Why Do Older People Fall and What Can Be Done?
 

Why do older people fall, and can they improve their balance at even an advanced age so that falling is less likely? My Dad is 93 and just moved to assisted living, in part because he was afraid of falling at home where he was living alone. He's been there in assisted living less than 2 weeks, and they called me today to tell me that he fell when he was going to the door to let someone in. He hit his head on the door handle, but he checked out OK at the ER and only has a bruise on his forehead. He already uses a walker indoors and out so I'm not sure what else he can do. He can't really explain what's going on although supposedly he does not have dementia. He just says "My balance isn't good".

I think there are so many variables that it’d be hard to answer; however, I can say in my mother’s case that poor nutrition coupled with pernicious anemia (b12 anemia) and muscle atrophy created a perfect storm for her. In the case of my 94-year-old aunt, I’d say it is a combo of poor nutrition and small strokes with overall muscle atrophy.

To improve balance, I’d say start with nutrition. Then work on overall strength.

i read several articles on this and basic factors contribute to loss of spatial awareness:
- vision
- hearing

the articles recommended ensuring that you're (or your loved ones who are elderly) up to date with your eye exams and glasses, etc. and eye exams may reveal many other health issues such as diabetes. Hearing and best ear health contributes to balance and spatial awareness.

physical musculature as others have mentioned will keep your reaction time and confidence in walking and moving at their optimal levels.

another consideration is that since your dad just moved to the facility, perhaps he needs more time to get acclimated and use the facilities such as floorplan layout, doors, ramps, hand-holds (railings), etc. if they offer tai chi classes, that's a good way to beef up his balance strength. perhaps they have safety classes - maybe instruct him that although he means well in opening doors for others, he might put himself at risk in doing so.

Don't forget to rule out the side effects of any medications he's on.

As someone who has worked in nursing homes off and on during her nursing career, I've seen a lot of falls.

Its a lot of things that cause falls.
Loss of balance, poor vision, generalized weakness, poor nutrition, the list goes on.

Ask the AL if your dad can get some physical therapy. Most either have a therapist on staff, or they contract with a company and therapists come in several times a week. I've seen people go from being so weak they need 1-2 people to help them transfer in and out of chairs/bathrooms to walking the hallways alone. A good therapist will work on balance, strength and tips on how to do things to reduce the risk of falls.

Have his doctor or pharmacist go over his medications. He might need adjustments in what he's taking, or dosage adjustments.
Often elderly people are put on blood pressure meds at say, 70, and by 90 they no longer need them or need the dosage to be reduced. A lot of falls are caused by a sudden drop in blood pressure as they get up, change position. I've had a few doctors tell me that in very elderly, people 90+ its almost better for them to have slightly higher blood pressure than younger people.

I also worked as an RN in nursing homes for several years before I retired and I agree with all the above!

I've been dealing with my MIL falling. She falls every couple of months, and always hits her head, so she ends up in the ER getting scans. So far, she's been lucky and hasn't been seriously injured.

I believe that the falling is due to deconditioning, weakness, balance issues due to hearing loss, and side effects from medication.

The pandemic has caused most people to become less active. Before the pandemic, my MIL was very active. Since the pandemic started, she has been far less active, and has lost strength in her lower body and core. She has been getting physical therapy to increase her strength and improve balance.

I remember watching a documentary about this several years ago.

What researchers found was that many elderly people fall because they believe they are going to fall. They actually have plenty of strength in their legs but they are so afraid of falling that it becomes a self-fulfilling prophecy.

The documentary shows elderly people (80s and 90s) who had been checked out and shown to have good strength and coordination absolutely clinging to walkers and insisting they needed them.

When a physical therapist would try to take away the walker and get them to walk on their own, they would become frantic and beg for the walker.

I have imprinted that in my memory and hope to never end up in that situation. Once it happens, I'm not sure it can be reversed but positive thinking could be a strategy.

I think this is true. It takes one fall and the confidence goes away. They become more dependent because they fear more falls. I also think it is because of being disoriented and their perception is off. Like they think they are close to the door and the door handle but they are not. If they are on medications, their medications makes them more tired and disoriented. My mother had a history of falling. When she was 80 she was given a walker because they put her some high powered meds for her cancer. I could not understand her need for it inside because she could easily go from point A to point B in their condo and hold onto something. Her continued spiral downward was when she was walking with her walker and and had taken her meds she was so disoriented that literally just walked away from her walker, she then panic and fell. I also agree that strength and balance are key components as well. The thing is where your balance might get weak it is not difficult to get it back if you do the exercises.

I also have a MIL who falls frequently, but she has Parkinson's and they shuffle their feet without picking them up. She was in the same situation (in an assisted living apartment) and got up to answer the door.

My mother got to the point where she couldn't walk at all, without assistance. First it was with a walker and as she declined further she needed an electric power chair to get around.

Some people will not exercise, but end up having to do some type of PT after a fall. My MIL broke her shoulder and her head has been banged up pretty good. It's scary when our loved ones live alone and are at an age where their body doesn't function as well as it used to. My mom had chronic pain all the time, but no matter how I tried to help her with gentle exercises, she was too stubborn to do it.

There is so much information available nowadays. Especially on the internet with YouTube, etc. In certain states Classical Stretch episodes air on TV pretty regularly, as well as a few other exercise programs.

My mom was in a senior apartment that offered Tai Chi classes regularly pre-Covid, so she did try that while seated. But, when you're working on balance you need to be able to stand long enough to lift your feet and arms. It's a good idea to work on your feet first and work your way up the body and strengthen those muscles. It has to been done consistently.

