I was recently in Boston visiting with a very close friend when I fell while walking to dinner. One moment, we were talking and laughing, and the next, I was splayed out over the sidewalk after tripping over a tree root. I was lucky that I sustained no serious injuries other than a bruised knee and ego. The cause? Not paying attention, an uneven sidewalk, not-the-safest-but-really-cute shoes and bifocals. Like most falls, it was multifactorial.
According to the CDC, one out of three older adults falls each year, and among older adults, falls are the leading cause of both fatal and non-fatal injuries. In 2013, the direct medical costs of falls, adjusted for inflation, were $34 billion. Many elders lose confidence after a fall and become more socially isolated, inactive and depressed.
So what can be done? As it turns out, there is evidence that a number of different interventions can help reduce the risk of falls.
First, exercise not only helps prevent falls but has many other health benefits, so is probably a first line intervention for most older adults. The regular practice of tai chi seems to be particularly effective for fall prevention. Tai chi involves very slow, purposeful movements in coordination with breathing and muscle activity, which in turn affects balance and gait. But any exercise, especially exercises that include a balance component, such as yoga or dancing, can be helpful.
Although the evidence is not conclusive, vitamin D supplementation appears to reduce the risk of falls. Most experts recommend at least 800 IU daily.
Benzodiazepines and other sedatives have consistently been shown to increase the risk of falls among elders. Since moving to Whatcom County, I have been shocked to see how many older adults in this community regularly use some kind of benzodiazepine. According to The American Board of Internal Medicine Foundation’s Choosing Wisely campaign, benzodiazepines or other sedatives/hypnotics should never be used as a first choice for insomnia, and should only be used for alcohol withdrawal or severe anxiety disorder unresponsive to other therapies. Other combinations of medications, including too much blood pressure medication, can also put some elders at risk.
Eyesight is important, and older adults should have their eyes checked every year or two. Cataract surgery can help prevent falls, as can avoiding wearing bifocal or progressive lenses while walking.
Some years ago, I read a study in a medical journal that came to the conclusion – surprise! – that high heels increase the risk of falling. Did we really need a study to tell us that? But seriously, footwear is important. Wearing shoes with high heels, slippery soles, a tendency to twist (like some clogs), or shoes that are too loose, can lead to falls. Wearing socks or slippers can also increase the risk of falling, particularly on smooth flooring.
There are a number of things you can do to make your house more “fall-safe” including removing throw rugs, cords and other obstacles, and ensuring that handrails are in place along stairways. Grab bars next to the tub, shower or toilet, using non-slip mats in the bathtub and on shower floors and improving lighting can all reduce risk.
For those people who fall despite taking all precautions, it is important to be screened for osteoporosis (and treated for it, if it is found). Having a physical therapy evaluation for assistive devices and safety training can be invaluable. Lifelines and other safety measures are important to ensure that help can be summoned if a fall does occur.
If you fall, talk to your doctor or practitioner about it. He or she can review your risk for falls, advise you about vitamin D, review your medication list and make other recommendations for fall prevention, if you are worried, or at risk.
For my part, I am taking yoga, using trekking poles on my hikes and my bifocals go into my purse when I leave my desk. And while I haven’t yet worked up to throwing out my cute Boston shoes, I am keeping them in the closet for now.
ABOUT THE AUTHOR
Dr. Bree Johnston is director of palliative care for PeaceHealth and president of the Whatcom County Medical Society.