To be honest, people don’t usually ask me this.
Instead, they want to know things like “How do I keep my mother from falling?” or “What should I do? My grandfather’s been falling.”
After all, falls are a scary thing. Most people know that falls are dangerous for older adults.
The Center for Disease Control (CDC) reports that one in five falls causes a serious injury such as a broken bone or head injury. Fear of falling can also seriously affect an aging adult’s quality of life and sadly, can keep a person from being active and thriving.
So, many seniors and family caregivers are interested in fall prevention because the risks are so great. And the good news is that although it’s not possible to prevent all falls, it almost always IS possible to take actions that will reduce the chance of a bad fall.
If you want to learn more, you’re in the right place.
In this post, I’ll cover:
- How understanding why aging adults fall can help you keep an older parent — or yourself — safer,
- Why personalized fall prevention plans work better than relying on general fall prevention tips,
- The four-step process I use to help older adults prevent falls,
- A practical example showing you how to use these steps to avoid falls yourself.
First, understand why older people fall
There are many reasons that aging adults fall. Most older people will be falling due to their own unique combination of reasons.
So how, exactly, should YOU go about reducing fall risk?
Now, you can — and should — try to implement the general tips that are often listed in most fall prevention resources: exercise, medication review with the doctor, vision checks, and home safety reviews.
But if you really want to help an older loved one avoid falls, I recommend you learn to better understand why he or she, in particular, might fall.
Why? Because when you understanding the specific reasons an older person may be falling, you’ll then be able to:
- Identify which fall prevention strategies are most likely to help the person you worry about,
- Recognize risky situations, and take steps to avoid them,
- Know which medical conditions — and which medications — to ask your doctors to look into,
- Understand what may have caused a specific fall, which can help you avoid future falls.
In other words, learning why older people fall means that you’ll be able to figure out why YOUR older relative is likely to fall — and take steps to help them.
Why personalized fall prevention works better than general fall prevention
Once you understand the particular factors contributing to your older loved one’s risk, it will be easier to focus on the fall prevention strategies that are most relevant to your situation. In other words, you’ll be able to personalize your approach to fall prevention.
Personalizing fall prevention is critical. You don’t want your mom to start by spending a lot of time on tai chi, if her current major risk for falls might be that her blood pressure medications are too strong, or her eyesight is terrible.
Also, don’t assume that most doctors will identify and manage the most important risk factors for falls. In my experience, busy doctors often miss opportunities to reduce fall risk, unless a family is proactive in asking for the right kind of help.
Now that we’ve covered how understanding falls can help you, let’s talk about falls. First, I’ll explain why any fall happens. Then I’ll share my framework for understanding why a particular older person might fall.
Why a fall happens
Why does a fall happen? Fundamentally, no matter who you are and what age you are, here’s why:
Challenge to balance or strength > Ability to stay upright”
In other words, we fall when we experience some kind of event that challenges our balance or strength. If this event overwhelms our ability to remain upright, down we go.
When we’re young and healthy, we tend to have lots of ability to stay upright. So if we stumble, we can often catch ourselves and recover before we fall. But of course, a big enough knock off-balance will send even a 20-year-old sprawling. And if that 20-year-old happens to be tipsy, it will take even less of a trigger to provoke a fall.
Illness or weakness is another situation that will reduce anyone’s ability to stay upright. (This is why people of all ages are prone to fall in the hospital.) But of course, older adults often have many other things going on which affect their ability to stay on their feet.
4 Steps to Reduce Fall Risk
Falls in older people are almost always “multifactorial.” This means there are usually several factors that are contributing to a fall, or to a person’s fall risk.
It can be hard to try to address every single factor. And some, such as slower reflexes, may be impossible to reverse.
Still, it’s often useful to go through them and try to spot a few that are either easy to fix, or potentially offer a big reduction in fall risk.
As a geriatrician, here’s what I do:
- Create a list of factors contributing to an individual older person’s fall risk.
- Identify risk factors and triggers related to recent or recurrent falls.
- Identify the factors that are easiest to modify or change. This is partly about the factor itself, and partly about what’s feasible for my patient to try to change. (Stairs can be a risk, but changing houses can be tricky.)
- Implement practical strategies to address modifiable fall risk factors.
3 types of fall risk factors you should consider
I also find it helpful to think of the factors as belonging to one of three categories:
- Health-based risks. This includes things like balance problems, weakness, chronic illnesses, vision problems, and medication side-effects. They are specific to an individual person.
- Environmental risks. These are things like home hazards (e.g. loose throw rugs), outside hazards (e.g. icy sidewalks), or risky footwear (e.g. high heels). This category can also include improper use of a walker, cane, or other assistive device.
- Triggers: These are the sudden or occasional events that cause a challenge to balance or strength. They can be things like a strong dog pulling on a leash, or even health-related events like a moment of low blood sugar (hypoglycemia) in a person with diabetes.
Now, you will probably find it hard to make a list of all these factors on your own. The health-based factors, in particular, tend to be closely related to medical problems. So they can be hard to properly sort out unless you’ve learned a lot about medicine.
Still, I encourage older adults and family caregivers to learn to think about fall risk factors, since this can help people get better at asking their doctors the right questions.
Below are slides from a talk I’ve given, on how older adults can reduce their fall risk:
Example: Why is Mr. Jones falling?
Let’s consider an example together, to illustrate how you can put this understanding to work.
Mr. Jones is 82 years old. He lives at home with his wife, and takes a daily walk in his neighborhood. He has had diabetes for a long time, and has chronic numbness in his feet. He is on medication for diabetes, high blood pressure, and also uses Tylenol PM.
His daughter Wendy subscribes to a newsletter about better health for aging parents, and she recently read the CDC’s fact sheet on how important fall prevention is. She would like to keep her father from falling.
What should Wendy do? As I mentioned earlier, the usual recommendations to lower fall risk are a good place to start. So Wendy could encourage her father to remain physically active, and she might want to take a closer look at the house to remove common trip hazards.
She might also want to help him get evaluated for vision problems and for low leg strength, since these are common fall risk factors among people Mr. Jones’ age. Furthermore, diabetes can cause or worsen vision problems.
But if Wendy wants to personalize the fall prevention plan, she should also consider asking the doctor to help make a list of Mr. Jones’ health-based risk factors.
