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Preventing Falls

by Emily Piven Haltiwanger, OTD, MHE, OTR

Sadly, my friend’s mother died recently of a fall that could have been prevented. At age 97, she carried a vacuum cleaner upstairs, even though she already had another vacuum cleaner on that floor. On the way back down, she fell and broke her arm, and the next day she died from a blood clot. No doubt one cause of this accident was stubbornness, which remains a difficult condition to treat. But fortunately, for many other causes of falling, there are preventive steps that can be taken by older adults who are willing to make the effort.

Falling is a serious public health concern because falls are the leading cause of injury and accidental death in people age 75 and older in the United States. Falls are the most common reason for emergency room visits in people age 45 and older, and 9 in 10 hip fractures are caused by falls. Nursing home residents fall three times more frequently than people living in the community. A person’s risk of falling increases with age; this is true for both sexes and all racial and ethnic groups. One in three adults age 65 and older who does not live in a care facility will fall within a given year, and 10% of those who fall will receive serious injuries that may include head trauma, soft tissue injury, joint dislocation, and hip fracture. Falling may lead to limitations on activity, loss of independence, a lower quality of life, greater anxiety, reduced self-confidence, institutionalization, and even death. This article aims to explain how falls occur and what you can do to prevent them.

Why people fall
Older adults have more chronic illnesses, such as diabetes, stroke, heart disease, and visual problems, that increase the risk of falling. Also, as people age, they tend to get weaker, a process that is often accelerated by reduced physical activity. Older people tend to take more prescription drugs and therefore experience more drug side effects, including dizziness and muscle weakness. Older people may also experience social isolation, which leads some to take on physical tasks they can’t easily perform, both because no one is there to do it for them, and no one is there to advise against their doing it themselves. Being isolated can also make it harder to get help in the event of a fall.

Older people with diabetes are both more likely to fall and more likely to have fall-related complications than those without diabetes. Insulin users with an HbA1c level below 7% (indicating “tight” blood glucose control) are four times more likely to fall as those with an HbA1c above 7%. This is because among insulin users, a lower HbA1c is associated with a higher risk of hypoglycemia, which can cause blurred vision, dizziness, and weakness. According to Dr. Ann Schwartz of the University of California, San Francisco, however, achieving tight blood glucose control with oral diabetes drugs does not increase the risk of falling. But some oral diabetes drugs, notably metformin, can cause vitamin B12 deficiency, which can lead to postural instability (balance problems).

Peripheral >neuropathy (nerve damage) adds to the risk of falling in people with diabetes; some estimates state that one-third of people with diabetes have this complication. Peripheral neuropathy can cause loss of sensation, numbness, and pain in the feet and legs, often resulting in a slower gait and poor balance that can worsen when walking on uneven surfaces. Visual impairment resulting from diabetic retinopathy (or from cataracts, glaucoma, or macular degeneration) also increases the risk of falling. Impaired kidney function from diabetic nephropathy can lead to inadequate levels of vitamin D, which can reduce bone density and muscle strength. And people with diabetes can experience wounds, skin breakdown, joint inflammation, or joint deformity, all of which can lead to instability when walking.

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