Preventing Falls in the Elderly

First, some numbers. Between 30 and 40 percent of people over the age of 65 who live in the community (rather than in a nursing home) fall each year. That number increases to 50 percent for those over the age of 80.

Falls are the leading cause of death from injury for people 65 and older. One-fourth of those who fracture a hip die within six months of the injury, and another one-fourth require lifelong nursing care. In one study, 80 percent of older women reported that they preferred death to a ‘bad’ hip fracture that would require nursing home admission. Approximately 25 percent of people 75 or older living outside of nursing homes unnecessarily restrict their activities because of fear of falling. This fear is more common in individuals who live alone, are obese, have impaired mobility or balance problems, are depressed or have cognitive impairments.

By reducing the number of fall risk factors to which an individual is exposed, the risk of falling and the risk that a fall will be serious can be reduced. Most people who fall are exposed to multiple risk factors, many of which are preventable.

Many people who fall are taking multiple medications. Sedatives, antidepressants and antipsychotics particularly increase an individual’s fall risk by decreasing mental alertness, worsening balance and gait, and causing drops in blood pressure when standing up. In addition, an individual’s risk of falling increases with the number of different medications he or she is taking. Talk with your doctor about the side effects of your medications. Take the lowest effective dose and regularly assess the need for continuing your medications. Do not stop taking your medications without consulting your physician first.

At least one-third of falls in the elderly involve hazards in the home, most commonly, tripping over objects on the floor. Other hazards include poor indoor lighting, clutter, extension cords, lack of handrails, throw rugs, pets and wobbly furniture. Walk through your home to identify possible hazards, perhaps with an occupational therapist who is trained to identify risk factors. Use colored tape to mark changes in surface types or levels (for example, going from a tile floor to carpeting or going up steps.)

As seniors age, many of their body changes increase the likelihood of falling. Poor vision – cataracts or glaucoma – should be monitored closely by an ophthalmologist and corrected when appropriate or possible. Many older people do not get adequate exercise and so have poor muscle tone, decreased strength, loss of flexibility and loss of bone mass. Regular exercise decreases the likelihood of falling as well as the severity of falling. Wear properly fitting, supportive shoes with low heels or rubber soles. Clean your eyeglasses regularly.

People over the age of 65 with low serum vitamin D levels are at greater risk for loss of muscle strength and muscle mass and for hip fractures. Vitamin D supplementation – even in seniors with normal vitamin D levels – has been shown to decrease the risk of falls for older people. The daily intake of vitamin D should be at least 800 IU provided in the diet or as a supplement. Vitamin D is often available in combination with calcium, of which older adults should be taking at least 1,200 mg.

Dr. McMahon, a graduate of Yale University and the University of Pittsburgh School of Medicine, is board certified in Internal Medicine. She is a member of the American College of Physicians and the Allegheny County and Pennsylvania Medical Societies. She is in solo practice in the North Hills of Pittsburgh.