I am the OP. Thanks for everyone's comments. My Dad had a doctor's appointment today and found out his blood pressure is too low, and he is getting light headed when he stands up which is probably contributing to falling. Somehow they did not notice this the other day when he was at the ER with the bump on his head, and my Dad did not say anything to us about feeling this way until today's doctor appointment. Hopefully, his medication can be adjusted now to help with this problem. Between my Dad not telling us things and health care people not telling us things and not communicating with each other it's getting to be a lot to coordinate. I really don't know how elderly people navigate all of this.

He might not have had low BP in the ER.

Pain and fear make the BP go up. Its how I could notice a patient who maybe just had surgery, but was still sleeping, or in the very groggy phase was probably starting to hurt. Their BP would go up.

He easy could have had normal, maybe even slightly elevated BP due to being nervous cause who isn't nervous in the ER as a patient, and I'm sure he was sore after the fall.

My experiences with my dad were very similar to a lot of issues already mentioned.

In terms of structural stability, his feet were physically damaged and couldn't provide the sort of balance help they once did. (Fallen arches, foot changes from long term muscle, bone and nerve related issues, nerve damage that affected the way his bones healed, arthritis, broken bones he couldn't feel, wounds that would develop on his feet that needed casts and bandages and non-weight bearing, etc.) The older he got, the harder it was for him to manage.

His own fear of falling played a huge role in his general decline. He fell repeatedly over the years, at one point breaking a leg and winding up alone on the floor for hours one night til he turned over a table and the crash woke me up. After that he was pretty much wheelchair dependent. He'd participate in rehab immediately after the latest injury, mostly so he could go home, then once there, he'd just slide back to his just-enough-to-get-by habits. Naturally this lead to a general decline.

Over and over, he'd be astonished to find that he wasn't physically able to just get up and do things. It was a huge struggle, and wildly stressful for both of us.

Toward the end of his life, I do think his growing dementia played a role in his inability to calculate the level of risk he might be in, his inability to recover once he lost his balance, etc.

His sense of bodily proprioception got worse and worse both because of his nerve damage and his general physical decline. He lost muscle memory because he'd quit being active.

Sorry to ramble, but it was a long, slow process, made more difficult by the limitations of his insurance and his own unwillingness to be proactive.

I feel it is my duty to tell you it might be the shoes. I fell on the sidewalk when I just took one step back, 7 months ago and hurt my back, and am still not healed. I was wearing new runners I bought online that did not fit well. They were Reeboks and nothing like they used to be - very poorly made. Since I have found better shoes, both New Balance and Saucony, I feel so grounded and solid when I walk. Check his shoes and see if they fit well or are maybe too tight or too loose, or have a slippery sole. Just an idea because of what happened to me. You can step as carefully as possible, take one normal step, and if the shoes are not decent, they can make you lose your balance. Never had this problem in my life before - never ordering shoes online again.

I'm 60 right now, not really old, but what I've noticed is that the fluid in my ears controlling balance, the semicircular ducts, has slowed a lot. I notice problems getting out of bed and bending over to pick up things. I have to do it lots slower than I used to to not lose my balance.

I think the comments about the feet are very interesting. Miranda and other Essentrics instructors often talk about the importance of how much of your general physical well being starts with your feet. She has many exercises you can do to keep your feet thus your balance healthy.

I fell twice really hard while walking off a sidewalk curb and couldn't understand why. A friend said, you have trifocals! Trifocals mess up your depth perception when you look down!

After that i was more careful and have had no problems.

I usually wear bifocals and going down steps is tough. I have to really pay attention.

Anna, i remember how you described how lovingly you cared for your dad, and i appreciated your description of how various factors led to his decline. it's a good lesson for me to read this.

my mom was caregiver to several elderly people, including caring for my dad while also being a senior herself!

my grandpa was living with my mom before he passed. he loved working in the yard and it was his form of exercise. he did it until age 90 when he passed away. he wore rubber slippers and i think this kept his feet muscles agile.

one day the neighbor found him laying down on the grass - he fell, couldn't get up but wasn't injured! he has a soft voice, so i don't think anyone could hear him. when my mom got home, she was shocked to hear what had happened - by then he was up and about.

that day, my brother installed railings all over the yard using metal pipes from Home Depot. my mom left chairs in various parts of the yard so that he could take breaks. he owned a quad cane but didn't need it when working out in the yard.

Have you had your ears checked by an ENT? Ear problems can be caused by allergies and sinus problems.

I came across this video when I was looking up Fitness Fix with Denise Beatty. She has a YouTube channel, Fitness Fix, and this balancing video caught my eye.

Friday Fix - Balancing

She does a great job explaining exactly what's going on with your body during the exercises.

You've gotten some great responses so far. We talked about this issue during the Yoga for Healthy Aging training I did last fall. One of the teachers of this training, Dr. Baxter Bell, addresses this in his book by the same name. I found an excerpt here that you might find helpful:

https://www.shambhala.com/wp/wp-cont..._Shambhala.pdf

Unfortunately, falls are a huge factor in hip and other fractures, too. Osteoporosis is a risk factor, but it's a fall that usually is the cause of the actual fracture.

For those of us who haven't been impacted yet, it's so important to work on balance and strength now.

ETA - here are a couple of podcasts with Baxter Bell based on the book:
https://jasonyoga.com/podcast/episode92/
https://podcasts.apple.com/us/podcas...=1000403954654