About 1-in-4 Americans age 65 and older reports falling every year, according to the Centers for Disease Control and Prevention, And the fall death rate is increasing, the CDC says. Photo by Greta Hoffman/Pexels
For seniors, life can change in the blink of an eye if they trip on a rug or slip on a wet floor.
Injuries from falls represent a significant source of pain, disability, loss of independence and early death in order adults, according to the World Health Organization. Advertisement
About 1 in 4 Americans age 65 and older — more than 14 million — reports falling every year, according to the Centers for Disease Control and Prevention. And the rate is increasing, the CDC says.
“Every second of every day, an older adult (age 65+) suffers a fall in the U.S –making falls the leading cause of injury and injury death in this age group,” the agency says.
And the National Institute on Aging reports that “the risk of falling — and fall-related problems — rises with age.” Advertisement
In late March, former U.S. Sen. Joe Lieberman’s death at age 82 due to complications from a fall at his home cast the spotlight on serious injuries that can affect seniors.
Another celebrity who endured falls was the late Nancy Reagan. The former first lady stumbled multiple times in her senior years, fracturing her pelvis, tailbone and ribs.
The reasons people are more likely to fall as they age stem in part from age-related changes in gait, strength and balance, said Dr. Elizabeth Phelan, a falls expert and founding director of the Fall Prevention Clinic at UW Medicine in Seattle.
“However, falls are not inevitable,” said Phelan, who also is a professor of geriatrics. “They are largely preventable. Awareness of what contributes to falls is critical to preventing them.”
Vision and hearing impairments contribute to falls. So does the accumulation of chronic conditions that affect cardiovascular, musculoskeletal and neurological systems. And a drop in blood pressure — which may happen when someone stands up after lying down or sitting — also raises fall risk, Phelan said.
Medications that cloud people’s thinking or make them feel sleepy or off-balance are another major risk factor for falls. People who die from a fall tend to take multiple medications — six on average, she said. Advertisement
“It’s important for people to understand the link between medications and falls, and to initiate conversations with their doctors about whether there is an ongoing need for each of their medications,” Phelan said. “There are safer alternatives to medications for many symptoms.”
Alcohol use also is a risk factor that can be controlled. Recent research has found an increase in alcohol consumption among older adults and a rise in emergency department visits for alcohol-related fall injuries, she said.
Identifying and addressing modifiable risk factors reduces the chances of falling. Among people who fall repeatedly, falls “are not purely accidental,” Phelan said. “This is a commonly held, but false belief. In fact, falls result from the interaction of a person with their environment.”
People who experience fatal falls may have had preceding decline in their functional ability — physical, cognitive or both — that led them to limit their outdoor mobility, so their falls occur indoors, Phelan said.
While hip fractures are associated with more advanced age and an underlying neurological condition, she noted that head injuries are more common among men, people who take blood thinners and those without a musculoskeletal diagnosis.
Even improper footwear can play a role in falls, said Dr. Amanda Lathia, a geriatrician who helps manage the interdisciplinary falls clinic at University Hospitals in Cleveland. Advertisement
“Wearing slippers or socks in the home increases the risk for falling,” Lathia said. “It is best to wear shoes with good support in the home and outside the home.”
Other hazards include a lack of handrails, clutter, stairs, poor lighting, ice, snow and pets, Lathia said, noting that “the bathroom is the location of most falls as we get older.”
She suggested installing handrails in the bathroom and along all stairwells, using a raised toilet seat, and avoiding going outside in bad weather.
Although most falls don’t cause injury, potentially serious ones can occur. Fractures are the most common. Having a hip fracture increases the risk of dying, particularly within the first year afterward, Lathia said.
Fall-induced head trauma, such as a brain bleed, can lead to death if left treated. And if older adults fall and remain stuck on the ground for a long time, they can suffer a traumatic breakdown of muscle, which can lead to serious kidney failure and even death, she said.
Once an older adult falls, the risk for future falls rises. This “unfortunately leads to the double-edged sword of people starting to restrict their activities because they’re afraid to fall,” said Dr. Laurie Theriot, chief of geriatric medicine at Prisma Health’s upstate region in Greenville, S.C. Advertisement
“It’s counterintuitive, but we actually want to see that patient walk more, create a support system and get more active to improve balance and mobility,” Theriot said.
“In the hospital, we consult on so many falls that involve broken hips,” she said, cautioning that health professionals need “to be really careful how we obtain [a patient’s] history because, especially with osteoporosis, we may find that you fractured your hip before you fell.”
That’s because “osteoporosis is often undiagnosed because gradual loss of bone density is not painful until the bone actually breaks,” Theriot said.
Falls that lead to death are most often due to hip fractures or head injuries. People who die after a fall that results in a hip fracture tend to be older and have an underlying neurological condition, Phelan said.
On the other hand, she noted that fatal falls stemming from a head injury are more common among men, people who take blood thinners and those without a musculoskeletal diagnosis.
Another problem arises when people forget if they took their medications, said Andrea Fleischman, an assistant professor in the department of occupational therapy at Creighton University Health Sciences Campus-Phoenix.
“Sometimes, older individuals will double up on their medication regimen, which can make them increasingly lethargic or dizzy,” Fleischman said. She said she recommends that older adults regularly review medications with their clinicians and family members, especially if they have memory issues. Advertisement
Fall prevention strategies include regular exercise to maintain muscle mass and bone density. Routine physicals and vision checkups are also important, Fleischman said.
She also cited the importance of ensuring the home is safe from tripping hazards, such as throw rugs. That’s because older adults may not be able to catch themselves or cushion a fall as easily as younger or middle-aged people.
But whether injuries lead to death depends to a large extent on the person’s age and overall health status, Fleischman said.
Even so, “the unfortunate statistic is that the morbidity rate for a person who falls and breaks a hip is upwards of 50%,” she said. “It’s due to decreased mobility.”
Older adults often hit their head because protective reflexes — which prompt people to put their hands out to stop or cushion a fall — diminish with advanced age, Fleischman said.
After a fall, timely medical care and follow-up can make a difference. “Hopefully you’re able to recover, but you need that additional support to determine your risks and prevent future falls,” Theriot said.
She added that “physical therapy, occupational therapy and interventions like a fall risk assessment in your home environment are all important.”
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