Here’s a sobering statistic: According to the Centers for Disease Control and Prevention (CDC), about 1 in 4 adults age 65 or older will take a fall at least once a year. One out of 5 of those wipeouts will cause serious injury or worse: Impaired vision more than doubles the risk you’ll take a tumble.
“Balance is controlled mostly by vision,” explains Pamela Beach, professor of motor behavior and codirector of the Institute of Movement Studies for Individuals with Visual Impairments at SUNY Brockport. “Seventy percent of the sensory receptors in our bodies are located in our eyes. When you lose vision, you’re losing much of that critical information, which makes it more likely that you’re going to lose your balance.”
Check out these strategies for staying on your feet, which are particularly useful if your vision is poor.
1. Give your rooms the once-over
“On slippery floors, use rugs with nonslip padding under them,” suggests Natalie Baker, president of the Gerontological Advanced Practice Nursing Association. Clear trip hazards, such as power cords and clutter. Install handrails along stairways or steps going to your house, the garage, basement or second floor. Place contrasting anti-slip tape to the edge of steps so they stand out, and use contrast to distinguish items, like a dark bath mat with rubber backing on a light floor (see this resource for more home-safety ideas).
An occupational therapist or certified aging-in-place specialist (CAPS) can suggest modifications to make your home safer, says Baker. Contact the National Association of Home Builders (800-368-5242) or go to its website, nahb.org, and look under Find a Certified Aging-in-Place Specialist. AARP also has a checklist of safety improvements you can make to prevent falls in your home
2. Light the way
Illuminate pathways inside and outside your house. “Use night-lights or sensor-motion lights for navigating in the dark,” says Baker, particularly in hallways and in the bathroom. Add toe-kick lights around kitchen islands or cabinets, and motion-sensor night lighting to illuminate a path inside or outside your home. Put lights on timers so they automatically come on at dusk. Invest in smart technology, like Alexa or Google Home, to set up voice-activated assistance that allows you to use your voice to turn on a light when entering a dark room. Install overhead lighting to eliminate shadows in rooms, and open curtains or blinds during the day to let in natural light.
3. Consider your eyeglasses
Have your vision checked regularly to make sure your prescription is up to date. And though your bifocals and progressive lenses — with different areas of correction for near and distance vision — may be fine for reading, wearing them constantly can increase your risk of falling. A study published in the British Medical Journal found that single-lens distance glasses were associated with 40 percent fewer falls outdoors in highly active wearers near 80 years of age, compared with multifocal glasses. So it can’t hurt to keep a spare pair of single-vision distance glasses on hand for when you go out.
Also be careful when you get new glasses with a big change in prescription; while you’re adjusting to the difference, your balance can be thrown off-kilter by causing objects to appear closer or farther than they are, according to a 2014 study published in the journal Optometry and Vision Science.
4. Work those legs
Age-related muscle weakness can contribute to falls. Focus on exercises that build strength and flexibility. Sit-to-stand exercises strengthen the quadriceps — the group of muscles that cover the front and sides of the thigh, which are some of the most important muscles for preventing falls. Ankle mobility is equally important because if the muscles and tendons that surround the joint are stiff, you have less range of motion, making it harder to maintain your balance. (See sidebar for exercises.)
5. Improve your reaction time
How quickly you’re able to react to a situation — say, trying to right yourself when you step onto a patch of ice or after a stumble — decreases over time. That’s why power exercises (basically, strength exercises done faster) are important. “Increasing power will help you to react more quickly because you are training your body to move more quickly,” Beach explains. “That is critical with falling, when you have to take that quick step or make that quick adjustment.”
“Lunges are also great for lower-body strength and, when done with increasing speed, can increase power,” Beach adds.
6. Practice proprioception
Good balance depends not only on vision but on proprioception, a fancy word that basically means the ability to sense the position and movement of your body in your environment. Much of our proprioceptive information comes from the bottoms of our feet. Practicing standing on uneven surfaces or something that’s a little compliant — say, a garden mat, balance mat or square cushion — in bare feet while doing the dishes can help you focus more on that proprioceptive information and less on visual information.
