Older adults worried about falling typically receive general advice: Take an exercise class. Get your vision checked. Stop taking medications for sleep. Install grab bars in the bathroom.
In 2016, 25,189 people in this age group died from falls, compared with 8,613 in 2000. The rate of fatal falls for adults 75 and older more than doubled during this period, to 122.2 per 100,000 people in 2016 from 51.6 per 100,000 people in 2000, the report found.
What’s needed to check this alarming trend, experts suggest, is a more personalized approach to preventing falls, more involvement by medical practitioners, and better ways to motivate older adults to take action.
Elizabeth Burns, a co-author of the report and health scientist at the U.S. Centers for Disease Control and Prevention (CDC), said it’s not yet clear why fatal falls are increasing. Older adults are probably more vulnerable because they’re living longer with conditions such as diabetes and cardiovascular disease and taking more brain-altering medications such as opioids, she noted.
The steep increase in fatal falls is “definitely upsetting,” especially given national, state, and local efforts to prevent these accidents, said Kathleen Cameron, senior director of the Center for Healthy Aging at the National Council on Aging.
Since 2012, the CDC has tried to turn the situation around by encouraging physicians to adopt evidence-based fall prevention practices. But doctors still aren’t doing enough to help older patients, Burns said.
These assessments evaluate a person’s gait, lower-body muscle strength, balance, medication use, problems with their feet, blood pressure when rising from a sitting position, vision, vitamin D levels, and home environment.
Physicians’ involvement is important because older adults tend to take their doctors’ advice seriously, said Emily Nabors, program manager of the Fall Prevention Center of Excellence at the University of Southern California.
Also, seniors tend to underestimate their chance of falling.
“It’s very easy for people to look at a list of things that they should be concerned about and think, ‘That doesn’t apply to me. I walk just fine. I don’t have trouble with my balance,’” said Dorothy Baker, a research scientist at Yale School of Medicine and executive director of the Connecticut Collaboration for Fall Prevention.
What’s the alternative to giving seniors a laundry list of things to do and hope they pay attention? We asked experts around the country for suggestions:
If the answer is yes to any of these questions, you’re probably a good candidate for a comprehensive fall risk evaluation.
Dr. Muriel Gillick, a geriatrician at Harvard Medical School, believes older patients and their families should “clamor” for these assessments. “Tell your doctor, ‘We’re really worried about falls. Can you do this kind of evaluation?’” she said.
If your doctor doesn’t offer these services, ask for a referral to another medical practice, said Leslie Allison, editor-in-chief of the Journal of Geriatric Physical Therapy. Physical therapists can provide an in-depth review of walking, muscle strength and balance, she noted.
“The goal is to come up with personalized recommendations, which older adults are far more likely to take up than generic non-tailored approaches,” said Elizabeth Phelan, a researcher of falls and associate professor of geriatric medicine at the University of Washington.
Take programs that address balance, for example. Some are designed for older adults who are frail, some for those who are active, and still others for those in between. “If a senior goes to a program that doesn’t meet her needs, it’s not going to work out,” said Mindy Renfro, associate professor of physical therapy at Touro University Nevada.
The single most important intervention is exercise—but not just any kind. Notably, simply walking—the type of exercise most older adults get—won’t help unless seniors have previously been sedentary.
“If you’re walking, by all means, don’t stop: It’s good for general health and well-being,” Phelan said. “But to prevent falls, you need to focus on strength and balance.”
Your doctor’s guidance will be needed to review medications that can contribute to falls. Using three or more psychotropic medications such as opioids, antidepressants, antipsychotics, benzodiazepines (such as Valium), and “Z” drugs for sleep (such as Ambien) puts seniors at substantial risk, said Dr. Donovan Maust, an assistant professor of psychiatry at the University of Michigan Medical School.
Hospital staffers should discuss fall prevention before older patients leave the hospital, Hoffman said, calling it “a time when it’s critical to intervene on fall risk.”
“Telling older adults what they need to do to be safe feels patronizing to many people and raises their hackles,” Hoffman said.
Instead, seniors respond better to messages such as “taking these steps is going to help you stay independent,” Burns of the CDC said.
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