Fear of Falling = Loss of Independence

Before her fall, Margie had a large circle of friends with whom she traveled, went to church and to other community events. After her fall, fear became her most frequent companion.

Margie’s intense fear of another fall made her hesitant to even leave her home. She feared the terrible pain, another hospital stay, and the arduous rehabilitation she endured to regain her ability to walk.

Margie’s story is similar to that of 2.5 million older Americans who go to emergency rooms for fall-related injuries each year, according to the Centers for Disease Control and Prevention. Falls are the chief cause of fractures, hospital admissions for trauma, loss of independence and injury deaths for adults over age 65.

Annually, falls cost the American health care system almost $20 billion in direct medical costs. Hospitalizations account for 63 percent of the total, 21 percent for emergency department costs and 16 percent is spent on outpatient treatment. Fractures are just 35 percent of non-fatal injuries but account for 61 percent of total costs.

Tell your doctor about every fall

Margie had experienced several minor “slips” in the three years prior to her traumatic hip fracture. She didn’t tell her doctor about the falls during regular checkups because she didn’t think she needed to. She’d only had some bruising, nothing broken; why bother the busy doctor, she reasoned. She was feeling her age but didn’t want her two daughters to think she couldn’t live independently anymore. They both seemed to think a nursing home was the only “safe” place for her. Margie valued her independence and didn’t want any changes in where she lived.

Margie should have told her doctor about the falls because many of the underlying causes of falls can be treated or corrected. Falls can be the sign of a new health problem that needs attention. Margie’s doctor could have double checked her medications for anything that increased fall risks. He could have referred her to a physical therapist who could help her improve her balance and encourage more walking to strengthen leg, hip and back muscles. A home safety specialist could have helped evaluate her home and yard for fall hazards. They might have corrected the loose stair tread and lack of stair railing that caused Margie’s fall to the bottom of her basement stairs.

Address every risk factor

Most falls are caused by a person’s physical condition or a medical problem. According to the National Institutes of Health, these are the prime risk factors that can increase your chance of falling:

  • Muscle weakness, especially in the legs, including declining endurance and flexibility
  • Balance and gait (how you walk) are usually linked to a lack of exercise, or a nervous system problem, arthritis or other medical condition
  • Blood pressure, especially if it drops too much when you stand up and makes you dizzy enough to fall
  • Poor health, including diabetes, heart and blood vessel diseases, and thyroid problems can alter your balance
  • Slower reflexes – part of normal aging
  • Foot problems that cause painful feet or altered gait
  • Unsafe footwear including backless shoes or slippers, high-heeled shoes, smooth leather soles
  • Sensory problems can make you less aware of where you’re walking; numbness in the feet removes your sense of where you’re stepping
  • Poor vision, poor depth perception, glaucoma, cataracts and slower adjustment when you move from dark to light and light to dark areas
  • Poor hearing can decrease your ability to react to what’s around you
  • Poor lighting, both inside and outside
  • Medications can cause dizziness or confusion; the more meds you take, the higher your fall risk
  • Sedatives and some types of antidepressants are closely associated with fall risk; ask your doctor about tapering off them
  • Alcohol can greatly affect your balance and reflexes
  • Unsafe walking areas that include loose rugs, clutter on the floor or stairs, spills, lack of stair railings and grab bars, carrying heavy/bulky things up or down stairs

To preserve her independence, Margie decided to take matters into her own hands. She began an exercise program through a couple of morning exercise and yoga programs on television. Her nephew showed her some upper body exercises with two-pound weights to strengthen her bones. Strong bones can help prevent fractures if she does fall again. He also encouraged her to climb stairs every day. Eventually she was strong and confident enough to extend her walks to the neighborhood and a nearby park.

Regular exercise improves muscle tone and strength, heart function, and keeps joints, tendons and ligaments flexible. Multiple studies document a reduced rate of falling in older people who participate in exercise programs focused on balance, strength, flexibility and stamina.