7. Try tai chi
This gentle form of martial arts is another great way to improve proprioception and balance. “When you’re practicing the movements, you’re shifting your weight from one foot to the other to maintain balance. By doing this, you become more aware of the position of your body in space, something we become less aware of as we age,” says Michael Irwin, a professor of behavioral sciences and director of the Mindful Awareness Research Center at UCLA. Tai chi also creates a kind of “softening,” according to tai chi fitness expert Scott Cole. “You learn to sink into the earth and feel the connection with your feet,” which can help you negotiate uneven surfaces.
8. Get help for depression
A 2015 Australian study of older adults found that depressive symptoms and antidepressant use were associated with a greater fall risk, independent of antidepressant medication use. “People may not be thinking clearly, or they may not be eating or drinking enough,” says Baker. “Malnutrition and dehydration can lead to falls.” Excessive fear of falling, which is frequently associated with depression, can also lead to an impairment of balance. A study of community-living adults ages 60 to 97, published in The Journals of Gerontology, found that fear of falling in older adults was associated with changes in gait — specifically, a significantly slower gait speed and shorter stride length.
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“Individuals that have fallen are often worried about future falls, especially if they had a fall with an injury,” says Thomas Caprio, M.D., professor of medicine and geriatrics at the University of Rochester Medical Center & Geriatric Assessment Clinic. “It’s OK to be cautious. The problem is, many times people unconsciously begin to restrict their activity. They go out of the house less, they limit areas — for example, avoiding stairs — and suddenly get into a cycle where they lose muscle strength and have a decrease in their overall endurance. Suddenly, they’re at much higher risk for falls — the same thing they were worried about to begin with. Also, when they don’t go out and engage with other people, they become socially isolated, which can lead to depression. It becomes a kind of self-fulfilling prophecy.”
9. Watch the meds
“One of the first places I start looking when it comes to reducing falls is at the medication a patient is taking,” Caprio says. “Certain drugs can have side effects like dizziness, sleepiness or a general feeling of imbalance. They can also interact with each other and contribute to unsteadiness.” Common culprits include benzodiazepines, such as Valium and Xanax, commonly used to treat anxiety. “They affect the nervous system, and their mechanism is similar to alcohol, so they can make a person unsteady,” he says. (Also, of course, watch the alcohol.)
Another class of drugs that can affect balance are some of the antihistamines (commonly used for allergies), as well as certain medications for overactive bladder, such as oxybutynin; these anticholinergic drugs, which work by relaxing the bladder muscles, can lead to overall muscle weakness and falls.
Exercises to Help Prevent Falls
Strengthen your lower body
Sit in a chair, arms folded across your chest, rise to a standing position, then return to a sitting position, as quickly as you can, five to 10 times. Do it again, this time in slow motion. Alternate between the two.
Stand with feet about hip-length apart and arms on hips. Step forward with your right leg and bend both knees; gradually lower your body until your knees are bent at (or close to) a 90-degree angle. Shift forward so that most of your weight is through the front leg. Hold the position for a few seconds, then return to the starting position by straightening your leg. Repeat 10 times.
Increase ankle flexibility
Work out with resistance bands (you can buy them in stores or online for less than $10 for a set). While seated, place a band around the arch of your foot, holding the ends in each hand. Point your toes and flex your foot as far as you can. Switch sides and repeat.
Also try heel lifts. Stand at a kitchen counter or table so that you can lightly touch the surface for balance, with feet hip-width apart. Slowly lift up your heels and rise up on your toes. Hold for five seconds, then slowly lower your heels back down. Repeat two to three sets of 10.
Improve reaction time
When you’re watching the news, do sitting calve raises or squats. Start slowly, and then try increasing the speed in which you do them.
Sherri Betz, a Louisiana-based board-certified clinical specialist in geriatric therapy, is a fan of Clock Yourself, a fun, challenging app ($1.99 for iOS devices) designed to improve your reaction time. How it works: You imagine that you’re standing on the face of a clock, right in the middle of it. The app will randomly call out numbers. When it says “2,” you step on your right foot on the 2 of the clock; when it says “7,” you step with your left foot on the 7, and so on. Bonus: By touching on different points and reacting quickly, you’re engaging your cognitive function, as well.
Barbara Stepko is a longtime health and lifestyle writer, and former editor at Women’s Health and InStyle. Her work has appeared in The Wall Street Journal, Parade and other national magazines.