Falls are the leading cause of fatal and nonfatal injuries in adults over age 65 — but that doesn’t mean they should be viewed as an inevitable part of growing older. Falls are not a diagnosis in and of themselves but rather a symptom or a warning sign. When a fall occurs, there is often a deeper underlying problem that must be addressed. The first line of defense in reducing fall risk is identifying and addressing any underlying diseases or medical conditions that predispose an older person to spills, trips, and slips.
“The elderly are prone to poor vision, poor balance, and muscle and nerve atrophy. When you put all those things together, it’s a perfect set up for a fall,” says Daniel Callaghan, MD, who practices family medicine in Rocky Hill, Connecticut, and has treated patients for falls at St. Francis Hospital in Hartford, Connecticut.
Some of the most prevalent medical conditions shown to increase a senior’s chance of falling include arthritis, circulatory disease, depression, diabetes, glaucoma, macular degeneration, and neurodegenerative diseases such as Parkinson’s and Alzheimer’s. While treatment for these medical conditions is necessary and can often help mitigate fall risk, it often becomes a catch-22 — the medications prescribed may cause dizziness, drowsiness, or sedation, which compound fall risk.
“A lot of the elderly are on multiple drugs to treat their conditions,” adds Callaghan. “And some medications can make your blood pressure too low, or make you drowsy or not as alert as you should be.”
Awareness Is Key to Prevention
In order to prevent falls — and their oftentimes dire consequences — in older people who live with chronic diseases, care must be well-coordinated and monitored by healthcare providers, and seniors must understand their own risk factors. According to the U.S. Centers for Disease Control and Prevention (CDC), an older adult is treated in the emergency room every 17 seconds for a fall and dies every 30 minutes as a result of a fall. Of those who are nonfatally injured, 20 percent to 30 percent will suffer lacerations, hip fractures, and head traumas that frequently lead to loss of mobility and independence. This can result in further physical decline, as well as social isolation and feelings of helplessness.
While falls cannot be prevented entirely, helping seniors and their caregivers understand how a particular disease increases fall risk, and recommending the right fall-prevention strategies for that specific disease, can significantly lower their risk of falling. Here are some of the most common conditions that can lead to falls in the elderly and the preventive measures and lifestyle modifications they can make in order to keep themselves safe.
Diseases That Impact Balance and Gait
Arthritis weakens the muscles that keep us steady and causes joint pain that alters our gait, and for these reasons, arthritis greatly increases fall risk in adults. Compared to adults without arthritis, adults with arthritis are 2.5 times more likely to experience injuries after a fall. Researchers say that exercise or physical therapy to improve balance, gait, and lower body strength can reduce fall risk in arthritic patients by 14 percent to 37 percent, but at least 50 cumulative hours of practice is required to reap this benefit.
Parkinson’s disease also impairs balance, as it causes abnormal posture, leg weakness, muscular stiffness, and a shuffling gait that grows more severe as the disease progresses. And peripheral neuropathy, a common complication of diabetes affecting about 70 percent of older adults who are diagnosed, manifests as numbness, tingling, and pain in the lower extremities and impacts gait, balance, and strength.
Seniors who struggle with balance and gait issues should consider adaptive devices to make their homes safer.
“Grab bars are a good thing to have beside the toilet and inside and outside of the shower and tub,” says Tobi Abramson, a psychologist with a specialty in gerontology and New York Institute of Technology’s director of mental health counseling. “And a raised toilet seat may make getting up easier, making seniors less likely to topple.”
Seniors with these diseases also should ensure their staircases have secure handrails on both sides, avoid using ladders or step stools, and check to see if any sidewalks or stairs outside their homes are broken, Abramson says. Helping your loved ones learn how to create a safer home is vital to reducing their fall risk.
A decrease in vision caused by cataracts, glaucoma, macular degeneration, or diabetic retinopathy can make it far more difficult for seniors to avoid obstacles in their everyday environments that could lead to a tumble. Symptoms such as blurred or cloudy vision, depth-perception deficits, and difficulty adjusting to shifting lighting conditions can place them at a high risk for falling. In seniors with these conditions, it’s important to emphasize keeping good lighting throughout their homes, particularly in the area between the bedroom and the bathroom.
“Many falls occur in the middle of the night in the dark when an older person gets up to go to the bathroom,” says Callaghan. Installing night lights in hallways, the bedroom, and the bathroom can increase visibility at night and make the home environment safer.
