Health Tip: What Causes Older People To Fall, And How Can We Reduce Their Risk?

During the holiday season we often reconnect with our older relatives and friends, and may notice some new deficits in their ability to walk or transfer safely. For this reason, I think it's an opportune time to review a frequently overlooked health topic: are you or your loved one having falls?

Falls are one of the greatest health threats to people over the age of 65. An estimated 37.5% of those who fall sustain injuries severe enough to restrict their mobility or require medical treatment. A recent CDC report suggests that seniors are so embarrassed about their falls (or fear loss of independence), that they fail to report half of them. This can lead to sedentary behavior in an attempt to avoid further incidents. Unfortunately, skimping on exercise only makes the body weaker, which actually increases the risk of toppling over.

Why does our fall risk increase as we age?

1. Balance deficits. As we age, cells responsible for detecting where our bodies are in 3-D begin to die off. This affects the vestibular system in our inner ears, causing a decrease in body awareness during motion.
2. Slower reaction times. Our ability to react quickly to environmental stimuli decreases with age, probably as a factor of impaired vestibular systems, combined with poorer vision, and weaker muscles.
3. Muscle atrophy. Without sustained effort to avoid muscle loss, most people lose 3-5% of muscle mass per decade after age 30. Weaker muscles don't perform as well, particularly in getting up from low surfaces.
4. Neuropathies. Nerve damage is more common with age (especially for those with diabetes), reducing sensation in the feet and leading to stumbles.
5. Medication effects. The average American over age 65 takes about 5 prescription medications per day. Many of these have side effects (such as dizziness or low blood pressure) that can contribute to fall risk.
6. Vision changes. Our eye tissues are less flexible as we age, causing difficulty adjusting our focus (hence the need for "reading glasses.") Cataracts (cloudiness in the lenses of the eye) may also reduce our vision. In fact, internationally-speaking, cataracts are the #1 cause of blindness. We tend to need more light to see well as we age, due to light scatter from aging lenses and corneas or perhaps macular degeneration (vision loss due to cell damage in the back of the retina).
7. Blood pressure variability. As we age, our hearts are a little slower to compensate for changes in body position. So going from sitting to standing too quickly may cause dizzy feelings or fainting spells, leading to falls.
8. Clutter. Ok, this isn't really a factor of aging, but I can tell you that many of the patients I see in my rehab practice have tripped over area rugs or household clutter and fallen down. I suspect that since we tend to collect more worldly items as we age, our risk of falling may increase specifically due to that!
   

Now that we all feel somewhat depressed about the natural aging process and what we are all facing, I have some good news: we can take steps to reduce our (and our loved ones) fall risks. In my next post I'm going to review the CDC recommendations for reducing falls, and call out the practical things you can do that have been proven to work. So stay tuned…

References

https://www.cdc.gov/homeandrecreationalsafety/falls/compendium.html
https://www.wsj.com/articles/falling-is-dangerous-for-the-elderlyand-often-preventable-1510542240
https://www.askdoctork.com/why-does-balance-decline-with-age-201306054928

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