These strategies can help you avoid potentially serious injuries and keep you strong
By Janet Lee
May 15, 2021
Falls are the leading cause of fatal and nonfatal injuries among U.S. seniors, leading to the deaths of at least 30,000 older adults each year.
Weakness can increase fall risk, and many older adults may have lost muscle strength during the pandemic: some because of time spent in bed while sick with COVID-19 and others because their activity level dropped while staying at home to avoid exposure to the coronavirus. “People are coming back to clinics with huge deficits due to the stay-at-home orders, larger than we would expect due to aging alone,” says Jennifer Stevens-Lapsley, PhD, professor of physical therapy and director of the Rehabilitation Science PhD program at the University of Colorado School of Medicine.
Numerous other factors may also contribute to falls, including diminishing senses, certain medications, and even inadequate hydration, which can trigger dizzying dips in blood pressure. “In my experience, many people who faint and fall are dehydrated,” says Barbara White, DrPH, executive director of the Osher Lifelong Learning Institute at California State University, Long Beach.
Being afraid of falling—especially if you’ve previously tumbled—can hike your fall risk, prompting you to change your gait in ways that worsen balance. Plus, “the fear of falling decreases your willingness to move and be active and independent,” Stevens-Lapsley says. The following steps can help you be more balanced.
1. Attend to Your Environment
Reducing fall risks at home—like throw rugs, poor lighting, and small animals who like to be underfoot—is a must. (A pet may need retraining to respond better to voice commands.) In addition, wear well-fitting, low-heeled, supportive shoes with nonslip soles, indoors as well as outside. One study, published in 2010 in the journal Footwear Science, found that wearing slippers or being shoeless more than doubled the risk of being seriously injured in a fall. (The Centers for Disease Control and Prevention’s STEADI initiative has more on DIY fall-proofing.)
2. Work on Your Strength
“The leg and hip (gluteal) muscles are some of the more important muscles to strengthen, as well as the calves,” Stevens-Lapsley says. “Those are the muscles that will help you catch yourself if you start to fall.” See “How to Stay on Your Feet,” below, for two good exercises.
If you need help, you might want to enroll in a strength program for older adults. (SilverSneakers, for instance, has online and in-person classes.) Or work with a physical therapist or trainer with experience with older adults.
For those who are at high risk of falls, a fall-prevention program may be useful. (The National Council on Aging has a list of programs.) At the University of Colorado Anschutz Medical Campus’ Multidisciplinary Center on Aging’s fall-prevention clinic, benefits include exercise recommendations, a medication review (see “Watch Your Meds,” below), and advice on modifications to make to increase home safety.
3. Better Your Balance
When it comes to strength and balance, consider the Asian mind-body exercises of tai chi. A systematic review and meta-analysis of 18 studies, published in 2017 in the British Medical Journal, found that tai chi significantly reduced fall risk in older adults. In addition to building strength, tai chi helps with dynamic balance—your ability to stay upright while you’re moving. “With tai chi you’re not just standing statically, you’re moving your legs through space and bending and twisting and turning,” Stevens-Lapsley says.
You can also improve dynamic balance with non-tai chi moves. Walking in a serpentine or grapevine (crossing one leg in front of the other) pattern, changing directions suddenly (turning around or to the right or left), and walking backward help, Stevens-Lapsley says.
4. Watch Your Meds
More than half of seniors take four or more prescription medications, according to a 2019 Kaiser Family Foundation poll. This can increase the risk of drug interactions and side effects such as dizziness, foggy thinking, and low blood pressure. A study published in 2020 in the journal BMC Public Health found that people who took more than four prescription drugs accounted for roughly 23 percent of falls that led to hospitalization. So ask your doctor whether you need to be on all the medicines you currently use.
For instance, some high blood pressure medications (often diuretics) and over-the-counter antihistamines (such as diphenhydramine, aka Benadryl) can cause symptoms that alter balance. The use of antidepressants, antipsychotics, benzodiazepines for anxiety, and sedatives in older adults should also be limited to reduce fall risk, according to guidance from the American Academy of Family Physicians. “We’ve seen an explosion in mental health issues, especially anxiety, due to the pandemic, and a lot of those anti-anxiety medications can affect balance as well as cognition,” says Matthew Swan, MD, an internal medicine physician at AdventHealth in Overland Park, Kan. (Benzodiazepines for anxiety include Ativan, Valium, and Xanax.)
