Don't Let A Fall Define You: Fall Prevention In Older Adults
Nearly 1 in 4 adults over the age of 65 report a significant fall each year.
This equates to about 36 million falls in the US each year. Of those 36 million, 8 million of those falls cause injury and 32,000 are directly related to death.
Falling doesn’t have to be just another inconvenient part of getting older. There are steps that you (or your parents and grandparents) can take to help prevent falls and maintain your independence.
Why Do Falls Matter?
Falls in older adults are a common and serious health concern, particularly for those aged 65 and older. According to the Centers for Disease Control and Prevention (CDC), falls are the leading cause of injury and injury-related deaths in this age group. As stated above, at least 1 in 4 older adults report falling within the last year, and the actual number may be higher. Research suggests that as many as 70-80% of falls go unreported, usually when no serious injury occurs.
In Minnesota specifically, around 28% of older adults have fallen within the last year, and the rate of death from a fall is nearly double the national average. Every non-fatal fall will create about $10,000 in medical costs, while fatal falls create around $26,000 in medical costs. In 2014, that equated to about $713 million in medical costs alone, not including costs relating to disability, decreased quality of life, or decreased independence.
Falls can lead to a variety of physical injuries, such as hip fractures, head injuries, and broken bones, and can also result in long-term consequences such as decreased mobility, loss of independence, and reduced quality of life. In addition to the physical impacts, falls can also have psychological and social consequences, such as fear of falling, anxiety, and social isolation. This can lead to a decreased willingness to participate in activities, which can further exacerbate physical and mental health issues and lead to a faster decline and loss of independence.
(Side note on hip fractures specifically - about 20-25% of older adults who fracture a hip will die within one year of their injury, likely related to a loss of independence, difficulties with recovery, low strength, and an overall loss of their will to live. Preventing a fall can prevent that injury, keeping you or your beloved older adult happy and independent for longer.)
Falls often start a cascade of negative events in an older person’s life. Once we (or our loved ones) can’t trust ourselves to stay on our feet, moving around can get more intimidating, whether you’re in your home or out in the community. When we stop moving, we get weaker, more unsteady, and generally unhealthier. We might also find it harder to be socially connected to our friends, our family, and our community, which can create some mental health issues like depression, which can further worsen overall health and quality of life. Both the physical and mental health issues can lead to an increased risk for another fall as well, which would then exacerbate these issues further, creating a downward spiral of injury, loss of independence, and overall physical and mental decline.
Needless to say, we don’t enjoy seeing ourselves or our loved ones declining as they age. While certain things are unavoidable when we age, much of what we consider “normal aging” is related to less-than-ideal lifestyle choices and societal beliefs. There are a number of things we can do to prevent falls and this subsequent spiral, but first, we need to understand why older adults are at a higher risk of falling.
What Causes Falls In Older Adults?
There are a number of things that can contribute to fall risk in older adults, and understanding these factors can help you to build a plan to prevent falls for you or another older adult in your life. Some things that can cause falls in older adults include:
Unsteady Gait - As we age, we tend to get stiffer, less mobile, and less able to react quickly to changes around us. Older adults tend to have shorter, smaller steps, poorer posture control, and slower reflexes. These issues can stem from decreased physical activity, certain chronic diseases (Parkinson’s, stroke, diabetic neuropathy, among others), and muscle weakness.
Poor Balance and Coordination - As people age, their balance and coordination can deteriorate, making them more prone to falls. Balance is related to three factors: vision, proprioception (position sense), and vestibular sensation (your inner ear). Typically in older adults, decreased vision and decreased proprioception are the cause of this decreased balance and coordination, though inner ear issues can also contribute in some cases.
Vision Problems - As stated above, vision is important for staying balanced. In addition, poor vision or visual impairment can make it difficult to see obstacles, changes in surfaces, or other hazards that could cause a fall. It’s important to stay on top of your vision and eye health, particularly as we age. Maintain good vision and eye health can keep you mobile and independent for longer, since you can easily move around your home, drive around town, and generally stay active and engaged.
Muscle Weakness - Older adults experience a decline in muscle strength and endurance, which can affect their ability to maintain balance and control movement. On average, adults over the age of 30 lose 6-8% of their lean muscle mass every decade, which doesn’t sound like much, but it adds up over the course of a lifetime. Without doing some sort of exercise, this loss of muscle mass can get even faster after age 60, leading to significant weakness, lack of endurance, and ultimately decreased mobility and ability to do the things you want to do in life.
Medication Side Effects - Over half of adults over age 65 are on more than 5 medications. Research also shows that the more medication you’re on, the higher your risk of falls. This is not saying to stop taking your medications, as that is outside of the scope of practice of a chiropractic clinic. What we are suggesting is to discuss your medications with your primary care or prescribing physician, particularly if you have fallen or are worried about falling, to see if there might be better options for you. For more information, click this link to view a guide from the CDC about fall risk and specific types of medications.
