8th April 2024
HEALTHbeat – Harvard Medical School
Falling is a normal part of early childhood. However, as we age, even a minor fall can be debilitating. Falling as an older adult can lead to serious consequences including injury, disability, and even death. The good news is most falls can be prevented. Taking precautions, such as making changes in your home, starting an exercise routine, and regular check-ups with your doctor, may help keep you safe.
Why do we fall?
Our risk of falling increases as we age, with an estimated 36 million falls occurring every year in adults over the age of 65. Older adults who are frail or have other medical conditions are at a higher risk for falls. The number one risk factor for falls in older adults is history of a prior fall.
One of the best ways to prevent falls is to understand why people fall. Anything that decreases your strength and mobility, affects your balance, or changes your ability to walk and stand upright may increase your risk of falling. This includes:
- Muscle weakness
- Gait abnormality
- Foot, knee, or back pain
- Weight changes
- Lack of sleep
- Injury
Certain health problems can also lead to balance problems and increase your risk of fracture or other injury from a fall. For example:
- Inner ear problems
- Vision problems
- Dementia
- Vitamin D deficiency
- Arthritis
- Osteoporosis
- Diseases of the nervous system, such as Parkinson’s disease.
In addition, side effects from many medications can contribute to falls. These include:
- Blood pressure medications, which can cause low blood pressure upon standing quickly (postural hypotension)
- Sleep medications, anti-anxiety drugs, or antidepressants, which may make you groggy and less aware of your surrounding
- Diphenhydramine (Benadryl), an antihistamine that is an ingredient in many popular over the counter sleep products. Regular use is linked to memory problems and a higher fall risk.
Regular follow-up with your doctor to identify and address these issues can help prevent falls.
Fall risk assessment
It is important to see your doctor every year to review your medical conditions and medication list. Among other benefits, this appointment is an opportunity to identify any risk factors for falls. You should also see your doctor if you sustained a recent fall, feel unsteady on your feet, or are worried about falling. Your doctor may ask about your fall history and assess your risk factors using a questionnaire. Some other common assessments that can help identify an increased risk for falls include:
- Strength, gait, and balance tests
- Blood pressure measurements while sitting, lying, and standing
- Visual acuity test
- Vitamin D levels
- Review of potential home hazards
- Evaluation of your feet and footwear.
Based on these findings, you doctor may adjust treatment of your medical conditions and develop a personalized care plan to reduce your risk factors.
Balance test
Balance involves an ability to both stand upright and to anticipate changes in movement. It requires coordination from many parts of your body. Your doctor may have you perform a balance test, which assesses your ability to hold a few different positions without moving or needing support for 10 seconds. A 2022 study published in the British Journal of Sports Medicine found that an inability to balance for 10 seconds while standing on one foot was associated with a significantly increased risk of dying from any cause.
To assess your own balance, a simplified balance test can be completed at home and only requires a stopwatch. An inability to complete this test means you may be at increased risk for falls.
How to do a 10-second balance test:
- Start standing with both feet side by side and your arms by your sides.
- Keeping one foot planted firmly on the floor, lift the other foot at least 12 inches above the ground.
- Without lowering your raised foot, using any support, or raising your arms, remain in this one-legged position for 10 seconds.
Mobility aids
Approximately one-third to one-half of adults over the age of 65 are affected by limitations in mobility — the ease with which one can move freely and purposefully in their environment. Assistance devices are a helpful way to aid your mobility while providing an extra layer of safety and precaution against falls. Consult your doctor regarding the best form of mobility aid for your needs. Assistive devices for walking include:
- Canes: an easy, lightweight option designed to support about 25% of your body weight
- Walkers: a better option for increased stability, with the ability to support up to 50% of body weight
- Wheelchairs: the best option during times of impaired mobility or injury if little to no body weight can be supported.
Fall prevention exercises
Physical activity is key to preventing falls in older adults. Aside from the positive impacts on heart health, mental health, and weight management, exercise can improve your strength, balance, and endurance. These factors work together to improve your mobility and are considered the most important factors in fall prevention.
When starting a daily exercise routine, consistency is key. Even small changes in your daily activities can make a difference. Consider starting with small exercise goals and aim for a variety of different forms of exercise.
