What home and/or community strategies or modifications are most important to reduce the risk of falling and how can policymakers encourage their widespread adoption? View the full forum.
By Dorothy Baker
People across the age span are at risk of falling. But the probability increases with age, historically seeding the assumption that older adult falls were inevitable. In the 1990’s, National Institute on Aging (NIA) funded research provided evidence that the rate of older adult falls could be reduced by as much as 30%. The key to preventing falls and other geriatric syndromes is based on the concept of multifactorial causality. The greater the number of specific characteristics a person accumulates, the greater the probability of falling.
Listed chronologically as they commonly develop, we may see a sedentary lifestyle early or mid-life leading to a loss of fitness and muscle tone (“deconditioning”), weakness, joint discomfort, stiffness, and weight gain. These can ultimately challenge one’s ability to defy gravity. They result in an inability to stand on one leg long enough to shift weight to the other leg with sufficient stride length to walk efficiently. Hence one begins to “shuffle,” increasing the chance of tripping. Weak legs impede the ability to maintain control of body weight when moving from sitting to standing and reverse. It is increasingly common for Americans of all ages to use over-the-counter and prescription pharmaceuticals rather than trying lifestyle changes. The ability of the body to clear medications slows with age, increasing the probability of becoming overmedicated. Taking multiple medications concurrently, especially if dehydrated, causes the blood pressure to drop too low when moving from lying to standing and can result in dizziness, imprecise navigation, and falls.
If one enters “the golden years” deconditioned, overmedicated, and dehydrated, the stage is set for a fall when normal changes of aging occur. These include reduced sensory abilities of the eyes, ears, feet and mental processing. Multitasking is a challenge at any age. But if the environment requires specific focus to navigate safely, fall risk increases. Hence, at least 30% of older Americans living in the community fall each year, at an estimated cost of $34 billion in 2013 for fall-related injury medical care. Preventing older adult falls involves helping people understand that they are at risk, why they are at risk and how to reduce or manage each risk to the extent possible. Opportunities for managing the risk of falls among older adults might include proper hydration, timed toileting, reducing the medication load, exercise to improve balance and strength, correcting sensory deficits and reducing environmental challenges.
It is never too early, or too late, to reduce the risks of falling. Falling is a public health problem that can be prevented in part by healthier lifelong habits. Children need time to play outside to develop self-confidence, learn to enjoy moving and develop their gross motor skills. Youth athletic programs should strive to involve all, not just the “athletes,” and should focus on health rather than winning. Walkable communities, bicycle lanes and community-based exercise opportunities help people of all ages. We all need a basic understanding of how the body functions to protect ourselves from the relentless marketing that encourages unhealthy behavior. In short, we should promote better living through natural biological processes rather than through an excessive reliance on pharmaceuticals.
Dorothy Baker is the Senior Research Scientist of Internal Medicine, Geriatrics & Director CT Collaboration for Fall Prevention at the Yale School of Medicine.
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Any views expressed on this forum do not necessarily represent the views of the Senior Health and Housing Task Force, its co-chairs, or the Bipartisan Policy Center.