Falls in Older Adults: Causes, Prevention, and Occupational Therapy After Fracture, ORIF, and Hip Replacement

Falls are one of the most common events that change an older adult’s life overnight. A simple trip on a rug, folk dancing, stepping on a ladder, or waking up to drink water in the middle of the night can result in a wrist or shoulder fracture, a hip fracture, or a fear of movement that slowly steals independence. As occupational therapists (OTs), we see the full story: the medical side (fractures, surgeries, precautions), the emotional side (loss of confidence, anxiety), and the daily-living side (bathing, dressing, cooking, walking safely at home). The good news is that many falls are preventable, and recovery after a fall can be guided in a way that helps people return to meaningful routines safely.

Important medical note: This article is educational and not a substitute for individualized medical advice. After any fracture, ORIF, or hip surgery, your surgeon’s instructions (including weight-bearing status and specific precautions) override general guidance. Always confirm exercises and movement restrictions with your orthopedic surgeon, OT, and PT, especially if you have osteoporosis, heart conditions, dizziness, or balance issues.

Why Falls Happen: The Main Causes in the Elderly

A fall rarely has only one cause. Most falls are “multifactorial,” meaning a few small risks stack up until one moment triggers the fall. Understanding those risks is the foundation of prevention.

1) Balance and strength changes

As we age, muscle mass and power tend to decrease (especially in the legs and core). Even a slight reduction in ankle strength or hip stability can make recovery from a stumble more challenging. Slower reaction time also matters because when the body doesn’t respond quickly enough, the foot doesn’t “catch” the trip in time.

Common functional signs:

• Difficulty rising from a chair without using hands

• Shuffling gait, reduced step height

• Narrow base of support, unsteadiness when turning

• Hesitation on stairs or curbs

• Fatigue-related instability later in the day

2) Vision changes

Vision is not just “seeing clearly.” Depth perception, contrast sensitivity (the ability to see the edges of steps), and peripheral awareness (the ability to see obstacles to the side) all contribute to fall risk. Older adults may misjudge a curb, miss a step, or not notice a pet or object.

High-risk factors include:

• Cataracts, macular degeneration, and glaucoma

• Multifocal glasses on stairs (depth perception issues)

• Poor lighting in hallways and bathrooms

3) Medications and side effects

Certain medications can cause dizziness, sedation, or drops in blood pressure when standing. The risk rises when multiple medications are used (“polypharmacy”).

Common medication-related risks:

• Drowsiness or slower reaction time

• Orthostatic hypotension (blood pressure drop when standing)

• Confusion, blurred vision

• Balance changes

If falls are happening, it’s worth asking a physician or pharmacist for a medication review.

4) Blood pressure drops, dehydration, and dizziness

Standing up quickly, not drinking enough fluids, or having certain heart conditions can cause lightheadedness. Even mild dizziness can trigger a loss of balance.

Watch for:

• Dizziness getting out of bed or after showering

• “Black spots” or feeling faint when standing

• Frequent bathroom trips at night (rushing increases fall risk)

5) Foot problems and unsafe footwear

Foot pain changes gait. Numbness (often from neuropathy) reduces the sensory feedback needed for balance. Shoes without support or with slippery soles can turn a minor misstep into a fall.

Risk factors:

• Neuropathy, bunions, plantar pain

• Loose slippers, backless shoes

• Worn-down soles, high heels, slick socks on tile

6) Home hazards and environmental obstacles

Many falls occur at home, especially in bathrooms, bedrooms, the kitchen, and on stairs.

Common home hazards:

• Throw rugs, clutter, cords

• Poor lighting, glare

• Slippery tub or shower floor

• No handrail on stairs, uneven steps

• Pets underfoot

• Wet or oily floor.

7) Cognitive changes and dual tasking

Doing two things at once (walking while talking, carrying items while turning) can increase fall risk, especially for those with mild cognitive impairment, dementia, or simply slowed processing speed.

8) Fear of falling and activity restriction

This is a major cycle: a fall happens → fear increases → activity decreases → strength and balance decline → fall risk rises. OTs directly address this cycle using graded exposure, confidence-building routines, and safer ways to stay active.

