Falls in Older Adults: A Growing but Preventable Problem

According to CDC statistics, as the older population grows, the number of falls and fall-related injuries has increased, and the fall death rate has risen by about 30% over the past decade. Each year in the United States roughly 36 million older adults fall, leading to more than 32,000 deaths. Every adult aged 65 and over is at risk of falling, and as the population ages this adds a rising economic burden year after year.

The rate of falls increases with age, and it is higher in women than in men. Women aged 85 and over are the most likely to fall. Falls often come with a rapid decline in health or quality of life. Falling is not an inevitable part of aging — it can be prevented.

A few important facts about falls in older adults

Falls and motor vehicle crashes are the two leading causes of injury and injury-related death in older adults.

One in five falls causes an injury, such as a fracture or head injury.

More than 95% of hip fractures are caused by falls, usually a sideways fall.

Women fall more easily than men and account for three-quarters of all hip fractures.

Clinical recommendations for fall prevention from the British and American geriatric societies

1. Screen all patients aged 65 and over for fall risk.

2. Assess the patient’s reversible risk factors and history of prior falls.

3. Use effective strategies for prevention to reduce the risks that have been identified.

Simple measures to prevent falls (CDC recommendations):

• Review medications to see whether any may increase fall risk.
• Learn about health conditions that may increase fall risk (such as depression or osteoporosis).
• Have your eyes checked at least once a year and update your lenses as needed.
• Do exercises that strengthen the legs and improve balance.
• Make the home safer: keep floors clean and clear, add grab bars in the bathroom, and install handrails and lights on all stairs.
• Check your feet and discuss suitable footwear with your physician.

Risk factors for falls

Physical factors

• Older age (especially 75 and over)

• White ethnicity

• Being housebound, living alone

Past history

• Use of a cane or walker

• Frequent falls in the past

• Acute illness: colds, fractures, infections, and so on

• Chronic illness, especially neuromuscular disease

• Polypharmacy, especially taking four or more medications

Physical impairments

• Cognitive impairment, dementia

• Reduced vision, including age-related changes (reduced accommodation, intolerance of glare, altered depth perception, presbyopia, reduced night vision, reduced peripheral vision)

• Difficulty standing up from a chair

• Foot pain or other foot problems

• Neurological decline, including age-related changes (that is, postural instability; slower reaction time; reduced sensory awareness of light touch, vibration, and temperature; reduced central integration of visual, vestibular, and proprioceptive input)

• Reduced hearing, including age-related changes (that is, presbycusis [increased pure-tone thresholds, mainly at high frequencies], impaired speech discrimination)

Other factors

• Environmental hazards

• Medications that may increase fall risk (discuss with the prescribing physician; medications serve a purpose and, in appropriate doses, control disease, so adjusting them on your own is not advised)

• Sedative-hypnotic and anti-anxiety medications (especially long-acting benzodiazepines)

• Tricyclic antidepressants

• Sedatives

• Some antihypertensive medications

• Cardiac medications

• Corticosteroids

• Nonsteroidal anti-inflammatory drugs

• Anticholinergic medications

• Glucose-lowering medications

• Medications that may affect balance

References

• CDC Keep on Your Feet—Preventing Older Adult Falls
• Am Fam Physician. 2000;61(7):2159-2168