Falls, and the Dog Underfoot

Falls Prevention Awareness Week runs September 21 through 25 this year.

The scale, briefly, because it is worse than most people assume. More than one in four adults 65 and older reports falling each year. Falls send about 3 million older adults to the emergency department annually, and in 2021, the most recent year with a published count, they killed more than 38,000. The death rate has kept climbing since: it rose 21% between 2018 and 2024 (CDC).

The number that is actually actionable is a quieter one. Less than half of older adults who fall tell their doctor (Stevens et al., 2012, cited in the CDC Foundation’s fall prevention toolkit). If you know about a fall and the doctor does not, you are holding the piece of information that starts everything else. That is a small, unglamorous thing that caregivers are uniquely positioned to do.

The Dogs

One of us has a dog who is reliably underfoot, which is what sent us looking. The evidence turned out to be better than we expected.

The CDC studied this. An estimated 86,629 fall injuries a year in the United States are associated with cats and dogs. Dogs account for 88% of them (MMWR, 2009). The mechanisms are exactly what you would guess:

• Tripping or falling over the dog: 31%
• Being pushed or pulled by the dog: 21%
• Falling over a pet toy or a bowl: 9%
• Walking the dog accounted for 26% of activities at the time of injury

Cats are rarer but more concentrated. Two thirds of cat-related falls were tripping over the animal.

Two details matter for this group in particular. The injury rate climbs steeply with age, from 47.3 per 100,000 at ages 65 to 74, up to 70.6 at 85 and older. And women were 2.1 times more likely to be injured than men.

The leash piece has gotten worse since that study. Fractures among adults 65 and older from walking a leashed dog rose 163% between 2004 and 2017, from 1,671 a year to 4,396. Seventy-eight percent were women. About half were upper extremity, and 17% were hip fractures (Pirruccio et al., JAMA Surgery, 2019).

What to Do About It

This comes from a state falls-prevention coalition rather than a company selling something (Standing Strong NC). Their suggestions:

• Do not step over a dog on the floor. Make the animal move instead.
• Put a bell on the collar so you can hear where they are.
• Clear the pet’s zones first. No loose rugs where they sleep, play, and eat. Better lighting in those spots. Wipe up around the water bowl right away.
• Discourage sleeping right beside the bed or a chair, which is where the middle-of-the-night trip happens.
• For a dog that pulls, a chest harness rather than a neck lead. Veterinary researchers also suspect retractable leashes raise the risk, though that is a hypothesis and has not been tested (JAVMA, 2024).

Two honest caveats. Nobody has ever run a trial on whether any of this actually prevents falls. The mechanism data is solid and the intervention data does not exist, so the list is sensible rather than proven.

And the answer is not to get rid of the dog. A dog gets someone up and moving on a schedule, and inactivity carries its own risk. Dog walking is not the balance and strength training the trials actually tested, which is covered further down, but it is a long way from nothing. The dog is both a hazard and a reason to keep moving, and the work is managing the risk rather than removing the animal.