How to Prevent Falls

Every 11 seconds in the U.S., an older adult ends up in an emergency room due to a fall.

“It’s the leading cause of accidental death in the elderly,” says Cathleen Colón-Emeric, M.D., chief of geriatrics at the Duke University School of Medicine.

Falls can result in a variety of injuries, including hip fractures and head trauma—which can have lasting consequences.

“There’s such a high risk of dying in the first year after a hip fracture,” says Leah Witt, M.D., a geriatrician and pulmonologist who’s an assistant professor of medicine at the University of California, San Francisco. “Plus, people often aren’t able to function as well and aren’t as independent as they were before the fall.”

Traumatic brain injuries (TBI), such as a subdural hematoma—where blood pools inside the skull, creating a potentially fatal buildup of pressure on the brain—are also an increasing problem for older adults.

“Baby boomers are living longer, and they’re more active,” says Kathleen Bell, M.D., a physiatrist and chairwoman of the department of physical medicine and rehabilitation at the University of Texas Southwestern Medical Center. “There’s that boomer mentality that they can do more, but sometimes that’s not the case.”

Older adults are at a higher TBI risk because the brain shrinks with age, leaving more room for it to move about in the skull during falls. Blood vessels are also more fragile and easily injured. “A very innocuous fall or jolt could lead to a subdural hematoma or concussion,” says Bell.

Here are eight tips to help you keep your balance.

Watch for Medication Side Effects

Some prescription and over-the-counter (OTC) meds can affect balance. For instance, diuretics may lower blood pressure too much and lead to dizziness on standing. Some allergy drugs, such as diphenhydramine (Benadryl and generic), may cause dizziness and sleepiness.

Drugs can also interact with each other. “Dizziness is a common interaction that can increase the risk of falls,” says Shelley Bhattacharya, D.O., a geriatrician at the University of Kansas Medical Center’s Landon Center on Aging. Some meds can cause dehydration, which can also increase the risk of falling when you stand up, she says.

Taking multiple medications may raise the odds of a serious fall for somewhat younger people as well. A new study published in the Journal of Acquired Immune Deficiency Syndrome evaluated a group of mostly male veterans in their late 40s, 50s, and 60s, some with HIV. The researchers looked at whether the veterans were taking certain medications, including drugs for hypertension, pain (including opioids), depression, acid reflux, and diabetes.

They discovered that current use of five or more medications was linked with greater odds of a fall that led people to seek medical care. This was true for people with and without HIV. (The researchers focused on people with HIV because they tend to take numerous medications.)

At least once a year, review your meds—OTC drugs, alternative products, and supplements—with your doctor. When you’re buying OTC remedies, check the labels for those that note they can cause drowsiness or dizziness.

Keep Your Senses Sharp

Eyesight naturally changes with age, and problems like macular degeneration, glaucoma, and cataracts become more common, says Bhattacharya. Conditions such as type 2 diabetes can also affect vision. All can make it more difficult to see shifts in terrain and other stumbling blocks. See your eye doctor every year or two (more often if you have a vision condition).

Hearing loss, too, has been linked to an increased risk of falling. A 2012 study from the Johns Hopkins University School of Medicine, for instance, found that middle-aged people with mild hearing loss were nearly three times as likely to fall.

A review of 28 studies on the effect of sound on balance published in the March 12 issue of JAMA Otolaryngology-Head & Neck Surgery suggests that sound helps the body "anchor" itself in its surroundings. “None of the studies used ‘real-world’ sounds—they used things like static, running water, or beeps—so more research is needed. But the research still shows that sound is stabilizing,” says study author Maura Cosetti, M.D., associate professor of otolaryngology at the Icahn School of Medicine at Mount Sinai in New York. Not being able to hear well, she says, puts people at risk for falls. In those who had impaired vision, balance problems, or other sensory issues, the effect was more pronounced, indicating that sound may be even more important when other senses are diminished.

