Research for Consumers

Understanding Falling in Old Age

Throughout much of life, falling down may seem like a relatively benign event. A bruised body part, or ego, is usually the most a person suffers. It's hard for a young, vigorous individual to imagine that tripping on a rug or a slippery sidewalk could cause a life-threatening injury. But for some older people, it could mean exactly that. Aging bones are more likely to fracture -- a painful and serious injury in an older adult. Other physical impairments may make it impossible for an older person to get up after a fall, putting him or her at great risk of dehydration, confusion, pneumonia, or even death, especially if the person lives alone. For others, a pattern of falls may not just be the result of environmental factors, but rather of an underlying medical condition.

The unfortunate reality is that many seniors are less able to cope with a fall at the time in their lives when they have become most prone to falling. This predicament can lead to a series of events that profoundly affects not only their health, but their quality of life as well. Many older people are so afraid of falling that they begin to limit their activity, and, in some cases, are afraid to leave their houses. A sedentary lifestyle is just as unhealthy for an older adult as it is for someone younger. Research has found exercise to be an effective treatment at any age for all kinds of conditions from heart disease to diabetes. Furthermore, it is an effective preventive measure against future falls. Lack of exercise weakens muscle tone and balance, and exacerbates joint stiffness due to illnesses like arthritis. In addition, the isolation that comes from being housebound can lead to depression. It is easy to see how a fall can precipitate a downward spiral toward physical and emotional distress.

Understanding the causes of falling in the elderly is crucial to finding ways to prevent them, and is a major subject of research at Hebrew SeniorLife's Institute for Aging Research.

What Causes Older People to Fall?
Common environmental hazards that a young person can deal with often cause older people to fall, because conditions unique to aging make them more susceptible. With age, musculoskeletal changes occur, which can alter an older person's sense of balance and space perception, often causing a "dizzy" sensation. Any unexpected change in the environment, such as a loose carpet or a chair out of place can pose a hazard to an older individual who may be a little unsteady.

Syncope, or fainting, is also a significant cause of falls among the elderly and has been a major focus of study by IFAR researchers. Ongoing studies of the causes of syncope in seemingly healthy older individuals has produced findings that help explain why this is such a problem. In older adults, common daily activities can result in dangerous reductions in blood pressure (hypotension). With age, a person's ability to compensate for these activities becomes compromised. This drop in blood pressure reduces blood flow to the brain, often resulting in loss of consciousness and a consequent fall.

Dehydration, another cause of hypotension, is also a problem among healthy elders. Older people do not experience thirst as readily as younger individuals do. They often will not adequately replace fluid that they may lose due to acute illness or ingesting certain medications. Again, the resulting hypotension can precipitate fainting and falling.

As one can see, even a healthy older adult is subject to falling, but many individuals also suffer from chronic illnesses that cause dizziness, fainting or impaired movement. In some cases, several conditions may be operating at once to put a person at even greater risk. Additionally, medications prescribed to treat a condition may be the culprit. All of these factors point to the need for careful monitoring of an aging person's health and effective communication and coordination between physicians, patients and any other caregivers.

As researchers at Hebrew SeniorLife are able to identify more precisely the mechanisms that trigger fainting and falling, seniors and their caregivers will be able to better predict circumstances that may lead to a fall and develop more effective prevention strategies. Based on current knowledge, however, there are precautions one can take now to reduce the likelihood of falling.

Experts at HSL offer the following advice:

  • If you are taking medications that lower blood pressure, ask your doctor or pharmacist if you can take them between meals to avoid a large drop in blood pressure. If you become dizzy after large meals, small frequent feedings, a glass of water with the meal, or walking after meals may help.
  • Take prescribed medications as ordered; do not take extra pills to make up for missed doses. Be careful of medications that can make you drowsy. Do not take any over-the counter-medications before talking to your doctor. Remember that these medications may interact with medicines you are presently taking.
  • Wear shoes that fit well and have low heals, and don't walk around in socks or stockings that could make you slip.
  • Have your eyes and ears examined annually.
  • Ask your doctor about exercises that will improve your strength and endurance. In addition to walking, consider weight-lifting exercise. Research at Hebrew Rehabilitation Center shows that resistance training builds muscle size and strength and improves gait and mobility.
  • Use a cane or walker if it has been prescribed, and make sure the cane or walker is adjusted to your height. Learn to use it properly.
  • Take safety precautions: keep your home well-lit, remove scatter rugs, remove or tape down telephone and electrical cords, install grab bars in the shower/tub and next to the toilet, and use a non-skid bath mat in the shower.
  • If you have a fall, even if you do not hurt yourself, report it to your doctor. If you fall and have trouble getting up, or you think you lost consciousness, call your doctor immediately.

As more people live longer lives than ever before, the need to find ways for seniors to live productive and safe lives in community settings will continue to grow. It is clear to see that falls constitute a major threat to maintaining independent lives for older people. The solution to the problem, however, is not simple. Prevention requires an understanding of many gerontological issues, and IFAR findings will continue to shape strategies aimed at helping people maintain a good quality of life as they grow old.

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