Causes and Risk Factors
Falls don't "just happen," and people don't fall because they get older. Often, more than one underlying cause or risk factor is involved in a fall. A risk factor is something that increases a person's risk or susceptibility to a medical problem or disease.
As the number of risk factors rises, so does the risk of falling. Many falls are linked to a person's physical condition or a medical problem, such as a chronic disease. Other causes could be safety hazards in the person's home or community environment.
Scientists have linked a number of personal risk factors to falling. Muscle weakness, especially in the legs, is one of the most important risk factors. Older people with weak muscles are more likely to fall than are those who maintain their muscle strength, as well as their flexibility and endurance.
Your balance and your gait -- how you walk -- are other key factors. Older adults who have poor balance or difficulty walking are more likely than others to fall. These problems may be linked to a lack of exercise or to a neurological cause, arthritis, or another condition that might be treated or managed.
Blood pressure that drops too much when you get up from lying down or sitting can increase your chance of falling. This condition -- called postural hypotension -- might result from a drop in blood volume, dehydration, or certain medications. It might also be linked to diabetes, Parkinson's disease, or an infection.
Some people with postural hypotension feel dizzy when their blood pressure drops. Other people don't feel dizzy, even if their blood pressure drops a lot when they get up.
Your reflexes may also be slower than when you were younger. The increased amount of time it takes you to react may make it harder to catch your balance if you start to fall.
Foot problems that cause painful feet, and wearing unsafe footwear can increase your chance of falling. Backless shoes and slippers, high-heeled shoes, and shoes with smooth leather soles are examples of unsafe footwear that could cause a fall.
Sensory problems can cause falls, too. If your senses don't work well, you might be less aware of your environment. For instance, having numb feet may mean you don't sense where you are stepping.
Not seeing well can also result in falls. One reason is that it may take a while for your eyes to adjust to see clearly when you move between darkness and light.
Other vision problems include poor depth perception, cataracts, and glaucoma. Wearing multi-focal glasses while walking or having poor lighting around your home can also lead to falls.
Confusion, even for a short while, can sometimes lead to falls. For example, if you wake up in an unfamiliar environment, you might feel unsure of where you are. If you feel confused, wait for your mind to clear or until someone comes before trying to get up and walk around.
Medication use can increase a person's risk of falling, too. Sometimes the increased risk is because of the health problems for which the person takes the medications. In other cases, medications cause side effects like dizziness or confusion. Drug interactions can also lead to falls.
The more medications you take the more likely you are to fall. People who take four or more prescription drugs have a greater risk of falling than do people who take fewer drugs.
Never add or stop taking medications without talking with your doctor first. Also, ask your doctor if changes in your medications could lower your risk of falls. Your doctor can tell you which drugs, including over-the-counter medicines, might cause problems.
Be sure to talk with your doctor if you fall, as well. A fall could be a sign of a medical problem such as an infection or a cardiovascular disorder. It could also suggest that a chronic ailment, such as Parkinson's disease or dementia, is progressing.
Although falls can happen anywhere, well over half of all falls happen at home. Falls at home often happen while a person is doing normal daily activities. Some of these falls are caused by factors in the person's living environment. For instance, a slick floor or a poorly lit stairway may lead to a fall.
Other factors that can lead to falls at home include loose rugs, clutter on the floor or stairs, and carrying heavy or bulky things up or down stairs. Not having stair railings and not having grab bars in the bathroom can also result in falls.
Simple changes can help make your home safer. The section called Preventing Falls and Fractures -- Home Safety offers some tips for preventing falls at home.
1. Falls usually happen because of
A. a single risk factor.
B. more than one risk factor.
B is the correct answer. Often, more than one risk factor is involved in a fall. As the number of risk factors rises, so does the risk of falling. Muscle weakness, poor balance, medication problems, too much drop in blood pressure, and vision problems can all lead to falls. Problems with your feet and wearing unsafe footwear are risk factors, too. Environmental factors, such as a slick floor or loose rug, can also cause falls.
2. A person is at greatest risk of falling if he or she takes
A. no prescription medications.
B. only one prescription medication.
C. four or more prescription medications.
C is the correct answer. People who take four or more prescription drugs have a greater risk of falling than do people who take fewer drugs. Medications can cause side effects that lead to falls. Drug interactions can also cause problems that result in falls. Never stop taking your medications without talking with your doctor first.
3. A fall may be a sign of a medical problem such as
A. an infection.
B. a cardiovascular problem.
C. dementia that is progressing.
D. all of the above
D is the correct answer. A fall may be a sign of a medical problem, such as an infection, cardiovascular problem, or blood pressure disorder. It could also suggest that a chronic problem, such as Parkinson's disease or dementia, is getting worse.
4. Most falls happen
A. in parking lots.
B. at home.
C. in shopping centers and malls.
B is the correct answer.
Falls can happen anywhere, but more than half of all falls happen at home. They often happen while a person is doing normal daily activities.
Some factors in people's living environments that can lead to falls are slick floors, poorly lit stairways, loose rugs, and clutter on floors or stairs. Not having stair railings and not having grab bars in the bathroom can also result in falls. Simple changes can make your home safer.
Preventing Falls and Fractures
Falls and fractures are not an inevitable part of growing older. Many can be prevented. To reduce your risk of falls and fractures, you can
- make personal changes that involve your lifestyle or physical well-being
- make changes in your home
- consider using walking aids or other assistive devices
- take steps to maintain or improve your bone health.
