A friend’s mother—a healthy 72-year-old—stepped outside the home into a gap between two paver stones on the footpath, stumbled, fell and broke her hip. She was operated within 48 hours but just couldn’t get back to her normal routine. She deteriorated physically and mentally and died 14 months later.
This is not an uncommon story. Many of you may have already faced such situations, either with yourselves or with elders in the family and realised how devastating falls and falls-related injuries and their aftermath can be.
Almost one-thirds of people above 60, fall at least once in their lifetime and some, multiple times. There are now almost 91 million people (9.1 crore) in India above 60, which means that a large number of people are at the risk for falling and falls-related injuries and complications. For example, in 2019, 2.2 lakh (2,20,000) people died of falls and falls-related complications [1], which is likely an underestimation.
While physical activity, eating sensibly and sleeping well are important cornerstones of our quest to improve our healthspan, not falling and not fracturing if and when you fall are equally important, the older you get.
There are many guidelines and suggestions, some based on data and some on common sense telling us what to do to prevent falls and fractures.
1. Physical activity and strength training improve muscle and bone strength
Physical activity and strength training have the best evidence for preventing falls, especially for those at high risk for falls or those who have already had a fall.
2. Yoga and tai-chi help improve balance
Modern medicine data has shown that tai-chi [2] can reduce the incidence of serious, injurious falls. Though yoga is a popular method to improve balance, there is no data over the last 100 years that shows that yoga prevents falls and falls-related fractures. In such situations, we just use common sense to assume that if tai-chi can help, so can yoga.
3. Using walking aids like canes and walkers are double-edged swords
The use of walking aids such as canes, sticks and walkers is an intuitive personal measure that can apparently help us walk with more confidence and reduce our risk of falling. Paradoxically though, there is an increase in falls and injuries for a variety of reasons, including improper usage of these aids, poor quality of the devices and overconfidence while using them. It is important to use them correctly with guidance from professionals with proper and regular monitoring.
4. Make sure you can see and hear well and address medical issues like hypotension
While we obsess about our food and physical activity and supplements, we forget that simple issues like seeing and hearing well are equally important for a long healthspan. Poor vision and poor hearing put people at risk for falls and falls-related fractures. The moment there is a vision or hearing problem, these need to be corrected immediately. I will discuss these in more detail in the future.
If you feel giddy when you suddenly get up from bed or from a toilet seat, you need to listen to your body and move slowly to prevent falls.
5. Falls-proof your home and surroundings
A Cochrane analysis [3] of multiple studies, in 2023 has shown that home falls-hazard reduction interventions significantly reduce the risk of falling and rate of falls in elderly individuals. In effect, the more falls-proof the house is, the less is the chance of falls.
Interestingly, in September 2023, a study was published out of Kerala on a similar topic [4] where the authors visited the homes of the elderly who had a history of falls. This is what they have said in the abstract:
“The areas around the houses were slippery and had several tripping hazards. Marble, granite and tiled floors were found to be slippery. Door thresholds, door mats with no grip backing and plastic chairs were found to be potential tripping hazards. Steps/stairs were important in causation of falls. The bedrooms were often dark, small and cluttered with furniture. The bathrooms were frequently located outdoors and at a different level from the rest of the house. Lighting was a problem within the house, inside the toilet and bathrooms. Commonest alteration made to prevent falls was introduction of mats inside and outside the house. Changes that were needed for a safe environment for older persons are often challenged by the need to display status markers.”
There are many measures that can help falls-proof a house (non-skid floors, hand-rails, adequate lighting, etc) and I will discuss these in detail in a subsequent piece. It is equally important to be aware of our surroundings when walking, given the poor state of our roads and pavements and the hurdles and obstacles that keep coming our way and can trigger falls and fractures.
6. Assess and manage frailty
Frailty, which is medically defined as “a decline in functioning across multiple physiologic systems, accompanied by an increased vulnerability to stressors” is not uncommon in the elderly population worldwide and predisposes an individual to increased falls, poorer resilience to infections and diseases and earlier death. This should be diagnosed and managed by doctors or trained healthcare professionals.
7. Medications
Inappropriate medicines can cause giddiness and increase the rate of falls. Polypharmacy (taking more than 5 medicines, including Ayurveda and supplements) can create more problems than they solve and you should question every pill that goes into your body.
8. Avoid dangerous activity
The last two parents of friends who fractured had similar stories. They were climbing on footstools to reach out for something in the kitchen and fell and fractured. I am not even talking of dangerous activities like skiing or skating; even climbing onto ladders or unstable stools, trying out new dance steps (one parent during a wedding sangeet started dancing vigorously, slipped, fell and fractured), aggressive yoga postures… as we age, we need to understand the limitations of our bodies and behave accordingly.
9. Assess and manage osteoporosis
If you are a woman over 60 years, it is recommended to get one bone density test by DXA [5]. If you are osteoporotic, then medications such as bisphosphonates (not calcium and vitamin D) may help improve bone density and reduce the risk of fracture if and when you fall.
What does mean for you and I? In your quest to live long, healthy, you need to make sure you do not fall, and if you do fall, you do not land up with serious injury.
Footnotes
1. Kaur R,. Natl Med J India. 2020 Jul-Aug;33(4):195-200.
2. Li F et al.. JAMA Netw Open. 2019 Feb 1;2(2):e188280
3. Lewis SR, Griffin XL. Cochrane Database Syst Rev. 2023 Mar 10;3(3):ED000162.
4. Ravindran R, Kutty V. MRAJ [Internet]. 2023 [cited 2023 Nov 7];11(9).
5. Bhadada SK et al. Arch Osteoporos. 2021 Jun 26;16(1):102.