A Serious Problem
Every year one out of three community-dwelling seniors over age 65 experiences at least one fall. That's almost 12,000,000 people. The financial, emotional and functional impact of falls is... staggering. Falls cause about 350,000 hip fractures per year, a number that is expected to rise to 600,000 over coming decades as our population ages. The mortality following hip fracture is approximately 25% at one year, while among survivors, about half will not be able to resume their previous level of independence. Seventy-five percent of fall-related deaths occur among people of 65 and older. Recurrent falls are a major reason for loss of independence and nursing home admission.

Fortunately, 80-90% of falls don't result in serious or disabling injury. The trouble is, falling in the older population is usually due to ongoing risk factors that will cause more falls in the future. In fact, people who fall once are two to three times as likely to fall again within a year. So, most falls can be thought of as a warning to seek intervention before serious injury occurs. But why is falling such a problem among older people in the first place?

Why Are Seniors at Increased Risk of Falling?
Normal changes of aging are part of the answer. For example, it is normal to experience a decline in muscle mass and consequent loss of muscle strength after a certain age. Likewise, neurological functions controlling balance and position awareness become less sensitive. But the more important risk factors for falling are certain medical conditions common among seniors, such as stroke, inner ear disorders, Parkinson's disease, neuromuscular disease, urinary incontinence, visual impairment, heart rhythm disturbances and arthritis. Such conditions can usually be improved with treatment.

Prescription and non-prescription drugs can also be major culprits. Pain pills, sedatives, antihistamines, cardiac and blood pressure drugs, diuretics and antidepressants are just some of the many classes of drugs that can contribute to falling. Depending on the drug, falling risk can be aggravated in one of three ways: by causing confusion or drowsiness, by lowering blood pressure and by contributing to dizziness, especially the kind that is precipitated by sudden standing.

Interestingly, one recent study showed that older individuals who wear multifocal lenses are at about a two-fold increased risk of falls due to impaired depth perception for objects at ground level.

Finally, there is another important risk factor for falling: the fear of falling itself, a serious problem in its own right that causes many to curtail walking, social interactions, church attendance and other activities. Inactivity aggravates the very muscle weakness and gait instability that make falling more likely. Thus, experts agree unanimously that withdrawing from life's activities is exactly the wrong way to deal with falling risk, since in the end it just makes things worse.

What Can One Do To Prevent Falls?
Fortunately, a number of studies have shown that a great deal can be done to reduce falling incidence. First, get a medical evaluation directed at discovering and treating medical conditions that contribute to falling. To ignore this step is to risk overlooking things like a correctible inner ear disorder or a drug modification that could be beneficial. When seeing a physician for such an evaluation, bring a your medication bottles (including non-prescription medications).

After a medical assessment, physical exercise is an indispensable component of any fall prevention strategy. Just the muscle-strengthening benefits of a general exercise like walking would be expected to improve gait stability, and to an extent this is true. But for people at increased risk of falls, supervised exercise targeted at improving balance is a better bet, especially if done under the direction of a physical therapist or other health professional with special training in this area. There is also evidence that Tai Chi, the oriental exercise consisting of slow, coordinated movements and relaxation, reduces falls and improves confidence in seniors. Many senior centers and recreation centers offer Tai Chi classes at reasonable cost..

Well-fitting shoes with thin, non-slip soles are a prudent measure for all seniors and a must for those at increased risk for falls. (Thick-soled shoes are a bad idea because they impair balance and position sense.) Assistive devices like canes or walkers can be indispensable. It's best to have a physical therapist go over their proper use, however, as many people don't get the benefit of such aids because of lack of instruction.

Modifications of the home environment can be beneficial at reducing falls. Some simple steps include making sure rooms are well-lit, avoiding clutter, eliminating throw rugs, tacking down carpets and placing non-slip mats in tubs and in front of sinks. More involved but still beneficial in some cases are interventions like installing grab bars in bathrooms or solid railings on both sides of a stairway. Studies show that such measures probably help, but not by themselves; they need to be incorporated into a comprehensive program that also includes the components of medical evaluation and exercise. See the additional resources listed below for detailed suggestions on home modification and hazard reduction.

In summary, although falling can cause serious injury and disability, most falls don't--but they should be regarded as a warning that investigation and intervention are needed. Above all, don't withdraw from activities or live in denial. With a little patience and courage, there really are better options available to seniors at risk for falling.

Where to get additional information:
There are numerous resources offering help with various components of falling risk evaluation and prevention. Start with your primary physician, so that he/she can coordinate your care. The following organizations provide excellent general information:
The National Center for Injury Prevention and Control (770) 488-1506 www.cdc.gov/ncipc
The American Academy of Orthopaedic Surgeons (800) 346-AAOS www.aaos.org
The Temple University Fall Prevention Project www.temple.edu/older_adult/

November, 2002