By Alain Alvarez, MD
Picture someone who has always been active. She gardens, she walks every morning, and she has never thought of herself as “at risk.”
One night, half asleep, she gets up for the bathroom, her slipper catches the edge of a small rug, and she falls. It takes a couple of seconds. The result is a broken hip and a very different year ahead. (This is an illustrative example, not a real patient.)
Stories like this are not rare. More than one in four adults over 65 falls each year, which is more than 14 million people in the United States. Falls are the leading cause of injury-related death in older adults. About 280,000 Americans break a hip each year, and studies show roughly one in five people dies within a year of a hip fracture. Many survivors never fully regain their former independence.
Falls also carry a heavy cost. Medical spending on older-adult falls was estimated at about $50 billion in 2015, and one updated estimate put non-fatal falls alone near $80 billion in 2020, with Medicare paying the largest share. For one person, an average hospital stay for a fall injury cost roughly $18,000 in one national analysis, and other studies put it much higher. That doesn’t count rehabilitation, home care, or family caregiving.
The encouraging news is that falls rarely have a single cause, and many of the causes can be changed. Here are six of the biggest, with a practical step for each.
The Six Risk Factors and Their Fixes
1. Weak muscles and poor balance
Exercise lowers the rate of falls by about 23 percent in a major review of 59 trials. Programs that challenge balance work best, and Tai Chi helps too. Try this at your kitchen counter: hold on for safety and stand on one leg for ten seconds, then switch. A physical therapist can build a program that fits you.
2. Medications
Sleeping pills, anti-anxiety medicines, some antidepressants, antipsychotics, opioids, and seizure medicines have been associated with roughly 40 to 100 percent higher odds of falling in studies. Never stop a medication on your own. Instead, bring everything you take, including supplements, to your doctor or pharmacist and ask whether it could affect your balance or blood pressure. Medication review works best as part of a bigger plan.
3. Vision
Cataract surgery was linked to about a one-third lower risk of falling in trials. Get regular eye exams, keep your prescription current, and take extra care with new glasses.
4. Dizziness when you stand up
Orthostatic hypotension, a blood-pressure drop when you change position, affects about one in five older adults living at home. In one study of adults 70 and older, about two-thirds of those with it felt no dizziness at all. Ask your doctor to check your blood pressure lying down and then standing, and rise in stages: sit up, wait, let your legs dangle, then stand while holding something steady.
5. Foot pain, joint problems, and footwear
Foot pain roughly doubles the odds of falling in pooled studies, and foot-care programs that include proper footwear reduced falls by about 23 percent in trials. As a rheumatologist, I’ll say it plainly: arthritis, plantar fasciitis, and bunions are treatable, so don’t just put up with the pain. Choose shoes with a firm, snug fit, a low heel, a non-slip sole, and a secure fastening. Skip slippers, backless shoes, and high heels.
6. Hazards at home
In people at higher risk, home safety changes lowered falls by about 26 percent. Start with the path from bed to bathroom: add night lights, secure or remove loose rugs, clear cords and clutter, install grab bars, and check that stair handrails are sturdy.
One myth to retire
Vitamin D pills have not been shown to prevent falls in people whose levels are normal. If your level is low, that’s worth treating, so ask your doctor to check.
Please tell your doctor
If you’ve fallen in the past year, feel unsteady, or worry about falling, say so. The CDC reports that fewer than half of older adults who fall tell their doctor.
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