The Older We Are the Harder the Fall

One of the many things that becomes more problematic as we age is our ability to prevent falls. It turns out that falls are a very common problem and an increasing problem for us all as we get older. In fact, there were 29 million falls and 7 million injuries in 2014 among the elderly population. As this country continues to add more and more elderly to our population by 2030 it is predicted that there will be 12 million injuries from falls. Today the estimated cost associated with falls is $31 billion. This is real hardship and real money and means we need to do all we can to assess risk and prevent falls.

Causes of Falls in the Elderly

There are a number of reasons for the increasing incidence of falls as we age. Among the conditions that contribute to falling are poorer eyesight, vertigo, impaired hearing, and reflexes. There are also a number of diseases that can contribute to falls including Parkinson’s and other neurologic disorders, diabetes, heart disease, abnormal thyroid function, feet pathology, and vascular supply to the legs and feet. In addition to all this, many medicines contribute to the condition we discussed last month, postural hypotension, which causes dizziness upon standing and sometimes to falls.

Consequences of Falls

The worst consequence of a fall is to suffer a head injury or break a bone or joint, such as an arm or hip. These injuries require hospital visits and often surgery. Sprains and strains of joints and tendons also are common injuries that result from a fall. And the older we are, the more prolonged the recovery from these injuries and the more costly the hospital and medical expenses become. Even if we do not break anything or hurt ourselves we can cause other damage to others, things (think dropped cell phone), or even pets. So it behooves us to assess our risks of falling and to have a preventive strategy in place.

Assessing Our Risk

It is important for us to understand our risk and the figure below shows a simplified algorithm published by the CDC. Because about 25 percent of elderly people will suffer an important fall each year, it is wise to calculate your own personal risk.

The risk analysis depends on your history of falling, a medical evaluation, and whether or not falls have caused injury. Looking at the figure, you can calculate your own risk by answering the questions. If you have no history of falling, no history of concern, and there is no medical reason, then your risk is low. If you have had one fall but no injury, you fall into the moderate risk category. You are in a high risk of having falls if you have two or more falls a year or one fall with injury. The medical evaluation part of this algorithm is important and your physician should ask you every time he sees you if you have experienced any falls since the last visit. If yes, the evaluation should be done immediately.

personal risk for falls chart


There are a lot of things that can and should be done to prevent falls. Some of the major actions are listed in the table below. By reading the suggestions in the Fall Prevention Strategies listed below you can get a good idea about how well positioned you are to prevent falls. It is important to do all of the things in the table, even if you are in a low risk category, simply because the older we all get the more likely we are to increase risk. If you have any of the factors mentioned in the risk paragraph it is very important to observe all the suggestions below.

Fall Prevention Strategies

  • Stay physically active
  • Do balancing exercises
  • Have eyes and ears tested
  • Sleep six to eight hours a day
  • Watch for postural hypotension
  • Monitor medications and relationship to alertness and steadiness
  • Avoid intoxicating drinks and medicines
  • Use walking aids when prescribed (canes or walkers)
  • Walk gingerly on wet or slick surfaces
  • Wear non-skid shoes
  • Use a "reach stick" rather than a ladder for reaching high
  • Safety-proof your house:
    • Non-slick waxing of floors
    • Remove small mobile rugs
    • Keep wires and cords out of the way
    • Rug and carpet edges should be secured to floor

Bottom Line

As we age, falls become more common and more threatening to our health. It is incumbent on each of us to assess our risk for falls and to keep our physician appraised of this aspect of our health. Even if at low risk for a fall, it is important to proactively do the things that will prevent falls including making our home safe for us and our guests.