Environmental Hazards - Hazards in the environment, like clutter, uneven surfaces, or poor lighting, can increase the risk of falls. This is particularly of concern when coupled with other fall-related risks, like vision problems or poor balance, as a slight misstep in someone with balance issues could easily lead to fall, while someone with normal balance might be able to stay upright.
Chronic Health Conditions: Certain chronic health conditions can make falls more likely. Conditions like Parkinson’s and stroke can make balance harder, diabetic neuropathy or spinal stenosis can reduce sensation in your feet, and cardiovascular diseases like orthostatic hypertension can cause dizziness and general imbalance. Additionally, musculoskeletal conditions like arthritis can make it harder to stay active and healthy as we age.
Inactivity - Older adults who are sedentary or have limited mobility will likely have more muscle weakness and reduced flexibility, which can increase the risk of falls. Staying physically active, even if it’s doing chair yoga or something simple, is important for maintaining our mobility and independence as we age.
There are some general risk factors for falls that are unavoidable and often related to some of the other causes mentioned above. These include age (as you get older, your risk of falling increases), gender (women are slightly more likely to have a fall than men), and race (people of white/Caucasian descent tend to fall more often than people of black/Asian descent). While you should note these risk factors to see if you’re at a higher risk for falls, don’t focus on them too much; they are things you can change, and they’re likely more related to other factors listed above anyways.
How Can I Prevent Falls?
Now that we understand what might cause falls, we can discuss prevention in more detail. There are a number of recommendations for fall prevention, but ultimately you need to address your individual situation and environment to determine what the best way to manage falls is for you. If you need help doing that, Northbound Chiropractic offers house calls and mobile chiropractic care, allowing us to prove care in your home and get a look at your individual risks and concerns. Schedule a visit with us online, or by calling (763) 373-9710.
Some of these recommendations can be challenging. It’s hard to admit that you’re getting older or that you might not be as steady as you used to be. These can be challenging conversations to have, but they’re necessary to keep you independent and mobile. We do recognize these challenges, and we still encourage you to take the plunge and start sooner rather than later.
We’ll break down these recommendations into four categories: environment, physical activity, nutrition, and health concerns.
Environment - Staying Safe In Your Home & Community
Declutter your home - Having clutter around your home makes it harder to navigate. Ideally, you should have clear and open paths between the areas you visit often (your bedroom, kitchen, bathroom, living room, etc.), so you don’t have to move around obstacles or change direction as often. Decreasing clutter also reduces tripping hazards.
Secure loose wires and rugs - Loose wires and curled-up rugs are significant tripping hazards. Tape these down, remove them, or somehow secure them so that they can’t catch your feet as you walk.
Have proper lighting - Having enough light in your home is an essential part of managing fall risk, particularly in these northern states like Minnesota where natural light is limited for large parts of the year. Particularly, make sure that you have constant light sources like nightlights along common pathways, like in the hall between your bedroom and bathroom. Having an easy way to turn lights on, like lamps, is essential. Keep the lamps nearby and be sure that they’re easy to switch on and off. You could also consider an Alexa or other voice-operated device to turn the lights on or off for you!
Check your bathrooms - Having grab bars and non-slip surfaces in your bathroom and bathtub are essential parts of managing fall risk. You should have an easy to get on and off the toilet and in and out of the shower, so grab bars work well here. Additionally, you can consider getting a shower with a low step rather than a bathtub. All bathtubs or showers should have a non-slip mat in them to keep you from slipping on a wet surface. If you’re at high risk for falls, it might be a good idea to have someone in the house or on the phone with you while you bathe, just in case you take a tumble.
Your Community - Engaging socially with others in your community is important at any age, but it can be more challenging if you’re feeling unsteady or concerned about falling. Finding groups or activities that you can engage in is a key part of staying active and mentally well, so do some shopping around your area. Senior centers, churches, or community education programs might all be good places to look for these opportunities.
Physical Activity - Staying Active Is Essential
Footwear - Anytime you’re moving, even just around the house, having stable footwear is important. Shoes that cover your heel can help to keep you more stable. Avoid floppy shoes like flip-flops or slippers when possible, as these can easily catch on obstacles and throw you off balance.
Get consistent physical activity - This recommendation really depends on you and your physical capabilities. Ideally, get at least 150 minutes of some kind of activity every week (30 minutes, 5 days per week, or about 20 minutes every day). If you’re relatively healthy and mobile, walking, weight training, yoga, or almost anything else in the exercise world can be modified to work for you! If you’re less mobile, home exercises like sit-stands, balance exercises, chair yoga, and walking laps around your home can be a great place to start.
Consider Tai Chi - Tai Chi is a great option for physical activity, and the research has shown that it is very effective at maintaining your physical ability and reducing fall risk. There are classes available in most communities, or you can find guided videos on YouTube.
Consider Group Exercise Classes - These group exercise classes are guided, so you always know what to do next. Additionally, you get social interaction, and there are always people around to help if you take a tumble.
Staying physically active might be the most important thing you can do to manage fall risk. Everything else is great, but keeping your muscles and your body strong and healthy is one of the best things you can do as you age.