Medical Conditions That Can Lead to Falls (and Those That Can Result From Falls)

Conditions that can increase fall risk

• Osteoporosis/osteopenia: does not cause falls directly, but increases fracture risk if a fall occurs

• Arthritis: pain and stiffness can limit step height and turning ability

• Stroke, Parkinson’s disease, MS: balance and coordination challenges

• Diabetes with neuropathy: reduced foot sensation and balance feedback

• Vestibular disorders: dizziness, vertigo, unsteadiness

• Cardiac conditions: fainting, irregular heartbeat, orthostatic hypotension

• Urinary urgency/incontinence: rushing to the bathroom

• Depression/anxiety: can reduce activity, worsen attention, and reaction time

Conditions and complications that can emerge after a fall

Falls can cause:

• Fractures: wrist, humerus (upper arm), pelvis, spine compression fractures, femur, hip (femoral neck/intertrochanteric), and ankle

• Head injuries: concussion, subdural hematoma

• Soft tissue injuries: bruises, sprains, tears

• Functional decline: difficulty with bathing, toileting, mobility

• Loss of confidence: fear of falling, isolation

• Deconditioning: muscle weakness and reduced endurance

• Post-operative complications: pain, swelling, risk of blood clots, risk of infection, disorientation in unfamiliar settings

The Most Common Injuries: Fractures, Femur ORIF, and Hip Replacement

Fractures in older adults

In older adults, especially those with low bone density, fractures may occur from a fall that wouldn’t injure a younger person. Wrist fractures often occur when someone tries to break their fall. Hip and femur fractures are especially serious because they can limit walking and lead to prolonged rehab.

Femur ORIF (Open Reduction Internal Fixation)

ORIF means the bone is surgically realigned (“open reduction”) and stabilized with hardware like plates, screws, or rods (“internal fixation”). Femur ORIF often follows:

• Intertrochanteric hip fracture

• Femoral shaft fracture

• Some fractures near the hip or knee

Rehab after ORIF depends heavily on:

• Weight-bearing status (non-weight-bearing, toe-touch, partial, weight-bearing as tolerated)

• Fracture location and stability

• Surgeon’s protocol

• Pain/swelling and overall endurance

Hip replacement (Total Hip Arthroplasty, THA) or hip fracture surgery

A hip replacement may be necessary due to severe arthritis or as a treatment for certain fractures. Hip fracture surgery may also include:

• Partial hip replacement (hemiarthroplasty)

• ORIF for femoral neck/intertrochanteric fractures

• Other fixation methods

Each procedure can come with specific movement precautions to protect healing tissues and prevent dislocation.

Fall Prevention Strategies That Actually Work

Fall prevention is strongest when it is personalized. Here are high-impact, practical strategies OTs use.

1) Strength and balance training (done safely)

Balance isn’t just standing on one leg. It includes stepping strategies, turning, reaching, and recovering from small stumbles.

Examples of functional training goals:

• Sit-to-stand with better control

• Safe turning and pivoting

• Step-up practice for curbs and stairs

• Reaching into cabinets without overbalancing

• Walking while carrying items safely

An OT often coordinates with PT because PT may focus on gait mechanics and exercise progression, while OT integrates these skills into daily tasks (kitchen routines, bathing, laundry, community mobility).

2) Vision and lighting improvements

• Use brighter bulbs (especially in hallways, kitchen, bathroom)

• Add night lights from the bedroom to the bathroom

• Reduce glare (shades/curtains)

• Mark step edges with contrast tape when appropriate

3) Medication review with a clinician

Ask the primary care provider or pharmacist:

• Are any medications increasing dizziness or sleepiness?

• Are there interactions?

• Is the dosing timing contributing to nighttime falls?

4) Footwear and foot care

• Supportive shoes with non-slip soles

• Avoid loose slippers and socks on tile

• Address foot pain and toenail issues (podiatry can help)

5) Bathroom safety upgrades

The bathroom is a high-risk zone due to the presence of water, slick surfaces, and tight turns.

