As we age, the chance of an unexpected fall increases. Unfortunately, falls happen in the blink of an eye and can lead to major injuries such as hip and skull fractures. The good news is that there is a solid “fall prevention” skill set that anyone can learn. You can apply this skill set to help yourself or a loved one to reduce their fall risk.
As a prevention focused Internal Medicine doctor who worked in hospitals caring for patients, and as a medical educator (who taught interns, residents, and medical students how to be doctors), I have always thought this is an exciting topic that everyone should know about. Why? Because there is so much that can be done to proactively reduce fall risk and thus prevent injuries.
These practical recommendations to reduce falls can be applied to anyone over the age of 65. The real benefit, however, comes from identifying high risk people and then making systematic recommendations which should be followed up every 6-12 months.
Fall Prevention in 3 Steps
Step One – Take the CDC quiz to determine increased fall risk
This is a fantastic screening tool used to identify people at increased risk of falling. It has been clinically validated, so we know it is an effective way of identifying increased fall risk. A score of 4 points or greater suggests that there is an increased fall risk, and that person would benefit from fall prevention measures.
Click here to view and take the quiz.
Step Two – Understand the steps you can take to reduce fall risk
Review your medication list regularly and frequently and make sure it is reviewed by your doctor. Many medications cause symptoms that increase fall risk. Examples of problematic symptoms include dizziness, drowsiness, cognitive effects, weakness and hypoglycemia (low blood sugar). The elderly get into trouble with medications because kidney function declines with age. Often, body weight also declines with age. The result is that a medication that was dosed correctly at age 60 or 70 becomes way too much for an 80-year-old. Many medication classes can be problematic for the elderly, these are some of the most common ones to consider in somone at increased fall risk: [2]
- Diabetes medications: A common scenario is an older person who was diabetic requiring medication but then lost weight. The weight loss leads to improvement or resolution of diabetes, but if no regular medical follow up and the same medication is continued, that person will end up over medicated with low blood sugar. This can lead to falls and/or passing out.
- Pain medications, sedatives, anti-anxiety medications and sleep aids: Examples include opiates, tramadol, gabapentin, benzodiazepines (Valium, Xanax).
- Blood pressure medications can lead to many side effects, including but not limited to low blood pressure causing dizziness and/or passing out.
- Statin drugs can contribute to muscle weakness and cognitive effects in the elderly.
Get regular exercise with the goals of increasing balance, strength, flexibility.
Get your eyes checked
Everyone can understand that poor vision would be a problem for falls. What many people do not realize is that a one sided cataract can lead to loss of depth perception and increased fall risk. This is important since it is highly treatable with surgery.
- Be sure to have your eyes checked to rule out cataracts and other treatable causes of visual impairment.
- Know that glasses can be a problem in two scenarios:
- Bifocals are a common problem in falls. The problem is that the wearer, when looking down, cannot see their feet or the ground well. This is especially problematic when balance is impaired and something called proprioception is decreased (one’s ability to sense the location and movement of ones own body parts).
- Tint changing glasses can limit vision when entering a darker area from full sunlight. Be aware and either stop and wait until they adjust or change glasses immediately upon entering a darker area.
Arrange for a home safety evaluation to identify and reduce trip hazards and other risks in the home.
Vitamin D supplementation has been shown to reduce fall risk. [1]
Ensure foundational health and nutrition with adequate protein for maintaining muscle mass.
Get a physical examination to check for correctable things that can increase fall risk. Here are some examples of what can be detected on a physical exam.
- Orthostatic Hypotension is when the blood pressure drops when standing after being in a seated position. Treatment is correcting underlying causes which can include dehydration, excessive salt restriction, or medication side effect.
- Heart Rate, if too slow or too fast that needs further evaluation as it can increase the risk of falling and/or passing out.
- Sensory exam to detect impaired sensation in feet.
- Proprioception
- Get up and go test
- Muscle strength and tone
- Observation of gait (how does the patient walk and are there balance, coordination or other issues interfering with normal gait.
Step Three – Checklist for taking action
[ ] Schedule eye doctor appointment.
[ ] Strongly consider referral to Physical Therapy. The physical therapy practice can help you with many of the items above, including physical therapy for strength and flexibility and occupational therapy for the home safety evaluation. If there is instability of gait, it is very important to have a trained physical therapist recommend the correct type of assistive device (i.e. cane, walker, etc.) and make sure the person can use it safely. Otherwise the device could increase the chance of falling.
[ ] Discuss vitamin D supplementation with your doctor and consider testing the blood level.
[ ] If you have not seen your PCP recently, request a dedicated appointment to discuss reducing fall risk for you or your loved one.
In sum, falls in the elderly can be prevented by applying the proactive, multipronged approach to reducing fall risk described in this article.
Sharon Goldberg is a Santa Fe based Integrative and Functional Medicine Physician who specializes in personalized preventive and wellness focused patient care. She is Board Certified in Internal Medicine since 2000 and has advanced training in Tropical Medicine and Hygiene. She has over two decades of practice experience working with both complex chronic illness and disease prevention. She is a medical educator, peer reviewer and coauthor of integrative and prevention related clinical research.
Additional Resources
[1] Thanapluetiwong, Saran, et al. “Vitamin D supplement on prevention of fall and fracture: a meta-analysis of randomized controlled trials.” Medicine 99.34 (2020).
[2] The American Geriatrics Society POCKET GUIDE TO THE 2019 AGS BEERS CRITERIA®
The guide is for health practitioners, but it can be useful information to discuss with your PCP if you or your loved one are being prescribed any of the medication on the list. The guide is based on The 2019
AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults.
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