CDC: More than 14 million older people (25%) report falling — it has become the top cause of injury-related death for people over 65
By Deborah Jeanne Sergeant
The Centers for Disease Control and Prevention reports that falls are the top cause of injury-related death for people 65 and older.
Falls in this age cohort are common.
The CDC states that more than 14 million older people (25%) report falling — and that does not include those who fall but do not report it.
“The age-adjusted fall death rate increased by 41% from 55.3 per 100,000 older adults in 2012 to 78.0 per 100,000 older adults in 2021,” the CDC states.
But why are falls so harmful to older adults?
“As we get older, we have less reserve. Its physiological reserve, the cushion to draw upon when our body is stressed,” said geriatrician Sharon Brangman. “As you get older, that cushion gets thinner and thinner so even a small incident like a fall is a bigger impact. The minute we start to limit mobility it leads to lower bone mass and muscle mass. You get weaker.”
Brangman serves on the faculty at SUNY Upstate Medical University and is a distinguished service professor, the chairwoman of geriatric medicine and the director of the Upstate Center of Excellence for Alzheimer’s Disease.
“As we get older, the bones are often thinner and more brittle,” Brangman added. “You’re more likely to have a fracture with a fall.”
After a fall, many frail older adults do not regain the same level of vitality as they had before, even if they did not experience a bone break. Beyond the pain experienced during a fall, the consequences of falling can be severe for older adults as their bodies decondition while they’re laid up. Preventing falls can help avoid these outcomes.
The reasons for falling are complex.
“Part of it is the natural changes as we get older put us at risk for falls and make us more vulnerable for a bad outcome if we fall,” Brangman said.
Many older adults have a harder time lifting their feet high enough. Their vision may be dimmer and their reaction time is slower. Instead of catching themselves before falling, they respond too slowly and fall.
“Generalized weakness, especially core muscles that keep us erect and help with balance, those muscles get weaker with age and you need to do specific exercises,” Brangman said. “It’s the same with leg muscles. A lot of people who fall have a fear of falling and move less and that increases their chance of falling because their muscles are weaker, shorter and tighter.”
In addition, many older people experience momentary dizziness upon rising as the blood vessels going to the head constrict. Some older people take medication that worsens this effect.
How people move can make a difference in whether or not they fall. For example, shuffling may seem like a safer way to walk. However, since it reduces their base of support, they’re more likely to be unable to catch themselves if they stumble. A longer, more natural stride is safer.
Becoming less active to prevent falls is counterproductive, according to Maureen Loyal, physical therapist and director of rehabilitation and physical therapy with Finger Lakes Health.
“Fear of falling has you do less outside the home,” she said. “You become deconditioned and it’s a cycle. Do the opposite of what people do, which is confine themselves to their homes and have people do errands for them. People who are older should park farther away so they’re walking more. ‘Use it or lose it’ is important. It’s never too late to have balance exercises.”
She encourages older adults to seek help to improve their endurance, strength, flexibility and balance if they begin to experience instability while walking. Too many people reach for a cane or walker early on when improving their physical condition would prevent that reliance.
Instead of performing random exercise movements, Loyal focuses on functional movement that will help people better carry out activities of daily living like carrying grocery bags, standing and sitting and climbing stairs.
“We want to keep that function throughout life,” she said, “And you do that by keeping your strength. You may weigh the same, but you can see there’s more fat than muscle. You may think you have the same muscle capacity, but you don’t. I try to focus on functional exercises, not sitting in a chair and kicking your legs up. When do you ever do that movement?
“Do sit-to-stand exercises where you stand and then slowly sit down. If you can keep your quad muscles strong, it decreases risk for falls and keeps you independent in the community.”
The home environment makes an enormous difference. Poor lighting, clutter on the floor, throw rugs, uneven flooring and multi-level living spaces all contribute to a higher risk of falling. Upgrading the bathroom and bedroom — the most fall-prone rooms of the house — can reduce fall risk.
Grab bars by the shower and toilet also assist in stability, as does a bedrail in the bedroom.
Seeing where you’re going helps you stay on your feet. Place nightlights and lamps where they can be turned on upon entering the room.
It can also make sense to outsource tasks that involve climbing on ladders or other activities that can cause falls.