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Risk of Falling by Maintaining Health
Dr. David Lipschitz
After age 65, about 30 percent of people fall at least once annually.
If a hip fracture occurs, 25 percent will die in a year and 50 percent
will become dependent — frequently requiring nursing-home care. Fortunately,
much can be done to reduce the risk of a fall, the need for lengthy hospital
stays or the loss of independence.
The risk of falling frequently is due to declines in balance, mobility and gait,
as well as a high risk of fainting caused by a blood pressure drop when attempting
to stand up. Visual difficulties, dizziness, inappropriate shoe choices and drug
side effects often contribute to falls. Tripping due to environmental hazards
in the home or elsewhere remains the major cause of falls at any age.
For a person at risk of falling, an evaluation by a physician is essential. Medical
conditions that contribute to falls must be identified and treated, and problems
with gait and balance should be evaluated. Medications that increase the risk
of falling should be avoided. Wherever possible, keep medications to a minimum
and avoid sleeping pills, tranquilizers and alcohol. Patients must be made aware
that medications to treat hypertension can lead to dangerous drops in blood pressure,
with changes in posture. Never stand up suddenly and always have something to
hold on to.
No matter your health, aging is associated with a relentless loss of muscle mass,
an increased proportion of weight as fat, and progressive weakness that slows
gait speed, affects balance and increases the risk of falls. It follows that
the more we do to maintain strength the better.
Physical therapy can help reduce falls. Treatment includes balance exercises
and working with weights that build muscle, bones and most importantly, strength.
The older the patient, the longer the time taken to see tangible improvements,
but they will occur and in the long term, the results are well worth the effort.
When physical therapy ends, keep moving and consider joining a health club to
maintain and improve strength and balance.
If needed, do not be embarrassed to use a cane, walker or wheelchair. But walk
as much as possible. The more time spent being immobile or sitting in a wheelchair,
the greater the loss of muscle and the increased chance of a fall.
Most serious falls occur in the bathroom. Carefully review the bathroom and make
sure slippery surfaces can be avoided, that water does not leak from the shower
or tub, and if possible, install handrails from the bed all the way into the
bathroom. Often a raised toilet seat with armrests can prove helpful. A sturdy
plastic seat should be placed in the tub or shower and use a hand-held shower
to bathe. If a wheelchair is needed or gait and balance is significantly impaired,
a uniquely designed bathtub or shower may be necessary.
Fall-proof the home by clearing walking areas of boxes and electrical and phone
cords. Remove low coffee tables and move magazine and plant stands out of the
way. Loose rugs should be removed or taped to the floor; uneven wooden floorboards
or carpeting must be repaired; and skidproof materials should be used for cleaning.
Many falls are caused by standing on a chair or attempting to remove something
from an out-of-reach cupboard. For this reason, clothing, cleaning materials,
dishes, utensils and food must be accessible and stored within easy reach.
Adequate lighting decreases the risk of a fall. Assure that each room has ambient
light from outside during the day, is well lighted at night and use nightlights
liberally. Always switch on a light before climbing the stairs and install glow-in-the-dark
or illuminating light switches.
If the risk of a fall is too great, consider whether living alone in a large
house with stairs is appropriate. It may be time to move to a one-level home
or assisted-living facility, where help is available and people surround you.
And as you grow older, no matter your health, live as close as possible to immediate
Accidents due to falls are a major cause of physical disability, the need for
nursing-home care and poor quality of life. The earlier precautions are taken
to reduce the risk of a fall, the better.
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