Eleanor Kusel never gave much consideration to the bumps in the sidewalks or the rugs lying on the floor of her apartment. But after the 75-year-old San Franciscan fell and fractured her pelvis while getting out of a car, she began to notice the many hazards that could cause her to fall again.
"I never thought about it until this happened," Kusel said of her recent accident.
Kusel is not alone. One out of every three Americans 65 years and older falls at least once a year, with 10 percent fracturing a bone, dislocating a joint or incurring some other serious injury, said Dr. Mary Tinetti, Chief of Geriatrics at the Yale University School of Medicine.
After three months of bed rest and therapy, Kusel is gradually moving back into her daily routine. She's resumed her volunteer work at a local hospital and is once again making her way around town.
But she may be one of the luckier ones. Nearly one-half of the older Americans who incur a serious injury never fully recover and many lose their ability to function independently for the rest of their lives, said Dr. Bree Johnston, assistant clinical professor of medicine at the University of California, San Francisco's department of geriatrics. A good proportion end up in nursing homes, making falls and the injuries that result one of the most substantial health threats facing older Americans.
The problem could be even more pressing: A study published in May 1999 in the Journal of the American Medical Association (JAMA) showed that falling injuries among the elderly are on the rise.
Finding a Cause
While common sense dictates that falling accidents are the result of household hazards such as slippery bathroom floors or poorly lit stairwells, that's not what some researchers have found.
In a recent study, Yale University researchers identified hazards in the homes of 1,100 people who were 72 years or older. After following the study participants for three years, the researchers compared the number of falls with the kinds of household hazards they initially identified. The result: household hazards did not affect the number of falls people had.
"We were quite surprised because this is counter to conventional wisdom," said Dr. Thomas Gill, associate professor of medicine at the Yale University School of Medicine, who led the study.
Instead, a person's health may have more to do with how frequently they fall and injure themselves, he said. Weak leg muscles, poor vision and medications that compromise balance may put elderly people at risk for falling. People should ask their doctors about the possibility of lowering the dosage of certain daily medications -- such as sleeping pills, antidepressants and blood pressure medications that could impair a person's sense of balance -- or eliminating them completely.
Gill presented his findings in May 1999 at the annual meeting of the American Geriatric Society. The study is currently under review for publication.
What You Can Do to Help Prevent Falls
- Remain active
- Weight training to strengthen leg muscles
- Tai chi for balance and strength
- Wear flat, wide-toed shoes
- Eat calcium-rich foods
- Take calcium supplements
- Preventing Falls and Injuries
Maintaining muscle strength through exercise may be the key to fall prevention. "Many elderly are scared of falling, so they restrict their activities and that can begin a downward spiral," Johnston said. "Paradoxically, what people need to do is to keep exercising to maintain their function to keep from falling."
She recommends strengthening leg muscles through weight training. She also advocates tai chi, a calm form of Chinese martial arts, which has been shown to reduce fall frequency because it promotes balance and strength.
Choosing shoes that are flat and have a wide toe is also important in fall prevention.
Because falls aren't always avoidable, older Americans should prepare themselves, Johnston said. Eating calcium-rich foods and taking calcium supplements to keep bones strong will play a big part in determining how people fare during and after a fall.
"If elders can stay active rather than becoming sedentary, they will do much better in their later years," she said. "There's hope. It is never too late."