Fear of falling.

One out of every four seniors in America falls every year. What causes these falls and what can be done to prevent them?
One out of every four seniors in America falls every year. What causes these falls and what can be done to prevent them?

Unfortunately, there are plenty of good reasons for seniors to be afraid of falling. According to the CDC, 2.5 million people ages 65 and older visit the emergency department (ED) because of falls—more than any other age group.

As a result, according to the National Council on Aging, an older adult is treated in an emergency room for a fall every 11 seconds.

The first fall, unfortunately, is only a precursor to more falls or even death. According to The American Journal of Emergency Medicine, more than one-third of older adult emergency department fall patients revisited the emergency room or died within one year. This makes falls the leading cause of both emergency department visits for trauma and injury deaths.

In fact, one senior dies from a fall every 19 minutes.

What causes so many falls and such life-threatening injuries? There are a number of different reasons. The vast majority, however, are simply related to the combined and cumulative effects of aging.

According to one study, seniors who have one or two of the following risk factors have a 27% greater chance of falling, which rises to some 78% when four or more are present:

Social isolation

The U.S. Census Bureau reports that some 28% of people age 65 or older lived alone as of 2010. That equated to 12.5 million people. Of those, more than 5 million were determined to need assistance with long-term care to perform activities of daily living. What’s more, of the 60-70% of seniors with dementia living in the community, 25% live completely alone.

Between age, chronic illness, poor nutrition, mismanagement of medication and no one around to look out for tripping hazards, the stage is automatically set for seniors who are living alone to be at risk for falls.

And, should a fall or other emergency occur, there’s no one else around to help, resulting in a “long lie” (a long waiting time on the ground before help arrives) and an increased risk of death.

Depression

Isolation can lead to loneliness and depression—while depression and falls have been proven time and again to have a significant relationship to each other. In fact, depression is judged to increase the risk of falls by some 32%. What’s more, the relationship between depression and falls is considered “bi-directional,” in that each feeds off of and aggravates the other.

Depression is associated with challenges in both attention and psychomotor skills, making a complex activity like walking even more complex. It also results in a poor appetite and nutritional deficiencies that are related to weakened overall health and susceptibility to falls.

Once someone has had a fall and possibly an injury, however, the probability of depression only grows. The more falls, the greater the odds. This occurs as fear and anxiety over future falls becomes disabling, resulting in even less mobility, less muscle tone, and greater weakness.

Ironically, the antidepressant medications used to treat depression can also pose an increased risk of falls. One type of antidepressants, called tricyclic antidepressants, are thought to increase the risk of falls due to side effects such as sedation, sleep disturbances, daytime sleepiness, and confusion, while those called “SSRIs” are thought to increase the risk of hip fracture by reducing bone mineral density.

Chronic diseases

A number of common health conditions such as osteoarthritis, Alzheimer’s disease or other forms of dementia, vascular disease, cataracts, and urinary incontinence, as well as more uncommon conditions as Parkinson’s disease, are all associated with falls. This, due to decreased function, muscle weakness, impaired balance, and problems with perception, as well as their own links to depression.

  • One study showed that women who had osteoarthritis experienced 30 percent more falls and had a 20 percent greater risk of fracture than those without osteoarthritis.
  • A second study showed that seniors with Alzheimer’s are three times more likely to suffer a hip fracture than those without the disease.
  • A third study found that even after cataract surgery (which one would hope would correct any existing vision problems), the number of patients who reported falling only dropped from 23 to 20 percent.

Medications

On the average, adults between the ages of 65 and 69 take some 14 prescriptions a year. And those aged 80 to 84 take an average of 18 prescriptions a year. What’s more, a Health and Human Services study found that as many as 55% of seniors take their medications incorrectly.

Many drugs cause drowsiness, dizziness, vision problems, muscle weakness or worsen osteoporosis, to begin with. However, between taking too many medications, to begin with, and taking even those incorrectly, there is a much higher risk of side effects, poor interactions between drugs and a higher risk of falls.

Recent research also indicates that half of the 20 most commonly prescribed drugs for seniors may heighten the risk of falls. These include:

  • Antithrombotic agents
  • Drugs for peptic ulcer and GERD
  • High ceiling diuretics
  • NSAIDs (women only)
  • Vitamin B12 and folic acid
  • Constipation drugs
  • Calcium
  • Hypnotics and sedatives
  • Analgesics and antipyretics
  • Opioids
  • Antidepressants
  • Thyroid hormones (men only)

While eliminating any of these medications from the healthcare plan of their senior patient may not be an option, doctors must constantly weigh the benefits against the risk. That’s the challenge in separating what was to blame for the fall—the medication or the condition that the medication was prescribed to treat.

Surgical procedures

Knee and hip replacements, as well as other surgeries (which may have been caused by a fall from any of the other factors in the first place), can leave an older person weakened and in pain, making them less mobile than they were before the surgery.

After surgery, according to one study, the risk of falls begins in rehabilitation, where 11.8% of the patients fell. Ironically, that risk only increased over the length of the stay as frailer patients gained mobility and attempted to walk by themselves.

The resulting fear of falling and anxiety can then result in reduced activity, decreased mobility, reduced muscle tone, bone weakness and an even greater risk of falling and further injury when walking is attempted.

Poor nutrition

Due to a number of different physiological, psychological, financial and environmental factors, it’s believed that 1 in 6 older Americans struggles with hunger on a daily basis. An additional 10.2 million Americans are threatened by hunger.

