Falls are very common. If you are sixty-five or older, you have a one in three chance of falling this year, and these falls are not innocuous. Your life can change in a second when you fall off a ladder, trip on a sidewalk, or slip on a wet bathroom floor. Falls account for more than half of injury related hospitalizations. One in eight fractures seen in the emergency department is a hip fracture.
As a geriatrician, I see fall prevention as the most important factor in fracture prevention. No matter what your bone density may be, if you do not fall, your chance of having a nonspine fracture is small. More than 90 percent of hip fractures are a result of falls. Falling is a strong risk factor for fractures.
Rates of Falls in the US
The rate of falls and the severity of the resulting injuries increase dramatically with age. The highest rate of deaths attributed to falls is in the oldest age group, eighty-five and older. Based on these figures, you can see why persons aged sixty-five and older are targeted for fall prevention.
It is extremely important to prevent falls. While it may not be possible to completely prevent them, you certainly can lower the risk. The likelihood of “freak accidents” can be decreased with attention to fall-proofing yourself and your environment. Accidents do happen. My husband, who studied airplane mishaps in detail as a naval aviator, preaches “Situational Awareness.” Take your time, don't rush, and keep alert to all your surroundings.
The biggest offender I see every day is cell phone use—walking and talking on your cell phone or, even worse, texting. You can't be alert to your surroundings while walking and using your cell phone. Concentrate on the task of walking. If you get a phone call, stop moving before you take the call. Do not walk and text at the same time.
Another lesson from airplane mishaps: Accidents occur as a result of a chain of events. If any link in the chain is broken, the accident will not occur. Your job is to lessen your risk of a fall by preventing events that would lead to an accident. Usually, there are modifiable risks in the chain of events leading up to the fall. Falls are not entirely random events.
YOUR STORIES…
Bruce, age seventy-six, was cutting the branches off a neighbor's tree because they were hanging over his side of the fence. He leaned too far to reach a branch and fell off the ladder, landing on his left side and breaking his left hip. He ended up in the intensive care unit because a tear in his spleen caused massive blood loss. Bruce's injuries and the repair of his hip put him in the hospital for two weeks. His full recovery, which allowed him to get back on his surfboard every morning, took an entire year.
Stay off ladders!
Ladders are dangerous. Take them out of your parents' garages so that they won't be tempted. I caught my eighty-plus-year-old father pulling out his ladder to hang Christmas decorations. Add staying off roofs to the list, too.
WHERE DO FALLS HAPPEN?
- Away from home?
- At work?
- On vacation?
Answer: More people are injured at home than anywhere else. Your home is a dangerous place. More fractures are seen during the winter, even in places without snow and ice. This is because most fractures actually occur indoors. Hip fractures are most likely to occur from a fall while standing or walking.
Interestingly, most fractures from falls occur during daylight hours. How ever, in my experience, nighttime is the most dangerous. Getting up to go to the bathroom during the night can be hazardous to your health.
Turn on the lights!
As you age, you need greater amounts of light. By sixty, you need about three times more light to see clearly than the amount you needed when you were in your twenties. Do not climb the stairs in the dark.
Stairs and steps are probably the most dangerous places in your home. A single step can be just as dangerous as a set of stairs. Always use a handrail. Do not leave objects on the stairs (I am guilty of this—leaving a stack of clothes or some books on the lower steps to take with me on my next trip up.)
Keep yourself safe while you move around your home:
- Get rid of scatter rugs and mats. This is one of my pet peeves. They are huge fall hazards. Toss them out, even the nonskid ones.
- Keep clutter off the floor.
- Immediately wipe up any spills on the floor. Keep an eye out for spills around your pets' water bowls, too.
- Wear well-fitting footgear while you are inside and outside. Get rid of your loose-fitting bathroom slippers and cheap plastic flip flops.
Outside, beware of sidewalks in your neighborhood! Sidewalks are a big hazard. They are often uneven or have cracks, holes, or a dangerous carpet of dead leaves and branches that could make you trip or slip.
BALANCE
Core muscle strength, along with strong thigh (quadriceps) muscles, are the keys to good balance. Even if you are physically fit, these muscle groups are not necessarily being engaged in your workouts. People are always amazed when they try a balance device such as a BOSU trainer and have difficulty. I will use the example of my strapping seventeen-year-old godson. He is a high school football player and the picture of health. I gave him this task: Stand on the BOSU, then squat. He fell over. He could not do it.
Core strength and balance ability are very deceiving. They look easy, but they are not. Add balance exercises to your regimen. Do what is appropriate for your level of function. Research studies show that it takes doing such exerscises three times a week to make a difference. You will know because you will have instant feedback. Your wobbling will improve with practice.
BE PREPARED
Make a plan in case you have a fall. Your homework is to practice getting up from the floor. Wait until you have someone around to help you. Then, go through a practice scenario. Get down on the floor and pretend a fall has happened. If you cannot get back up, discuss what your options are to get help. Make emergency plans. Being prepared will help you stay calm if you ever do fall.
If a Fall Happens…
If a fall cannot be avoided, toss anything you are carrying. Try to fall forward and to roll into the fall. Relax your muscles, if possible.
Once you have had a fall, the chances of another are even greater. Go systematically through the series of events just as though you were trying to find out why an airplane crashed. What can you change to prevent a fall from happening again?
Falls can also have psychological consequences. Fear of falling again and loss of confidence can set up a vicious cycle that leads to even less activity and poorer function. Professional help is needed. What I call “a touch of physical therapy” is not enough. Six to eight sessions with a physical therapist is the starting point. For the therapy to work, it needs to be consistently done week after week.
An evaluation of forty-four exercise research studies for falls with almost ten thousand subjects examined different features of the exercise programs. Three factors were found to be key for fall prevention exercise programs:
- Balance training
- “Exercise dose” over fifty hours
- A walking program was not included
The greatest effects of exercise for reducing falls were obtained from programs that had these three components. The exercise dose of fifty hours was considered the minimum. It is equal to a twice-a-week program, over the course of twenty-five weeks. The third factor may have surprised you. But the risk of falls is greater while walking. However, because of the other benefits of walking, you should not exclude it from your regular exercise routine. The research results point to getting a more intensive program with appropriate medical supervision.
Other studies, not focused on exercise, showed robust decreases in falls when vitamin D is given as a supplement. Vitamin D may help improve your muscle strength. The simple measure of adding this vitamin may make a difference in lowering your risk of falls. The vitamin D level for optimal thigh (quadriceps) strength should be over 30 ng/ml, which is short for nanograms per milliliter. More on this topic is included in the section on vitamin D.
Falls have multiple causes. More than four hundred separate risk factors have been described. Many of them are potentially modifiable. The challenge is to identify the risks and remove them from the chain of events that could lead to a fall and an injury. Any one event taken out of the equation means that the fall will not happen.
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The Bare Bones
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