Anyone can trip and be thrown momentarily off balance. But can you regain your balance — or do you go down? Anything that makes an initial misstep more likely or interferes with a person’s ability to self-correct increases the risk for falls. And many such factors become more common with age. For example…
Muscle weakness. If you stumble, it requires coordinated actions of your feet, ankles, knees and hips to prevent a fall. Muscle weakness in any of those areas impairs this ability. That’s why physical inactivity is a common — though often unrecognized — cause of falls.
Exercise helps slow the loss of muscle mass that occurs with aging. Stair-climbing is an excellent way to strengthen critical thigh muscles.
Also helpful: Leg extensions — while sitting in a chair, raise your lower leg until it is in line with the thigh. Repeat 10 times and switch legs. Perform this exercise three times a day.
Impaired nerve function. The nervous system plays a part in sensing loss of balance early and guiding the self-correction process. Blunted nerve function in the feet often is due to peripheral neuropathy, which can be caused by diabetes, vitamin B-12 deficiency or low thyroid levels (hypothyroidism).
Thinning bones. Bone mass declines with age. If the thinning process goes far enough, osteoporosis can develop — in both women and men — and those dangerously fragile bones are liable to fracture. Osteoporosis can worsen the consequences of a fall, but in some cases, weakened bones are the cause, rather than the effect.
Here’s what happens: As bones lose density, the body’s center of gravity shifts forward, causing an older person to lean progressively forward. Balance becomes more precarious, so a slip is more likely to become a fall. Small fractures of the vertebrae caused by osteoporosis accentuate the forward shift.
Low vitamin D levels. A 2005 analysis of five studies published in the Journal of the American Medical Association found a more than 20% reduction in falls in healthy older people who took vitamin D supplements, compared with those who didn’t.
Researchers theorize that vitamin D may have an effect on muscle that helps reduce falls. Although the Daily Value (the FDA’s reference guideline for daily nutrient intake) for vitamin D is 400 international units (IU), most studies have found that daily doses of 700 IU to 800 IU are needed to prevent falls and fractures.
Vitamin D deficiency is more common than previously believed — it’s often due to a lack of regular sun exposure and/or a low intake of foods containing or fortified with vitamin D. If either of these factors applies to you, ask your doctor to check your blood level of vitamin D.
“Silent” vision problems, such as cataracts and glaucoma that have not yet caused difficulties in reading or other activities, can increase a person’s risk for falls. Subtle vision changes, such as a decline in the ability to see contrasts in color or light and dark, can be missed as well. This makes tripping over curbs and on stairs or escalators more of a danger.
Correcting nearsightedness or farsightedness with glasses will help but initially can be risky. It takes time to adjust to new glasses — particularly when they have multifocal (bifocal, trifocal or variable) lenses. An Australian study found that in the period just after patients got new glasses, they were more likely to fall.
Even hearing loss may be linked to increased falls — possibly because some hearing problems reflect damage to the eighth cranial nerve, which also controls the inner-ear system that maintains balance.
Any drug that causes sedation can impair alertness, slow reaction time and disable the coordinated interplay of nerves and muscles that protects against falls. Some medications lower blood pressure when you stand up — these can cause weakness and light-headedness that can lead to a fall.
Among the most common culprits: Some antidepressants and antianxiety drugs… medications taken for enlarged prostate… painkillers, such as codeine and oxycodone (OxyContin)… and pills for high blood pressure.
Important: The more medications you take, the higher your risk of falling.
Hidden menace: Over-the-counter (OTC) drugs. For example, older OTC antihistamines that can have sedating effects, such as diphenhydramine (Benadryl), should not be used by older adults, who may experience confusion when taking such drugs. First try a nonsedating antihistamine, such as loratadine (Claritin).
Lack of sleep can increase fall risk by impairing alertness and slowing reaction time. However, sleeping pills aren’t the solution — their effects often linger, dulling the senses and slowing reaction time. Even newer sleep medications, such as zolpidem (Ambien), which are designed to be shorter acting, keep working longer in older people, possibly contributing to falls.
Anything that gets you out of bed in the middle of the night — such as an urgent need to urinate — also increases your fall risk. Keep a clear path to the bathroom, use nightlights and keep a cane or walker easily accessible, if necessary.
Falls also can be a harbinger of a new health problem, such as pneumonia, a urinary tract infection, heart attack or heart failure. In some cases, weakness that can lead to a fall is more evident than the usual symptoms for these illnesses.
The exact cause of a fall is often impossible to pin down and may actually be due to several subtle factors working together — such as a slight loss of sensation in the feet, mild sedation due to medication and minor difficulty with balance.
Fortunately, safety is cumulative, too. Slight adjustments can be lifesaving. For example, avoid shoes that don’t fit snugly or have slippery soles… instead, wear sneakers or walking shoes. In addition, get rid of any throw rugs… make sure that lighting is adequate and handrails are available where needed… and don’t be vain about using a cane or walker if it helps you move about safely.