5. Check Your Eyes and Ears
With vision, “we experience changes in depth perception and color discrimination with age, and those affect what we see and don’t see in our environment,” White says. A poor-fitting mask may be a concern, too. “Your ability to see your feet may be impaired, and it might affect your field of vision,” Stevens-Lapsley says. “If you wear eyeglasses, a mask can also cause them to fog up, and if you have hearing aids, the mask strap can interfere.”
The solution: A mask that fits closely around your nose or has a nose wire can reduce the fog factor, and some masks have straps that go around the back of your head, instead of the ears.
Poor hearing may also pose a problem. A study published in 2012 in the Archives of Internal Medicine found that middle-aged people with only mild hearing loss had a threefold higher risk of falling. So keep up with the vision and hearing screenings your doctor recommends, and wear glasses and hearing aids as prescribed.
How to Stay on Your Feet
These exercises, from physical therapist Jennifer Stevens-Lapsley, can help you gain leg strength and improve balance.
mini-lunge
Stand next to a sturdy surface like a table, in case you need to hold on to something. With feet hip-width apart, step forward with your left leg and bend knees slightly (about 45 degrees). Step back to starting position and repeat with opposite leg. Do two sets of 10 lunges per side.
heel lift
Stand next to a sturdy surface (hold on if you need to). Raise your left foot a few inches off the floor. Keep it there as you rise onto the toes of your right foot. Hold for 1 or 2 seconds if you can, then lower your right heel to the floor. Do 10 heel raises with your right foot, then repeat with the left foot.
What to Do If You Fall
If you fall, the National Institute on Aging (NIA) recommends that you take several deep breaths and remain still for a few moments. Once you’re over the initial shock of falling, take inventory: Do you feel pain? Did you hit your head?
If you’re not in pain and don’t think you’ve hit your head, roll over onto your side and rest a bit—this lets your body and blood pressure adjust, according to the NIA. Then slowly get up on your hands and knees, and crawl to a stable chair, table, or counter. You may need to hold on to one of these objects to pull yourself up, White says. Sit, and once you feel calm, call your doctor. They may want you to come in for an evaluation.
If you’re in pain, have hit your head, or feel dizzy, nauseous, or otherwise sick, don’t move—getting up too fast or in the wrong manner could worsen any injury. Call for help if you can. If you’re alone and can’t alert anyone or contact 911, you may have to crawl to a phone or door to summon assistance.
By Janet Lee
May 15, 2021
Falls are the leading cause of fatal and nonfatal injuries among U.S. seniors, leading to the deaths of at least 30,000 older adults each year.
Weakness can increase fall risk, and many older adults may have lost muscle strength during the pandemic: some because of time spent in bed while sick with COVID-19 and others because their activity level dropped while staying at home to avoid exposure to the coronavirus. “People are coming back to clinics with huge deficits due to the stay-at-home orders, larger than we would expect due to aging alone,” says Jennifer Stevens-Lapsley, PhD, professor of physical therapy and director of the Rehabilitation Science PhD program at the University of Colorado School of Medicine.
Numerous other factors may also contribute to falls, including diminishing senses, certain medications, and even inadequate hydration, which can trigger dizzying dips in blood pressure. “In my experience, many people who faint and fall are dehydrated,” says Barbara White, DrPH, executive director of the Osher Lifelong Learning Institute at California State University, Long Beach.
Being afraid of falling—especially if you’ve previously tumbled—can hike your fall risk, prompting you to change your gait in ways that worsen balance. Plus, “the fear of falling decreases your willingness to move and be active and independent,” Stevens-Lapsley says. The following steps can help you be more balanced.
1. Attend to Your Environment
Reducing fall risks at home—like throw rugs, poor lighting, and small animals who like to be underfoot—is a must. (A pet may need retraining to respond better to voice commands.) In addition, wear well-fitting, low-heeled, supportive shoes with nonslip soles, indoors as well as outside. One study, published in 2010 in the journal Footwear Science, found that wearing slippers or being shoeless more than doubled the risk of being seriously injured in a fall. (The Centers for Disease Control and Prevention’s STEADI initiative has more on DIY fall-proofing.)
2. Work on Your Strength
“The leg and hip (gluteal) muscles are some of the more important muscles to strengthen, as well as the calves,” Stevens-Lapsley says. “Those are the muscles that will help you catch yourself if you start to fall.” See “How to Stay on Your Feet,” below, for two good exercises.
If you need help, you might want to enroll in a strength program for older adults. (SilverSneakers, for instance, has online and in-person classes.) Or work with a physical therapist or trainer with experience with older adults.