In Mr. Jones’ case, some additional factors that jump out at me are:
- Chronic numbness in feet. This is a common problem in people who have had diabetes for a long time, and it can definitely affect how easily people stay on their feet.
- It’s good to be aware of this risk, however, this problem usually can’t be cured or reversed.
- Diabetes. Some people with diabetes are prone to episodes of low blood sugar (hypoglycemia), especially if they take insulin or other drugs to actively lower blood sugar.
- Wendy could ask her father if he ever has low blood sugar episodes, which could trigger a fall. If he does, she should make sure this is addressed with the doctor.
- It is often appropriate to relax blood sugar control as people become older and frailer. This is because as people age, tight control brings fewer benefits but more risks.
- Blood pressure medication. This could increase fall risk, especially if Mr. Jones’ blood pressure is often below 120/80.
- Wendy may want to take steps to make sure her father isn’t being over-treated for high blood pressure.
- Tylenol PM. Any over-the-counter medication labeled “PM” contains a sedative, usually in the form of an antihistamine such as diphenhydramine (brand name Benadryl). Older adults are often sensitive to these drugs, which can worsen balance or even thinking.
- Wendy should help her father review his medications. She should focus on spotting sedatives or any other medications with strong “anticholinergic” effects, such as a medication for overactive bladder. (For a link to a good list of anticholinergic drugs to avoid, see this post.) All sedating or anticholinergic drugs increase fall risk, but doctors may forget to avoid or minimize them unless a family specifically requests this.
You may have noticed that in this example, I’ve particularly focused on medications.
That’s for three key reasons:
- Medications are among the most common causes of increased fall risk in older people.
- Medications are often a fixable risk factor, when it comes to falls in older adults.
- Medication-based risks are often missed by busy regular doctors. Family caregivers can make a big difference by being proactive in this area.
If you’re concerned that you or your older relative might be on medications that are increasing your fall risk, see this article: 10 Types of Medications to Review if You’re Concerned About Falling.
Take the next step: create a personalized fall prevention plan
Remember, older adults usually fall because a) multiple risk factors make them vulnerable to falling, and b) a stumble or moment of weakness triggers the actual fall.
Most fall risk factors are health-based, and are related to chronic medical conditions or medications. And then some fall risk factors are environmental, and involve the home or outside environment.
You can definitely reduce fall risk by encouraging strength and balance exercises, and by optimizing the home environment.
But you’ll be most effective in preventing falls if you can get your doctors to help you understand your loved one’s personal fall risk factors.
This way, you’ll be able to develop a more personalized fall prevention plan…one that targets the risks and vulnerabilities most relevant to YOUR situation.
Questions about personalizing fall prevention? Please let me know in the comments below!
Or better yet, take our online Personalizing Fall Prevention Mini-Course, and I’ll help you identify the fall risk factors most likely to matter in YOUR situation.
Could Blood Thinners (Xarelto) taken daily have an effect on frequent falls at 82 Years?
Blood thinners sometimes cause anemia (low red blood cell count), because they can make people prone to have small — or occasionally bigger — bleeds in their stomach or bowels. Anemia can cause people to feel weak or dizzy, and can increase fall risk.
Blood thinners also increase the risk of injury — such as bleeding in or around the brain — in the event of a bad fall. The risk of bleeding AFTER a fall is the main reason clinicians sometimes hesitate to prescibe or continue blood thinners in an older adult who is at high risk for falls.
Otherwise, I don’t particularly think of blood thinners as being among the medications that increase the risk of falling. But of course, it’s always possible for an individual to have an unusual reaction to a medication.
If you are concerned about this medication, I would encourage you to discuss it with the prescribing doctor and/or your pharmacist.
My mom 86 is on warfarin blood thinner. She has very bad Arthritis bone on bone and sometimes the knee gets locked and she falls latelyit has been more often. Can you please let me know what I should do to prevent the falls
For any older person having falls, I recommend a comprehensive evaluation for triggers, causes, and contributing risk factors. There are covered in detail in our Fall Prevention Mini-Course. You can also start by making sure the health providers have checked for these things: 8 Things to Have the Doctor Check After an Aging Person Falls. Good luck!
I suddenly fall in the home sometimes
Sorry to hear this. I would definitely recommend bringing this up with your usual health provider. Good luck!
My mom’s neuro checked her b12 level and found it to be very low. She was put on 1000 mcg sublingual b12 and it has made a remarkabke difference in her balance! A simple fix for a serious issue in her case. I was amazed to read what bad symptoms a b12 deficiency could cause in the elderly. I had no idea!
B12 deficiency is indeed very common in older adults, and can be associated with nerve and balance problems. I have an article on vitamin B12 here: How to Avoid Harm from Vitamin B12 Deficiency.
Glad to know your mother improved once this issue was found.
I am having too many falls, and weakness in mornings. and I notice to my right are backwards when standing. my Doctor did blood work last week. hoping he can find something that will work. I have gone through much therapy . but this has started more. thanks for the post.
Recurrent falls are tough. It is often possible to identify several contributing factors and work to reduce them, but it can take some effort. Good luck!
Thx for the great information. I recently read an article in our local newspaper which talked about falling. The physio who was quoted said there is a lot of information on fall prevention but not much on how to fall safely. Because falls do happen. I’m studying up on that as I’ve had a few falls and hope to avoid future injuries.
I’m not aware of much high-quality research on helping older adults “fall safely.” It would be difficult to design a study of such an educational intervention. But if you come across any good information on this topic, let us know!
I was taught how to fall when I was in sports for high school football and wrestling.
Yes, it’s not uncommon for people to be taught a certain way to fall when they are learning certain sports. However, as far as I know, no one has successfully proven that one can reduce falls by teaching older adults how to fall.
Increasing leg strength and balance through specific exercises has been proven to reduce falls, and such exercises are also associated with reduced injury from falls.
Being ”taught to fall”..one tends to be young and fit when one is taught this..but imagine teaching a very unfit still elderly person to fall- they’d not have the confidence or muscle control to let fly with grace..
Possibly Yoga done from 50’s onwards might help, but older people are not likely to want to practice falling, even with crash-mats.