It’s a good idea in general to have your ears checked at least every three years starting at age 50, or earlier if you’re having trouble hearing. And if you are experiencing falls, or just feel off balance, ask your doctor for a hearing test. “Why we think the elderly are prone to falls is multifactorial, but the least addressed factor in the research and clinically is hearing,” Cosetti says. Even if you have other sensory issues, a hearing check is worthwhile, she says.

Declutter and Repair at Home

Rugs, clutter, steps, cracked driveways and sidewalks, poor lighting, slick surfaces—all can contribute to tumbles.

If you’re concerned about falling in the house and unsure about how to proceed, the Institute on Aging has a home safety checklist.

Strengthen Key Muscles

Exercises that enhance gluteal, leg, and core strength help with balance, says Colón-Emeric. “These muscles make it easier to catch yourself before you fall and make it easier to get out of bed, lift yourself off the toilet, or get out of the car.”

Moves like knee bends (stand tall and bend your knees as if you were going to sit in a chair behind you) and sideways walking (keeping feet parallel, step out to the side with one leg, bring the other foot in to meet it, then step out again) are part of a balance program called Otago that’s recommended by the Centers for Disease Control and Prevention.

Tai chi, which involves slow movements and shifting weight from one leg to the other, was found to significantly reduce the risk of falling in older adults in a 2017 review of studies in BMJ Open. According to the review, the more tai chi is done (aim for at least twice a week), the more protective it is. Search the directory of the American Tai Chi and Qigong Association for classes.

If you don’t feel comfortable exercising on your own, ask your doctor about physical therapists.

Practice for Falls

“Exercise is important, but simply practicing getting off the floor can make you stronger and less likely to fall,” says Bell.

She suggests getting up and down 10 times three to four times a week. (When starting out, do this next to a bed or another stable object you can hold on to.)

Skip the Fancy Footwear

If you struggle with balance, choose shoes with sturdy, nonskid soles that fit snugly enough so they’re not sliding around underneath you.

“You don’t have to opt for ugly shoes, but you don’t want to be walking around in bedroom slippers either,” Bell says.

If you’re unsteady, heels aren’t a good idea, nor are those hot-weather favorites, flip-flops. They offer zero support, catch on rugs, often have little grip on slick surfaces, and slip off easily.

Train Fido Right

Having a pet can be good for your health, but your beloved pooch may also trigger falls by tripping you or pulling you down.

A recent study published in JAMA Surgery found that dog-walking injuries treated in ERs among people ages 65 and older increased significantly from 2004 to 2017.

Overall, the numbers of such injuries seen in the ER are small, but it’s wise to protect yourself. “Besides making sure you’re matched with a dog that suits your lifestyle, working with a trainer to learn how to control your dog and using a good leash and collar can help minimize falls,” says Grace Anne Mengel, V.M.D., an assistant professor of clinical primary care medicine at the University of Pennsylvania School of Veterinary Medicine.

Face Your Fears

Research suggests that simply being afraid of falling increases your likelihood of taking a tumble. In part, anxiety about falling can make it harder to focus on your surroundings.

This fear can also cause you to limit physical activity, which can in turn lead to muscle weakness. If you find yourself frequently worried about falls, speak to your doctor.

What to Do After a Fall

One in 4 people age 65 and older takes a tumble each year, according to the Centers for Disease Control and Prevention. About 20 percent of these falls will result in a fracture or other serious injury, though most don’t cause significant problems. But even if you think you’re unhurt, let your doctor know. He or she can determine whether you need medical attention after all. Tell the people you live with, too, so they can keep an eye on you.

See a doctor ASAP if you’ve hit your head, lost consciousness, or are in pain. “If you have an unprovoked fall or recurrent falls, definitely talk to your doctor, who should devise a fall-reduction plan,” says Colón-Emeric.

In the hours or days after you fall, if you notice that you’re feeling sleepy when you usually wouldn’t be, you’re having trouble thinking or talking, or you’re stumbling more than usual, go to an emergency room. There, doctors can evaluate you and may do a CT scan to rule out a brain bleed.

Editor’s Note: A version of this article also appeared in the June 2019 issue of Consumer Reports On Health.

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