How to Prevent Falls in Older Adults
When it comes to older adults’ health, you’ll find lots of articles about heart disease, stroke, and cancer, but the biggest threat may be the one we think about the least: injuries from falls.
According to the Centers for Disease Control and Prevention, falls are the leading cause of injury-related death among adults ages 65 and older and they are the leading cause of all injuries for this age group.
The CDC data show that over 14 million annually, or 1 in 4 older adults, report falling. Injuries can be serious, including broken bones requiring months of healing and rehab.
We asked physical therapist Julianna Gatto, PT, DPT from UR Medicine’s Physical Medicine and Rehabilitation to talk about fall risks and prevention strategies, and Sports Medicine registered dietician Holly Gilligan, MA, RD to explain the importance of preserving bone health with a good diet.
What causes falls in seniors?
There are a number of factors, including medications that cause dizziness or balance problems, neurological conditions, muscle weakness, balance disorders, a recent hospitalization, and surgery. Poor bone health leading to osteoporosis also can cause falls when a bone spontaneously breaks.
Why are older adults especially at risk of falling?
As we get older a lot of things in our body typically slow down, including knowing where your body is in space (proprioception). Related to this is your kinesthetic sense—knowing where your body is when you are moving. Vision also gets worse, and as we get older and other senses decline, we rely on it more for orientation and balance.
Also, for many older adults, nerve damage—neuropathy—can cause loss of sensation in feet. The most common cause of foot neuropathy is diabetes, but other factors include medical treatments like radiation and chemotherapy.
How can you prevent a fall?
If you have a condition that increases your fall risk, get evaluated by a physical therapist, who can guide you through balance exercises for seniors that also improve strength. Your therapist also can offer tips for navigating your home environment and completing tasks of everyday living. If you’re unsteady on your feet, you may need an assistive device like a brace, cane, or walker.
Fall risks checklist:
- Talk to your doctor if medicines are causing dizziness or balance problems.
- Keep up to date on your eye exams and wear corrective lenses whenever you are moving about.
- Get rid of throw rugs, which are a tripping hazard.
- Clean up clutter: keep loose items off the stairs, and make sure the pathways in your home are clear and wide enough for you to pass safely. Allow enough room between pieces of furniture; at least 36 inches is recommended.
- Always use the handrail when going up or down stairs and make sure the stairs are well lit.
- Install grab bars in the bathroom. Closing your eyes in the shower when shampooing can make you unsteady. Brace yourself by placing a hand on the grab bar or the shower wall.
- Have a nightlight in your bedroom or a light next to your bed if you need to use the bathroom at night. Ensure the path to the bathroom is also well-lit. Many falls occur at night when people wake up and suddenly need to use the bathroom.
- If you have a cane or walker, use it all the time. Don’t go “furniture surfing” by holding onto furniture to prop you up.
When should people start thinking about fall prevention?
If you have any condition that would put you at high risk of injury from falling, get an evaluation now so that you can help protect yourself.
If you don’t have any identified risks, it’s still a good idea to practice fall prevention sooner rather than later. As you approach retirement age, get evaluated and work on your strength, balance, and home environment to preserve the abilities you have and set yourself up for success. The last thing you want is an injury that can diminish your health in the last 30 or 40 years of your life.
The importance of calcium for your bone health
"Our bones are constantly breaking down and rebuilding. Calcium is essential to this process. However, many people are not getting enough of it," said Holly Gilligan, MA, RD.
According to the , approximately 30 percent of postmenopausal women in the U.S. and Europe have osteoporosis, and at least 40 percent of these women develop at least one fragility fracture (a fracture that occurs after minor trauma, such as a fall from standing height or lower).
The NIH estimates that 49 percent of children ages 4–18, and 39 percent of people ages 4 and older, consume less than the recommended amount of calcium from food and supplements.
And as you age, you need more calcium because your bones don’t absorb it as efficiently. The Recommended Daily Allowance rises from 1000 mg to 1200 mg when women reach 50 and when men reach 70.
Can you take calcium supplements such as calcium chews? Or is it better to get calcium from food?
It's best to get calcium from foods. Among foods high in calcium, dairy is the leading source. If you’re concerned about fat, you can find good sources of calcium—milk, yogurt, cheeses—that are lower in fat or have virtually no fat. But remember, we need a certain amount of fat.
For people who have a dairy intolerance, alternative milks and yogurts made from nuts or grains like oats can be good sources of calcium. Foods fortified with calcium, Vitamin D, and other essential vitamins include cereals, breads, and juices.
Vitamin D and calcium absorption
Vitamin D is the “chauffeur” that helps deliver calcium to our bones so that it is absorbed more fully. And many people are deficient in this vitamin, too. One of the main sources of Vitamin D is sunlight, and in western New York, where we have long winters, many people are not getting enough Vitamin D.
Which foods are high in Vitamin D?
- Many fish varieties, including trout, salmon, and sardines
- Soy milks
- Yogurt, milk, kefir, and cheese
- Egg yolks
- Raw mushrooms
- Fortified orange juice
Which foods interfere with calcium absorption?
Caffeine is a big one. Generally, if you drink more than three cups of caffeinated coffee or tea a day, you will be impacting your calcium absorption. Foods high in oxalates, like spinach, can also block calcium absorption. Sodas, sparkling waters, and seltzers that contain phosphoric acid also can interfere with calcium absorption. If you drink a lot of coffee, tea, or soda and not a lot of dairy, that can be a problem. You may want to take a calcium-Vitamin D supplement to ensure you’re getting enough.
How much calcium-rich food do I need to meet the daily requirement?
If you’re a woman over 50, 1200 mg a day means you should get three to four servings of calcium-rich food a day. So, a cup of milk at breakfast, two ounces of cheese, a 6-ounce serving of yogurt, and you’re likely meeting your needs.
Should I take a calcium-Vitamin D supplement just to be safe? Is it possible to overdose on calcium?
You can get too much calcium, but if you’re eating a normal amount of it in your diet and take a supplement, you are probably still not going to be overdoing it.
Does it matter when I take the supplement?
You should spread out your dairy intake throughout the day and avoid taking your supplement with dairy to maximize its effectiveness. Try taking the supplement at night. Some medications can interfere with the absorption of calcium; levothyroxine is one of the more common ones. Since that is typically taken in the morning on an empty stomach, it’s good to take your dietary calcium and supplement well after that.
Geriatric Fracture Center
The Geriatric Fracture Center is the first facility of its kind that's dedicated exclusively to the care of older adult patients who suffer fractures. Our surgeons and geriatricians co-manage care to better handle the unique medical needs of older adult patients.
Author
