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New Thinking on Avoiding Deadly Falls

Fatalities from injuries among older adults are rising dramatically — and the advice for preventing them is changing

Woman climbing stairs with walker

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Supplements to strengthen bones no longer are touted as the best way to prevent fractures from falls.

En español | For anyone over a certain age who worries about taking a nasty tumble, a report released this spring by the Centers for Disease Control and Prevention wasn't exactly comforting. It showed that for those 65 and older, falls are the number one cause of injury and death from injury. Plus, the number of falls is surging.  Even after adjusting for the population growth of older adults, the agency found that the death rate from falls  increased 31 percent from 2007 to 2016.

Experts aren’t sure why such deaths are on the rise, though there's been some speculation that it’s related to the growing number of older adults living with chronic conditions and taking medications for them, says Elizabeth Burns, a health scientist within the Division of Unintentional Injury Prevention of the CDC’s Injury Center. Still, she says, it’s important to remember that “falls are not an inevitable part of aging” and many falls are preventable. With education and support, you can stay healthy and active for many years to come. Here's what you need to know now to stay on solid footing.

Calcium Is Out, Exercise Is In

While it was once standard advice to boost your calcium and vitamin D intake to fend off fractures caused by falls, new guidelines from the U.S. Preventive Services Task Force back off from that approach after finding evidence that such supplements don't always do much for the general population, and that mega-doses (such as more than 5,000 IU per day) may actually cause harm.

JoAnn Manson, M.D., chief of preventive medicine at Harvard-affiliated Brigham and Women’s Hospital in Boston, recommends talking to your doctor about the pros and cons of supplements for you — since extra calcium, say, may still be appropriate for those with known deficiencies or who are at high risk for falls. But the bigger point, she notes, is that “you can’t rely on popping calcium or vitamin D pills to prevent falls or fractures. There are other, more effective interventions.”

Chief among these? According to the task force guidelines, exercise is your No. 1 weapon against falls. Research shows simply staying active can reduce your risk of a tumble by 10 to 20 percent, and exercising more than three hours a week is linked to a 39 percent reduction in falls.

You can take a group exercise classes, do yoga, walk or even clean the house — as long as it’s something you can do consistently, says Eric Larson, M.D., vice president for research and health care innovation at Kaiser Permanente Washington and author of Enlightened Aging: Building Resilience for a Long, Active Life. “The hard thing for many people when it comes to exercise is getting started and sustaining,” he says. “Make exercise like brushing your teeth — something you do every day no matter what.”

Your exercise will be even more effective at preventing falls if you do the following:

Add strength and resistance training. People on average lose about 30 percent of their muscle power between ages 50 and 70. That leads to weakness, which can increase your risk of falls and fractures. If you strength train, however, you can actually reverse age-related muscle loss, says Greg Hartley, a board-certified physical therapist in Miami and president of the Academy of Geriatric Physical Therapy. That doesn’t have to mean lifting weights. Pilates, resistance bands and body weight exercises like push-ups or planks also build muscle.

Strengthen your quads. While it’s best to strengthen every major muscle group, if you have time for only one, focus on the big muscles at the front of your thighs, Hartley says. Your quads carry your body weight when you walk and help you catch yourself if you trip, and studies show quad strength is a strong predictor of your likelihood of a fall. One easy exercise to start with: wall slides. Lean against a wall and slide down into a squat, and then stand up again, using the wall for support. Try to do at least two or three sets of 8 to e12 reps at least twice a week. Eventually, try squatting without wall support.

Work on your balance. If you’ve been feeling a little wobbly, a physical therapist can work with you on exercises to improve your balance. Or look for a community balance program such as A Matter of Balance, Stepping On, Otago, Fallproof!, or Stay Active and Independent for Life (SAIL). Another great option is tai chi, a gentle Chinese practice that focuses on balance. It has been found to reduce falls in seniors by up to 43 percent In the short term (under one year) and 13 percent in the long term. 

Other ways to lower your risk of a fall

While exercise is now the top advice for fall prevention, experts say that the following steps — and we bet you haven’t thought of a couple of these — are also important. 

Get your vision checked regularly (and rethink your bifocals). Poor vision increases your risk of falling, Manson says. Cataracts, glaucoma and macular degeneration make it harder to see objects in your path, and even small changes to your vision can make it more difficult to judge depth and distance. In addition, if you wear multifocal or bifocal glasses, research shows they actually put you at greater risk because they can make it harder for you to see the area around your feet (so it’s easy to miss a bottom step or a crack in the sidewalk). If you regularly take walks, navigate up steps or spend time outdoors, talk to your eye doctor about switching to distance-only lenses during those activities. One study indicates the switch could lower your risk of a fall by about 40 percent.

Ask your doctor to check your meds for fall risk. Many medications have been linked to falls, including sleep aids, blood pressure medications, antihistamines, muscle relaxants and pain relievers. Drugs can interact with each other or cause fluctuations in blood pressure that can make you feel unsteady. If you sometimes feel lightheaded when you stand up, ask your doctor to test your blood pressure when you move from a lying or sitting position to standing, Manson says. A small dosing adjustment or change in medication may easily solve the problem.  

Choose the right shoes, and wear them in the house. Shoes that tie, buckle or close with Velcro are safer than those that slip on, Hartley says. And if you haven’t had your feet measured lately, do it. Aging feet flatten out and change size, and tight footwear makes it harder for you to respond to variations in the ground while you’re walking. To prevent slipping, look for rubber soles like those on sneakers. If you must wear dress shoes with smooth soles, scuff them up first by rubbing them on a cement sidewalk. Also, don’t leave your shoes at the door, Larson says. Research indicates that people are more likely to fall at home if they go barefoot, or wear only socks or slippers.

Make your home safer. Six out of every 10 falls happen at home, according to the National Institute on Aging. With that stat in mind, go through your house or apartment removing clutter and tripping hazards. Pick up any throw rugs, including the ones in your bathroom and kitchen. (Replace them with mats that have rubber backing and don’t slide.) Tuck electrical cords away, and install railings on both sides of any stairs. Use bright bulbs to create strong lighting throughout your house, and invest in a nightlight if you get up at night. Finally, add grab bars inside and outside your tub or shower and next to the toilet. 

Talk to a doctor about any dizziness. Dizziness is a common complaint among seniors, but don’t assume you have to live with it. If you experience dizziness when you stand up or turn your head quickly, you may have a condition called benign paroxysmal positional vertigo, or BPPV. The result of age-related changes in the inner ear, BPPV causes about half of all vertigo cases, according to the Vestibular Disorders Association. The good news? A trained physical therapist or an ENT (ear, nose and throat) doctor can do a series of maneuvers that cures it in most people.

Make sure you’re using your cane or walker correctly. Using a walking aid can help you avoid falls, but if you don’t have the proper fit or you use it incorrectly, it can actually cause you to stumble, Hartley says. If you borrow a device from a friend or family member, bring it to a physical therapist to get it properly fitted and to receive instruction in how to use it properly. The walker or cane should be about the height of your wrist when your arms are at your sides, Hartley says. If you use a cane, make sure it has a good rubber tip, and hold it on your stronger side (so if you have a weak left knee, hold your cane in your right hand). Otherwise, make sure you’re stepping “in” to any walker you use, and don't let it get too far ahead of you.

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