Written by Steven Burns
From his column To Your Health
“What’s going on with you today?” I said as I stepped into the exam room.
“Oh, not much.” Frieda was a short, round, elderly lady whom I had seen for many years. Her daughter was not so sanguine.
“She falls all the time,” she told me. “I keep trying to get her to use her walker, but she just won’t do it. I’m afraid she will hurt herself one of these times.”
“But I bounce when I fall,” Frieda added.
And so she did, bouncing on and on—until she didn’t. The hip fracture kept her down for three months of intensive rehabilitation, and the walker became necessary, not optional.
Frieda’s experience is common. One out of four people over age 65 fall every year, and 20 percent of those falls result in serious injuries, including broken bones or head injuries. In the U.S., 2.8 million older people are treated in emergency rooms for falls every year. Over 800,000 are hospitalized, usually because of head injuries or hip fractures. And the cost for falls in the U.S. comes to about $31 billion annually.
So, what causes all these falls?
There are several major reasons, and most older adults who fall usually have more than one problem. In general, though, the causes can be boiled down to two categories: balance and weakness.
Balance is determined by the inner ear, in the vestibular system or bony labyrinth. The labyrinth is a system of three semicircular canals in which a liquid (endolymph) shifts whenever the head is moved in any direction. Tiny hair cells on the inside surface of the canals sense the movement and transmit balance information to the cerebellum, a part of the brain at the back of the head, just above the neck.
As we grow older, the vestibular system becomes less reliable. Calcium particles form in the endolymph, and can get “stuck” against the walls, causing the hair cells to send false balance information to the brain. When this happens, your world spins, and you may fall down.
The senses that help with balance—vision and proprioception—also get worse. As vision worsens, we can’t see obstacles as well, and our depth perception can suffer. Proprioception is the sense of knowing where the body is in space, and that worsens as well, with loss of feeling in the feet and legs becoming common with age.
The aging of the balance system combines with diseases (Parkinson’s, stroke, benign positional vertigo), medications (sedatives, pain suppressants, antihistamines, blood pressure medicines, antidepressants), and arthritis to make falls much more common.
Besides balance problems, weakness greatly increases the risk of falling. In my practice, we test muscle mass, and it is almost universal to have lower-than-expected muscle in the legs and core of the body. What that means is, when poor balance causes a fall to begin, muscle weakness makes a completed fall much more likely. If you can’t catch yourself, then your weight is likely to land on your outstretched wrist, shoulder, or hip, possibly causing a fracture.
“What can I do about all this?” you say. I’m glad you asked.
Your best starting point is to get stronger. If you are not already having balance problems, then start immediately to build the muscles in your legs and core. Such exercises as Tai Chi and balance classes, available at many senior centers, can help with lower body strength and balance. If you have weakness due to arthritis, stroke, or injuries, you may need to work with a physical therapist to learn strengthening exercises that are customized to your situation.
If you are currently having balance problems, your first priority should be getting a diagnosis of the reasons. Start with your primary care physician. You may need to see a neurologist or physical therapist. Physiatrists (doctors specializing in physical medicine and rehabilitation) are especially good at both diagnosis and treatment.
Your primary care physician can help review medicines you take that might affect balance or cause weakness. You should insist on taking only the medications you absolutely need, and that they be reviewed regularly. Don’t forget that over-the-counter medicines can cause problems as well. For instance, anti-inflammatories such as ibuprofen and naproxen affect the inner ear, as well as hearing.
Start today! Visit this link at the National Institutes of Health. There you’ll find simple exercises that could prevent falls from being part of your future.
Dr. Steven Burns is board-certified in family medicine and has been in practice for more than 30 years.