The drug element is very interesting.[painkillers, blood pressure meds]
My lovely 92 yr old neighbour has had yet another bad fall..she was too disorientated to even press her medic alert button- her carer who pops in once a day has no key could not get in ..none of us have keys, which is crazy- only someone aged 85 down the road has a set..neighbour says ”I’ll let you in”
But in a case of a fall, of course she cannot get to the door.
Her daughter lives about 45 mins drive away.
I heard today that our lovely neighbour ”won’t make it”..she was found very dehydrated.
If I’d had a key, I’d willingly have checked up on her..goodness knows how long she was left lying there..I didn’t hear anything.
Older people need neighbours to have keys..there was ”bother’ about no keys when neighb broke leg a few years ago..plus she fell after that- while on the phone and the company she was on the phone to called an ambulance [well done Panasonic]
Blood pressure meds I think in her case don’t help.
🙁
Thanks for sharing these thoughts and your neighbor’s story.
Good point re the key! If I ever get around to writing more articles on safety, I’ll have to remember to address this point. One good option is for the older adult (or family) to place an extra key in a lockbox outside. Trusted people can be given the code to the lockbox, and then can open the door if needed during an emergency.
It’s also important for older adults to have a plan for calling for help, or at least scheduling daily check-ins with others. I address this and some related issues in this article:
3 Ways to Prevent Injury From a Fall (Plus 2 Ways That Don’t Work as Well as You’d Think)
There is a new invention called Hip to Hope which is designed to help geriatrics with falling and breaking their hips. It acts as a way to prevent damage once the person is falling.
“Once Hip-Hope’s multi-sensor detection system senses an impending collision with a ground surface, two large airbags are deployed instantly from each side of the belt to cushion the hips, and a connected smartphone app sends an automatic alert message to predetermined recipients.”
You can read more about it here:
https://www.israel21c.org/hip-hope-cushions-falls-to-prevent-fractures-in-elderly/
Yes, I have come across similar innovations. If an older adult is willing to wear such a device then it might reduce hip fractures. But historically older adults have been reluctant to wear such protective equipment.
There are other ways to reduce fractures and injuries in the event of a fall. These include detecting and treating osteoporosis, and also providing older adults with a mechanism to get help in case they fall and can’t get up.
I am 86 years old and in good health except for a pacemaker implanted 3 years ago. No problems there.
I drive, travel. Shop, everything. I fell Wednesday when simply stepping up a curb and fell again last night in my home while walking slowly on a carpet. I am checking all of my prescriptions and will notify my doctor (who was a pharmacist prior to becoming a doctor) tomorrow. Your information is very helpful. Thank you.
So sorry to hear of your recent falls, I hope you were not injured.
Checking your prescriptions is a good idea; I have just published an article that provides more detail on which medications to re-assess: 10 Types of Medications to Review if You’re Concerned About Falling.
However, I would also encourage you to work with your doctor on checking for other problems that might be causing falls, or increasing your vulnerability to falls. This article lists some things that doctors can check: 8 Things to Have the Doctor Check After an Aging Person Falls.
Last but not least, if you’re concerned about falls, it’s often a good idea to make sure you have been appropriately screened for osteoporosis, and offered treatment if you do have significant osteoporosis.
Good luck and take care!
i fall often. i am 59 years old not so old right but i have pretty bad numbness neuropathy in my feet. i think this causes alot of my tripping. i’m not as active as i used to be because i’m afraid to do much walking because of trippping. it seems to be a vicious circle. what should i do. i try to not have risk factors like high heels or rugs. what else can i do. i drive w/ hand controls on my car because i can’t feel the brakes so its pretty bad……i just feel and really hurt both knees badly on hard tile floor ;-(
I’m very sorry to hear of your difficulties. It’s not very common for people to have such severe neuropathy, or to have so many falls at your age.
I would certainly recommend you work closely with clinicians to make sure your neuropathy has been carefully evaluated and that everything is being done to try to improve it.
Otherwise, it’s still quite possible that you would benefit from the fall prevention strategies that I cover in this article and in other articles on this site: have your medications carefully checked and avoid those associated with falls, get a physical therapy assessment, find out if you’d benefit from physical therapy or a structured exercise program to improve leg strength and balance, make sure your vision has been checked, make sure you’ve done everything possible to make your home safe, etc.
Try these articles if you haven’t already seen them:
10 Types of Medication to Review if You’re Concerned About Falling
Otago & Proven Exercises for Fall Prevention
If you are extremely unsteady, you might also ask the doctor or the physical therapist to discuss the possibility of a mobility aid.
Good luck!
I’m only 69 but I think I’m more apt to trip over a tripping hazard than I was when I was younger. I don’t have any of the conditions you mentioned. I have fairly low blood pressure and take fludrocortisone to raise it, but none of my trips related to fainting. My vision is still quite good, but I’m wondering if I simply fail to lift my foot high enough or whether my feet sometimes droop or whether depth perception worsens with age even with good vision. (I had cataract replacement surgery when I was in my 50’s so my eyes don’t change much.) Or perhaps I multitask (thinking about something else while walking) even more poorly than I did when I was younger. Do any of those explanations make sense? I obviously can’t distinguishing between the causes because if I were aware of the cause at the time I would not fall.
Yes, people do become worse at multitasking as they age.
If you have not yet talked to your doctor about your falls, I would recommend you do so. Your doctor can do a neurological exam to see if there’s anything obviously amiss with your reflexes or the way you are moving. I would also recommend a physical therapy evaluation.
We don’t always uncover specific causes for falls when we investigate, but it’s important to check. The explanations you are considering for yourself are plausible. Improving your balance and lower leg strength through certain exercises might help. Good luck!
I am 65 and work full time. I go to the gym three to four times a week. Yet I’ve had two falls one very recently. I’m in good health without no medication.
Sorry to hear of your recent falls. I would recommend a comprehensive evaluation to assess why you might be falling. There is often more than one issue putting an older person at risk for falls. Your health provider can also discuss your gym routine and whether adding different types of exercises might help. Good luck!
At 65 and 2 hip fractures I seem to be starting on this trip we call geriactric and all the things you will need to know to make life some what normal. I have read all the comments written and sometimes am overwhelmed at all the problems and concerns I need to have. Since I am just starting on this journey I have a lot to think about as well as doing my best to find the correct way to handle the issues I seem to have at this point in my life. Thank you for your support and ways to look at problems in a solving frame of mind. Also…where do I find a geriactric doctor?
