By David Dunaief, M.D.
Taking a tumble can cause broken bones and torn ligaments. While these might not be life-altering in younger folks, they can have serious consequences for older patients, including a decrease in functional ability and a decline in physical and social activities, which can lead to a loss of independence (1)(2). One recent study found that older adults who had suffered a fall had poorer health and well-being two years later when compared to those who had not fallen (3).
What increases your fall risk?
Obviously, environmental factors, like slippery or uneven surfaces, can increase your risk of falling. Age and medication use are also contributing factors. Some medications, like those used to treat high blood pressure or those targeting anxiety, depression and insomnia, are of particular concern. Chronic diseases may also contribute.
If you have upper and lower body strength weakness, decreased vision, a hearing disorder or psychological issues, such as anxiety and depression, these conditions predispose you to falling (4).
How can you reduce your fall risk?
Most importantly, exercise. Exercises that involve balance, strength, movement, flexibility and endurance all play significant roles in fall prevention (5). The good news is that many of these can be done inside with no equipment or with items found around the home. We will look more closely at the research.
Nonslip shoes are a big help. Look for slippers and shoes with non-skid soles. During the winter, choose footwear that prevents sliding on ice, such as boots with cleats or slip-on ice cleats that fit over your shoes.
In the home, secure area rugs, remove tripping hazards, install grab-bars in your bathroom showers and tubs, and add motion-activated nightlights.
And, of course, always pay attention when you’re walking. Don’t text, read or video chat while you’re moving around. A recently published study of young, healthy adults found that texting while walking affected their gait stability and postural balance when they were exposed to a slip hazard (6).
How do medications increase risk?
Several medications heighten fall risk, including psychotropic drugs and high blood pressure medications.
A well-designed study showed that those taking moderate doses of blood pressure medication had the greatest risk of serious injuries from falls, a 40 percent increase (7).
Because these medications can reduce cardiovascular risks, physicians must consider the risk-benefit ratio in older patients before prescribing or stopping a medication. We also should consider whether lifestyle modifications can reverse your need for medication or your dosage (8).
Using exercise to reduce fall risk
A meta-analysis showed that regular exercise significantly reduced the risk of a fall (9). It led to a 37 percent reduction in falls that resulted in injury and a 30 percent reduction in falls that required medical attention. Even more impressive was a 61 percent reduction in fracture risk. The author summarized that exercise not only helps to prevent falls but also fall injuries.
Unfortunately, those who have fallen before often develop a fear that leads them to limit their activities. This leads to a dangerous cycle of reduced balance and increased gait disorders, ultimately resulting in an increased fall risk (10).
Any consistent exercise program that focuses on flexibility and muscle tone and includes core strengthening can help improve your balance. Among those that have been studied, tai chi, yoga and aquatic exercise have all been shown to reduce falls and injuries from falls.
A randomized controlled trial showed that those who did an aquatic exercise program had a significant improvement in the risk of falls (11). The goal of the aquatic exercise was to improve balance, strength and mobility. Results showed a reduction in the overall number of falls and a 44 percent decline in the number of exercising patients who fell during the six-month trial, with no change in the control group.
Tai chi, which requires no equipment, was also shown to reduce both fall risk and fear of falling in older adults (12).
Another pilot study used modified chair yoga classes with a small, over-65 assisted-living population where participants had experienced a recent fall and had a resulting fear of falling (13). While the intention was to assess exercise safety, researchers found that participants had less reliance on assistive devices and three of the 16 participants were able to eliminate their use of mobility assistance devices.
Our best defense against fall risk is prevention with exercise and managing our environments to reduce fall opportunities. In addition, if you are 65 and older, or if you have arthritis and are over 45, it may mean reviewing your medication list with your doctor. Before you consider changing your blood pressure medications, review your risk-to-benefit ratio with your physician.
References:
(1) MMWR. 2014; 63(17):379-383. (2) J Gerontol A Biol Sci Med Sci. 1998;53(2):M112. (3) Aging Ment Health. 2021 Apr;25(4):742-748. (4) JAMA. 1995;273(17):1348. (5) Cochrane Database Syst Rev. 2012;9:CD007146. (6) Heliyon. 2023 Aug; 9(8): e18366. (7) JAMA Intern Med. 2014 Apr;174(4):588-595. (8) JAMA Intern Med. 2014;174(4):577-587. (9) BMJ. 2013;347:f6234. (10) Age Ageing. 1997 May;26(3):189-193. (11) Menopause. 2013;20(10):1012-1019. (12) Mater Sociomed. 2018 Mar; 30(1): 38–42. (13) Int J Yoga. 2012 Jul-Dec; 5(2): 146–150.
Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.
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