OT-recommended basics:

• Non-slip bath mat or adhesive strips

• Shower chair or tub transfer bench

• Handheld shower head

• Grab bars installed properly (into studs or with secure mounting systems)

• Raised toilet seat or toilet safety frame if needed

6) Safe mobility habits (pace, planning, and positioning)

• Stand up slowly and pause before walking

• Use the walker/cane consistently (not just “when tired”)

• Keep frequently used items between waist and shoulder height

• Avoid carrying too much at once; use a basket or a walker bag

7) Reduce nighttime fall risk

• Clear path from bed to bathroom

• Night lights, bedside lamp within reach

• Consider a bedside commode if urgency is severe

• Keep glasses and phone within reach

• Sit at the edge of the bed for 10–20 seconds before standing

8) Address fear of falling

This is where OT shines. We use:

• Confidence-building routines

• Graded exposure (safe practice in real environments)

• Education on how to move safely

• Breathing strategies for anxiety

• Planning and pacing for fatigue

How Occupational Therapy Helps After a Fall

After a fall, people often think rehab is only about walking again. But independence is made of dozens of daily actions, such as getting dressed, showering, cooking, getting in and out of a car, and navigating a home safely. OTs focus on restoring those activities and making them safer.

OT evaluation after a fall typically includes:

• ADL assessment: bathing, dressing, toileting, grooming

• IADL assessment: cooking, laundry, medication management, shopping

• Mobility and transfer safety: bed, chair, toilet, shower, car

• Home safety assessment: hazards, lighting, layout, step/stair risks

• Cognition and safety awareness: attention, memory, problem-solving

• Upper extremity function: especially after wrist/arm fractures

• Endurance and pacing: fatigue management strategies

• Equipment and training: walker, cane, shower bench, reacher, sock aid

OT interventions after a fall may include:

• Teaching safer ways to move (body mechanics, turning strategies)

• Training with adaptive equipment for dressing/bathing

• Home modifications and environmental changes

• Energy conservation and pacing (especially after surgery)

• Balance and functional strengthening are integrated into real tasks

• Caregiver training to support safety without taking over independence

• Fall recovery training (what to do if you fall, when to call for help)

Occupational Therapy After Femur ORIF and Fracture Rehab

Rehab after femur ORIF can feel overwhelming because walking and transfers may be painful and limited at first. The key is a structured, surgeon-approved progression that rebuilds confidence and function.

The first priorities after ORIF

1. Safe transfers: bed ↔ chair, toilet, shower

2. Pain and swelling management: positioning, pacing, gentle movement

3. Follow weight-bearing precautions: critical for healing

4. Prevent secondary problems: deconditioning, stiffness, skin breakdown

5. Regain self-care independence: dressing, bathing, toileting with adaptations

Common functional challenges after femur ORIF

• Difficulty lifting the leg in/out of bed

• Trouble standing up from low chairs

• Pain with weight shift

• Reduced endurance for basic tasks

• Fear of falling again

OT-friendly rehab exercises often used after femur ORIF (general guidance)

Only do these if your surgeon/PT/OT approves and your weight-bearing status allows. Start small. Quality matters more than intensity.

A) Early-stage exercises (often done in bed or seated)

These help circulation, reduce stiffness, and begin gentle muscle activation.

1. Ankle pumpsPoint toes away, then pull toes up.

2. 10–20 reps, several times per day

3. Helps with circulation and swelling

4. Quad sets (thigh tightening)With the leg straight, tighten the thigh muscle as if pushing the knee downward. Hold 3–5 seconds.

5. 10 reps, 1–3 sets

6. Glute sets (buttock squeezes)Squeeze glutes gently, hold 3–5 seconds.

7. 10 reps, 1–3 sets

8. Heel slides (gentle knee bending)Slide heel toward the buttocks slowly, within comfort and precautions.

9. 5–10 reps

10. Stop if sharp pain, pinching, or surgeon says limit bending

11. Seated knee extension (if allowed)From a seated position, slowly straighten the knee, then lower.

12. 8–12 reps, 1–2 sets

13. Helps rebuild quadriceps control for standing

B) Transfer and sit-to-stand strengthening (high functional value)

1. Sit-to-stand practice (with proper support)From a firm chair with armrests, push up using arms as needed, stand tall, then sit slowly.

2. 5–10 reps, based on fatigue

3. Focus on slow control, not speed

4. Confirm safe technique with your OT/PT

5. Weight shift practice (standing with walker, if allowed)Shift weight gently side-to-side and forward-back, staying within weight-bearing restrictions.