Target area #1: Strength
As we age, we lose a significant amount of muscle mass. It is important to maintain strength, particularly in the core and legs, to reduce your risk of falls. Your core is made up of your abdominal, buttock, pelvic, and back muscles. These areas work together to keep the body upright and stabilized over your center of gravity. The stronger your core and legs, the better you can stay balanced and move around. Building strength can be accomplished through:
- Functional exercises: exercises that mimic daily activities, such as rising up from a chair.
- Weight training: exercises that involve using hand weights or machines to target specific muscle groups.
- Resistance training: exercises that use body weight to challenge your muscles, such as doing a push-up.
Target area #2: Balance
When you are not steady on your feet, your risk of a fall increases. Besides core muscle strength, foot and ankle mobility are another important factor in achieving better balance. Exercises programs that have been demonstrated to improve balance include:
- Yoga, particularly hatha yoga: a more physical type of yoga that utilizes breath-controlled exercises.
- Tai chi: a mind-body activity that is described as “meditation in motion.”
- Pilates: a form of exercise that combines stretching, strengthening, and core exercises.
- Balance-training exercises: movements that build your ability to remain steady while standing still (static) or moving (dynamic)
Target area #2: Endurance
The less active we become, the more we lose our endurance, or ability to perform activities without becoming easily winded and out of breath. Lack of endurance is a risk factor for falls because it leads to impaired mobility. The best way to improve or maintain endurance is aerobic exercise that increases your heart rate. Examples include:
- Water aerobics
- Dance
- Zumba
- Cycling
- Stair climbing
- Walking
- Swimming
Many of these activities are available for free or at low cost at local gyms or senior centers. It’s important to talk with your doctor prior to starting any exercise regimen, and to choose a class that feels comfortable for you and your level of mobility.
Three at-home exercises to reduce your risk of falls
Exercise #1: Opposite arm and leg raise
Target area: core strength
Starting position: Kneel on all fours, knees hip-width apart. Align your shoulders over your wrists and your hips over your knees. Keep your head and spine in alignment.
Movement: Extend your right leg off the floor behind you while reaching your left arm out in front of you. Try to raise your extended leg and arm parallel to the floor. Hold for 10 to 30 seconds. Return to the starting position, then repeat with your left leg and right arm. Do this two to four times on each side. Rest 30 to 90 seconds and repeat the entire set.
Exercise #2: Heel toe standing (no support)
Target area: balance
Starting position: Stand up straight near a table or chair and look ahead. Line up one foot directly in front of the other.
Movement: Extending your arms outward for support, hold position for 10 seconds. Place the foot that is in front directly behind the other one. Hold for 10 seconds. If too easy, walk 10 steps with your feet lined up heel to toe. Turn around and walk back in the same way.
Exercise #3: Sit to stand (no hands)
Target area: leg strength, balance
Starting position: Sit on a chair that is not too low. Place your hands in your lap, across your chest, or out in front of you.
Movement: Place your feet behind your knees. Lean forward and slowly stand up without using your hands. Slowly sit down with control. Repeat 10 times.
Fall prevention at home
Home hazards may also make you more likely to fall. It is important to check room by room for potential fall hazards that may be lurking. Ensure your home is organized so that the items you use regularly are within easy reach. Make modifications so you can move freely about your home, with all paths clear and well lit. Pay careful attention to the floors, and check that they are free of spills and safe for walking. Some alterations that can be made at home include:
- Non-skid rugs on the floors
- Non-skid mats in the shower
- Benches, seats, and bars in the shower and above the toilet
- Lamps that turn on by touch or sound
- Plush or low-pile carpeting
- Handrails along all stairwells and the front/back steps of the home
Fall safely
Despite our best efforts, falls can still happen. Knowing what to do if you fall can help you avoid injury. To fall more safely with a softer landing:
- Lean forward, keeping your knees bent and feet down — this gives you better control of the direction of your fall.
- Fall onto body areas with the most “cushion” such as your buttocks and thighs.
- Lean your shoulder into the fall to protect your head.
- Aim for a soft area of grass, dirt, or carpet if possible.
- Stay relaxed
For more information on how to prevent falls, read Preventing Falls: Strategies to maintain health, strength, balance, and a safe home environment, an Online Guide from Harvard Medical School.