Yes, unfortunately there can be a lot to do and research and keep track of, to optimize health as one ages. I can certainly see how it would be overwhelming, especially at the beginning, where the more you learn, the more you realize you need to learn.
But, if you give yourself some time and pace yourself, you can probably find a reasonable balance in which you spend some time overseeing your health (you’ll need it, in order to make the best of life as you get older) without being too consumed by the details and every little thing you possible could do. (It’s just not possible to do every single little thing that might be good for one’s health.)
A good primary care provider or team can make a big difference. I have suggestions on finding geriatrics care here:
How to find geriatric care — or a medication review — near you
Also, if you’ve had falls or hip fractures, you might find some useful information here:
3 Ways to Prevent Injury From a Fall (Plus 2 Ways That Don’t Work as Well as You’d Think)
Good luck!
Prozac? Byetta? Also, can taking estrogen help?
Prozac is an antidepressant and Byetta is a diabetes drug. Both these types of medications are associated with increased fall risk, so they should be used judiciously. I explain medications in more depth here:
10 Types of Medications to Review if You’re Concerned About Falling
As far as I know, the research on estrogen maintaining balance or otherwise preventing falls is inconclusive. Estrogen does help maintain bone strength, and so people taking estrogen do have a reduced risk of fractures if they fall. But estrogen therapy is also associated with an increased risk of cardiovascular events, blood clots, breast cancer, and more. So…I would not recommend taking estrogen just to reduce fall risk or fall injury risk, and if you are already on it, I would say the main benefit is probably reduced risk of fracture if you fall.
I’m 90 years and in good heath. I go for short walk almost every day, weather permitting.
I think I now know why many elderly people fall when moving about. It’s because they are looking straight ahead. They need to be taught to look down to see where their feet are about to go next.
That’s particularly true when walking down stairs. Don’t look straight ahead, look at the next few steps.
Try it out for yourself. If you agree, tell your elderly relatives and friends.
Wonderful that you are doing well at age 90 and walking every day. Thanks for sharing what’s been working for you.
Yes we were all taught to look straight ahead keep our shoulders straight etc. I’m 66 and have had two falls one had stitches. These falls happened because I was walking around outside in low light with my head straight up looking forward On uneven ground. I have to teach myself to look down. It sounds like a easy thing to pursue but it is most difficult. A training of a lifetime it’s almost impossible I don’t know how I’m going to remind myself to look down.
My father is 96 and has fallen several times recently while doing yard work, to include a face plant using a leaf blower in a tight space. He fell on the running leafblower. I found him unresponsive. He awoke and took charge of his own recovery (he’s a control freak) and would not allow me to call 911, even though he sustained a gash in his forehead that was bleeding and was in a narrow space. He still drives. He is secretive about his health issues. I want to discover who is PCP is and consult about my father’s falling history and driving. His reasoning ability is declining, he’s frail and very difficult to deal with. He says he falls due to a leg giving out or losing his equilibtium. Should he be driving? Thanks for your help.
Oh wow, that is a tough situation. Hmm. If he is 96 and you’ve noticed declines in his reasoning abilities, it’s certainly possible that it’s unsafe for him to drive. The ideal would be for him to be evaluated, and for him to let a family member accompany him. But sounds like he’s likely to resist that.
Particular issues you raise:
– Why is he falling? What could be done to reduce or prevent his falls? For this, he needs a good evaluation for falls.
– What can you do if he falls, might be hurt, but refuses 911? Well, you can still call over his objections, you will just have to weigh whether the likely benefits outweigh the stress this puts on your relationship with him (he will be mad at you).
You should also carefully consider whether his reasoning and thinking might be so impaired that he no longer has capacity to make the decision; I have more on decision-making capacity here:
Incompetence & Losing Capacity: Answers to 7 FAQs
– If you aren’t sure who his PCP is: you would have to sleuth around on your own. Otherwise, I’m not sure you can find out without a court getting involved. An elderlaw attorney would be able to advise you of your options. If you do find out who his doctor is, you can learn more about what the doctor is allowed to tell you here: 10 Things to Know About HIPAA & Access to a Relative’s Health Information. There are actually circumstances under which doctors can reveal information to family even if the older patient doesn’t give permission, or objects. HIPAA also doesn’t prevent you from relaying your concerns to a person’s doctor, which you can do without anyone’s permission. (Although again, you have to consider the impact this could have on your relationship with your dad.)
– If you are truly worried about his safety and wellbeing, you can call Adult Protective Services. Your local Area Agency on Aging can help direct you. Your state may also have a mechanism for you to report a potentially unsafe older driver.
Still another option is to hire a professional to help you talk with your father, such as an aging life care professional (formerly known as geriatric care managers), or other expert with experience helping people in your situation. This does cost money, but it can be a very worthwhile investment if you find a good person to work with.
In short, there’s no easy answer for your situation. I do cover some additional ways to communicate with resistant older parents in these two articles:
QA: Helping a Paranoid Older Parent and Checking Safety
4 Things to Do When an Older Person Resists Help
Good luck!
My husband’s aunt 95yo lives with us. She has starting falling occasionally. It is usually related to her not wanting to use her walker. She also refuses to leave her door open while she is in her room. She has Dementia and advance stage Alzheimer. Short of removing her door or putting cameras in her room, what are my options? She is on medications but they are anti-depressant/anti-psychotics (sp) to regulate her mood swings. Otherwise, she is prone to violence if she doesn’t get her way and trying to leave the house (3 incidents prior to medications, 2 since) I had teeth marks from her biting me when I prevented her from leaving. She also spends much of her time talking to her dead sister and brother.
Well, if she is still able to walk, argue about whether the door should be open, and attempt to leave the house, I would say she’s moderate stage or perhaps in the moderate-severe stage. This can be when behavior is the most difficult to manage, because the person is still physically able to do quite a lot.
You generally can’t “reason” with someone with Alzheimer’s, to get them to change their behavior or feelings, but sometimes the right approach to fibbing can work. There’s no exact right answer: you could remove the door and tell her it was taken away for repair, or you could try cameras. For other suggestions, I recommend relaying your situation in an online support group; there’s a very active one at AgingCare.com.