6. 30–60 seconds, 2–3 rounds

7. Builds balance and confidence

C) Standing exercises (only if cleared)

1. Mini-marches (holding walker or counter)Lift one knee slightly (not high), alternate.

2. 10–20 total

3. Stop if pain increases or balance feels unsafe

4. Side steps along a counterSmall steps sideways, staying upright.

5. 5–10 steps each direction

6. Heel raises (with support)Rise onto toes slowly, then lower.

7. 8–12 reps

8. Builds calf strength for gait stability

What OTs add that makes these exercises “stick”

OTs embed movement into daily routines:

• Standing for grooming at the sink becomes endurance training

• Safe reaching in the kitchen becomes balance training

• Dressing becomes a structured practice of weight shift, hip control, and problem-solving with tools (Reacher, sock aid)

This is how rehab turns into real-world independence.

Hip Replacement and Femoral Neck Fracture Surgery: Contraindications and Movements to Avoid

Movement precautions depend on the type of surgery and surgical approach. Always follow your surgeon’s protocol first. Below are the most common precaution categories OTs teach.

Posterior hip precautions (common in posterior approach THA)

Often recommended for about 6 weeks (varies by surgeon). Typical precautions include avoiding:

• Hip flexion past 90 degrees (no deep bending at the hip)

• Hip adduction past midline (don’t cross legs)

• Hip internal rotation (don’t twist the operated leg inward)

Practical examples:

• Avoid low chairs and deep sofas

• Don’t bend forward to put on socks/shoes without adaptive tools

• Don’t twist your trunk over the operated leg when seated

• Sleep with a pillow between knees if instructed

Anterior hip precautions (common in anterior approach THA)

Some surgeons give fewer restrictions; others recommend avoiding:

• Excessive hip extension (leg far behind you)

• Excessive external rotation (turning the leg outward too far)

• Combined extension + external rotation

Practical examples:

• Avoid stepping way back into a lunge

• Be careful with backward walking or pivoting fast

• Follow guidance on sleeping positions and leg positioning

After surgery for femoral neck fracture (ORIF or hemiarthroplasty)

Precautions may mirror those for hip replacement, but they can vary. Additionally:

• Follow the weight-bearing status strictly

• Avoid sudden twisting/pivoting on the surgical leg

• Avoid low, soft seating that forces deep hip flexion

General “don’ts” after hip surgery (unless cleared)

• No bending to pick up items from the floor without a reacher

• No crossing legs or ankles (if posterior precautions apply)

• No pivot turns on the operated leg; take small steps to turn

• No low toilets or low chairs without raised seating support

• No forcing range of motion into pain

OT tools that protect precautions while maintaining independence

• Reacher/grabber

• Sock aid and long-handled shoehorn

• Dressing stick

• Raised toilet seat or toilet safety frame

• Shower chair or tub transfer bench

• Walker bag/basket to carry items hands-free

Home Modifications and Assistive Equipment: Building a Safer Environment

Home modification is not about making a home feel like a hospital. It’s about reducing hazards and making movement easier while healing.

Bathroom essentials

• Shower chair (for walk-in showers) or tub transfer bench (for tub/shower combos)

• Grab bars (professionally installed when possible; suction bars are not always reliable for full body weight)

• Handheld shower head

• Non-slip bath mat / anti-slip strips

• Raised toilet seat or toilet safety frame

• Long-handled sponge to avoid bending

Bedroom setup

• Clear walkway from bed to bathroom

• Night lights or motion-sensor lights

• Bed at safe height (not too low)

• Stable bedside table for support (not a rolling cart)

• Phone within reach; consider a medical alert system if appropriate

Living room and hallways

• Remove throw rugs or secure them with non-slip backing

• Tidy cords and clutter

• Add stable seating with armrests

• Ensure pathways are wide enough for a walker

• Improve lighting in transitions (hall to bathroom, living room to kitchen)

Stairs and entryways

• Secure handrails on both sides when possible

• Add contrast tape on step edges if visual processing is an issue

• Keep the entryway dry and clutter-free

• Consider a ramp or threshold ramp if walker access is difficult

Walker, cane, and mobility aids

OTs teach:

• How to size equipment correctly

• Safe gait patterns (especially with weight-bearing restrictions)

• How to carry items safely (walker bag)

• How to navigate tight spaces and turns at home

• When a cane is appropriate vs. when a walker is safer

Using a device is not “giving up.” It’s a tool that protects healing and prevents a second fall, which is often the fall that causes the biggest setback.

