Falls and Older Adults

About Falls

 

Many people have a friend or relative who has fallen.  Maybe you have fallen yourself.  If you or an older person you know has fallen, you are not alone.  More than one in three people age 65 years or older falls each year.  The risk of falling and fall-related problems rises with age.  

 

Each year, more than 1.6 million older U.S.adults go to emergency departments for fall-related injuries.  Among older adults, falls are the number one cause of

• fractures to the hip, pelvis, spine, arm, hand, or ankle.
• hospital stays.
• loss of independence.
• death.

 

Hip fractures are one of the most serious types of fall injury.  They are a leading cause of medical problems and death among older adults.  Only half of older adults who break a hip can return home or live on their own after a hip fracture.  

Many older adults are afraid of falling.  This fear becomes more common as people age, even among those who have not fallen.  It may lead older people to avoid walking, shopping, or taking part in social events.  Getting rid of your fear of falling can help you to stay active, maintain your physical health, and prevent future falls.

 

If you are worried about falling, talk with your health care team.  You might be referred to a physical therapist.  A physical therapist (PT) can help you in many ways.  A PT can show you how to

• improve your balance.
• strengthen your muscles.
• use a walking aid, if needed.

 

If you fall, be sure to discuss the fall at your next visit with your health care team, even if you are not hurt.  Falls do not “just happen,” and people do not fall just because they get older.  A fall could be a sign of a medical problem such as an infection or a cardiovascular disorder.  It could also suggest that a chronic ailment, such as Parkinson's disease or dementia, is progressing. 

 

Risk Factors

 

Often, more than one cause or risk factor is involved in a fall.  A risk factor is something that increases a person chance of having a certain problem.  Many causes of falls can be treated or corrected.  

 

Muscle weakness and balance

 

Muscle weakness, mainly in the legs, is one of the biggest risk factors.  Older people with weak muscles are more likely to fall than are those who maintain their muscle strength, as well as their flexibility and endurance.

 

Your balance and your gait (how you walk) are other key factors.  These problems may be linked to a lack of exercise or to a neurological cause, arthritis, or another condition that might be treated or managed.

 

Your reflexes may also be slower than when you were younger.  The increased amount of time it takes you to react may make it harder to catch your balance if you start to fall.

 

Routine physical activity is a first line of defense against falls.  It strengthens muscles and increases flexibility and endurance.  Your balance and the way you walk may change, decreasing the chances of a fall.  Work with a member of your health care team to plan a program that is right for you.

 

Exercises done at home that are designed for your problem areas by a physical therapist can reduce your risk of falls.  A supervised group program can also help.  Whether done on your own or with a group, be sure your program becomes more challenging over time. 

 

Tai Chi is one type of exercise that may help improve balance and control.  Tai Chi uses slow, flowing movements to help people relax and coordinate the mind and body.  It can also boost your self-confidence.  Dancing and other rhythmic movements can help as well.

 

Mild weight-bearing exercise, such as walking or climbing stairs, may help slow bone loss.  Having strong bones can prevent fractures if you do fall.

 

Your health care provider or a physical therapist can check your walking and balance.  They might do a “Get-Up and Go” test.  This simple test shows how steady you are when you get up from a chair.  The test also is used to check your walking ability.

 

The use of assistive devices can also help prevent falls when used with other programs for improving balance.  These devices include canes, walkers, and “reachers”.  A cane or walker can help you feel more stable when you walk.  Walking aids are very helpful when you're in places you don't know or where walkways are uneven.  A physical or occupational therapist can help you decide which devices might be best for you and teach you how to use them safely. 

 

 

• You may have a choice of the type of cane you get.  Some have grips made of foam or that fit the shape of your hand.  Many canes can be adjusted, but some cannot.  A physical therapist can advise you about which cane to choose.  Be sure the length fits you well.  Your elbow should be at a comfortable angle.  A cane that is too short may make you unsteady.  A cane that is too long is harder to use.  If you use a cane, be sure to learn how to walk with it the correct way. 

 

• A walker will help you stay balanced by giving you a wide base of support.  Be sure to choose a walker that fits you and gives the level of stability that is best for you.  Use it when needed and use it properly.  The types of walkers vary.  Some walkers have two wheels so the walker should not roll away from you.  These walkers work well if you need to put weight on the walker when you move.  Other walkers have four wheels and brakes for going down inclines.  You can add a basket, tray, or pouch to some walkers to carry items.

 

• A “reacher”, or “grabber”, can also help prevent falls.  This simple tool lets you take lightweight items from high shelves, from the floor, and other places.  Use a reacher rather than standing on a stool to get something from above.

 

• When bending over to pick up items from the floor or a lower level like a step or low shelf, use one hand on the counter top, furniture, or a walker for support.  When able, use a reacher to pick up lightweight items. 

 

• A portable telephone may be helpful for you.  Carry the phone with you from room to room.  When it rings, you won't have to rush to answer it. 

 

Blood pressure

 

A member of your health care team should check your blood pressure and pulse after you have been lying down for at least 5 minutes and again after you get up.  If it drops too much when you get up, ask if any of your medicines should be decreased or if you should make other changes.  Some people with this drop in blood pressure feel dizzy.  Other people do not feel dizzy, even if their blood pressure drops a lot when they get up.  Other things can help.

