Falling down is scary. It’s even scarier when you’re in your 70s or 80s. Many people, however, have issues with falling as they age.
There are lots of reasons for this, according to Dr. Laura Longwell, an internal medicine specialist at the UCHealth Primary Care Clinic – Rockrimmon in Colorado Springs. Many, perhaps the majority, of her patients are age 55 and older. As a physician who cares for people who are older, she is acutely aware of the statistics from the National Council on Aging (NCOA) website:
- Falls are the leading cause of fatal and non-fatal injuries for older people
- Falls threaten seniors’ safety and independence and generate enormous economic and personal costs.
So why do people fall down?
“There are two camps here,” Longwell said. “There are some things you can’t control, like slips and trips that happen to people at any age. Maybe you’ve had the flu or are dehydrated and you pass out and fall. A sinus infection can throw off your balance and you might fall. These can happen to anybody. So, we’re all at risk, at any age.”
As we approach those golden years, about age 65 or so, other factors also start to figure into the equation.
“At that point, things that lead to falls include impaired vision, hearing and balance.”
Aging can cause our senses to erode.
“Vision is one of our senses and tells our brain where our body is in space. Hearing also contributes to that. The ‘hearing nerve’ does two things. Hearing is just one of them. It’s also a balancing nerve. Being able to see and hear well affects our sense of balance. Cataracts and other vision issues can play into the problem.”
“A common complaint of aging patients is numbness in the feet. It’s called neuropathy, and idiopathic neuropathy (no distinct identifiable cause) can be a factor,” she said.
“If it’s present, you can’t feel your feet as well as you once could. That can increase falls.”
Chronic pain also is a culprit.
“I would argue that (if you have chronic pain) you are at a higher risk of falls. It can be very distracting. If we are hurting it can change how we walk. So that affects gait and balance impairment. If my back hurts and I can’t stand up straight, I might lean forward and throw off my center of gravity. That can lead to falls,” Longwell said.
We have nerves that perform the job of helping us keep our balance – what’s called proprioception. Simply defined, it refers to the brain’s ability to perceive what’s going on in the body.
“It’s our ability to maintain balance and correct it when we have an imbalance,” she said. “The brain has to compute quickly how to correct balance, but as we age, the brain’s response to an imbalance signal might be slower.”
Dementia is another culprit.
“Patients with dementia have a high fall risk. That’s because your brain’s processing speed is slowed down,” she said.
“Those are all intrinsic risk factors,” Longwell noted, “that are happening inside your body and you can’t control them. That’s especially true for the older population.”
Seniors prone to falling may have to make some lifestyle adjustments.
“Be less sedentary and more active,” Longwell said. Check out senior wellness centers, engage in physical therapy including balance training, and try some activity that has proven good results – like tai chi and yoga. If you can afford it, perhaps hire a personal trainer to help you with strength and balance issues.
Dr. Longwell also asks patients to look at their environments. “Look at where you live. Is your environment safe for you? Are there a lot of stairs or obstacles that might cause a fall? Look at lighting, throw rugs, slippery floors, handholds in the shower and by the toilet.” She sometimes recommends a home safety evaluation, which will assess all those things.
For patients who have fallen, she sometimes recommends walking aids.
“Walking aids are helpful, but I always want a physical therapist to assess patients to see if a walking device is needed, and if so, which one, and to teach a patient how to use it correctly. There is a right and wrong way to use a walker and if used incorrectly, it can actually increase your risk of falling.”
Depending on the patient’s condition, he or she may need anything from a four-pronged cane to a walker with a seat. An occupational therapist can make sure the device works with the patient’s ability to grip and maneuver it.
She recommends medical alert buttons if they are warranted and “especially if the patient lives alone and doesn’t have someone readily available to help them.”
None of these things are useful if the patient doesn’t use them, of course.
Does fear of falling affect people’s ability or willingness to remain active?
“Yes, it’s an easy way someone can become isolated,” Longwell said. “If they fear they may fall, they may avoid going places. They can develop depression or anxiety. And isolation in the elderly can worsen cognitive function, which can be irreversible. Not to be too dramatic about it, it can actually shorten life span.”
The NCOA site has this to say: “Falls, with or without injury, also carry a heavy quality of life impact. A growing number of older adults have a fear falling and as a result, limit their activities and social engagements. This can result in further physical decline, social isolation, depression, and feelings of helplessness.”
Depression screening is important, too, she said.
“I ask: ‘Are you going out and doing things?’ Have them take the Geriatric Depression Scale – it’s a good, quick survey. Mental health is a huge issue. People can be depressed and nobody notices or asks them about it.”
She also looks for substance abuse, most often alcohol. Looking at a person’s mental health as well as their physical ability is important.
The upshot: “If you can prevent falls, you can prevent injury and increase a person’s sense of wellness.”
UCHealth in Colorado Springs offers a Stepping On class to help people with balance. Go to uchealth.org/SteppingOn or call Health Link at 719-444-CARE (2273) and select option 3.