A fall can start and accelerate a decline in health for older people
Joseph Lieberman, the former U.S. senator from Connecticut and Al Gore’s running mate in the 2000 presidential campaign, passed away Wednesday at age 82 from complications after a fall.
Learning that Lieberman had died after a fall wasn’t all that surprising. Every year 1 in 4 people older than 65 in this country suffer a fall, making it the leading cause of injury for this demographic.
But it doesn’t have to be this way. I’m an urgent care physician in Palo Alto, and it’s rare to go a day without seeing an older patient for a fall-related injury. Last week, for example, I saw a patient in his 80s who had tripped while getting out of a car and had hit his head on concrete. He was in my clinic with his worried wife. With a cut on his forehead, he uttered, “I am just so mad at myself.”
For older people like my patient, anything and everything can be a tripping hazard. My patients have tripped over benches, garden hoses, rugs and doorsteps. But for the most frail, falls can happen by simply turning too quickly.
My patient was thankfully OK. His exam and CT scan did not reveal any fractures or brain bleeding.
Yet, many others are not as lucky; 1 in 5 falls in people 65 or older lead to a major injury, and head injuries are the most likely to be fatal. Because bones become more fragile as we age, what would’ve been a simple bruise for young people can turn into a break in older individuals, especially in the ribs, ankles, wrists, hips and pelvis; 1 in 5 people die within a year after a hip fracture.
Falls are associated with a significant increase in death even without a fracture because they are the cause and the effect of declining bodily function. At a minimum, adequate vision, balance and muscle strength are required to avoid falling. With aging — and especially with medical conditions like dementia, heart disease or diabetes — these vital body functions can deteriorate and manifest as falls.
Once a fall happens, a fracture can make it painful or difficult to move, resulting in muscle atrophy. Physical deconditioning makes it more likely for someone to fall in the future and increases the risk of illnesses like pneumonia, skin infection and blood clots.
In other words, a fall can start and accelerate a decline in health for older people. It is not surprising that frequent falls are common in the last months of life.
At the very least, our society should take falls seriously because it is possibly the biggest threat to what we want in our golden years: to stay in our homes and maintain independence for as long as possible.
Someone turning 65 today has a 2 in 3 chance of needing long-term care and a 1 in 3 chance of spending time in a nursing home. With the shortage in nursing homes and home health workers, helping our seniors stay independent is in everyone’s best interest, especially considering the over-65 population will rise 50% by 2030.
If these are not enough reasons to care, consider the significant economic impact of falls: Every year we spend $50 billion on fall-related injuries, equivalent to the cost of breast and colon cancer care combined.
But there is a silver lining: Falls are preventable.
In doctor’s offices, we can screen for fall risk and address factors such as medicines that may increase the chance of falls or a patient’s poor strength and balance. Geriatricians, specialists in caring for seniors, also play a vital role yet their number has decreased in recent decades despite our increasing senior population. We need to recruit and train more geriatricians, which will require making the profession more attractive, including increasing compensation (currently additional geriatric specialty training leads to lower salary than generalist).
Outside doctor’s offices, we prevent falls and their complications by facilitating and incentivizing strength and balance training in older people. Catching oneself after tripping requires coordination, flexibility and strength, all of which can be learned. Many Medicare Advantage health plans offer discounted or free membership to gyms and fitness programs, which more people should utilize. Research shows that strength and balance training programs can significantly reduce falls.
Lastly, seniors at high risk of falling can “fall-proof ” their homes by removing potential tripping hazards (e.g., rugs) and installing handrails in bathrooms. The California Department of Aging’s Dignity at Home fall prevention program offers in-home assessments for making living spaces safer and other fall prevention resources to seniors who meet income-eligibility requirements.
Aging and dying may be inevitable, but falls are not. We know what’s at stake and how to solve it. We just need to stand up to the challenge.