Older Adults and Falls: Deadly But Preventable

Contributor: Ronan Factora, MD

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One sentinel event – an unexpected incident that can result in death or serious harm – often overlooked in older adults is a fall.  About one in three people older than age 65 will experience a fall in one year.

People in this age range who fall and fracture their hip have a 25 percent to 30 percent chance of dying after one year. In addition, these people often cannot regain their earlier level of independence. Falls are the most common reason for nursing home placement.

Given the problems associated with falls, the American Geriatrics Society recommends people age 65 or older receive an evaluation if they fall or complain of difficulty with balance. This evaluation is meant to prevent the next fall or a fall related to balance difficulty.

Both of these problems typically have several contributing factors. They may include:

  • Problems with vision such as cataracts, macular degeneration, diabetic eye changes and glaucoma.
  • Uncontrolled pain, which is most often due to arthritis, particularly in the back, hips or knees.
  • Muscle weakness, which often related to prolonged periods of inactivity
  • Medicine – the risk of falls increases with the number of medications an individual takes. Lightheadedness, particularly when getting up from a lying or sitting position, can indicate that blood pressure medications are too strong. Psychotropic medications like antidepressants and antipsychotic medications all increase the danger of falls.

By addressing these issues, the possibility of falls can decrease.

There are some risk factors for falls, though, that cannot be changed. These include age-specific medical conditions such as dementia, Parkinson’s disease, peripheral neuropathy, prior fall and the need to use an assistive device to move around.

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At the doctor’s

What should you expect from an evaluation with your doctor? You should be checked for orthostatic hypotension, which is a significant change in blood pressure when changing position from lying or sitting to standing. Hypotension often is associated with lightheadedness or dizziness that happens after the change in position, but then goes away.

Your doctor also should ask about pain that limits mobility, check you for muscle weakness, particularly in the lower extremities, look for significant balance problems, watch you while you walk to see if there is anything unusual and ask you about pain.

In addition, your doctor should evaluate your medications to see if there are any that contribute to risk of falls that can be discontinued. Your doctor also may recommend that you get your vision evaluated by an ophthalmologist. This type of specialist has the training and experience to check for problems with the retina, such as macular degeneration or diabetic retinopathy, and problems with peripheral vision.

Reduce your risk of falling

What can you do yourself to reduce your risk of falling? Getting your medications reduced – particularly removing any psychotropic medications – is probably the most useful intervention.

A physical therapy evaluation can identify specific problems with strength and balance that can be corrected with an individualized regimen of exercises. It’s important to do these exercises every day, and continue the exercises even after formal therapy is completed. Otherwise, all that’s gained from the therapy could be lost very quickly.

Removal of cataracts, particularly in people who have had a fall, is beneficial. It’s important to make sure both eyes are done in the shortest period of time possible, and that your prescription for corrective lenses is adjusted after the cataracts are removed.

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Research suggests several exercises, including tai chi and yoga, help reduce the risk of falls. Falls risk reduction from tai chi can last for up to two years after a 12-week program is completed.

An evaluation can identify many interventions that you can incorporate into your lifestyle to reduce the risk of falling. So the problem of falling is one that can be reasonably addressed. The alternative of ignoring the issue can have significant implications for your future well-being.

This post is based on one of a series of articles produced by U.S. News & World Report in association with the medical experts at Cleveland Clinic. 


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