En español | Emergency departments treat more than 3 million older Americans each year for fall injuries.
One out of every 4 people age 65 and older is likely to be one of them. And those falls can be the beginning of a downward spiral.
“I use the phrase, ‘Fall is a four-letter word,’ ” says Dr. Lisa Caruso, a geriatrician at Boston Medical Center who also holds a master’s degree in public health. “Falls are definitely something we ask about and want to prevent.”
That’s because mobility is key to independent living.
When people begin to lose their balance or fall frequently, not only is injury possible, but they’re often no longer able to do the daily activities that used to come easily.
“The important message to always give is that we want you to maintain your independence,” Caruso says.
If you begin to notice your parent or spouse is having some trouble standing up and walking around, here are some steps you can take to turn things around.
The danger of a broken hip
The chances of fracturing a hip increase as a person ages. The injury is considered among the most serious consequences of a fall because many people cannot live on their own afterward.
• More than 300,000. The number of people 65 and older hospitalized each year for hip fractures.
• 95 percent. The rate of hip fractures that come from falling, usually sideways.
• Three quarters. The percentage of all hip fractures that women suffer, in part because they are more prone to osteoporosis. Osteoporosis makes bones more porous and fragile.
Talk it out
Deb Hallisey remembers the first time she noticed her mom’s decline in mobility.
“We were actually at a family gathering and she was walking out, and she fell. And she was so embarrassed,” says Hallisey, an author and eldercare advocate who started Advocate for Mom and Dad LLC in New Jersey.
Hallisey realized she had to change the way she broached difficult subjects with her mom, who is now 87.
“I call it the ‘drip method’ with my mother,” she says. “I bring it up multiple times, in multiple ways, in different situations where there’s an opening.
“And it’s always not a ‘you should, you must’ statement,” Hallisey says. “It’s a ‘I noticed this. I’m concerned. Would you like me to look into this for you?’ — keeping the control with her.”
Get it checked
Once you’ve started the conversation, making a medical appointment is the next crucial step, says Dr. David Reuben, chief of the Division of Geriatrics at the University of California, Los Angeles, Center for Health Sciences.
“Get an evaluation,” he says. “See where you’re starting from.”
A physician might do a strength, gait and balance evaluation or order a bone-density scan. The doctor will check things such as blood pressure and heart rate after standing, and underlying conditions. Hearing and vision should also be checked.
The physician may suggest ways to improve function; write a prescription for physical therapy, which Medicare often covers; or discuss surgery options or medicines that might help.
Do a pharmacy review. The doctor also can check your list of prescribed and over-the-counter medications to see if anything may have side effects of dizziness or sleepiness that could lead to falls.
Get an eye exam. Not only can the right prescription glasses help people see where they’re going, but researchers have found that procedures such as cataract surgery can help older people reduce falls.
That’s a common fix since 1 in 5 adults older than 65 has a cataract.
Pay attention to diet. Dehydration can lead to weakness, so make sure your love one stays hydrated and limit alcohol use.
If your loved one’s vitamin D level is low, the doctor might encourage taking vitamin D every day. Or to improve bone density, a suggestion might include calcium-rich foods, like milk and yogurt.
“The best and most robust data that we have is that even increasing your physical activity a small amount every day can really have very powerful effects on older people’s physical function and also prevent them from becoming disabled,” says Roger Fielding, associate center director of the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University.
It’s never too late to start exercising, says Fielding, a senior scientist who has spent the past 25 years studying how skeletal muscle mass functions as people age.
“Even trying to walk 10 to 15 minutes, just a comfortable pace, every day, seems to help prevent mobility decline,” he says.
Add strength training. Your local senior center or YMCA might offer classes such as resistance exercise or strength training.
“The biggest thing we know is that even in very old people, the capacity of your muscles, your skeletal muscle, to adapt and respond to exercise, it doesn’t appear to be lost,” Fielding says.
Try tai chi. “They’ve just done studies on what kinds of exercises help, and the No. 1 exercise is tai chi,” says Dr. Suzanne Salamon, a geriatrician in Boston who is associate chief of clinical geriatrics at Beth Israel Deaconess Medical Center. “And a lot of senior centers have tai chi classes. It builds up your muscle, and it helps balance.”
A study published in 2018 in the Journal of the American Medical Association Internal Medicine looked at 670 adults 70 years or older with a history of falls or impaired mobility and found that falls were reduced by 31 percent in the tai chi group compared with a group that did a mix of aerobics and exercises for strength, balance and flexibility.
Use it or lose it. Whatever you do, keep moving, Caruso says.
“Stay as active as possible, whatever that means for you,” she says. “If that means taking a walk down your hallway three times a day and back, or if that means going out to a gym and working on cardio machines, whatever that means for you to maintain your level of functioning, stay active.”
Try a device. If your loved one already has mobility problems and function can’t be restored, it’s time to think about using a cane or walker, Reuben says. It can be a humbling discussion.
“These are big psychological issues,” he says. “We’re used to being on two legs. There’s an old, very famous riddle from ancient times: ‘What walks on four legs in the morning, two legs in the afternoon and three legs at night?’ And it’s man: All fours as a child, two feet as an adult and with a cane as an elderly person.
“What I frequently try to do is frame it with patients is the purpose of these is to keep you out, keep you active, keep you mobile, but doing so safely,” he says.
Make it fashionable. If the idea of a cane is a hard sell, you can appeal your loved one’s sense of style.
“It’s starting to be fashionable now to use walking sticks, the kind you use for hiking,” Salamon says. “And you can use either one or two, just like the hikers do. And I’ve had a few, not a lot, but a few patients who kind of perked up at the idea of using a walking stick instead of a cane. Somehow, it doesn’t have the same connotation.”
Consider a walker. Today’s walkers aren’t like they used to be either, Salamon says.
Medicare covers basic models, and upgrades are available online for less than $100. Modern ones are nicer-looking than the old days and much more stable, she says.
Some come with seats and baskets, four wheels and even hand brakes.
Focus on safety
Around the house, make things safer by getting rid of clutter and taking other precautions. For example:
- Remove trip hazards from the stairs.
- Repair loose railings.
- Remove or secure loose rugs.
- Add task lighting.
- Put a nightlight in the bathroom, and make sure the floor isn’t wet.
“My mother and father were very smart,” says Hallisey, the eldercare advocate who helps care for her mom. “They took out the tub and put in a walk-in shower with a bench years ago. They put up grab bars.
“I put up a higher toilet because she was struggling even with the grab bars. We did a lot more task lighting,” she says. “One of the best things I ever did was buy her an Alexa because we have smart plug-ins. She can turn things on and off at will.”
Get a medical alert device. Salamon tells her patients that their best insurance may be to get a medical alert device that they can wear on their wrist or around their neck.
The devices are waterproof, so they even work in the shower. And if the wearer falls, the person can at least call for help.
They come with a monthly fee, but “it’s extremely reassuring,” Salamon says.
Don't be afraid of scare tactics. If other approaches aren’t working, Salamon isn’t afraid of using scare tactics with her patients, who range in age from 65 to 104.
“I say, ‘Don’t you know anybody that’s broken a hip? And they almost always do. And, you know, it can be really devastating.”
So, she appeals to their desire to say on the safe side.
“Most people, even if they’re 90 on the outside, they’re 40 on the inside, and they like to think of themselves that way,” Salamon says. “I think all of us think that we’re younger than we actually are. So I just try to appeal to their staying independent more than anything else.”
Tanya Bricking Leach has been a journalist for more than 25 years, covering everything from health care to hurricanes.