Losing your balance can be an unsettling experience. If you fall, it can be dangerous as well. And unfortunately, falls and fall-related injuries are common occurrences. According to the World Health Organization, falls are the world’s second leading cause of unintentional injury deaths. Falls are also the leading cause of injury in adults 65 and older, notes the Centers for Disease Control and Prevention.
However, Katharine Forth, who has a PhD in motor control and completed her postdoc at NASA, where she studied how the body controls itself for balance, likes to remind people that just because fall-related injuries are common doesn’t mean they are normal. Especially for older adults, she encourages people not to assume they are destined to fall based on their age.
Understanding balance challenges and fall risks for people of all ages is vital, Forth adds, both in keeping the greatest number of people safe from disastrous falls and in having respectful, productive conversations with older adults about the potential for falling.
By assessing your current fall risk and prioritizing your physical or cognitive health to maintain or improve your balance, you may be able to reduce your risk for falls at any age. Below, explore how the aging process impacts your fall risk and how you can prevent falls and fall-related injuries.
[READ: How to Test Whether You’re Aging Well]
Falls Among Older Adults
About 14 million adults fall each year, according to the CDC. Not all falls result in death, but they can still lead to injuries. Particularly for frail individuals or vulnerable older adults, fall-related injuries can be severe.
“This is a problem for lots of ages,” Forth says. “However, we know that if you are 80-plus, there’s frailty that’s more likely to occur. So, if somebody goes down, they are more likely to have hip fractures, for example.”
Hip fractures are one of several dangerous health consequences that may be caused by a fall. Bone fractures elsewhere in the body and traumatic brain injuries can also occur.
[Read: Senior Home Care: Services, Costs and Tips for Aging in Place]
How to Prevent Falls in Older Adults: Health Tips
You can take steps to support your health to improve your balance and reduce your risks of falling. Health tips for preventing falls include:
1. Undergoing a thorough fall-risk assessment
2. Maintaining a regular exercise routine
3. Using physical therapy to gain or maintain strength
4. Supporting brain and heart health
5. Checking vitamin levels
6. Taking inventory of your medication use
7. Avoiding or reducing alcohol consumption
8. Understanding that you cannot eliminate all risk
1. Undergo a thorough fall-risk assessment
According to Forth, the standard of care for assessing fall risks is to ask someone if they’ve fallen within the last 12 months. If they have, care should be triggered. If they haven’t, care may not be necessary. The problem that can result, however, is two-fold: People who answer yes could already be severely injured, while people who answer no may be inaccurately presumed safe.
“The quality of care that’s provided for falls would not be acceptable for cardiovascular health or cancer,” Forth says. “Imagine (asking someone), ‘Have you had cancer yet?’ It seems so ludicrous when you compare it to these other conditions, but somehow with falling, it’s acceptable.”
Forth has led an effort to improve fall-risk assessments and help people make informed decisions about their health by designing and marketing a stability scale with the company Zibrio, where she is the CEO.
Some providers are taking other steps to make fall-risk assessments more comprehensive, too. Dr. Esiquio Casillas, senior vice president and chief medical officer for the AltaMed Health Services Program of All-Inclusive Care for the Elderly, or PACE, in the Los Angeles area, says interdisciplinary team members help conduct a formal fall risk assessment that includes but is not limited to looking for vision deficits and checking for addressable obstacles in the home.
2. Maintain a regular exercise routine
Regular exercise, especially exercise that improves your strength, flexibility and balance, can keep your body fit and agile so that you’re more capable of balancing and avoiding falls and also more capable of catching yourself if you start to fall.
“Keeping active and regularly exercising muscle groups that are important in walking, bending and balance can help avoid future falls,” Casillas confirms.
The CDC recommends older adults exercise for 150 minutes a week using moderate-intensity exercises, like brisk walking, or 75 minutes a week of more intense exercise, such as jogging or hiking. The agency also recommends devoting two days a week to strengthening muscles.
In addition to your overall exercise routine, Forth recommends practicing foot-specific movements to support your balancing capabilities. These can include simple exercises like sitting down and spreading your toes wide a few times before going for a walk, she says.
“Waking the feet up a little bit and wiggling those toes around can be very helpful,” she adds.
3. Use physical therapy to gain or maintain strength
Strong muscles and bones can support balance, helping people continue to perform their daily activities without falling.
