Falls pose a significant health risk for older adults, and the likelihood and severity of fall-related injuries increase with age. Yet many people remain unaware of the factors that contribute to falls, including anxiety, hearing loss and mobility problems.
After falling down stairs more than a dozen times, Ben Melancon, a former athlete now in his 70s, became afraid to use them.
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“I was scared to death of those stairs,” Melancon said in a press release from The Ohio State University Wexner Medical Center. His final fall caused an injury that required nine stitches near his left eye.
“That was pretty much the icing on the cake,” Melancon said.
Melancon is one of many older people whose experiences with falling can lead to a lasting fear of losing their balance. But while this fear may lead to avoiding potentially dangerous activities, it can also increase their risk of falling by making them less active and reducing their strength and mobility.
“When you’re not confident, you may avoid activities because you’re afraid you’re going to fall,” said Michelle Easley, a board-certified nurse practitioner at Ohio State Wexner Medical Center’s Fall Prevention Clinic. “That fear of falling is actually one of the biggest risks of falling.”
A new national survey of 1,007 United States adults from The Ohio State University Wexner Medical Center found that 63% do not recognise anxiety about falling as a risk. The survey also found that 60% do not recognise hearing loss as a risk, while 74% do not recognise that an urgent need to use the bathroom can increase the chance of falling.
“The number one risk for a fall is a previous fall,” Easley said. “If more people knew about this, we could intervene earlier, get people help and prevent more serious falls.”
Falls across Europe
The problem extends well beyond the United States. Falls are a major public health concern across Europe, contributing to hospital admissions, disability, loss of independence and premature death among older people.
According to a European factsheet published by the European Association for Injury Prevention and Safety Promotion EuroSafe, approximately 35,848 people aged 65 and older were reported to die from falls annually in the EU, based on data from 2010 to 2012. Falls were also identified as the leading cause of injury-related emergency department attendances among older people, accounting for 58% of these visits.
Almost half of fall-related emergency department attendances across Europe result in fractures, while around one in five involve injuries to the head. Beyond the physical injuries, falls can lead to anxiety, fear and increased dependence on family carers or admission to residential care facilities.
The severity of injuries increases with age. The factsheet estimates that 32% of fall-related injuries among people aged 65 to 74 require hospital admission. This rises to 39% among those aged 75 to 84 and 45% among people aged 85 and older.
Addressing the risks
Falls are rarely caused by a single factor. They can result from a combination of physical, behavioural and environmental risks.
These include reduced muscle strength, poor balance, impaired vision or hearing, chronic health conditions and the use of multiple medications. Behavioural factors, such as inadequate footwear and changes in mobility caused by fear of falling, can also contribute.
The home is a particularly important setting for prevention. According to the EuroSafe factsheet, 64% of fall-related injuries occur at home. More than half of injuries occurring inside the home happen in living rooms or bedrooms, followed by bathrooms and stairs.
Outside the home, uneven pavements, slippery surfaces and poorly maintained public spaces can also increase the risk.
Improving strength and balance through physical activity, particularly programmes supervised by physiotherapists, is an important part of prevention.
Melancon attended Ohio State's Fall Prevention Clinic several times a week for four months, working with a physical therapist to improve his strength and balance. He also began exercising at home each morning and wearing athletic shoes that provided better support.
He has not fallen since completing the programme.
“I’m not fearful anymore of steps,” Melancon said. “I can go up and down any steps you want.”
European evidence supports a multi-faceted approach, combining individual risk assessments, medication reviews, tailored exercise programmes and improvements to home and public environments. Studies cited in the EuroSafe factsheet suggest that targeted fall-prevention programmes can reduce injury rates by 20% to 40% among high-risk groups.
Easley recommends checking homes for poor lighting, loose rugs and stairs that may be difficult to use. Bathrooms should also be easy to enter and leave safely, without hazards that could cause a fall.
“Rugs are a huge issue, and they need to be removed or secured,” Easley said. “It’s all about safety, not taking away independence.”
People should also review their medications with their healthcare provider or pharmacist, since some can cause dizziness or balance problems.
Melancon encourages others who fear falling to seek help and stay committed to recovery.
“You can do this,” he said. “If you make a commitment and have dedication, you’re going to do it.”