Margie had her hearing and eyes checked. New bifocals made a big difference and increased her confidence in moving around.

A trip to the shoe store provided safe footwear, a pair of rubber-soled, lace-up shoes. She donated her highest heels, unsafe slippers, and thin-soled flats to charity.

She finally had railings installed on both sides of her basement stairway; a grab bar was added to the one-step down to her back porch.

Other important lifestyle changes include:

  • Limit the amount of alcohol you drink
  • Use a cane or walker if you feel unsteady
  • Avoid walking on wet or icy surfaces
  • Clean up spills immediately
  • Get enough sleep
  • Avoid wearing socks or smooth-soled slippers
  • Stand up slowly, being sure you’re not wobbly or dizzy before walking
  • Have medications checked for side effects that cause dizziness or sleepiness
  • Avoid blocking your view of stairs when carrying a bulky object – always keep one hand on the railing
  • Consider an emergency call system with a necklace or wristwatch-type button that can be pushed to summon emergency help

Safe-proof your home and yard

More than half of falls happen at home. Safe-proof your home and yard with these suggestions:

  • Install or tighten handrails on both sides of every staircase, even one stair needs a grab bar
  • Install good lighting throughout your home and at all outside doors, including switches at the top and bottom of stairs and at both ends of long halls
  • Never place electrical or phone cords in walking areas
  • Keep floors, halls, stairs and outside pathways completely free of all items
  • Repair uneven pavement or walking surfaces in your yard, driveway or garage
  • Arrange furniture so there are clear paths to walk throughout your home
  • Donate furniture that is too low for you to comfortably sit down and get up from
  • All carpets or rugs should be fixed firmly to the floor; do not use throw rugs or small area rugs
  • Add grab bars near toilets, and inside and outside of tubs and showers
  • If you remodel a bathroom, consider a higher toilet, raised toilet seat or one with armrests; consider a sturdy seat and hand-held shower nozzle for seated bathing
  • Use non-skid mats or strips on all surfaces that may get wet
  • Add non-slip treads for bare-wood steps
  • Always know where pets are before taking a step
  • Install and use night lights; have a lamp within easy reach of your bed
  • Keep a telephone near your bed and flashlights in easy-to-find places in case of power outages
  • Never stand on a chair or step stool without a handrail
  • Use a “reach-stick” (available at hardware or medical supply stores) to get things from high shelves or that are out-of-reach
  • Rearrange kitchen and other storage areas so the most frequently used items are within easy reach
  • Get help changing light bulbs; consider switching to fluorescent bulbs that last much longer and save money, too

More dangerous for elders

Every one falls occasionally but falls tend to cause more serious injuries as we age. More than 35 percent of people 65 or older will fall each year. The risk of falling increases with age. Falls are the main cause of fractures, hospital admissions for trauma, loss of independence and injury deaths for older adults. The most common fall-related fractures for older adults occur in the hip, pelvis, spine, arm, hand or ankle. Broken hips are the most serious and costliest. They are the leading cause of injury, loss of independence and many require long-term care after a hip fracture.

Dr. Robert Shmerling, writing for the Harvard University Health Blog last month, describes how older adults’ significantly slower reaction times make falls more dangerous for them.

“It’s a combination of age-related changes in the brain, slowed signals from the brain to nerves and muscles, reduced flexibility of joints and tendons, and weaker muscles. Older individuals tend to have less accurate awareness of their extremities’ position in space. These changes conspire to increase the likelihood of falling and to reduce one’s ability to make quick adjustments if a fall does occur.”

When an older person falls, it can push health to a downward spiral that robs him or her of good health, independence and self-confidence. A fall can often lead to hospitalization or institutionalization. The fear of falling keeps many older adults from participating in outside activities. Their world shrinks, they become withdrawn and depression is common.

Any investment made to prevent falls – both public and personal – can reap enormous savings in health care costs and long-term care usage, and help maintain a healthy and independent lifestyle.