For those who are at high risk of falls, a fall-prevention program may be useful. (The National Council on Aging has a list of programs.) At the University of Colorado Anschutz Medical Campus’ Multidisciplinary Center on Aging’s fall-prevention clinic, benefits include exercise recommendations, a medication review (see “Watch Your Meds,” below), and advice on modifications to make to increase home safety.
3. Better Your Balance
When it comes to strength and balance, consider the Asian mind-body exercises of tai chi. A systematic review and meta-analysis of 18 studies, published in 2017 in the British Medical Journal, found that tai chi significantly reduced fall risk in older adults. In addition to building strength, tai chi helps with dynamic balance—your ability to stay upright while you’re moving. “With tai chi you’re not just standing statically, you’re moving your legs through space and bending and twisting and turning,” Stevens-Lapsley says.
You can also improve dynamic balance with non-tai chi moves. Walking in a serpentine or grapevine (crossing one leg in front of the other) pattern, changing directions suddenly (turning around or to the right or left), and walking backward help, Stevens-Lapsley says.
4. Watch Your Meds
More than half of seniors take four or more prescription medications, according to a 2019 Kaiser Family Foundation poll. This can increase the risk of drug interactions and side effects such as dizziness, foggy thinking, and low blood pressure. A study published in 2020 in the journal BMC Public Health found that people who took more than four prescription drugs accounted for roughly 23 percent of falls that led to hospitalization. So ask your doctor whether you need to be on all the medicines you currently use.
For instance, some high blood pressure medications (often diuretics) and over-the-counter antihistamines (such as diphenhydramine, aka Benadryl) can cause symptoms that alter balance. The use of antidepressants, antipsychotics, benzodiazepines for anxiety, and sedatives in older adults should also be limited to reduce fall risk, according to guidance from the American Academy of Family Physicians. “We’ve seen an explosion in mental health issues, especially anxiety, due to the pandemic, and a lot of those anti-anxiety medications can affect balance as well as cognition,” says Matthew Swan, MD, an internal medicine physician at AdventHealth in Overland Park, Kan. (Benzodiazepines for anxiety include Ativan, Valium, and Xanax.)
5. Check Your Eyes and Ears
With vision, “we experience changes in depth perception and color discrimination with age, and those affect what we see and don’t see in our environment,” White says. A poor-fitting mask may be a concern, too. “Your ability to see your feet may be impaired, and it might affect your field of vision,” Stevens-Lapsley says. “If you wear eyeglasses, a mask can also cause them to fog up, and if you have hearing aids, the mask strap can interfere.”
The solution: A mask that fits closely around your nose or has a nose wire can reduce the fog factor, and some masks have straps that go around the back of your head, instead of the ears.
Poor hearing may also pose a problem. A study published in 2012 in the Archives of Internal Medicine found that middle-aged people with only mild hearing loss had a threefold higher risk of falling. So keep up with the vision and hearing screenings your doctor recommends, and wear glasses and hearing aids as prescribed.
How to Stay on Your Feet
These exercises, from physical therapist Jennifer Stevens-Lapsley, can help you gain leg strength and improve balance.
mini-lunge
Stand next to a sturdy surface like a table, in case you need to hold on to something. With feet hip-width apart, step forward with your left leg and bend knees slightly (about 45 degrees). Step back to starting position and repeat with opposite leg. Do two sets of 10 lunges per side.
heel lift
Stand next to a sturdy surface (hold on if you need to). Raise your left foot a few inches off the floor. Keep it there as you rise onto the toes of your right foot. Hold for 1 or 2 seconds if you can, then lower your right heel to the floor. Do 10 heel raises with your right foot, then repeat with the left foot.
What to Do If You Fall
If you fall, the National Institute on Aging (NIA) recommends that you take several deep breaths and remain still for a few moments. Once you’re over the initial shock of falling, take inventory: Do you feel pain? Did you hit your head?
If you’re not in pain and don’t think you’ve hit your head, roll over onto your side and rest a bit—this lets your body and blood pressure adjust, according to the NIA. Then slowly get up on your hands and knees, and crawl to a stable chair, table, or counter. You may need to hold on to one of these objects to pull yourself up, White says. Sit, and once you feel calm, call your doctor. They may want you to come in for an evaluation.
If you’re in pain, have hit your head, or feel dizzy, nauseous, or otherwise sick, don’t move—getting up too fast or in the wrong manner could worsen any injury. Call for help if you can. If you’re alone and can’t alert anyone or contact 911, you may have to crawl to a phone or door to summon assistance.