In terms of getting her to use the walker or accept supervision: she will likely continue to either forget or decline to use her walker, unless you are there to coax/encourage her (and even then you might have difficulty, if she’s the kind to get angry and bite when frustrated). Some families change the bed to a mattress on the floor, so that the person can’t get out of bed alone, but this can seem restrictive to those with moderate dementia. Some families use cameras but you will still need some type of alert to know when she’s starting to move about in a way that might be unsafe. Families have used bed alarms and motion sensors. None of these have been rigorously studied to my knowledge. Again, a support group is a good place to get practical suggestions.
Otherwise, in terms of reducing fall risk:
– antidepressants and antipsychotics both increase fall risk. You may want to look into whether there might be other ways to manage her difficult behaviors. Sometimes treating pain or constipation helps an older person with dementia become less reactive. I have more on this here: 5 Types of Medication Used to Treat Difficult Dementia Behaviors
– She might benefit from strength or balance exercises, but it can be hard to get a person with dementia to do exercises regularly.
– If the falls are a newer problem, or seem to be getting worse, consider having her checked for other medical problems that might be increasing fall risk. I explain what doctors often check for here: 8 Things to Have the Doctor Check After an Aging Person Falls
I’m sorry she’s giving you such a hard time…she’s very lucky to have family taking care of her but it sounds like she may not be very appreciative. Good luck and take care!
yesterday during the afternoon period, my mum told me that she fall, when she was trying to sweep her shop and she is 52year old, please what can be the cause of this?…
There are many many reasons that a person can fall. I explain the most common things that doctors check for in this article:
8 Things
A careful evaluation can usually determine why the person fell, and what other risk factors they might have for falling. I would highly recommend you have your mother see a health professional for further evaluation. Good luck!
what is your opinion about the sign of falling risk in hospital. do we have to tag on to every older people?
thank you
Sounds like you are referring to some of the fall prevention initiatives going on in hospitals. In many hospitals, they have attempted to reduce falls by identifying people at higher fall risk.
It’s not clear to me if this is in of itself effective, since most older adults end up qualifying as being at high-risk. If nothing else, when they are in the hospital is when they are sicker and weaker than usual.
Most hospital-based fall prevention initiatives involve multiple components, so it’s hard to know what is the effect of “tagging” at-risk people in particular.
Hospital Fall Prevention: A Systematic Review of Implementation, Components, Adherence, and Effectiveness
Thank you very much for your article. Do you know of any research regarding Alka Seltzer addiction/fall risk? It jumps out at me as potentially problematic when I read your article. Thanks so much.
No, I don’t think Alka Seltzer and fall risk have been studied. Alka-seltzer contains aspirin, so I suppose a heavy Alka Seltzer user would be at risk for side-effects and adverse events associated with aspirin, such as developing bleeding somewhere in the bowel.
This could cause anemia, which can increase fall risk. Alka-seltzer can also interact with a variety of medications, which could be problematic and depending on the interaction, increase fall risk. Really, Alka-seltzer is not meant to be taken more than occasionally, as far as I know, so if you or someone in your family is using it more than occasionally, I would certainly recommend discussing it with your healthcare providers.
My mother kept falling over a period of 3 years. Head-hitting falls from a standing position, usually as she was cooking/preparing food. She had many things that could cause it (anemia, diabetes, recurrent UTI, and BP meds). The doctor worked on each thing, adjusted BP meds, and she responded well and was only falling once every 3 or 4 months, vice several times a month as in the beginning. Her doctor asked if it looked like a seizure. It didn’t. But that’s what it was. Mini-seizures caused by a mini-stroke that damaged part of her brain. We didn’t even know she had a stroke. Unfortunately, we found this out as she was recovering from a broken hip. Then she fell again before the hip was healed and didn’t recover that time. We didn’t know this was a possibility, so I’m posting for others’ awareness.
Thank you for sharing your story. So sorry to hear that your mother eventually didn’t recover from a fall.
Seizures are indeed possible but they can be very hard to diagnose if a person doesn’t have obvious seizure activity. Actually, since we don’t routinely check for seizures when people fall, we probably don’t really know how common it is…it’s presumed to be uncommon, but if we did EEGs on every older person who falls, who knows what we might find. Here is a related article
Fall related to epileptic seizures in the elderly
I recently started falling. One time was in front of a group of people. The best advice I received was from someone in the group. She said a doctor had told her that older people don’t tend to pick up their feet when they walk. (My rubber soled shoe had just just scraped the rubber tiled floor when I fell and was thrown forward.). This advice has stayed with me and has made a big difference.
Thanks for sharing your story. Yes, it’s true that some older adults seem to pick up their feet less. A physical therapy evaluation can help assess an older person’s walking pattern, to see if this is the case. Physical therapists are also able to assess balance and leg strength; many older adults at high risk for falls benefit from doing exercises that improve balance and leg strength. Good luck preventing future falls.
My wife is 48 and is getting her second knee replacement soon. She generally walks fine, but twice in the last 6 months, she has stumbled on uneven sidewalks and fallen down. Both times I was holding her hand, but when she started to go down, I held on, but I couldn’t keep it from happening.
When she wore a gait belt after her last knee replacement, I was able to keep her from falling, but she’s not going to wear a gait belt forever. I’m strong enough to keep her from falling, if I knew how to do it.
Any advice?
Honestly, I don’t know much about how to hold up a person who is falling. I would recommend talking to a physical therapist as they have experience doing this and also they will be able to advise you as to how to protect your own body while doing it.
I would also encourage you to talk to your wife’s doctor about why she is falling, especially if you think the falls may continue. Good luck!
because of recent falls I have had with no apparent reason, I am wondering if Tai Chi or Yoga would be good for improving balance.
I am very healthy; I do have hearing impairment and am deaf in the left ear.
I also tend to fall on my left side.
I do have good hearing aids and do wear them.
Thanks for replying.
I appreciate all your advice on aging etc.
Anne
Sorry to hear of your recent falls. I think either Tai Chi or yoga could help, but Tai Chi has a more substantial track record in clinical studies, in part because the movements are more standardized whereas there are many different types of yoga.
I discuss different types of exercise for fall prevention in this podcast episode with Tiffany Shubert, a physical therapist and expert on fall prevention: 052 – Maintaining Mobility & Preventing Falls in Aging: Myths & Truths.
