Falling down is scary. It’s even scarier when you’re in your 70s or 80s. Many people, however, have issues with falling as they age.
There are lots of reasons for this, according to Dr. Laura Longwell, an internal medicine specialist at the UCHealth Primary Care Clinic – Rockrimmon in Colorado Springs. Many, perhaps the majority, of her patients are age 55 and older. As a physician who cares for people who are older, she is acutely aware of the statistics from the National Council on Aging (NCOA) website:
- Falls are the leading cause of fatal and non-fatal injuries for older people
- Falls threaten seniors’ safety and independence and generate enormous economic and personal costs.
So why do people fall down?
“There are two camps here,” Longwell said. “There are some things you can’t control, like slips and trips that happen to people at any age. Maybe you’ve had the flu or are dehydrated and you pass out and fall. A sinus infection can throw off your balance and you might fall. These can happen to anybody. So we’re all at risk, at any age.”
As we approach those golden years, about age 65 or so, other factors also start to figure into the equation.
“At that point, things that lead to falls include impaired vision, hearing and balance.”
Aging can cause our senses to erode
“Vision is one of our senses and tells our brain where our body is in space. Hearing also contributes to that. The ‘hearing nerve’ does two things. Hearing is just one of them. It’s also a balancing nerve. Being able to see and hear well affects our sense of balance. Cataracts and other vision issues can play into the problem.”
A common complaint of aging patients is a numbness in the feet. It’s called neuropathy, and idiopathic neuropathy (no distinct identifiable cause) can be a factor, she said.
“If it’s present, you can’t feel your feet as well as you once could. That can increase falls.”
Chronic pain also is a culprit
“I would argue that (if you have chronic pain) you are at a higher risk of falls. It can be very distracting. It can change how we walk, if we are hurting. So that affects gait and balance impairment. If my back hurts and I can’t stand up straight, I might lean forward and throw off my center of gravity. That can lead to falls,” Longwell said.
The numbers on falling
•One in four Americans aged 65 or older falls each year.
•Every 11 seconds, an older adult is treated in the emergency room for a fall; every 19 minutes, an older adult dies from a fall.
•Falls are the leading cause of fatal injury and the most common cause of nonfatal trauma-related hospital admissions among older adults.
•Falls result in more than 2.8 million injuries treated in emergency departments annually, including more than 800,000 hospitalizations and more than 27,000 deaths.
•In 2015, the total cost of fall injuries was $50 billion. Medicare and Medicaid shouldered 75 percent of these costs.
•The financial toll for older adult falls is expected to increase as the population ages and may reach $67.7 billion by 2020.
Source: National Council on Aging
We have nerves that perform the job of helping us keep our balance – what’s called proprioception. Simply defined, it refers to the brain’s ability to perceive what’s going on in the body.
“It’s our ability to maintain balance and correct it when we have an imbalance,” she said. “The brain has to compute quickly how to correct balance, but as we age, the brain’s response to an imbalance signal might be slower.”
Dementia is another culprit
“Patients with dementia have a high fall risk. That’s because your brain’s processing speed is slowed down,” she said.
Those are all intrinsic risk factors, Longwell noted, “that are happening inside your body and you can’t control them. That’s especially true for older population.”
“There are things we can do to intervene and drastically reduce falls,” Longwell said.
For one thing, “doctors need to check everything from ears to toes,” she added. If a patient is falling, doctors check the effects of medications that a patient is taking. “We look at anything that might affect balance or alertness and address that appropriately,” Longwell said.
She periodically checks hearing, but she also checks her patients’ feet.
“We ask them to take their socks off and check them. Ask: ‘Can you feel them?’ Look for hammertoes and other deformities. Those can affect their gait,” she said.
To once again quote the National Council on Aging, “Falling is not an inevitable result of aging.”
Getting some exercise
Seniors prone to falling may have to make some lifestyle adjustments.
“Be less sedentary and more active,” Longwell said. Check out senior wellness centers; engage in physical therapy, including balance training; and try some activity that has proven good results – like tai chi and yoga. If you can afford it, perhaps hire a personal trainer to help you with strength and balance issues.
Dr. Longwell also asks patients to “Look at where you live. Is your environment safe for you? Are there a lot of stairs or obstacles that might cause a fall? Look at lighting, throw rugs, slippery floors, handholds in shower and by the toilet.” She sometimes recommends a home safety evaluation, which will assess all those things.
For patients who have fallen, she sometimes recommends walking aids.
“Walking aids are helpful, but I always want a physical therapist to assess patients to see if a walking device is needed, and if so, which one, and toteach a patient how to use it correctly. There is a right and wrong way to use a walker and if used incorrectly, it can actually increase your risk of falling.”
Depending on the patient’s condition, he or she may need anything from a four-pronged cane to a walker with a seat. An occupational therapist can make sure the device works with the patient’s ability to grip and maneuver it.
She recommends medical alert buttons if they are warranted and “especially if the patient lives alone and doesn’t have someone readily available to help them.”
None of these things are useful if the patient doesn’t use them, of course.
Does fear of falling affect people’s ability or willingness to remain active?
“Yes, it’s an easy way someone can become isolated,” Longwell said. “If they fear they may fall, they may avoid going places. They can develop depression or anxiety. And isolation in the elderly can worsen cognitive function, which can be irreversible. Not to be too dramatic about it, it can actually shorten life span.”
The NCOA site has this to say: “Falls, with or without injury, also carry a heavy quality of life impact. A growing number of older adults fear falling and, as a result, limit their activities and social engagements. This can result in further physical decline, social isolation, depression and feelings of helplessness.”
Depression screening is important, too, she said.
“I ask: ‘Are you going out and doing things?’ Have them take the Geriatric Depression Scale – it’s a good, quick survey. Mental health is a huge issue. People can be depressed and nobody notices or asks them about it.”
She also looks for substance abuse, most often alcohol. She had one patient whose daughter was concerned that her mother was drinking more alcohol than she had previously. The mother reluctantly admitted that she was.
Longwell said it’s important to look at the mental health as well as the physical fitness of each patient.
When she sees a geriatric patient, she sometimes does the “get-up-and-go test” where she asks them to stand up out of a chair, walk a short distance, turn around, walk back and sit down again.
“Do they look off balance? Is it hard to get up or down? Can they turn without losing their balance? If they have anything that’s off, I’ll ask them about it. It’s a simple test, but it can tell you a lot.”
As people age, things change, and “you get used to a new normal. They may have an issue, but they say “I thought it was normal when you get older.’ But we don’t want you to live with things that put you at risk of not living well.”
The upshot of all this is: “If you can prevent falls, you can prevent injury and increase a person’s sense of wellness.”