Death is a regular visitor to the senior community where my mother lives. We often tell the same story when we discuss a recent loss. Her neighbor fell and then things got worse. According to a 2018 U.S. Centers for Disease Control and Prevention report, falls are the seventh leading cause of death for Americans 65 and over. Even if a fall doesn't cause severe injuries, it can lead to death for older adults. Patricia Dykes, who is a researcher at Brigham and Women's Hospital, Boston, says that even if a fall does not cause serious injury, it can still be threatening. They fear moving. They may think, "Maybe I shouldn't walk as much." This leads to more falls, injuries, and worsening of their health. She says that older people are unable to do the things that will prevent them from falling because they fear falling.
There are many factors that could explain the increase in falls-related deaths. One reason is that more people survive heart disease, strokes, and cancer, and live into their 80s and nineties with disabilities and chronic conditions that make it difficult for them to stand, according to Elizabeth Burns, a CDC epidemiologist, who co-authored 2018's report. She also says that Americans are now taking more medication than ever before. The risk of falling is increased by polypharmacy, which means taking four or more drugs. The same goes for taking drugs that affect the central nervous system (e.g., opioids or antidepressants). Risk is also increased by age-related changes in vision, cognition and muscle strength.
Experts insist that falling is possible but not inevitable. The risk can be reduced by performing targeted exercises, modifying drug regimens, and correcting vision problems. The latest technology, such as smartphone apps that analyze gait and AI tools that alert busy healthcare providers to fall risk among their patients, may be a help.
The most important thing anyone can do for their body is to improve their balance, strength, and gait. Dykes states that just as you must eat every day you also need to exercise daily. Physical therapists have been able to reduce falls by 35 percent in the Otago exercise program. Numerous studies have examined the possibility of combining exercise programs with other changes such as reducing medication use and decreasing household hazards. An average of 23 percent of the 62 studies reviewed in 2018 found that such multifaceted approaches reduced falls.
However, such results are not always possible in the real world. The STRIDE study was a highly anticipated effort by researchers. It followed 5,451 older adults at 86 primary care clinics across the U.S. and found that all were at high risk of falling. Half of the participants agreed to target one or three risk factors. The other half received basic information about how to prevent falls. The results were published in 2020 and showed no significant differences between the two groups. Dykes, who was co-author of the study, believes that people might have missed important factors. Many older people aren't willing to remove scatter rugs (a tripping hazard) or put grab bars next to the toilet. It takes patience and time to convince a patient to stop using a medication they have used for years. Certain drugs can increase the risk of falling if they are not treated. Burns states that this makes it difficult for doctors to make informed decisions.
These challenges have led to several new initiatives that focus on providing better support for health-care providers. For example, the CDC's STEADI program gives doctors a range of tools to help patients identify and reduce falls. It reduced the chance of falling-related hospitalizations by 40% in a large New York State study. Dykes and her colleagues are currently testing Web-based tools to scan patient electronic records for fall risk factors, and then use algorithms to recommend remedies.
Technology can help people become more aware of possible problems. Apple will soon add a rating for walking stability to its iPhone Health app. It uses a combination of walking speed, step length, step harmony, and an indicator for shuffling to measure stability. Low ratings allow users to access Otago-based exercises videos and other tools. The app and similar tools can help more people feel safer, provided it doesn't scare them into going to bed.
