Every year, one out of every three adults over the age of 65 takes a tumble. And every year during Falls Prevention Week, senior sites and mags issue warnings.
So why are we here again?
We all know the basic precautions for avoiding falls: installing grab bars, lining the shower floor with a rubber mat, securing scatter rugs with non-skid backing. And yet we’re still falling. The reason: There’s not enough talk about the secret causes of falls; the hidden health issues and normal byproducts of aging that can make us prone to this potentially catastrophic event.
The problem As we age, our eyes refocus more slowly; that’s why we need reading glasses, bifocals or trifocals. But these glasses can blur faraway objects, impairing depth perception and contrast sensitivity. If you walk around wearing your reading glasses, you may miss a stair step or fail to see a loose extension cord on the floor.
What you can do about it If you wear multifocal glasses for distance vision while walking, tilt your head down, rather than looking with your eyes through the bottom part of the lens.
The problem Falling can be caused by problems in the way we walk, stand and even sit – commonly referred to as “gait.” Gait can be affected by factors ranging from joint problems to plain old age. Signs of gait disturbance include an unsteady or slow walk, poor balance, stooped posture, muscle weakness and slowed reflexes.
What you can do about it Your primary care doctor should perform the Tinetti Balance and Gait Evaluation, which looks not only at how and how fast you walk, but also how you get up from and sit down in a chair, and how you balance while standing with eyes open or closed. Every check-up should include the simplest gait assessment of them all: watching an older person walk down a hall.
The problem With age, we can lose some of the neurological functions that coordinate movement, such as sensation in the feet. Feedback from our feet, legs and inner ear, as well as our eyes, literally tells us where we stand.
What you can do about it Those thick-soled “sensible” shoes and sneakers can trip us up — literally. They dull sensation from the feet. If you’re prone to falls, you should actually wear thinner-soled shoes so you can feel the floor better.
Weak Knees (and Bad Canes)
The problem Some 70 percent of folks over 70 suffer from osteoarthritis, which often affects knees and feet, and thus your gait. If you have knee osteoarthritis, chances are you lack strength in key leg and thigh muscles, as well as in your core muscles and upper body. All of this makes you unsteady.
What’s more, the cane you use may actually be making you less steady. “Many people do not use canes properly,” says geriatrician Amy R. Ehrlich, MD, an associate professor of clinical medicine at the Albert Einstein School of Medicine and Montefiore Medical Center. “Especially navigating stairs.”
What you can do about it After a fall, you might be prescribed an assistive device by a hospital or rehab facility. Don’t just walk into the local drugstore and walk out with a cane; find a physical therapy practice in your area and get advice on its use, including the cane’s proper height.
Too Many Meds
The problem More than 60 percent of adults age 65 to 85 use five or more prescription medications, over-the-counter drugs and/or dietary supplements. Taking multiple meds puts nearly one in 25 older adults at risk for a major drug interaction that can lead to a fall. (See our article, “Your Meds Might Be Making You Sick”)
Big culprits include psychiatric drugs, sedatives and sleep aids, especially popular over-the-counter meds that combine acetaminophen and Benadryl.
What you can do about it Many falls occur in the morning (or during nighttime bathroom trips); when we get up from the bed, our aging bodies don’t adjust quickly from their normally-lower blood pressure during sleep. This problem may be compounded by OTC sleep aids or medications that lower blood pressure.
Mini strokes and Vascular Disease
The problem Many strokes are so small that they may go unnoticed. These mini-strokes, called transient ischemic attacks, in some cases can cause vascular dementia, leading to gait problems and falls. This is the second most common kind of dementia after Alzheimer’s disease.
If you have vascular dementia you may stoop, taking short, shuffling or halting steps, and often moving one foot forward, then stopping to bring the other foot next to it, rather than using a normal alternating stride. You may also fall backward due to a loss of normal postural reflexes.
What you can do about it Vascular dementia shares some physical characteristics with Parkinson’s disease, such as rigidity in lower extremities, which a doctor can feel during an exam. Since signs of vascular dementia may not be seen on brain scans, physical signs combined with cognitive testing can be helpful in making a diagnosis.
Fear of Falling
The problem One of the biggest hidden risk factors for falling is fear of falling. Many of us as we age, especially those who are naturally anxious, actually overestimate our risk of falls. And that starts a vicious cycle.
“People who fear falling do less. And the less you do, the less you want to do,” says Dr. Ehrlich. That means you walk less often, losing muscle mass and muscle memory. Being fearful can also prompt you to walk hesitantly, possibly leading to a fall.
What you can do about it Start building muscle mass with some simple chair exercises so you can start walking and build those muscles more. When you feel strong, you should feel less vulnerable.