With a pair of older public figures in news recently for injuries from falling, an expert runs down the risks

When the famous fall, such as Elton John and Mitch McConnell, it makes news. When regular older people fall, it makes doctors worried – for good reason. 

“The reason we care so much about falls is that about 20% of falls in older adults result in a serious fracture or head trauma,” said Erin Mashack, D.O. She specializes in geriatrics, the care of older adults.

“I'm particularly passionate about hip fractures and preventing those, because hip fractures substantially increase the risk of major morbidity and death in older patients. After a hip fracture, about half of older adults are not able to regain their ability to live independently. That's even after going through rehab and therapy. And studies show that the one-year mortality rate after having a hip fracture in older adults is as high as 37%.”

That’s a lot of people when you consider the fact that the Centers for Disease Control and Prevention estimates one in three adults age 65 and older report falling each year. It’s an even bigger number for people 80 and up. “About half of adults in that age range report falling each year,” Mashack said.

So what’s causing those falls, and what can be done to try to prevent them? Several things, Mashack said.

Causes of falls

“With falls, it's certainly multifactorial. They're rarely due to a single issue. So you really have to think about what cumulative effect of multiple impairments could be going on,” Mashack said.

“Say you have hypertension, heart failure, diabetes, COPD – having any two or more chronic conditions that are very common can increase your risk of falls. Another factor is a decline in vision, which of course we know gets more common the older that you get. Also, dehydration and having what we call orthostatic hypotension – so low blood pressure with changes in position sets you up for falls.”

She said one of the other key things doctors need to keep an eye out for is the possible impact of patients’ medications. “Some increase the risk for falls. Really common ones include medications for blood pressure or arrhythmias, antidepressants, insulin – those are a few of the super common ones – but, in fact, there's an entire list. It's called the Beers Criteria list. That's a list of potentially inappropriate medicines for older adults.”

Preventing falls

There are several steps people can take to reduce the risk of falls, Mashack said. One involves trying to find a doctor who specializes in treating aging patients. MUSC Health has a Center on Geriatrics and Aging and a team of health care providers who work in the field.

“It's important to go to a geriatrician if you're older than 70 and have multiple chronic conditions. That's especially true if there’s any cognitive impairment. It's not to say that a regular primary care doctor can't do that. But geriatricians do have the benefit of having that extra year of training to focus on conditions that specifically affect older adults. And often we have the benefit of longer appointments, too, to have the time to be able to focus on those things.”

 

Mashack said it’s important for any doctor treating older patients to look at the Beers Criteria list to see if they need to reconsider some medication choices. You can see the list in this report by the Journal of the American Geriatrics Society.

She said it’s also valuable for older people to get bone density scans, which could tell them if they’re at especially high risk of serious injury from a fall. There are also simple measures people can take at home.

“When I have patients that I'm worried about falling, we try to get someone in the home to look for modifiable risk factors – like area rugs, lack of railings, poor lighting. That's a very common thing I see happen. Like just yesterday, I was in an assisted living apartment visiting a patient for an unrelated complaint. And she went to go sit on the bed, and her bed moved over like a foot,” Mashack said.

“She luckily did not fall, and we were around her. But that told me right there, she needs to get the room a little safer. If you order home health occupational therapy, they come out and do a safety assessment, as do physical therapists. So that's a common thing I order for my older patients.”

As for the famous folks who have made news recently for their falls, Mashack hopes the public takes note. “I like to think it makes people more aware. But I'm not sure that it does, to be honest. I think everyone on some level, at least my older patients, are scared of falling, but until it's happened to you, it's hard to really understand that risk.”