OT After a Fall: A Step-by-Step Recovery Roadmap

Phase 1: Safety and stabilization (early days to 2–3 weeks)

• Pain management and positioning strategies

• Transfer training: bed mobility, toilet transfers, shower transfers

• Education on precautions and weight-bearing

• Adaptive equipment to reduce bending and strain

• Simple endurance-building routines for self-care tasks

• Home safety changes to reduce immediate fall hazards

Phase 2: Rebuilding independence (weeks 3–8, varies)

• Progressing bathing and dressing toward independence

• Kitchen safety and meal preparation modifications

• Balance training integrated into real tasks

• Gait and turning strategies for home/community mobility

• Confidence-building and fear-of-falling interventions

• Caregiver training: how to cue safely without over-assisting

Phase 3: Return to meaningful life roles (later recovery)

• Community mobility: car transfers, errands, social outings

• Higher-level balance tasks: carrying items, reaching, navigating crowds

• Fall prevention plan to reduce future risk

• Home program that fits routines long-term

Sample Patient and Caregiver Testimonials

The following examples are representative stories based on common OT experiences. Names and details are changed for privacy.

Testimonial 1: “I felt trapped in my own bathroom.”

Patient, 77, post-fall with hip fracture repair“After my fall, the bathroom became scary. I didn’t want to shower because I couldn’t picture how to get in and out safely. My OT brought a tub transfer bench and taught me step-by-step, with the hip precautions explained in a way I could actually remember. We practiced until I could do it calmly. I got my dignity back.”

Testimonial 2: “We didn’t realize the house itself was part of the problem.”

Caregiver, daughter of 86-year-old after femur ORIF“My mom fell twice in six months. We thought it was just her balance, but the OT pointed out the lighting, the rugs, the low couch, and how she rushed to the bathroom at night. We changed small things, and suddenly the whole house felt safer. The plan was realistic, not overwhelming.”

Testimonial 3: “I stopped moving because I was afraid.”

Patient, 71, wrist fracture from a fall“I was embarrassed and scared. I stopped going out. My OT helped me practice safe ways to carry items, step off curbs, and turn without losing balance. We focused on building strength in a way that aligned with my daily life, rather than random exercises. I’m back to my routine, and I’m not panicking every time I walk.”

Testimonial 4: “The OT taught me how to help without doing everything.”

Spouse caregiver, 74-year-old, after hip replacement“I thought helping meant lifting and hovering. The OT showed me how to set up the environment, how to cue my husband, and how to use the equipment correctly. That reduced both of our stress. It became teamwork, not fear.”

Testimonial 5: “I thought a walker meant I was done.”

Patient, 84, post-fall with femoral neck fracture surgery“I refused the walker at first. The OT didn’t pressure me. She explained how it protects healing and prevents another fall. She showed me how to move through the kitchen with it, how to carry a cup safely, and how to turn without twisting. It gave me freedom, not limitation.”

A Practical Fall-Prevention Checklist for Older Adults

Daily habits

• Stand up slowly; pause before walking

• Hydrate throughout the day

• Wear supportive, non-slip shoes

• Keep pathways clear

• Use the walker/cane consistently if prescribed

Home safety

• Add night lights

• Remove or secure rugs

• Install grab bars and use a shower chair/bench

• Keep frequently used items within easy reach

• Ensure stairs have sturdy handrails

Health management

• Review medications regularly

• Get vision and hearing checked

• Address dizziness promptly

• Discuss bone health (vitamin D, calcium, osteoporosis management) with a provider

Confidence

• Stay active within safe limits

• Practice balance and strength as guided

• Don’t let fear shrink your world. Ask for OT support early

When to Seek Occupational Therapy After a Fall

Consider an OT evaluation if you or a loved one:

• Has fallen once and feels less confident walking

• Has had multiple near-falls (stumbles, catches self on furniture)

• Struggles with bathing, dressing, toileting, or kitchen tasks after injury

• Has new equipment but doesn’t feel safe using it

• Is recovering from fracture, ORIF, hip fracture surgery, or hip replacement

• Needs home safety recommendations that are specific and realistic

Final Thoughts: Prevention and Recovery Are Both Possible

A fall can feel like a turning point, but it does not have to be the end of independence. Prevention is about reducing stacked risks. Recovery is about rebuilding daily life safely, step by step, with the right support and a well-planned approach.

At A Touch of Hope OT, our approach is professional, caring, and deeply practical. We focus on what matters most: helping older adults live safely at home, regain confidence after injury or surgery, and return to the routines that give life meaning.

To schedule a comprehensive evaluation, call 786-277-9497 or fill out the contact form to schedule a meeting.