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.