Simple ways to prevent falls among older adults

As we age, the risk of falling increases and becomes increasingly perilous. A fall can be a real health setback for a frail, elderly person. And, more older adults are dying from falls today than 20 years ago. A recent study showed that more than 25,000 U.S. adults age 75 or above died from a fall in 2016, up from more than 8,600 deaths in 2000, and the rate of fatal falls for this age group roughly doubled. But the risk of falling can be minimized, says Dr. Elizabeth Eckstrom, professor and chief of geriatrics at Oregon Health & Science University. "A lot of older adults and a lot of physicians think that falling is inevitable as you age, but in reality it's not."

NPR's Lulu Garcia-Navarro and Luisa Torres spoke to Eckstrom about the most common causes of falling among seniors and the best ways to prevent them.

This interview combines two separate conversations with Eckstrom and has been edited for clarity and length. Are seniors falling more than they used to? Or are there more seniors? Does something else explain this increase?

I think it might be a little bit of both. There are so many more seniors, and there's probably better reporting than there used to be. There's more awareness about falls as older adults and doctors are starting to think about it a little bit more. I think our older adults are starting to [be more active], and that also is going to put you at risk for falling. I always tell people to please not be sedentary to prevent falls. That's the worst thing you can do. You've got to be out and active, but being out and doing things does allow you to put yourself in a position where you could fall.

Also, I think one of the biggest problems for falls is that so many older adults are on risky medications. Those sleeping pills, pain pills, a lot of the drugs that older adults have been prescribed for years and years have markedly increased risk for falling. And if we could get everybody off of those pills, it would be so helpful.

How do pain pills increase the risk of falls?

Pain pills have similar side effects [compared to] sleeping pills. They can make you dizzy. They can make you confused. They can make you lethargic. They can cause you to not be as sharp so that you're not paying attention to curbs or uneven sidewalks.

Are there any other drugs that seniors should be aware of?

Yeah, absolutely. There are a lot of drugs that fall into a class called anticholinergics. It's the class that has cold medications in it, like Sudafed PE, [and] drugs to help control bladder problems, like Detrol. All of those drugs are in that very dangerous anticholinergic class, [which] increases your risk for falling.

The other thing that a lot of older people take is blood pressure pills. Managing blood pressure is a little tricky [because] you don't want your blood pressure to be too high, because that increases your risk for heart attacks and strokes. But if you take too many blood pressure pills, it makes your blood pressure too low, and you get dizzy and you fall.

A study from the Centers for Disease Control and Prevention found that physicians routinely failed to perform basic interventions to help prevent falls. Why do you think that is, and how could doctors help?

Most primary care doctors have no more than 15 minutes with a patient, and they're managing their diabetes, congestive heart failure, their asthma — all of those other medical conditions. And [they] don't recognize the importance of fall prevention in that milieu. It takes a lot of work to help an older adult reduce their risk for falling. You've got to talk about the glasses; you've got to make sure they're wearing the right shoes; you've got to make sure they're using a gait aid [like a cane or a walker] if they need one — and all of those things take time.

The CDC has also done a beautiful job of putting together a fall prevention package in an initiative called STEADI (Stopping Elderly Accidents, Deaths & Injuries). You can go to their website and find all sorts of useful information to help both clinical teams, older adults and families to reduce risk for falling. Can you remind us why falling is so dangerous for older adults?

About a third of older adults who fall actually have some form of injury, and a lot of those are hip fractures and head injuries. And those can be fatal, of course. A vitally important thing is fear of falling, and many older adults who fall curtail their activities because they're afraid they're going to fall again. And, again, that's kind of the worst thing you can do because now you're losing mobility, you're getting weaker and you're not moving around as much.

What are some of the interventions you've used that can help seniors? You can do so many things. First of all, I tell everybody you've got to do some balance training. Tai chi is probably the best exercise to prevent falls, but whatever works for you. And, interestingly, just walking does not reduce your risk for falling. So a lot of doctors will say, "Just get out and walk 20 minutes every day, and that'll keep you safe. That'll help you stay healthy." Walking is great for your heart; it's great for your brain; it's great for lots of it. But in order to really reduce your risk for falls, you've got to do something specific to balance. What makes tai chi a good exercise to prevent falls? And why isn't walking a good alternative?

Walking is kind of just keeping you in one plane moving forward, and it's not doing any kind of postural training. What tai chi does is it gives you an increased area of postural stability, [which is] kind of your being able to remain upright in space. When you do tai chi, you do stepping moves to the front, to the side; you move your arms out, you reach, you bend. And basically that increases the size of your postural stability so that you can catch yourself and not have the fall. You can be a little bit off kilter and right yourself.

Do you have any more advice on how seniors can prevent falls?

For most people, it's not just one bad thing. It's not just your balance, or it's not just your vision, or it's not just one pill that you're taking. If somebody wants to reduce their risk of falls, they should really think about all of the various ways: making sure you're wearing the right shoes, using a walker if you need it, getting off those risky medications. It's really important to tend to all of those little details to really get your fall risk as low as possible. I encourage people to just work on that really, really hard. It's worth the trouble.

Francesca Paris and Ed McNulty produced and edited this story for broadcast. Copyright 2019 NPR. To see more, visit https://www.npr.org.

(2019-07-15 04:00:00 UTC):

A previous Web version of this story stated that Sudafed is an anticholinergic. It is not, but the more commonly available Sudafed PE is.