Talk with your doctor or another health care professional about how to prevent falls at home and elsewhere.
Preventing Falls and Fractures - Personal Changes
Many falls result from personal or lifestyle factors that can be changed. Your doctor or other health care provider can assess your risk of falling and suggest ways to prevent falls.
At your next check-up, talk with your health care provider about your risk of falling and changes you might make. You might be referred to another health care provider who can help. Also, let your doctor know if you've fallen or almost fallen.
Here are some changes you might make.
- Be physically active.
- Have your medicines reviewed.
- Have your blood pressure checked when lying and standing.
- Get a vision check-up.
- Choose safe footwear.
Be Physically Active
Regular physical activity is a first line of defense against falls and fractures. Physical activity strengthens muscles and increases flexibility and endurance. In turn, your balance and the way you walk may change, decreasing the chances of a fall.
It's important to keep muscles strong. Strengthening muscles in the lower body can improve balance. Work with your doctor or a physical therapist to plan a physical activity program that is right for you.
A supervised group program can help with balance and gait training. Strength and balance exercises done at home can also reduce your risk of falls. Whether done with a group or on your own, be sure your program becomes more challenging over time. This will help improve your balance and strength.
Tai Chi is one type of exercise that may help prevent falls by improving balance and control. This exercise uses slow, flowing movements to help people relax and coordinate the mind and body. It can also boost your self-confidence. Dancing and other rhythmic movements can help as well.
Mild weight-bearing exercise -- such as walking or climbing stairs -- may help slow bone loss from osteoporosis. Having strong bones can prevent fractures if you do fall.
Your doctor or a physical therapist can check your walking and balance. They might do a "Get-Up and Go" test. This simple test shows how steady you are when you get up from a chair. The test also is used to check your walking ability.
Have Your Medicines Reviewed
Find out about the possible side effects of medicines you take. Some medications might affect your coordination or balance, or cause dizziness, confusion, or sleepiness. Some medications don't work well together, adding to your risk of falls.
Bring your prescribed and over-the-counter medicines with you when you visit the doctor. Also bring any vitamins, minerals, and herbal products you are taking.
Ask if any of your medicines or over-the counter products could increase your risk of falling. Also ask if you no longer need to take any of your medications or if the doses might be decreased. Never stop taking your medications unless you talk with your doctor first.
Also, limit the amount of alcohol you drink. Even a small amount can affect your balance and reflexes.
Have Your Blood Pressure Checked When Lying and Standing
Some older people have normal or increased blood pressure while seated, but their blood pressure drops too much on standing. There is no way to know unless you check. Most often, though, your blood pressure is checked when you are sitting.
Your health care provider should check your blood pressure and pulse after you have been lying down for at least 5 minutes and again after you get up. If it drops too much when you get up, ask if any of your medications may be decreased or if you should make other changes. Drinking more water, getting up more slowly, pumping your feet or hands before getting up, or wearing special stockings can help, too.
Get a Vision Check-Up
Have your vision tested regularly or if you think it has changed. Even small changes in sight can make you less stable.
Wear your eyeglasses so you can see your surroundings clearly. Keep them clean and check to see that the frames are straight. When you get new glasses, be extra cautious while you are getting used to them. If you use reading glasses or multi-focal lenses, take them off when you're walking.
Choose Safe Footwear
The soles of our feet have nerves that help us judge the position of our bodies. To work correctly, our feet need to be in touch with the ground and our shoes need to stay securely with the foot as we take each step. Otherwise, falls may occur.
It's important to select your footwear carefully to help prevent falls. Wear sensible, low-heeled shoes that fit well and support your feet. There should be no marks on your feet when you take off your shoes and socks.
Your shoes should completely surround your feet. Wearing only socks or wearing floppy, backless slippers or shoes without backs can be unsafe. Also, choose shoes with non-slip soles. Smooth soles can cause you to slip on waxed or polished floors.
1. One way to prevent falls is to
A. avoid physical activity as much as possible.
B. be physically active.
B is the correct answer. Regular physical activity strengthens muscles, enhances balance, and improves flexibility and endurance. This in turn helps prevent falls. Your doctor or a physical therapist can help plan a group or individual exercise program that's right for you.
2. It's important to have your medicines reviewed because
A. some medicines cause side effects that can lead to falls.
B. some medicines interact in harmful ways.
C. your doses might be too high.
D. all of the above
D is the correct answer. It's important to have your doctor review your prescribed medicines and over-the-counter products. Some prescribed medicines and other products cause side effects or interact in ways that can lead to falls. Also, some medicines may no longer be needed or the doses could be reduced. But, never stop taking your medications unless you talk with your doctor first.
3. Vision-related falls can be prevented by
A. having your vision tested regularly and wearing glasses if needed.
B. putting on reading glasses when walking.
C. wearing multi-focal lenses when walking.
A is the correct answer. Vision-related falls can be prevented. Have your vision tested regularly or if you think it has changed. Also, wear your eyeglasses if you need them, but take off reading glasses or multi-focal lenses when walking to avoid tripping.
4. Falls can be prevented by wearing
A. only socks or backless slippers or shoes.
B. loose shoes with smooth soles.
C. low-heeled shoes that fit well and support your feet.
C is the correct answer. Wear safe, low-heeled shoes that fit well, have non-slip soles, and support your feet. Shoes should completely surround your feet. Avoid backless shoes. Wearing only socks or floppy, backless slippers can be unsafe. Wearing shoes with smooth soles can be unsafe on waxed or polished floors.