Marvin M. Lipman, Consumer Reports’ chief medical adviser, leaves almost every older patient he sees with these parting words: “Remember, don’t fall.” He usually adds, “Look where you’re going, keep a nightlight on, lift your feet and don’t take chances.” The people he cautions about falls are in their 80s and 90s, and they have weathered the threats of middle-age heart attack and cancer. Their major remaining preventable cause of death or disability from injury is a fall.
Each year, about half of Americans age 65 and older suffer a fall; almost 10 percent are seriously injured. In 2011, almost 23,000 U.S. adults older than 64 died from a fall.
Although death sometimes occurs immediately after a fall — from a broken neck or a brain hemorrhage, for instance — deaths most often happen as a result of a complication from the initial injury. According to the American Academy of Orthopaedic Surgeons, almost one in 10 people who fracture a hip die within a month.
One hip-fracture complication — blood clots to the lungs — has become much less of a threat, thanks to the almost universal use of anti-clotting drugs after hip and knee replacements. But pneumonia remains a frequent foe, killing 43 percent of those who develop the infection after hip fracture.
Another common fall-related concern, delayed bleeding in the head, may not reveal itself for weeks. (If you hit your head, report any limb weakness or difficulty with speech or balance to your doctor.) Fall-related psychological aftereffects — fear, insecurity and depression — can be life-changing.
Aside from the proverbial slip on a banana peel, the causes of most falls are age-related. They include painful arthritis, strokes, vision problems, low blood pressure, nutritional deficiencies that can lead to nerve damage in the feet or muscle weakness, and medications that cause dizziness and decreased alertness. If you suspect you’re at risk of falling during daily activities, discuss your concerns with your doctor.
Of all the causes of major falls, impaired gait and balance are tops on the list. So test yourself: Are you limping or shuffling? Can you do heel-to-toe walking (taking steps with one foot directly in front of the other) without lurching off-balance? Can you stand on one leg for at least 30 seconds? (An inability to do so suggests a balance problem.)
You can also do two other tests, both of which have a high predictive value for future falls if you flunk.
For the Get Up and Go Test, sit in a chair without arms, rise, walk 10 feet forward, quickly turn, walk back to the chair and sit back down. Have someone time you. If it takes more than 14 seconds, you are at risk for falls.
For the Functional Reach Test, stand with your feet no more than shoulder-width apart. Extend an arm in front of you at shoulder height. Reach as far forward as you can with that arm without falling. Have an observer measure your reach. If it’s less than seven inches, you’re prone to falls.
In certain cases, corrective measures target specific problems. Nerve damage from vitamin B12 deficiency can be mitigated by replenishing that vitamin. Taking vitamin D has been shown to reduce fall rates, although the mechanism is unknown. A cardiac pacemaker can help with stumbling and falls that result from a slow heart rate. Proper medication can improve the shuffle of Parkinson’s disease, and cataract surgery can correct vision problems. Eliminating alcohol, adjusting blood pressure medicine or limiting the use of tranquilizers and sleeping medicines may diminish fall risks. Your doctor may also want to evaluate you to see whether a cane or walker would be helpful.
Because multiple factors are often at play, physical therapy has been shown to be effective at reducing fall risks and rates. Your doctor can prescribe physical therapy to strengthen your muscles and improve your balance, flexibility and endurance. Group exercise programs or tai chi classes may also help you to be less prone to falling.
You can also improve your balance and strength with several at-home exercises, such as heel-to-toe walking, leg lifts performed while holding on to the back of a chair and practicing standing on one foot. For instructions on those exercises, go to go4life.nia.nih.gov/exercises/balance.
For further guidance, go to www.ConsumerReports.org/Health, where more detailed information, including CR’s ratings of prescription drugs, treatments, hospitals and healthy-living products, is available to subscribers.