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Fear of falling makes falls more likely

September 01, 2022 | Valerie Elwell
A senior couple practices yoga in a beautiful park.
"To help prevent falls, older adults need daily exercise to maintain or improve balance, strength and flexibility," says Dr. Elham Arghami.

When UCI Health geriatrician Dr. Elham Arghami speaks at senior centers or meets with her own patients, they say they worry most about falling and hurting themselves.

It’s no wonder. Each year, 3 million older people visit emergency departments after a fall, and 20% of them are treated for a broken bone, a head trauma or other serious injury, according to the U.S. Centers for Disease Control and Prevention (CDC).

But frequent falls are not a normal part of aging, Arghami says. In fact, the fear of falling, itself, “can actually increase the likelihood of taking a tumble.”

It’s a vicious cycle, she explains.

“Fear of falling causes seniors to limit their activities, social interactions and exercise. This inactivity leads to muscle weakness, especially in the spine and hip areas, and a loss of core strength that can lead to balance issues and falls.”

Limiting social interaction and exercise also affects mental health and can lead to depression, resulting in a diminished quality of life.

Get moving

Exercise is your friend. Although, every person is unique and has a different level of fitness, older adults need daily exercise to maintain or improve balance, strength and flexibility.

It really comes down to a ‘if you don’t use it, you’ll lose it’ mentality, Arghami says.

For someone who is not already active, she recommends starting an exercise program at home to build up core and hip muscles. Start by doing simple exercises seated in a chair, she says. As you progress, you can use the chair or a wall for stability.

Walking, climbing stairs, cycling and low-impact activities that get the heart and other muscles moving are also important to preserve bone strength.

“Maintaining bone strength is important because if you do fall, you’ll have less chance of a serious injury,” she says.

There are many online exercise routines geared specifically to older adults. You may also want to consider yoga or tai chi, a low-impact traditional Chinese exercise method that employs slow movement and deep breathing.

“Studies show that tai chi can improve the balance, strength and flexibility needed to prevent falls,” she says. “The smooth movements are gentle on bones and muscles so if someone has arthritis or other pain, it won’t aggravate it.”

Arghami also recommends gardening and dancing to many of her more active older patients. “Gardening gets you outside and if you are digging or lifting planters, it’s a good workout,” she says.

“Dancing is especially good for flexibility and balance. It also provides social interaction and activates the brain because you have to remember steps and keep a rhythm.”

It’s good for your mental health, too, because all exercise increases hormones and endorphins like serotonin and dopamine, improving mood and decreasing feelings of depression, she adds.

Drug interaction dangers

The CDC reports that 83% of adults in their 60s and 70s reported using at least one prescription drug in the previous 30 days and about one-third used five or more. But many medications, including over-the-counter supplements, may interact in negative ways.

“Many seniors think drugstore brands or vitamins and supplements are not a problem,” Arghami says. “But they can seriously affect alertness and cause dizziness.”

Medications used for asthma, colds and allergies, anxiety, depression and insomnia are the most commonly associated with adverse effects and drug interactions including dizziness, depression, balance problems and cognitive impairment.

At least once a year, Arghami asks her patients to bring all their prescriptions in original containers, including over-the counter drugs, vitamins and other supplements. She and fellow physicians at the UCI Health SeniorHealth Center always check patient medications against the American Geriatrics Society’s publication, the Beers Criteria®, a compendium of medications that may be unsuitable for older adults for a variety of reasons.

Doctors can prescribe alternatives to a medication likely to cause dizziness and falls or cancel prescriptions patients no longer need. Most important, when a patient must take a drug of concern, she alerts them to the risks and how to minimize the dangers.

“I make sure my patients are on the appropriate medications and dosage.”

Get help immediately

Despite our best efforts, falls do happen. Just like with a stroke, time is critical.

“It’s important to get help quickly after the fall. This is just as important as avoiding falls in the first place,” says Arghami.

Researchers at the CDC’s National Center for Injury Prevention and Control found that nearly half (48.7%) of fall-related deaths among people aged 65 and older involved a head injury. Laying on the ground for a prolonged period can lead to painful pressure ulcers and more serious conditions. Even less severe injuries such as broken bones can result in complications.

“And don’t hide it if you do fall. It’s important for medical staff and your doctor to know, so they can check for injuries,” she adds.

Use technology tools

Digital assistants, also known as virtual assistants and smart speakers, have become wildly popular especially among older adults. The American Association of Retired Persons (AARP) estimates that about 30% of seniors now use smart speaker technology, such as Apple’s Siri, Amazon’s Alexa and Google Assistant.

“I’ve had patients come in and say, ‘Well, my watch said that my oxygen is low, or my watch said that my heart has arrhythmia, so I came in,’ ” says Arghami.

In the event of a fall, you can use your device to dial a family member or call for emergency assistance. When used with free phone tracker apps, a FitBit or an iWatch, you or a loved one can always get help when needed, wherever you are.

While not every fall can be avoided, a proactive approach can help older adults feel more confident and greatly reduce their risk of injury, disability and death.

“Prevention is really your best bet for maintaining your independence and mobility as you age,” says Arghami, “That’s why I focus on it when speaking with seniors. I want to encourage them and give them the tools and knowledge to live a healthy, productive life whatever their age.”

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