Nutrition - You Are What You Eat
Protein - Many older adults are at high risk for developing sarcopenia (age-related muscle loss) and weakness due to decreased physical activity and low protein and calorie intake. Adding extra protein can help manage these losses and thus prevent falls and frailty. Eating meat and eggs every day can help meet your protein goals, but a protein or meal replacement shake is a great idea as well, as it can provide a significant amount of protein without much effort.
Omega-3 Fatty Acids - Omega-3s many different parts of your body, like your brain and heart, as well as your mood and mental state. Most Americans (90-98%) are deficient in Omega-3s. Please note that if you’re on a blood-thinning medication, you should discuss taking omega-3s or fish oil with your primary care physician, as these two can sometimes work together to thin your blood too much.
Hydration - If you’re dehydrated, you’re more to likely to feel dizzy or unsteady, leading to a fall. Getting at least 6-10 cups of water with a pinch of salt per day can help maintain your hydration status. If you have kidney disease, these recommendations may be different, and you should discuss that with a healthcare provider.
Vitamin D with K2 - Vitamin D acts less as a vitamin and more as a hormone in your body, affecting many things from your bones to your immune system. Vitamin K2 helps to promote proper calcium deposition, pushing into your bones and not your blood vessels or other problematic places. Vitamin D doses vary significantly based on your body weight, overall size, and current blood levels, so it’s hard to make a dosage recommendation. In general, though, it’s safe to take up to 5,000 IUs per day, and many people take more without serious issues. If you’re going to start on a Vitamin D supplement, you should get your blood levels monitored consistently (at least yearly, if not every 3-6 months).
There are other things that you can do nutritionally to help with fall prevention and other aging-related issues, but these typically require a more individualized approach to help you get the best results. Some things like certain herbs, betaine HCl, or a multivitamin may not be a bad idea, but again should be addressed on an individual basis. Northbound Chiropractic provides nutrition services as well as chiropractic, so schedule an appointment with us today if you’re interested!
Health Concerns
Have regular check-ups - You should see your primary care physician and get bloodwork done on a regular basis to assess your current health status and monitor any chronic health issues you might be dealing with. As we discussed above, chronic health conditions can significantly increase your fall risk, particularly if they’re left unmanaged. Your primary care physician is also likely a good resource for other fall prevention measures as well, like physical therapy or other community services.
See an eye doctor - You should see your eye doctor at least yearly to evaluate your eyes and vision. Eye conditions like cataracts or glaucoma can impair your vision and your balance, and even having the wrong prescription can create significant issues.
Consider chiropractic care - Chiropractic care can help manage pain and other movement issues. Additionally, it can help with balance and sensation issues and may reduce the risk of falls. At Northbound Chiropractic, we also incorporate exercise in all of our treatment plans and can give you nutrition and lifestyle advice as well. Schedule your visit with us today, and we can start working to manage your fall risk.
Mental health concerns - Despite the fact that it’s not often discussed, many older people are at risk for developing mental health issues like depression, particularly when they are isolated or struggling with grief or health issues. Keep an eye on your mental status and energy levels, and consider talking to someone if you notice that you’re consistently feeling sad or low.
There are many more ways to reduce your fall risk, but these recommendations cover a large portion of them. The CDC has a great tool for creating a plan to manage your fall risk, and many local health departments or agencies can offer resources and assistance as well.
Parting Thoughts
Falls are a significant health concern in older adults. They can create serious physical injuries, like broken hips and head injuries, and also have a significant impact on mental health and well-being. Overall, they can create a downward spiral leading to loss of independence and severely reduced quality of life in our older adults.
Working to prevent falls before they happen is ideal, as it only takes one fall to significantly change your life. If you’ve already fallen, it’s still not too late to make changes to prevent future falls and injuries. There are a number of options you can take to prevent falls, primarily incorporating some exercise and lifestyle/home modifications into your daily routine. In addition, chiropractic care can help address some underlying issues that can create falls and provide a great resource to address any questions or concerns you might have about falls.
If you’d like more information about falls and fall prevention, visit the CDC Older Adult Fall Prevention webpage. Many local health departments have resources for fall prevention as well, and you can find their information in the phonebook or with a quick Google search.
At Northbound Chiropractic, we offer mobile/house-call chiropractic care for you and your family, including that older adult in your life who might struggle to get out of the house. We are a participating Medicare provider and can work with most Medicare Part C/Replacement plans as well!
Click the button below or call or text us at (763) 373-9710 to learn more about scheduling an appointment with us.
Giving you my best,
Dr. Nicholas Carlson
Northbound Chiropractic
Serving Delano, MN, Maple Plain, and the rest of Wright and West Hennepin Counties
**Note: These recommendations do not replace advice given by your healthcare provider. Always consult your healthcare provider for personalized medical advice. These are general recommendations, not specific to any one person or condition. Never perform any stretch or exercise that causes pain or discomfort. If you have physical discomfort or pain, stop immediately and contact your healthcare provider. Recommendations and Information provided are designed for informational purposes only, they are not intended to diagnose, treat, or cure any disease.