“Maintaining strength in activities of daily living is one of the key pieces to keeping people independent,” Casillas says.
Some people may benefit from physical therapy as a way to gain or regain strength and balance.
Dr. William Buxton, a board-certified neurologist and the director of neuromuscular and neurodiagnostic medicine and of fall prevention at Pacific Neuroscience Institute in Santa Monica, California, explains that a physical therapy routine supportive of balancing skills tends to prioritize various leg and core strengthening exercises. Core strengthening can be crucial in relieving tension on other parts of the body, like nerve pressure in the legs or bone spurs in the back, that can impact overall health and fall risks.
Working on balance, posture and even treating niche conditions in the body like ear issues can help with reducing fall risks, Buxton adds.
4. Support brain and heart health
A healthy brain and heart can support healthy balance. Taking care of the brain and heart can include managing blood sugar levels and treating conditions like diabetes and prediabetes, which can lead to nerve damage impacting balance, Buxton says.
5. Check vitamin levels
Healthy vitamin levels support balance. In particular, long-term deficiencies in vitamin B12 may increase fall risks by causing nerve dysfunction in the feet. Evaluating B12 levels is part of the routine workup for assessing balance problems, Buxton says.
Your doctor may also suggest you get tested for a B12 deficiency if you are experiencing other unexplained nervous system symptoms. This could include numbness or tingling in your arms or legs or weakness or balance issues. If your standard blood tests suggest you may be experiencing a type of anemia, it is wise to get that looked into too.
However, while it is important to listen to your doctor if they recommend you supplement for a vitamin deficiency, you typically do not need supplements if your vitamin levels are normal. For example, Buxton says that people who are not deficient in vitamin B12 do not need to take a vitamin B12 supplement.
“It’s not something everyone needs to take, but if somebody is having problems with balance, getting B12 tested can lead to an easily correctable factor,” Buxton adds.
[Read: Deprescribing Medications for Seniors]
6. Take inventory of your medication use
Certain medications can alter your alertness and hurt your balance. For example, antihistamines can make you drowsy, due to anticholinergic properties in products like Benadryl.
If someone who has recently taken Benadryl starts to fall, their brain may not respond as quickly as needed, which can increase the risk of a collision. These drugs can also make people more sleepy during the day, increasing risks of falling asleep — and falling over, Buxton says.
Drugs with anticholinergic properties can also block the neurotransmitter acetylcholine, which plays a role in involuntary muscle movements. By blocking this neurotransmitter, the drugs can slow your reaction time to certain events, such as delaying your ability to catch yourself during a fall.
In addition to any single drug’s impact on falling, Casillas explains that polypharmacy, or using five or more drugs at one time, may inhibit your balance.
“Falls often are related to side effects and drug interactions of people taking too many medications,” he adds. “If you are taking five or more medications, speak with your doctor to discuss the risks of polypharmacy and the option of reducing or eliminating unnecessary medications.”
Letting your doctor know about all the prescription and over-the-counter medications you’re taking when discussing your worries about falling enables them to effectively help with fall prevention strategies. If it’s hard to remember all your medications, consider if using a pill organizer or dispenser can help.
7. Avoid or reduce alcohol consumption
can impact alertness and affect balance. Health professionals discourage alcohol use for older adults, and people of other ages too. If giving up alcohol feels like too steep of an ask, consider how you can decrease your alcohol consumption to support your health.
“Anything more than a drink a day significantly increases risks of falls,” Buxton says.
Indirectly, alcohol contributes to damage in the nerves and feet, “which decreases the ability of our feet to give our brain feedback to know where legs are in space, which can throw off balance,” Buxton says. Directly, it is a toxin to the brain, causing harm to the cerebellum, “the balance center of the brain,” he adds. Alcohol also has short-term sedative effects, which can increase your risk for falling.
While anyone can experience these negative impacts of alcohol, the National Institute on Alcohol Abuse and Alcoholism notes that older adults may be more susceptible than younger adults as aging can lower the body’s tolerance for alcohol.
8. Understand that you cannot eliminate all risk
While the above fall risk reduction strategies can help you increase your stability and sense of safety when it comes to falls, they will not be able to reduce your risks of falling altogether.