I would also recommend discussing your recent falls with your health provider, so that they can assess you for issues that might be contributing to your falls. You might also benefit from exercises that strengthen the body, especially the legs. Good luck and take care!
My 69 yr old father has been falling recently from his legs being suddenly weak. The doctor says he may get weaker during hot weather?? Does that make sense?
He has diabetes although his levels are where they should be. He has no apparent neuropathy, no nerve damage in his feet or legs. Bloodwork came back fine but he still has falling episodes.
He does have heart disease as well. His heart was checked out and said to be doing well. Blood pressure is a bit off, usually 110/60?? The second number is always lower than it should be.
He is also having anxiety attacks where he breaks down and cries for no reason. Trouble sleeping-staying asleep and sleeps with very odd dreams.
Do you perhaps have any guidance please?
Hm. Well, if he is having falls, he needs a detailed evaluation to identify as many risk factors and contributors as possible.
Getting weaker during hot weather is sometimes related to mild dehydration. I have more on dehydration here: How to Prevent, Detect, & Treat Dehydration in Aging Adults
It might also be a good idea to ask your health providers to check your father’s blood pressure sitting and standing, to see if he’s experiencing a drop. (This can be made worse during hot weather or dehydration, too). You might also want to discuss what his goal blood pressure should be; if he’s having falls, it might be reasonable to consider a goal blood pressure in the 130s to 140s. A systolic BP (the top number) of 110 sounds a bit low to me for someone who is having falls and weakness.
I would also recommend bringing up his anxiety attacks and your other concerns with his usual doctors. Be careful about treating anxiety with medication, as most anti-anxiety medication does worsen balance. Good luck!
Hi, for the past couple of months I have started falling out of bed on a very regular basis, sometimes up three times in one night, it is now quite painful. For the past year I have been suffering with acute pain down my right-hand side, from my neck into my shoulder and through my arm, as though my muscles and inside my bones are on fire. One morning I woke up blind in one eye. I have had steroid injections, electric shock tests, nerve tests to no avail. My hip is also loosening after fifteen years which also causes pain. I currently take co-codamol to control the pain. I am also taking Astor statin (20mg) Venlafaxine (150mg) Felopadine (5mg) Losartan (100mg) Oxazepam to help me sleep and daily aspirin. I also have a history of fairly severe depression. I already see my Dr far more than I should but any ideas or clues in my description above? Thanks Tony
Sorry to hear of your recent falls. Honestly, your situation sounds more complicated than most, so good that you are working closely with your doctor. Regarding falling out of bed more frequently, I wonder if you have been able to get any other information on how you are sleeping and are you otherwise moving more than before while asleep? Perhaps evaluating and treating your sleep might help with the falls during the night.
Otherwise, oxazepam is a benzodiazepine and is associated with increased risk of falls. However, if you have significant anxiety or sleep issues, it can be hard to eliminate this type of medication.
Good luck!
In the case of someone who is wanting and/or needing strength and balance exercises to help maintain abilities and confidence for as long as possible to help reduce falls, how would you recommend this could be done without assistance? Are there any products or plans you might be able to recommend?
Generally, what is your opinion on ‘progressive resistive training’ on the lower body to reduce the instance of falls? What do you think are the difficulties that surround this area with the elderly?
By progressive resistive training, I assume you mean resistance exercises that are “progressed” so that they become more challenging over time; this is often done by adding some weights to the ankle.
Such exercises have a good track record in fall prevention, especially if they are combined with exercises that specifically challenge and improve balance. The Otago program combines such strength and balance exercises, and is proven to reduce falls in vulnerable older adults:
Videos Illustrating Otago Exercises for Fall Prevention.
Tai Chi has also been shown to help reduce falls.
The difficulty is that such programs require people to practice the exercises three times weekly. Strength exercises are also safer and more effective when a physical therapist or other qualified person is available to select appropriate starter exercises, train the older person in doing the exercises, and also step up the resistance or difficulty of the exercises when it’s appropriate.
I am not aware of any completely “do it yourself” programs that have been proven to reduce falls, plus doing a program on one’s own would require more motivation and discipline than many people can maintain on their own. So generally I recommend doing a program via a live class or with a physical therapist.
My 69 year old mother has had three falls in the past year, two while traveling, and one in our house.
All three falls had an environmental risk factor present: the first involved a broken entryway platform at a convenient store; the second happened at the top of an escalator; the third involved a throw rug. She also has potential risk factors in many areas: vision (cataracts/bi-focals), medications (post-MI maintenance drugs started in 2007, psych drugs started in 2012), absent strength (no exercise routine, started work-at-home 2016 so even less daily walking, recent foot surgery to straighten a claw toe but no PT after), and chronic health conditions (daytime sleepiness from apnea, depression, anxiety, non-MI angina). The most recent changes were a new bp medication that produced headaches, but they treated the headaches with more medication; the foot surgery and non-weight bearing period; and an increase in daytime sleepiness that was treated successfully with melatonin at night.
She trusts her doctor’s judgment with medications and has been hesitant to ask for changes unless the side effects are black and white. My dad said that when she fell the first two times, she didn’t even put out her hands to catch herself. Is this the result of slowed reflexes? Does the “not putting her hands out to catch herself” help to narrow down the possible contributing factors?
Also, after the first fall, my mom has been anxious about falling again. Even though she has a lot of possible risk factors, it seems that lack of strength plus the broken step could have been sufficient to have caused the first fall. Is it possible for anxiety or distraction to cause falls? I mean, I’ve noticed that when I’m not paying attention to what I’m doing, I can run into things. I usually catch myself though because I have good reflexes.
Finally, do you have any specific exercise or low-impact strength training programs that you recommend? I found one for lupus that seems simple enough (https://resources.lupus.org/entry/low-impact-exercise-routine-for-lupus). She is hesitant to do more involved exercises because they can be complicated, or because she says that she avoids getting down on the floor because she struggles to get up easily. Thank you.
Falls are usually due to multiple risk factors/contributors, plus a triggering event.
You have already done a good job identifying several contributing factors, so the question is which can be modified. A comprehensive falls evaluation might also uncover some additional factors or causes that you haven’t identified; occasionally there is some kind of neurological or cardiac issue playing a role.
