As a geriatrician and internist, I see many older patients in my office who have suffered a fall. The most common reasons are simple. Often they fall because they were walking around the house in the dark and tripped or they were lightheaded from getting out of bed too quickly. Others slip in the shower or lose their balance while reaching for something on the top shelf in the closet. Once, I treated a tiny woman who was literally blown over by a strong wind. Some people cannot even explain why they fell; they just tell me they couldn’t catch themselves the way they could before.
Unfortunately, falls lead to injury in about half of people age 65 and over, and 800,000 patients are hospitalized every year due to fall-related injuries, often hip fractures or head injuries, according to the Centers for Disease Control and Prevention.
Many older people who haven’t fallen tell me they are worried they will. They have family members or friends who have fallen, and they know it can have harmful consequences. The statistics back them up. More than 1 in 4 people age 65 and older fall each year, according to the CDC, and people who have been living independently are commonly admitted to long-term care due to recurrent falls. Among those hospitalized for hip fractures, for example, some 40 percent are no longer capable of living independently. Even among those not injured, the fear of falling again can cause them to be less active and more isolated, leading to overall functional decline.
While anyone can trip and fall, there are several factors—in addition to older age and a history of falls—that can increase your risk. These include orthostasis, which is a drop in blood pressure when standing up, as well as cognitive impairment such as dementia. Poor vision is also a risk factor, as are problems with balance, walking or strength, which are often related to arthritis, posture or a neurologic condition. Medications such as antidepressants, antihistamines, diuretics and those used to treat blood pressure and anxiety can also increase your risk of falling. Taking four or more medications at once can also increase risk.
Falls are not usually caused by just one thing but by a combination of those risk factors. That’s why targeting as many risk factors as possible is the best way to prevent falls. Here is some advice I give my older patients, plus steps you can take to decrease your risk:
Move, move, move!
I cannot overstate the importance of exercise and maintaining an active lifestyle. Older people who are more active before falling do better in recovery than those who had functional limitations before falling. Ask around your community about fall prevention classes that offer exercises to strengthen the legs and core. If you have a problem with balance or have fallen before, you might also qualify for physical therapy. Tai chi, a gentle form of martial arts that focuses on balance and core strength, has also been shown to significantly reduce falls.
Identify and fix hazards.
Check your home for loose rugs, cords and slippers before you trip on them in the middle of the night. Get a nightlight for the hallway or leave the bathroom light on after dark. Make sure that your vision exam is recent in case you need a new pair of glasses or have cataracts. Think about getting a shower seat or grab bar in the bathroom for extra support. Home safety checklists are available from the CDC. A home safety evaluation by an occupational therapist can also help evaluate hazards in the home.
Be careful.
As we get older, our strength, balance and reflexes are not what they used to be. While climbing on a chair to change a light bulb might not have been a problem a few years ago, now it might lead to a spill that sends you to the emergency room. Using a cane or walker can also help improve stability while you are walking. If an assistive device has been recommended for you, get one and use it. Improperly using (or not using) walkers and canes can cause falls. While it is good to be active, be mindful of your limitations and ask for help with more challenging tasks.
Review your medications.
As we get older and experience more medical issues, our medication lists also seem to multiply. If you are falling frequently, talk to your doctor to see if there are some medications that might be hurting more than helping. Cutting down the number of medications, especially those that cause sleepiness, impaired cognition or coordination or lower blood pressure, can help reduce your risk of falls.
Minimize injuries from falls.
If you live alone, make sure you have a way to call for help if you fall and can’t get up. An emergency response system or cell phone can get you help quickly. Ask your doctor if you should have your bone density checked to see if you have osteoporosis. People with osteoporosis are more likely to break a bone after a fall and might benefit from medications that improve bone density. Taking at least 800 units of vitamin D a day not only strengthens bones but may also prevent falls.
And remember, although falling is common, it is not an inherent part of aging. Make sure to tell your doctor if you are falling so you can figure out individual strategies that will help you remain healthy and independent.
Angela Hsu, M.D., is an internist and geriatrician with the Mid-Atlantic Permanente Medical Group in Springfield, who has a special interest in frailty and complex disease management.
To find out more about how to reduce the risk of falls in older people, visit the CDC’s STEADI resource page: Stopping Elderly Accidents, Deaths & Injuries.
