Preventing Falls in the Elderly
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
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.