Falling. Elders fear it more than being mugged, running out of money, forgetting an important appointment or losing a cherished keepsake.
With good reason. About one in three Americans over age 65 falls each year, and those who do are apt to suffer several falls in the course of a year. One fall in 20 results in a fracture, about one in 100 a broken hip.
As elders are keenly aware, the split-second it takes to fall can push them down a miserable spiral of pain, complications, loss of independence, institutionalization, depression, death.
Even those who avoid that path learn that a fall is a major setback. “It was devastating,” said Ruth Brodsky, 81, who isn’t back to normal six months after she fell in her apartment and heard a snap in her hip bone. “I couldn’t believe it happened to me.”
As researchers decipher the hows and whys of falling, they’re putting out the message that taking a disastrous tumble need not be an inevitable result of growing old.
“We shouldn’t be fatalistic, because there is much that can be done,” said Wilson Hayes of Beth Israel Deaconess Medical Center in Boston. “But it requires that we take a broad view about the causes of falling and fractures.”
For instance, until recently much emphasis–too much, in some researchers’ view–has been placed on how the bone-thinning disease called osteoporosis makes elders more likely to break a hip, pelvis or forearm when they fall.
This might encourage older individuals to view themselves as if they were brittle heirlooms just waiting to break.
Hayes noted there is wide variation in bone strength among people who fall and break something. Some who sustain fractures have no or little osteoporosis, and people with osteoporosis can fall without necessarily breaking a bone.
That insight led him and his colleagues on an intensive 15-year investigation of just how people fall, what it takes to fracture a hip and how the hip might be protected.
They have developed a horseshoe-shaped hip pad containing something like Silly Putty to deflect the enormous force that strikes the hip bone in a sideways fall.
The pad, not yet commercially available, can be worn unobtrusively in special underwear.
Meanwhile, other researchers have uncovered an array of risk factors that contribute to falls: muscle weakness, balance difficulties, medication side effects, deteriorating vision, hazardous environments, the wrong footwear, unstable posture–even the fear of falling.
“The fear of falling can become a risk factor for falls,” noted Jonathan Howland of Boston University School of Public Health, who worked with Northeastern University researchers on the survey that showed fear of falling tops elders’ worries.
When they’re preoccupied by a fear of falling, people “get out of shape and therefore become more subject to falls,” he added.
“They go shopping less, which can affect nutrition. They can become socially isolated and depressed and be prescribed drugs for depression, which then increase their risk of falling.”
“We need to get people walking and keeping their muscles strong and building their confidence,” said Dr. Lewis Lipsitz of the Hebrew Rehabilitation Center for Aged in Boston. “We can’t protect them by keeping them sedentary.”
It’s not easy to get people talking and thinking constructively about falls — a first step in preventing them.
“People feel they can’t talk about these events with their physicians and their kids because these are the people who will be involved in a decision to institutionalize them because of their falling,” Howland said.
Doctors often compound the problem. “Physicians rarely if ever think to ask: `Have you fallen in the last year?’ ” said Dr. Douglas Kiel a Hebrew Rehabilitation Center geriatrician. “The orthopedic surgeon who fixes your hip may send you home without inquiring why you broke your hip in the first place.”
But say you’ve decided to take the bull by the horns. How do you and your caregivers reduce the risk of falling? The number and variety of risk factors, from slippery throw rugs to shaky leg muscles to medication interactions, is dauntingly large.
Take heart. Dr. Mary Tinetti of Yale University Medical School has spent some years sorting through the kinds of interventions that work and those that don’t.
What doesn’t work very well, she said, are exercise programs that tackle the problem when individuals are very frail, institutionalized or programs that use “non-specific exercises not directly geared toward improving balance and strength” and focusing only on hazards in the home rather than to the elderly individual herself.