 

• Drink more water.
• Get up more slowly.
• Pump your feet or hands before getting up.
• Wear special stockings.

Foot problems

 

The soles of our feet have nerves that help us judge the position of our bodies.  To work correctly, our feet need to be in touch with the ground and our shoes need to stay securely with the foot as we take each step. 

 

It is vital to select your footwear carefully to help prevent falls.  Wear sensible, low-heeled shoes that fit well and support your feet.  There should be no marks on your feet when you take off your shoes and socks.  Your shoes should fully surround your feet.  Wearing only socks or wearing floppy, backless slippers or shoes without backs can be unsafe.  Also, choose shoes with non-slip soles.  Smooth soles can cause you to slip on waxed or polished floors.

 

Poor eyesight

 

Have your vision tested regularly or if you think it has changed.  Even small changes in sight can make you less stable.  Wear your eyeglasses or contacts so you can see your surroundings clearly.  Keep eyeglasses clean and check to see that the frames are straight.  When you get new glasses, be extra cautious while you are getting used to them.  If you use reading glasses or multi-focal lenses, take them off when you're walking. 

 

It may take a while for your eyes to adjust to see clearly when you move between darkness and light.  Other vision problems include poor depth perception, cataracts, and glaucoma.  

 

Confusion

 

Confusion, even for a short while, can sometimes lead to falls.  For instance, if you wake up in a strange place, you might feel unsure of where you are.  If you feel confused, wait for your mind to clear or until someone comes before trying to get up and walk around.

 

Medicines

 

Sometimes the increased risk is because of the health problems for which you take the medicines.  In other cases, the medicine causes side effects like dizziness or confusion.  Drug interactions can also lead to falls.

 

Never add or stop medicines without talking with a member of your health care team first.  Ask if changes in your medicines could lower your risk of falls.  Your health care team can tell you which drugs, including over-the-counter medicines, might cause problems.

 

Limit the amount of alcohol you drink.  Even a small amount can affect your balance and reflexes.

 

Bone Health

 

You can help prevent fractures by maintaining the strength of your bones.  Having healthy bones will not prevent a fall.  If you fall, though, having healthy bones can help prevent hip or other fractures that may lead to a hospital or nursing home stay, disability, or even death.  You are never too old to improve your bone health.

 

Osteoporosis makes bones thin and more likely to break.  It is a major reason for fractures in women past menopause.  It also affects older men.  If bones are fragile, even a minor fall can cause fractures.

 

At any age, you can take steps to keep your bones strong.  Be sure to consume adequate amounts of calcium and vitamin D.  People over age 50 should consume 1,200 mg of calcium daily by eating calcium-rich foods and taking calcium supplements.

 

Good sources of calcium in your diet include

 

• dairy products such as low-fat milk, yogurt, and cheese.
• orange juice, cereals, and other foods fortified with calcium.
• dark green, leafy vegetables such as broccoli, collard greens, and bok choy.
• sardines, salmon with bones, soybeans, tofu, and nuts such as almonds.

 

Vitamin D helps your body absorb calcium.  Exposure to sunlight causes your body to make vitamin D.  Many older people don’t get enough vitamin D this way.  Eating foods with vitamin D and taking supplements can help.

 

As you grow older, your need for vitamin D increases.  People over age 50 should consume at least 800 international units (IU) of vitamin D daily.  Talk with a member of your health care team about how much vitamin D you need.

 

Good sources of Vitamin D in your diet include

• herring, sardines, salmon, tuna
• liver
• eggs
• milk and foods fortified with vitamin D
• vitamin D supplements

 

Physical activity is another way to keep your bones strong.  Try to get a total of at least 30 minutes of activity a day.  This does not need to be 30 minutes at one time but can be shorter sessions many times a day.  For example, three 10 minute sessions would meet this need.  Find time for things like walking, dancing, stair climbing, gardening, and weight-lifting.

 

Talk with your doctor or nurse about having a bone density test.  This safe, painless test assesses your bone health and risk of future fractures.  Medicare and many private insurers cover this test for eligible people.  Women over age 65 and all men over 70 should have a bone density test.

 

A member of your health care team can also advise you about whether you should consider taking prescription medicines to improve bone health.  These medicines can slow bone loss, improve bone density, and lessen the risk of fractures.

 

Quit smoking and limit alcohol use to improve your bone health.  Smoking and heavy alcohol use can decrease bone mass.  Maintain a healthy weight.  Being underweight increases the risk of bone loss and broken bones.

 

Although falls can happen anywhere, well over half of all falls happen at home.  Falls at home often happen while a person is doing the normal daily routine.  Simple changes can help make your home safer.  The Health Facts for You “HomeSafety-PreventingFalls” (HFFY # 6626) offers some tips for preventing falls at home.

 

Source: NIH Senior Health:  National Institutes of Health, National Institute on Aging and National Library of Medicine 2007.  Use of information with permission.

 

Reviewed by: University of Wisconsin Hospital and Clinics: Geriatric Falls Clinic.

 

The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.

Last Updated: 06/30/2011

Copyright © 05/26/2010 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. UWH #6625

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