When my family moved to New Hampshire going into my freshman year of high school, Dr. C. Everett Koop, President Ronald Reagan’s surgeon general, became my neighbor.
As an aspiring doctor, I took every moment I could to seek him out and soak up his wisdom. While he shared many lessons, I never forgot one takeaway he always stressed: if you want to live a long, healthy life to the fullest, don’t fall – especially as you get older.
At the time, I found his frequent comments on not falling to be a bit odd, but as an orthopedic surgeon amid my final years of training, I now fully appreciate Dr. Koop’s point. In fact, I see it every day in our hospital emergency department – an elderly person falls and her life, as well as the lives of her loved ones, is changed forever. It is shockingly common, and recently we have witnessed two older members of Congress, former Speaker Nancy Pelosi and Senator Mitch McConnell, fall, with the former Speaker reportedly sustaining a hip fracture.
Each year, one out of every four Americans 65 years of age and older falls, leading to millions of emergency room visits and 1 million fall-related hospitalizations. Among the elderly, falls lead to hundreds of thousands of hip fractures every year and are the most common cause of traumatic brain injury. Most striking is that falls are the number one cause of injury-related death in this population. And the price tag on the health care system for falls among older adults? $50 billion.
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But falls are often preventable. There are three steps you can take to reduce your fall risk, yet continue to have an active and fulfilling lifestyle at the same time.
Maintaining a healthy lifestyle has many positive side effects, including reducing your fall risk. Staying physically active is crucial to general well-being, superior mental health and better quality of life. Exercise programs, started after consultation with your physician, can improve agility, strength, balance and coordination.
In addition, eating a well-balanced diet consisting of wholesome, high-quality foods that ensure an adequate dietary intake of calcium and vitamin D is central to good health, including bone health, which can help reduce the risk of sustaining a hip fracture should you fall. Smoking should be avoided, and alcohol should be minimized.
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It is also very important for older patients to have routine physical and eye exams with their doctors and health care teams. Not only does this provide people an opportunity to share any health concerns they may have, but it also allows doctors to catch potential health issues as early as possible. It also offers an opportunity to proactively manage bone health, including testing for and treating any bone loss, weakness or brittleness (i.e., osteopenia and osteoporosis), which commonly occurs as we age.
Additionally, many medications – both prescribed and over-the-counter - have common side effects, such as lightheadedness or confusion, that can lead to falls, so it is important for people to review their medication list with their medical team. This includes supplements, which are commonly missed but can also have detrimental side effects.
It is essential older people wear appropriate footwear to reduce their fall risk. Footwear should fit properly and have non-skid, or non-slip, soles. This includes shoes and sneakers, but also slippers and socks. Without "grips" on the soles, falls may occur unnecessarily, especially on hardwood or other more slippery services. If the footwear has laces, they should always be tied, with the length short enough to avoid tripping. Velcro closures may also be used, which can be quite helpful because they make putting on and securing footwear substantially easier. As women age, avoiding high heels, which can impact gait and balance, should be considered. The use of a shoehorn can also be beneficial and aid in putting on appropriate footwear.
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Most older American falls occur at home, yet we often overlook simple home modifications that can improve safety and reduce fall risk. It is important to ensure walking areas around the home are well lit, including at night via a nightlight, for example, if you need to go to the bathroom. Clutter and electrical cords should be removed from frequently used walking pathways and properly stored or placed along walls. In addition, something as simple as a throw rug can lead to unnecessary falls in the elderly; they should be removed, if possible, as people often catch their feet on the edges.
Additional physical supports that assist in activities of daily living can also improve safety and be quite helpful. For example, handrails on both sides of a set of stairs, non-slip mats in the shower or bath, grab bars next to toilets, and shower seats can all be beneficial in preventing falls when used.
While Sen. McConnell was fortunate that he did not have any serious complications from his recent fall on Capitol Hill, it appears as though former Speaker Pelosi was not as lucky. If reports are accurate, her injury will almost certainly need surgery, and it is often done within 1 to 2 days to address pain concerns and help patients get out of bed as quickly as possible to avoid complications from bed rest, such as pneumonia, bed sores, blood clots, and urinary tract infections. However, recovery following hip fracture surgery is a journey often requiring significant physical therapy, and it can lead to reduced independence and functional status. Importantly, even for Senator McConnell, having fallen at all can lead to greater hesitation in day-to-day activities and increased anxiety that it may happen again.
Falls can often have severe consequences for the elderly. Not only can they lead to injuries that change your independence, activity level and functional status, but they can even lead to death.
The reality is that there is a growing concern that as the population ages, the number of falls among older Americans will increase as well. Fortunately, many falls can be prevented if we are proactive in taking the steps necessary to reduce the risk. As is often the case, prevention is the best medicine.
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The opinions, thoughts, and ideas expressed in this article are those of the author only and not necessarily those of any employers or institutions of which he is affiliated.