Exercise would be helpful, it will improve her ability to recover from losing her balance and also is associated with less risk of injury when people do fall.
The National Council on Aging maintains a good page listing proven fall prevention programs here:
Evidence-Based Falls Prevention Programs
I especially like the Otago program and Tai Chi, but what is most important is to find something that your mother is willing/able to do several times a week.
Most people have difficulty motivating to do a program on their own, plus they might be doing the exercises incorrectly. So being in a group or in physical therapy is a good idea.
I would not recommend a program (such as the lupus one) that isn’t specifically designed for older adults and fall prevention. For instance, squats and deep lunges can be very difficult for older adults to do safely and effectively. Hope this helps and good luck!
Thanks for this advice for preventing falls. It’s nice to know that you should try to first list some factors that could contribute to someone’s fall risk. It sounds important to first know what could be considered a fall risk especially if it can help you identify areas where someone might fall.
Hi I am 56 years old and have a history of falling when I’m walking outdoors. I had a ASD closure in 2004 and was diagnosed with a hole in my heart/heart valve and had surgery to repair it. So lately with my falls and busting up my knees pretty badly I need to know why I fall so much. Going to dr in morning and see if they can check my heart but what other health concerns should I be looking for. I have type 2 diabetes on methformin , depression, on bp meds.
Sorry to hear of your recent falls, that must be scary.
It’s hard to summarize what should be looked for in just a few sentences. We do have lots of articles on the site and then the Fall Prevention Mini-Course does explain it all in more detail and walks you through a workbook, to help identify issues to ask your doctors about.
Otherwise, most of what is in our mini-course is covered on the CDC STEADi site. The good stuff is all in the recommendations for clinicians; they are available to the public but of course the tone is more technical. Good luck!
Regarding a neighbors locked doors, do not hesitate to call 911. Fire/Rescue trucks carry crowbars that will bust open any door. I fainted and fell . . . Was able to call 911 when I became conscious. Fire Dept broke in. Prob saved my life.
Thanks for sharing this tip. Glad the emergency services were able to reach you during your time of need.
It can also be a good idea to have a lockbox (let a few trusted family members or friends know how to access it), so that family can enter and check in if it seems necessary (e.g., no one has heard from you for a few days) but it’s not obviously a 911 emergency.
Are there signs that an elderly person is act risk of falling that can be monitored from a fitbit type device?
Change heart rate, blood pressure, balance for example.
In general, I don’t find currently available wearables to be particularly useful for identifying fall risk. The main risk factor is having had a fall or being afraid of falling. Otherwise a wearable is not going to be as useful as a decent clinical evaluation for fall risk factors. For certain specific fall risk triggers, it’s possible that a wearable could help detect them. But in most older adults, falls are multi-factorial and to effectively reduce the risk requires an individualized multi-component intervention. Most older adults also require some form of balance or strength exercises. Providing them with the correct exercises and the support to consistently do them is a much bigger barrier than “detecting they are at risk for falls.”
My almost 98 year old mother in law is living with us. She has fallen backwards twice in the last week. I witnessed one fall and it happened so quickly that I couldn’t even catch her. She said she doesn’t have any dizziness and no forewarning. I am having her eyes tested and also have an appt with her PCP to check her meds. Anything else I should be checking? She does use a walker but that doesn’t seem to help when she falls backwards. Thank you in advance for any help.
Sorry to hear of her falls. I cover what I recommend checking in this article:
8 Things to Have the Doctor Check After an Aging Person Falls
For her, I would especially recommend checking her blood pressure sitting and standing, and making sure her labs have been checked recently (to confirm that she doesn’t have anemia or any other medical abnormality that would make her much more prone to falls). Otherwise, almost everyone her age suffers from poor balance (usually for a variety of reasons) and low leg strength is also common. Exercises can help, although it usually takes some work to set up a routine that the older person will stick with (and that actually improves strength and balance). Good luck!
My dad is 86, has had triple by pass surgery, has COPD, a pacemaker & stage 4 lung cancer. In the past year his balance has gotten so bad he as fallen 5 times in the house, once landing him in the hospital. Yesterday he fell walking out of church and wound up with several cuts, which do not head due to the blood thinners. His right shoulder is almost nonfunctional due to (what i think is) a blown rotator cuff. To top all this off, he refuses to use any walking aids, no cane, no walker, nadda. Is there anything you can think of to help stabilize him?
Well, in principle he needs to be evaluated to help figure out what is contributing to his falls, and then his health providers and he could decide what’s feasible to modify and improve. There might be chronic problems contributing but given his cancer and blood thinners, a new problem (such as a low red blood cell count) is also quite possible.
But before spending a lot of time trying to modify his fall risk factors, you may also want to talk to his health providers about his overall prognosis and the bigger picture of his health care. Especially if he has stage 4 lung cancer, does he want to spend whatever time he has left doing exercises to improve his strength or balance? Especially if time may be limited, it is important to focus your energies on helping him in ways that he welcomes, and otherwise on focusing on your relationship with him.
Fall prevention is important, but has to be taken in the context of a person’s overall health, what’s feasible, and what’s in line with the older person’s goals and priorities. Good luck!
Hello Dr.
I am not sure if you will see this since apparently this article is a bit older. I thought I’d try however.
My mom will be 79 in December. She is a lung cancer survivor (2011 diagnosis and surgery to remove lobe of left lung) and a long term smoker. She also has high blood pressure, diagnosed as borderline diabetic (no insulin needed), mild COPD, and has a deadened thyroid, taking thyroid medication for that. She was fairly active (worked, social activities on occasion, bowling, dancing, raising 3 kids etc) in her younger years but has been sedentary for quite some time now due to health issues.
She has been complaining for a while of pain in her lower back and hips. She said if she bends over or lifts her leg, it eases slightly but I am noticing increasing limitations in her mobility. She tires and feels weak easily. She walks perhaps 10 to 15 feet recently and is either in so much pain she has to stop for a bit or, is slightly short of breath. She has begun to have a lot of falls over the past few months–perhaps 6 or so in the past 2 to 3 months. She also around that time began bleeding easily–even a little tiny scratch could cause bleeding that might last half a day or so. She has woken with her pajama leg bloody if she picks at a dry piece of skin in the middle of the night for instance. Her doc finally sent her to a hematologist (she is also seeing a dermatologist due to a sudden case of eczema that developed about a year or so ago) and her hematologist says she has a clotting factor disorder. Then she began losing bowel control (she has irritable bowel syndrome but never lost control as frequently as recently) from time to time.
