August 19, 2018
The Best Ways to Prevent Falls

The Best Ways to Prevent Falls

by Peter Jaret

It’s easy to fall. You hit a patch of ice on the sidewalk, you miss a step in the dark, you trip over a loose rug, and down you go. Little kids fall all the time while they’re learning the delicate art of putting one foot after the other, of course. Unfortunately, at the other end of the age spectrum, as we get older, the risk of falling returns. And at a time when bones are brittle and reflexes slow, even a minor tumble can cause serious injury.

Falls are the leading cause of fatal and nonfatal injuries among Americans age 65 and older, according to the CDC. In 2014, the most recent year for which statistics are available, about 2.8 million Americans were treated in emergency departments for fall-related injuries; 27,000 older adults died from complications resulting from falls.

The older you are, the greater the danger of falling—and the more likely you’ll hurt yourself if you do. Nearly 27 percent of people ages 65 to 74 reported falling at least once in the preceding year; the number rises to almost 30 percent among those ages 75 to 84. And more than 36 percent of adults 85 and older reported falling at least once in the past year.

Many older people who fall never fully recover. A serious fall can be the beginning of a steep decline in health and quality of life. And even when people do recover from a tumble, they may become anxious and depressed afterward. Too often, older people begin to limit their activities and even become housebound for fear of falling. That, in turn, leads to a decline in physical strength and balance that putsthem at even greater risk of falling.

Are You at Risk for Falling?

Some factors put people at higher risk than others for falling, including lower body weakness, balance problems, and use of certain medications.

A preventable problem

The single most dangerous myth about falling is that it’s an inevitable part of aging. It isn’t—falls can be prevented. You can take plenty of precautions to avoid falling, public health experts say. The fact is, there are so many tips and recommendations out there—on websites, in magazine articles, from official organizations—that it can be difficult to know where to start.

An analysis published in the Journal of the American Medical Association (JAMA) sought to identify the best strategies that prevent falls and injuries in older adults. Canadian researchers reviewed resultsfrom 283 randomized controlled trials of fall and fall-related injury prevention programs. In all, the studies included 159,910 participants, ages 65 and older.

The researchers found that combining the following strategies works best to help older people improve their odds of not falling and avoiding injury:

  • Exercising. Hands down, the best thing you can do to reduce your risk of falling is to be as active as possible. Exercise is the crucial element of any fall-prevention program. Regular physical activity maintains muscle strength, flexibility, and balance, which makes it easier to avoid falling. Almost any kind of activity that strengthens muscles—especially leg muscles—and requires balance can reduce risk. Examples include tai chi, yoga, aerobics, stationary cycling, stair machine workouts, and even a brisk walk.
  • Getting your vision tested regularly. Researchers have long known that uncorrected vision problems add to the danger of falling. The JAMA study found that programs combining exercise with vision assessment and correction offered the most effective combination for reducing falls.
  • Fall-proofing your environment. Adapting your home to reduce the risk of falls can also keep you safe. More than half of all falls among the elderly happen at home. Here’s how to steer clear of trouble:
    • Clean up clutter to avoid tripping.
    • Keep electrical cords out of your path.
    • Remove loose carpets and rugs.
    • Place nightlights in bedrooms, hallways, and bathrooms.
    • Install grab bars near the bathtub and toilet areas.
    • Wear sensible shoes or slippers with nonslip soles.
    • Use a walking aid, such as a cane, if you feel unsteady on your feet.

  • Getting regular health checkups. Health problems like diabetes and high blood pressure add to the risk of falling. The study found that exercise programs that included basic health assessment and treatment were effective at reducing falls and injuries. During a checkup, your doctor can review the drugs you’re taking to make sure none increase your risk of falling by making you sleepy or dizzy—such as medications that lower your blood pressure, including some for prostate problems.
  • Taking vitamin D and calcium supplements. Many of the studies that the researchers analyzed show that taking calcium and vitamin D supplements is associated with a reduced risk of falls and fall-related fractures in people at risk for osteoporosis. However, other experts are questioning the effectiveness of the supplements, especially in people with already-normal levels of vitamin D. A large analysis, published in December 2017 in JAMA, concluded that calcium and vitamin D supplements were not associated with a lower risk of fractures in older adults. Before taking supplements, ask your doctor whether you should be tested for low levels of vitamin D.
  • Using hip protectors and orthotics. Several studies reviewed in the report found that hip protectors (pants with built-in pads on the sides to protect the hips) and orthotics (custom-designed shoes to aid stability) help some older people avoid falls and fractures.

A personalized approach to preventing falls

Exercise is clearly the centerpiece for fall prevention, especially activities that maintain or increase strength and require balance. Some people prefer exercises they can do on their own at home. Othersdo better in groups, where they have the encouragement of fellow exercisers. People who have joint problems may prefer low-impact activities, such as swimming and water aerobics. Since increasing activity isn’t easy under any circumstances, the best exercise for you is the one you’ll stick with.

The new report makes it clear that fall-prevention programs should be tailored to each individual. Here’s one good reason why: While overall, exercise reduced falls and fractures in almost all the studies analyzed, in some groups of patients—those who had fallen previously, for example—exercise temporarily increased the risk of injurious falls. Researchers speculate that exercise may encourage people who were previously sedentary to become more mobile and engage in more activities.

But if they aren’t careful, they can initially increase their fall risk. That’s no reason not to exercise. But it does mean that if you’ve been inactive and decide to start exercising, you should take it slowly, and consider engaging in exercises that improve balance, such as tai chi or yoga.

You've Fallen: Here's How to Get Up

How you react immediately after a tumble is critical to minimizing any damage. Here’s what experts from the National Institute on Aging recommend you do if you fall.

Where to begin

Your doctor can assess your current balance and strength as well as your overall health to determine your risk of falling. It’s important to tell your doctor whether you’ve fallen recently, even if you didn’thurt yourself and got right back up on your feet. A minor tumble is good reason to assess your health, strength, and risk factors for falling—and to start a personalized program to prevent another fall.

Also see Keeping Your Balance as You Age.

This article first appeared in the March 2018 issue of UC Berkeley Health After 50.