As a result of this poor nutrition, the lack of Vitamin D and calcium leads to loss of bone mass and the threat of osteopenia and osteoporosis, making their bones more susceptible to fractures.

What’s more, this lack of adequate nutrition puts them at risk of sarcopenia or loss of muscle mass. Studies have shown that this makes them three times more likely to fall, regardless of age, gender or other factors.

Impaired vision

While America may be the richest country on earth, some 61 million adults are at high risk of vision loss due to advanced age, diabetes or other health issues, such as macular degeneration (the leading cause of serious vision loss in seniors) or glaucoma. Of those at risk of losing their vision, half do not receive annual exams. And one in twelve—some five million Americans—can’t afford eyeglasses. Their challenges will only grow worse as they age.

Studies show that seniors with impaired vision have a 1 ½ to 2 times greater risk of falling than those who do not. Affecting perception, balance and even posture, it may also reduce mobility—which further compromises functional abilities and, in return, even greater sensory loss.

Another study demonstrated that seniors with visual acuity less than 20/60 were 1 ½ times more likely to suffer a hip fracture than those who had good vision. This likelihood only increased as the quality of vision decreased.

While some forms of vision impairment may be corrected with glasses and/or surgery, neither options are without their challenges. If you don’t have health insurance or can’t afford eyeglasses, they can’t be of much help.

Even if you suffer from a surgically treatable medical condition, such as cataracts and can afford the surgery, that doesn’t necessarily reduce the risk of falls.

While more than half of all Americans have a cataract or will have had cataract surgery by the time they’re 80, challenges still remain as patients adjust to their “new” vision:

  • Older adults with cataracts appear to double their risk of falling after surgery on their first eye and before surgery on the second. This could be partially attributed to the eyes no longer being “equal” and the resulting loss of depth perception.
  • In the two years after surgery on their second eye, people’s fall risk was found to actually be 34 percent higher than before their first surgery.

Lack of exercise

It’s a fact that the body naturally begins losing muscle mass each year after age 30. For seniors who don’t challenge their muscles, that can lead to falls, fractures or premature death.

Unfortunately, the National Institutes of Health reports that only about 25 percent of those between the ages of 65 and 74 actually engage in it. This number drops to 11 percent once people reach 85 years of age.

While lack of exercise increases a senior’s initial risk of falling, the risk is compounded as it also minimizes their ability to respond to and recover from slipping or tripping.

The resulting deterioration in health leads to an overall decline in the ability to manage activities of daily living—which can be an indication of fall risk, as well. This is the case as studies have shown that seniors aged 75 to 84 who require help with activities of daily living are 14 times more likely to report having two or more falls in the previous 12 months compared with persons with no limitations.

Substance abuse

Compounded with age, health concerns, isolation, and depression, substance abuse is, unfortunately, all too common in the senior population. In fact, a study by the National Institute on Alcohol Abuse and Alcoholism found that one in five seniors have had an alcohol or other substance abuse problem at some point in their lives.

While the use of drugs or alcohol may have been more easily tolerated by the body in younger years (and better health), their usage results in dizziness, lack of coordination and memory issues to begin with.

Men and women over age 65, however, have a decreased ability to metabolize these substances. And drinking alcohol while taking prescription and over-the-counter medications only increases adverse reactions and the accompanying risk of a fall.

Behavioral hazards

The majority of falls for those who are frail and/or physically compromised occur in the home when they are attempting to walk or transfer—those activities required for basic mobility in a familiar environment. In healthy, active older adults, however, the majority of falls are more likely to occur away from the home.

Falls occur in the more-healthy portion of the senior population when the activity or task at hand simply exceeds the abilities of the individual attempting to perform it. This could be something that was once thought easy, such as climbing a ladder. Or it could result from carelessness such as trying to talk on a cellphone while descending stairs.

The challenge for the active, healthy senior is in modifying behavior enough to maintain a sense of independence and self-confidence, but not to the extent that it compromises mobility, leading to a decline in health.

Environmental hazards

It’s impossible to truly quantify the risk of falls due to environmental hazards as, in scientific circles, you can’t measure the risk against a control group without any hazards whatsoever. However, through self-reporting, environmental hazards are figured to play some role in one-third to one-half of all falls.

These hazards would include such things as electrical cords, poor lighting, clutter, unsecured mats, and rugs or non-skid surfaces in bathtubs. Pets, although loved, can also be dangerous—causing over 80,000 hospital visits a year.

Though certainly many of these hazards occur in combination with such things as impaired vision, substance abuse or any of the other factors listed here, they are, in many cases, preventable.

Unlike the other factors that contribute to falling, many of these hazards can be eliminated by decluttering and modifying the home to be more “senior friendly.”

The fear of falling itself.

Finally, some 70% of people who have fallen have the fear of future falls, while even those who haven’t ever fallen may have anticipatory anxiety. Either way, the fear of falling in itself becomes a significant predictor of future falls. This occurs in up to half the people who are afraid of falling as it reduces self-confidence and limits activities, leading to further physical deterioration and a greater risk of falls.

Summary

I knew a nurse at an assisted living facility who, upon admitting a loved one, would tell family members, “When your parent falls . . .” Unfortunately, many times, it is a “when,” not an “if.” By being aware of the risk factors as early as possible and working to eliminate them, however, you can work to delay that “when” as long as possible down the gray mile.

Tom Text

@TomJonesNBTX

8 thoughts on “Fear of falling.

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