She fell yesterday going into her doctors office–they sent her next door to the hospital. She scraped the top layers of skin off from wrist to elbow and the hospital cleaned it, bandaged her up, sent her home. She was hospitalized early in June for the weakness, severe dehydration (despite drinking plenty of water. She is also on Lasix) and they said she had an acute kidney injury and they said there was some internal bleeding. However the care was not up to par and they tried to do a colonoscopy and endoscopy but she had a mild heart attack for the first time and went into Afib on the table. They aborted the procedure. She later had the endo done and that was fine.
She is weak, today it is in the 80’s here and she is running a fever. The falls concern me as does the other issues. I feel we are going to lose her if they don’t find out what is wrong. What can I do to help? Who do I send her to?
Hello, I do review comments all my articles regardless of how old they are, but usually only once a week and last week I was out of town. I’m sorry to hear of your mother’s situation. Honestly, it sounds medically quite complicated and like there is more than garden-variety fall risk factors going on. I hope there’s been some progress in understanding what is going on. She does sound like she’s accumulated a lot of chronic pain and illnesses, and now is getting worse from something. I hope her doctors are able to figure it out soon. Good luck!
My doctor prescribed a wheelchair a couple of years ago because of problems with my knees and back, but I think it’s made things worse. I’ve lost muscle tone and have become weak. I’m now going against his and my other doctors’ advice to take it easy and except that I’ll just get worse as I age and nothing can be done.
They want me to just give up, but instead I’m exercising everyday and eating very healthy. It’s not only to keep weight under control, but to build muscle, increase energy, and aid in balance to mitigate falls.
I think they mean well and I still have to use the chair for large distances, but I think it’s actually a deterrent to my health.
I’ve asked most of my doctors for physical therapy to help me stop falling and although they’ll send me for back pain therapy, they won’t do it for falls for some reason.
Since I can’t get professional help, I’m doing leg lifts in bed, arm exercises, and contracting stomach muscles. In other words, I’m modifying exercises I learned in the military and elsewhere to work with my disability. There’s already a difference.
Why do doctors take the easy way out instead of being our partners in recovery?
Thanks for sharing your story. So sorry to hear that your health providers aren’t providing you with the support and referrals that sound needed. I think many doctors just haven’t had sufficient training in falls, and in leveraging exercise and other lifestyle methods for recovery.
You may want to keep asking them for physical therapy for gait and balance issues, as it seems to me it’s reasonable given what you describe. Sometimes persistence and being the “squeaky wheel” is necessary. good luck!
Hi My father had a cerebral stroke on November 2018. He is now 69 years old. now he is diagnosed with Pixel disease and alpha synuclein dementia. He is taking Amlodipine 2.5 mg, clopidogerl 75 mg, escitalopram 5 mg and bupropion HCl sustained-release tablet 300 mg. He is a diabetic patient taking mixtard 70/30.
Now a days tendency of falling has been increased. Please suggest how we can overcome the tendency of fall.
Sorry for delayed reply, we had a glitch in our system that we have just resolved.
Your father sounds like he has many health problems and risk factors that contribute to falls. Dementia affects balance and gait. Diabetes drugs can make blood sugar low, which can cause falls, and also long-standing diabetes can affect nerve function.
To reduce his falls, you would need to work closely with a health provider to identify all his fall risk factors and then to modify those that you can. You can’t reverse his dementia but you can adjust medications. He may or may not be able to participate in balance and strength exercises. Physical therapy can also help identify a suitable walker or other assistive device. Good luck!
I am a physiotherapist in Europe and i am telling my older clients to look forward instead of down at the floor while walking. I am tought this is the right way to walk and it will prevent falling. But most older clients tell me they feel safer looking down, because they can see when the floor is uneven or a curb is comming. Most of the time they have glasses and vision is good enough.
I wonder if the risk of falling is bigger when looking down (change in postur) or when looking forward.
I have tried to find articles on this matter, i have not found one.
Will you share your expertise in this matter?
Thanks for this question. I’m not aware of any research that answers this question. I think looking up and forward seems better for posture and body mechanics, but I understand why older adults may be looking down.
Ultimately I think the important question is what is feasible for the older adult. You can encourage them to look forward, but if they find it very difficult…it may be better to devote your energy and theirs to getting them to change something else…like doing their exercises to improve balance.
On the looking down versus forward issue – I look around, the floor, furniture, etc. before moving, note any obstacles and take whatever action is needed to remove or avoid hazards. Then I look forward and move with confidence that I know what is or isn’t a risk factor for falls. Never do I hurry. The few seconds it takes to be aware of your environment is much better spent than falling and having to recover.
Those are good ideas. Thank you for sharing them!
I have found your article most informative and has helped me address my problem by trying to accept the my imbalance is due to the inevitable aging process. For me, now I have a better understanding of my increased imbalance comes greater depression. They say walking is one of the best forms of exercise but wobbling around like a drunken sailor is not only embarrassing, it tends to increase the chances of a fall. The big Catch 22. I have recovered very well from a pontine stroke and now take x-ralto. I also take aspirin – is this a good idea? I am 76 and female.
Thank you for reading this.
Glad the article was helpful.
Xarelto is one of the newer blood thinners that has replaced warfarin. Aspirin is also used to prevent strokes; it doesn’t thin the blood the same way, but does reduce the risk of a clot. Both types of medication increase one’s risk of accidental bleeding.
Being on both a blood thinner and aspirin is occasionally recommended, but often the likely benefit of being on both (as opposed to just the blood thinner) doesn’t warrant the extra bleeding risk you have when you take both types of medication at the same time. And frequent falls are a risk for bleeding, because you can hit your head or otherwise provoke a bleed.
So, for anyone on both a blood thinner and aspirin, I generally recommend asking your doctors to explain why it’s absolutely necessary to be on both. In many cases, it’s possible to stop one of them.
I would also recommend balance and strength exercises, which can help reduce fall risk. Your wobbling sounds like it’s due to more than just aging but either way, balance exercises usually help.
Good luck!