Falls Can Raise Risk of Death. Yes, That’s How Bad They Are

CDC: More than 14 million older people (25%) report falling — it has become the top cause of injury-related death for people over 65

By Deborah Jeanne Sergeant

 

The Centers for Disease Control and Prevention reports that falls are the top cause of injury-related death for people 65 and older.

Falls in this age cohort are common.

The CDC states that more than 14 million older people (25%) report falling — and that does not include those who fall but do not report it.

“The age-adjusted fall death rate increased by 41% from 55.3 per 100,000 older adults in 2012 to 78.0 per 100,000 older adults in 2021,” the CDC states.

But why are falls so harmful to older adults?

“As we age, our bodies lose the ability to quickly heal and recover from things as small as a bump or bruise; the timeline increases,” said Season Bonino, physical therapist and Nazareth University clinical associate professor of physical therapy.

A fall that would end with a rueful laugh and a bruise can mean “something much more significant,” said Bonino, who is also a board-certified geriatric specialist in physical therapy. “Even if it’s a minor fracture like limiting their weight bearing activity, it can have dramatic effects because of being sedentary for a while. A fall that can seem minor at the time can have a cascade of events with that person being in a very different place down the road.”

After a fall, many frail older adults do not regain the same level of vitality as they had before.

Beyond the pain experienced during a fall, the consequences of falling can be severe for older adults. Preventing falls can help avoid these outcomes.

How people move can make a difference in whether or not they fall.

“People tend to take short, shuffling steps because they don’t want to stand on one foot at a time,” Bonino said. “But what they don’t recognize is they’ve narrowed their base of support. If someone bumps into them, they’re going to fall.”

A longer, more natural stride is safer.

The home environment makes an enormous difference. Poor lighting, clutter on the floor, throw rugs, uneven flooring and multi-level living spaces all contribute to a higher risk of falling. Upgrading the bathroom and bedroom — the most fall-prone rooms of the house — can reduce fall risk.

“Where you get in and out of the tub, could we put in a grab bar?” Bonino suggested.

Grab bars by the toilet also assist in stability, as does a bedrail in the bedroom.

Seeing where you’re going helps you stay on your feet. Bonino recommends nightlights and placing lamps where they can be turned on upon entering the room.

“In a lot of older homes, you have to cross the room to get to a light switch,” she said.

Bonino asserts that physical therapists can help prevent falls.

A 2018 study at Nazareth indicated a significant reduction in falls in people who completed training with a slip trainer, a device physical therapists use to safely trip patients without any risk of injury. Patients wear a safety harness so that when the therapist initiates the fall, an injury is not possible. The equipment allows patients to practice falling so their brains relearn how to elicit a recovery response quickly enough to prevent a fall.

“It’s an ‘inoculation for falls,’” Bonino said. “It’s like getting a flu shot or tooth cleaning. Research finds that perturbation-based balance training takes 20 minutes and we see results that last for months.”

 

New York designates physical therapists as direct access providers, meaning patients can see a PT for 30 days or 10 visits (whichever comes first) without a physician referral.

 

‘Use it or lose it’

Becoming less active to prevent falls is counterproductive, according to Maureen Loyal, physical therapist and director of rehabilitation and physical therapy with Finger Lakes Health.

“Fear of falling has you do less outside the home,” she said. “You become deconditioned and it’s a cycle. Do the opposite of what people do, which is confine themselves to their homes and have people do errands for them. People who are older should park farther away so they’re walking more. ‘Use it or lose it’ is important. It’s never too late to have balance exercises.”

She encourages older adults to seek help to improve their endurance, strength, flexibility and balance if they begin to experience instability while walking. Too many people reach for a cane or walker early on when improving their physical condition would prevent that reliance.

Instead of performing random exercise movements, Loyal focuses on functional movement that will help people better carry out activities of daily living like carrying grocery bags, standing and sitting and climbing stairs.

“We want to keep that function throughout life,” she said, “And you do that by keeping your strength. You may weigh the same, but you can see there’s more fat than muscle. You may think you have the same muscle capacity, but you don’t. I try to focus on functional exercises, not sitting in a chair and kicking your legs up. When do you ever do that movement?

“Do sit-to-stand exercises where you stand and then slowly sit down. If you can keep your quad muscles strong, it decreases risk for falls and keeps you independent in the community.”