You should also recommend that your older patient keep her walker near her bed to reduce her risk of falling when entering and exiting and keep a commode in her bedroom to prevent the need to walk to the bathroom in the dark. Don’t assume the patient knows how to use adaptive equipment; make sure to demonstrate for her how to walk to and from the bathroom, get up and down from a chair, and get up from a bed. For all seniors, and especially for those who have impaired vision, taping down electrical and telephone wires and securing floor rugs that they might not see in their path is crucial.
Diseases that affect the heart, blood pressure, and arteries often result in senior patient falls. Cardiac arrhythmia, heart disease, peripheral artery disease, and postural hypotension (when blood pressure drops too much between sitting and standing) are among those conditions likely to cause dizziness, light-headedness, weakness, and fatigue with slight exertion. Even medications to treat hypertension as well as heart medications such as beta blockers can have side effects that increase fall risk.
Encourage your loved ones to discuss all the symptoms associated with circulatory disease with their cardiologist and primary care provider, especially because of the importance of determining proper medication dosages for these conditions. In addition, ask the senior if his dizziness or weakness is worsening — he may not always volunteer important information that can impact treatment, such as if his doctor recently changed his high blood pressure medication.
“A person might start having falls and think, ‘But I’ve always been on high blood pressure meds, so it can’t be that,’” says Abramson. “But any change in medication could potentially cause unsteadiness.”
Regardless of what causes it, all seniors prone to dizziness can make adaptive lifestyle adjustments. When they first wake up, they should dangle their feet at the foot of the bed rather than bolting up, which can cause blood pressure to quickly drop. They might also need more time to become alert in the mornings, so encourage them not to schedule errands or appointments too early.
Diseases That Impair Cognition
Alzheimer’s, dementia, and other diseases that impair cognition have been strongly correlated with increased fall risk in seniors. These conditions cause mental confusion, disorientation, and lack of coordination, which make it more challenging to navigate physical environments and slow a person’s reaction time. For all seniors, being able to quickly and easily call for help if they stumble is crucial.
Consider various forms of remote care technology that can be used in the case of a fall, such a medical alert device, some of which offer an added layer of protection and will automatically call for help when a fall is detected. You can also encourage caregivers to remove glass-top tables and replace any furniture with pointy edges — both of which pose serious health risks if a fall occurs.
Reducing Medication-Related Falls
The use or misuse of various classes of medications to treat these chronic diseases can increase fall risk and frequency in seniors — but luckily, drug-related risk factors are the most preventable or reversible. Analgesics for pain, benzodiazepines, and most recently, antihypertensives to treat high blood pressure have been closely associated with serious falls and injuries in seniors. Other common risk factors for seniors include forgetting to take their medications, taking the wrong dosages, or being unaware of drug interactions. Older people metabolize drugs and over-the-counter (OTC) medications more slowly, so the more they take at once, the greater their likelihood of falling because of adverse effects, such as impaired coordination and psycho-motor skills.
Proper medication management, as well as medication modification, can reduce fall risk considerably. Here are several ways to help seniors prevent falls related to their medication usage:
- If they’re experiencing dizziness, wooziness, or sedation while taking drugs shown to cause these symptoms, consider lowering their dose or switching them to a medication that poses less fall risk whenever possible.
- Remind them to take precautions when using OTC drugs, as they may interact with their prescribed medications. Urge them to give their local pharmacist a full list of their medications and ask if any OTCs they want to take interact.
- Tell patients and families that various medications may or may not work well when taken together; taking four or more medications of any kind increases fall risk by 30 percent. Caregivers and families should pay particular attention to new medications and ask whether their loved one is experiencing any new side effects.
- To ensure that seniors adhere to their medication regimen, suggest that they place a list of medications and dosage times on the refrigerator in large type. They can also take pills in conjunction with meals and bedtime and keep medications in the location of these daily events (such as on the kitchen table and nightstand).
- Seniors can have difficulty reading or opening medication bottles, which can lead them to take the wrong dose or skip a dose altogether. In one study, pillboxes and voice-activated medication dispensers were shown to boost medication compliance.
Above all, intervening proactively before a life-threatening fall occurs is vital to keeping seniors with chronic diseases from injury and death. “Don’t wait for an accident to happen,” says Ivan Wolfson, licensed clinical psychologist practicing in Providence, Rhode Island, who counsels adults who care for their aging parents. When a senior is diagnosed with a condition, she should be referred to a physical or occupational therapist for a fall risk evaluation. And because caregivers and family members are usually the first to notice changes, they should be reminded to keep their eyes and ears open.
“Caregivers should pay attention to whether the senior is more easily fatigued, holding onto walls while walking, or shuffling,” Wolfson says. Caregivers must remember to "not see their parent only as they wish to see him. Though it’s very loving, it can have disastrous effects.”