rest Institute for Positive Aging at FGCU, she has been focusing on investigating how older adults perceive their risk of falling compared to what objective screening tools tell us about their actual risk.
“It’s been fascinating to see how confidence, awareness and physical ability all come together in fall prevention,” she says. “I’m fortunate to mentor a wonderful group of student researchers who are continuing this work and taking it a step further, exploring how pelvic floor health may also play a role in fall risk through subjective questionnaires. It’s an area that doesn’t get enough attention, and we’re excited to bring more awareness to it.”
FGCU
Marieb College of Health & Human Services
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Fort Myers, FL 33965
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