Legend of the Falls

This is an update of a previous post which I wrote in 2014 on the same topic and which richly deserves an UpGrade.

You Can't Handle the Truth

Remember that famous line from the movie, A Few Good Men?

Well, the truth when it comes to seniors and falling may be hard to handle too, but we as UpGrading Seniors need to be fully aware of the risks - and of the steps we can take to reduce the odds of becoming a casualty.

Just the Facts, Ma'am

So, if you're ready, let's take a look at the facts:

  • More than a third of adults 65 and older fall each year
  • Falls are the most common cause of hospital admissions for trauma among older Americans
  • Falls are the leading cause of death by accidental injury among those over 65
  • CDC estimates 29 million falls occurred to older (65+) adults in 2014
  • 2.8 million people 65 or older are treated each year in emergency departments for fall-related injuries
  • Over 800,000 patients a year are hospitalized for a fall-related injury
  • The most common injuries suffered in a fall that results in hospitalization are a traumatic head injury or a hip fracture
  • Each year over 300,000 older people are hospitalized for hip fractures, and 95% of those fractures are caused by falling
  • Women are 67% more likely to suffer a non-fatal injury from a fall than men
  • The odds of fall-related fractures are more than twice as high for women
  • But, when it comes to dying from a fall, the fatality rate from falls was 49% higher for men in 2004
  • The direct medical costs for fall injuries are $31 billion annually, two-thirds of that figure being hospital costs
  • Only about half of older adults who are hospitalized after a serious fall can return home and live on their own
  • One in three adults who were living independently prior to a hip fracture had to remain in a nursing home for at least a year following the injury
  • One in five hip fracture patients dies within a year of the injury
  • An older adult who falls is twice as likely to fall again than someone who has never fallen

Why Do We Fall?

So, it's obvious that falling is a serious threat to our health, independence and even survival as UpGrading Seniors.

Maybe we should try to figure out what causes us to fall in the first place and what we can do to avoid those causes.

Many of the most common causes are obvious, but some are not.  Here are the common causes of falls suffered by seniors:

  • Difficulty walking
  • Poor balance
  • Weakness in the lower body
  • Impaired vision
  • Inappropriate footwear
  • Loose rugs or other obstacles on the floor
  • Slippery surfaces such as concrete after a rain
  • Stairs, especially those without handrails
  • Lack of vitamin D
  • Use of medicines such as tranquilizers, sedatives or antidepressants. Even some over-the-counter medicines can affect your balance
  •  Incorrectly administered prescription drugs, especially during a hospital stay (see discussion below)
  • Various combinations of all of the above risk factors.  Most falls are caused by a combination of risk factors

What's Our Plan For Fall Prevention?

OK, we UpGraders now have the facts and know the consequences that await us if we become a casualty of a fall, but what can we do to decrease our odds of falling?

First, let's just get this hard, cold truth out there in typical UpGrading Senior style: a high percentage of falls by seniors are self-inflicted, either directly or indirectly.

Yep, that's right.  We do it to ourselves through our actions or omissions.  That's a good news/bad news situation.  At least for self-inflicted problems there is a solution!

The reality is that many or perhaps most falls occur because:

  • We allowed ourselves to get too fat
  • We allowed our muscles, especially in our lower body, to become too weak
  • We were careless (choosing the wrong shoes, walking on ice or snow, walking in the dark, failing to pick up obstructions on the floor, climbing a ladder when we knew our balance was impaired, etc.)
  • Inappropriate use of drugs or alcohol
  • We failed to install safety equipment (handrails on stairs or in the bathtub) when we knew we probably should

Recommended Actions To Decrease Your Likelihood Of Falling

So what, specifically, can we UpGrading Seniors do to be sure we don't fall?  Here are some suggestions:

  • Lose weight if you need to
  • Get up off your rear and get in shape, focusing on strength and balance exercises
  • Remove the clutter from around your house, especially on the floor
  • Install handrails on stairs and tubs
  • Have your vision tested annually
  • Don't wear bifocals when walking or climbing stairs
  • Ask your doctor to evaluate your risk of suffering a fall
  • Don't place unsecured rugs on your floors
  • Be sure your home is well lit, including outdoor areas
  • Don't be stupid by trying to walk on uneven surfaces in the dark or walking on ice, etc. Some astute individuals might suggest that playing on a slackline like your UpGraded Senior-In-Chief is stupid, to which I reply "yes it is, but it improves my balance and coordination and it's fun!"

Selected Short Subjects Related to Falls

Talk To Your Doctor

There are 3 questions that the CDC recommends that health care providers ask their patients who are 65 or older and which you can ask yourself:

  1. Have you fallen in the past?
  2. Do you feel unsteady when standing or walking?
  3. Do you worry about falling?

If you answered "Yes" to any of these questions, your doctor can perform a risk assessment to evaluate the likelihood that you will fall.  The assessment would include asking about previous falls, assessing your gait and balance, reviewing your medications (especially those that might affect vision or balance), recommending strength and balance exercises, and (surprisingly) taking a vitamin D supplement for improved bone, muscle and nerve health.  I think natural vitamin D from the sun is preferable, but I'm not a doctor.

Electronically Prescribed Drugs May Contribute To Falls By Elderly Patients

Coincidentally, as I was writing this blog post about the risk of falls for seniors, Medical News Today published this report, which points out that 62% of falls by elderly patients in a hospital occurred in patients to whom high risk medications had been administered within 24 hours of the fall.

What I didn't realize is that the dosages for so-called "high risk medications" are often electronically prescribed without adjustment for the age of the patient and that the default dosages were actually higher than recommended for 41% of medications that were examined.

Exercises You Can Do

There are many exercises that you can do at home to increase your odds of avoiding a fall.  Some are simple and some are more advanced (slacklines come to mind).  Here's a basic one to try if you physical abilities are restricted.

Sit near the front of a sturdy chair with your feet flat on the floor. Keep your back straight and your hands resting gently on the sides of the chair. Breathe in slowly, lean forward, breathe out and slowly stand up using your hands as little as possible. Take a breath and then slowly sit back down. Ideally, do at least 10-15 repetitions and use your hands as little as possible. As you get stronger, you can increase the number of repetitions you do.

And, here are some videos with a little more advanced balance and stability exercises:

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