“We can’t really eliminate the risk,” Casillas emphasizes. “It’s trying to minimize the times that they would fall or the severity of their fall. Especially if their goals of care are to remain independent, living on their own, it may not be that they can ever eliminate all falls, but certainly it could be reduced to some extent.”
[READ: Best Exercises for Preventing Falls in Older Adults.]
Fall Prevention: 7 Steps to Prevent Falls at Home
In addition to taking care of your body, modifying your home can help reduce your risk of falling.
Some ways you can fall-proof your home include taking steps to:
1. Clear pathways and remove hazards
2. Add adaptive equipment
3. Put daily items in easy-to-reach places
4. Wear a fall detection device
5. Install night lights
6. Have a plan for travel
7. Wear sensible shoes
1. Clear pathways and remove hazards
Keeping a safe living environment can mean keeping a clean living environment — and decluttering appropriately. Casillas explains that stray or unnecessary items, including decorative furniture, can increase people’s risk of falling in the home.
“At times we save things that have sentimental value or gather items to give to loved ones,” Casillas says. “Other times we’ve become so used to having these items that we don’t even notice the clutter around our home.”
Getting rid of certain furniture may be an emotional experience, especially if they hold sentimental memories or meaning, Casillas says. If you’re struggling to part with old items, try to remind yourself of how doing so will benefit your health.
“This not only lowers your risk of falling or tripping, but it also makes it easier to move around your home — especially if you use a walking assistance device, like a cane or a walker,” Casillas says.
Some items to get rid of or store away include:
— Extension cords and wires
— Boxes
— Any item that can obstruct your walkways
— Throw rugs
If you have carpets in your household that you do not want to remove, it is wise to ensure they are firmly fixed to the floor, as wiggly carpets can carry sneaky risks for the older adult population.
“Falls caused by loose rugs and unsecured or damaged carpets are a major cause of injury in adults age 65 or older,” Casillas says. “Over time, both rugs and carpets can bunch or bulk up, making them a trip hazard. While no-slip strips can help keep area rugs in place on tile and wooden floors, they only last so long. Plus, they can easily get caught in a person’s walker.”
Casillas encourages getting in the habit of regularly picking up and putting away stray items in your household to remove tripping hazards. These items include:
— Bags
— Loose papers
— Laundry
— Shoes
— Pet accessories and toys
2. Add adaptive equipment
Preventing falls in the home isn’t solely dependent on removing items — adding helps too. Consider adding adaptive equipment, like handrails, to provide you with support around the home if you start to lose your balance.
Casillas highly recommends adding adaptive equipment to the bathroom, which is one of the most common rooms for falls. A 2014 study found that among community-dwelling older adults, falls are twice as likely to occur in the bathroom than in the living.
In the bathroom, adaptive equipment items can include:
— Shower chair
— Raised toilet seat
— Grab bars in the shower
— Grab bars near the toilet
3. Put daily items in easy-to-reach places
If you find yourself constantly straining to reach items from high shelves, this could increase your risk of falling.
“Keep routinely used items within reach, at waist or counter–level,” Casillas recommends. “Avoid using step stools and ladders, and do not stand on a chair or table to reach something that’s too high.”
To grab something up high, he recommends using a reach stick or asking for help.
4. Wear a fall-detection device
Wearing a fall detection device or programming your Apple Watch to act as a life-alert device can support you if a fall occurs. Fall detection is available in more recent versions of the Apple Watch. To turn on life alert features on the watch, go to Emergency SOS under the My Watch tab and select Fall Detection, then turn on Fall Detection — or ask a loved one to help do this for you.
Wearing a fall detection device can be particularly helpful if you live alone, as they “oftentimes can give the individual, their family members and their doctors comfort in having an added level of security,” Buxton says.
5. Install night lights
If you can see where you are going, you’re going to have an easier time getting from one place to another without falling. In the dark, this is easier said than done. Setting up supports like a night light can help you find your way if you need to get somewhere — for instance, the bathroom — during the night.
6. Have a plan for travel
While fall-proofing your home can do wonders in your living space, it won’t keep you safe in unfamiliar environments, like someone else’s house. Buxton recommends having a plan for traveling and being aware that fall risks can be higher in unfamiliar places.
