Aging gracefully: Preventing falls

Falls, for older people, are serious. They can significantly impair mobility and independence. They may lead to hospitalization and subsequent placement in a long-term care facility or nursing home. And as you get older, recovery is slower.

Falls are the leading cause of traumatic injury and death in older people, according to geriatric specialist Dr. Becky Powers. Older women are more often injured as a result of falls, but men are more likely to die as the result of a fall. According to the American Geriatrics Society, up to one-third of adults over the age of 65 living at home experience a fall, and nearly two-thirds will fall again.

Preventing falls, which requires a multifaceted approach, is one of the key components of not just living longer but living better. Here are five important considerations.

Multicomponent exercise

The latest guidelines issued this week by the US Preventive Services Task Force recommend “exercise interventions to prevent falls in community-dwelling adults 65 years or older who are at increased risk.” A comprehensive fall-prevention exercise program should include strength training, flexibility training, balance exercises and endurance or aerobic exercise, according to the National Institute on Aging.

Strength training is key to gaining muscle after the age of 50, but it is even more important in the geriatric population, as muscle loss accelerates after the age of 70 and can reach 15% loss per decade. Though lower body strength is most important, upper body strength is also key to minimize injury in the case of falls.

Endurance exercise should be done for at least 150 minutes per week and is important for maintaining heart health and bone density so that if you fall, you are less likely to break a bone. Flexibility helps you better perform activities associated with daily living safely.

Powers explained that balance training actually has the most research supporting its effectiveness in fall prevention. Tai chi is a popular and well-studied exercise for balance training, and a recent research overview suggests that it is helpful for fall prevention in an older population.

Home safety

Six out of 10 falls happen at home, according to the National Institute on Aging, so creating a safer home environment is key to fall prevention. Adequate lighting, minimizing clutter and small area rugs, and ensuring that you have adequate safety apparatus like bars and rails in place (especially in bathrooms and stairways) is essential.

The institute provides a useful room-by-room checklist to get you started.

In addition, footwear is very important. Avoid slippers and make sure to stick to firmer shoes to improve your balance and positioning perception, which can decline with age.

Medications

Medications can increase fall risk in several ways, including by causing dizziness, confusion, vision changes and light-headedness. Medication side effects may increase as you age due to slower drug metabolism, which increases the amount of time that it remains active in your body, and increased drug interactions.

The American Geriatrics Society considers these to be risk factors for falls: taking more than four medications daily, a recent change in the dose of a medication or a recent change in the number of medications that you are taking. It has a list of medications that should be used with caution in elderly patients, called the AGS Beers criteria. Tranquilizers, sedatives, sleeping pills, antidepressants, antipsychotics, diuretics and blood pressure medications may all increase your risk of falling.

Although you should never stop a medication or reduce the dose without talking to your doctor, be proactive in reviewing your medications regularly with them.

Powers also recommends checking blood pressure standing up at your doctor’s office in addition to sitting if you are taking medication for high blood pressure. This will help ensure that your blood pressure is not dropping too much when you stand, which puts you at an increased risk of falling.

Nutrition

Vitamin D deficiency has been linked to a higher risk of falling and is more common as you get older due to decreased in both sun exposure and the ability of your skin to convert sunlight into vitamin D. However, the latest guidelines on falls prevention issued by the Preventive Services Task Force recommend against vitamin D supplementation in older adults who do not have deficiency or osteoporosis.

B12 deficiency, which may affect up to 25% of older people, is also an important consideration, as it can lead to difficulty walking, muscle weakness and nerve problems, which can increase your risk of falling. If you are taking a proton pump inhibitor for heartburn or the diabetes drug metformin, or if you follow a vegan or vegetarian diet, ask your doctor to test your B12 blood levels.

Adequate high-quality protein intake throughout the day, along with a plant-rich diet, is also important for muscle preservation as you age. Drinking plenty of water, even if you aren’t feeling particularly thirsty, can help prevent falls by preventing dehydration, which can lead to dizziness or light-headedness upon standing.

Eye health

Though it may seem obvious, paying attention to eye health is important for fall prevention. Getting regular eye exams and updating eyeglass prescriptions as needed is important to prevent blurred vision, which can lead to falls.

In addition, cataracts, which occur in nearly 50% of people ages 75 to 80, should be addressed early to decrease your risk of falls. Research shows that having cataract surgery earlier in the course of the disease is associated with a reduced risk of falls.

Getting older is inevitable, but there is a lot you can do to age gracefully. Preventing falls by implementing these suggestions should be at, or near, the top of your list of healthy habits.

Clarification: A previous version of this story was less exact in terms of the Preventive Services Task Force’s Vitamin D recommendations for older adults.