Conquering Fear of Falling

Last Editorial Review: 1/30/2005

Stop the Drop

WebMD Feature

Reviewed By Gary Vogin

Feb. 18, 2002 -- Falling down isn't what it used to be. Remember slipping and sliding as a kid? Afterward, you'd jump up, pretending you weren't hurt. And a cast was good for autographs and bragging rights.

But even a minor fall can make older adults overly cautious. Various surveys show that 40% to 73% of people over age 60 who have fallen fear falling again, and half of those people restrict their activities as a result. (The worry is greatest -- and more justified -- in frail older people.)

"Some won't go on family outings or even leave home," says Edward Vandenberg, MD, geriatrician at the University of Nebraska Medical Center.

It's estimated that one in every three people over age 65 will experience a fall in any given year. Half of all falls cause only minor injury; 2% are fatal. Among seniors in nursing homes, 88% of falls are due to physical or medical problems. For older people who live in the community, 59% of falls are due to physical or medical conditions, and the rest result from accidents or tripping over obstacles.

Stop the Drop Before It Stops You

Vandenberg would like to halt a cycle he sees all too often. It starts with a fall, then inactivity, then weakness and finally greater risk for falling and injury. So many of the injuries he sees are preventable that he's entitled his public presentation on falling, "Old Age Isn't for Sissies," and explains, "If you want to enjoy old age, you have to work at it."

Limiting activity won't prevent falls, experts say. Self-defense will. Here are some tips to help you come up with a plan to prevent falls, for yourself or for an older person you know.

Reduce Environmental Risks

About 85% of falls occur at home. Many could be prevented if you:

  • Make sure you have adequate lighting.
  • Eliminate obstacles, such as throw rugs, clutter, and electrical cords.
  • Install handrails on stairs and grab bars near toilets and bathtubs.
  • Have a home safety assessment. (Often these assessments are done after a fall, but it's smart to be proactive. A doctor orders the assessment, which is covered by Medicare, and an occupational therapist or visiting nurse actually does it.)

Take Charge of Your Physical Condition

Don't accept physical limitations as inevitable with older age. Increase and manage your mobility by:

  • Correcting vision problems: Keep your eyeglass prescription updated with regular eye exams, and get treatment for cataracts and glaucoma.
  • Using drugs cautiously: Alcohol, sedatives, and sleeping pills, and some cold remedies and antidepressants, can impair your ability to react. Ask your doctor whether your drugs or drug combinations have these side effects and what you can do to minimize them.
  • Building strength: If your leg muscles are so weak you can't get up from a chair without using your hands, you're at greater risk of falling. "Weight training can improve strength at any age," says Michael Rogers, MD, director of the Center for Physical Activity and Aging at Wichita State University in Kansas. He knows of two people in one retirement community who regained sufficient strength and balance to put away their walkers.
  • Improving balance and gait: "You should be able to stand on one foot for 10 seconds," says Rogers. Practice standing on one foot while working at the sink or, if you feel confident enough, walking along a curb as though it's a balance beam. Some balance problems, such as inner ear disorders, require medical attention. But many can be improved by physical therapy, or through activities such as tai chi or yoga.

Boost Your Bone Strength

"Today we have a nice array of ways to make bones stronger," says Vandenberg. He recommends:

  • Getting enough calcium (1,500 milligrams for women; 1,200 for men) and vitamin D (800 units) every day.
  • Estrogen replacement for most women, based on other health factors. Ask your doctor about this.
  • Weight-bearing exercise.
  • Bone-building medication, calcitonin, and bisphosphonates for anyone losing bone density. Ask your doctor about this one, too.

Clearly, it requires effort to reduce environmental risks and take charge of your physical condition. But these self-defense strategies give you a measure of control in lowering your risk for falling and falling injuries.

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