“The risk is oftentimes higher in unfamiliar environments because people don’t know what to watch out for,” he explains. “So it’s important to be vigilant always in terms of things that could cause somebody to fall.”
If traveling to see family or friends, you may want to request that they have good lighting turned on and clear pathways before you arrive. On the flip side, if an older relative is visiting your home, be mindful of how you can make your home safer.
7. Wear sensible shoes
High heels, floppy slippers and shoes with slippery soles can make you trip and fall. So can walking in your socks. Instead, wear properly fitting, sturdy, flat shoes with nonskid soles.
What Causes Falls in Older Adults?
Anyone can slip and fall, but, over time, health changes and challenges may increase your risk for falling.
Casillas adds that “aging affects our muscle strength and flexibility, making it more challenging to maintain balance and stability.”
“Older adults are also more likely to have chronic conditions that can affect their mobility, coordination and overall stability,” Casillas continues. “Plus, age-related vision changes and hearing loss can make it harder to navigate and identify potential hazards.”
[READ: Fear of Falls in Older Adults]
Cognitive Factors and Fears That May Increase Fall Risk
Changes in brain function, such as cognitive diseases like Alzheimer’s disease and other dementias — which can develop in older adults but are not considered a natural part of aging — can increase your risks for falling. Mild cognitive impairments, lack of awareness of your health status or an internalized fear of falling may also increase your risk. Let’s explore below:
Alzheimer’s disease and dementias
Diagnoses like Alzheimer’s disease and other dementias impact memory and thinking, which can in turn increase fall risks.
Mild cognitive impairments
Mild cognitive impairments can impact judgment, which can increase fall risks. These impacts may appear less extreme than those related to Alzheimer’s or dementia, but they may also be easier to dismiss. With that in mind, it is important not to ignore mild cognitive impairments and the impact they could have on you or your loved one’s fall risk.
“Mild cognitive impairment may start impairing someone’s executive functioning and ability to judge risky situations,” Casillas adds.
This could lead to someone attempting activities like climbing a steep set of stairs without holding onto a railing or instead of using an elevator, when they could benefit from extra support.
Anosognosia
Anosognosia is a condition in which a person lacks insight into recognizing their health conditions. About 80% of people with dementia can develop anosognosia, making it a common issue and co-factor for fall risks. Because people are unaware that they are experiencing serious cognitive diseases, they may likewise be unaware that they are at an increased risk of falling.
Dementia patients with anosognosia “wouldn’t even have awareness that they have dementia and all of these physical impairments,” Casillas says. He adds that this is concerning because, unless stopped by a doctor or loved one, they may try to engage in dangerous activities, such as driving a car, “even though their license has been taken away, because they don’t even recognize that there’s a deficit there,” in some cases.
Fear of falling
Staying vigilant about your fall risks may help you mitigate falls. But fretting about your risk too much, or letting the fear of falling consume you, can do more harm than good.
“Once someone’s fallen, they sometimes create this worsening spiral effect where they get more nervous about doing certain activities,” Casillas says. “There’s some anxiety and maybe even some depression that comes with not doing those things.”
Professionals like physical therapists (PT) or occupational therapists (OT) can work with patients to overcome their fear of falling and encourage patients to continue to partake in activities that are safe for them while they build or rebuild strength.
“A skilled OT and PT can try to help patients overcome that fear of falling and encourage people to do more of what they can do, but that is sometimes a big challenge to overcome,” Casillas says.
Social workers may also provide interventions to help people overcome these fears, Casillas adds.
What to Do If You Fall
Falls can lead to serious consequences. So, if you lose your balance, it’s important to seek help.
If you fall, the National Institute on Aging recommends taking the following steps:
— Take deep breaths. This can help you relax.
— Before you get up, decide if you are hurt. Don’t get up too fast if you are hurt.
— If hurt, stay put and call for help. You can do this verbally, or through a life-alert device or smart watch if you’re wearing one. Dial a loved one on the phone if accessible or call 911 and wait for help.
— If you are OK to move, move slowly. Roll slowly to your side, resting, then crawling on your hands and knees to a sturdy chair. When getting onto the chair, put your hands on the chair first and position your body in a kneeling position with one knee down and one foot flat on the floor, before slowly rising yourself up to the chair.
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Fall Prevention for Older Adults: 13 Strategies to Stay Safe originally appeared on usnews.com
