Questions I and My Family Should Ask?

• Have I experienced a fall within the past year?
• In my opinion, what was the cause of the fall?
• Was I conscious at the time of the fall, or did I experience loss of consciousness?
• Can I clearly describe what I was doing before and after the fall?
• How long did the fall episode last?
• Was anyone present at the time of the fall? If so, what were their observations?
• Did I experience dizziness?
• Did I have a headache?
• Do I believe I experienced abnormal muscle movements, slurred speech, or confusion?
• Have I recently started any new medications or had any changes in medication dosage?
• Is my home environment safe, or does it increase my risk of falling?
• Do I experience difficulty when ascending or descending stairs?

What actions should I take after reviewing this section?

• Engaging in regular physical exercise is the most effective way to improve strength and balance, thereby reducing the risk of falls.
• Recommended types of exercise include Tai Chi, strength training, and resistance exercises.
• These activities enhance mobility, reaction time, and help maintain a healthy body weight.
• Studies also demonstrate that adequate dietary intake of calcium and vitamin D contributes to improved bone density and reduces the risk of osteoporosis and fall-related injuries.
• Fall risk can be reduced by identifying and managing potential hazards within the home environment, such as slippery surfaces, sharp edges, lack of stair handrails, and inadequate lighting.
• Ensure that vision and hearing are regularly assessed.
• Wear prescribed eyeglasses and hearing aids as directed.
• Consult your physician if you experience any visual or auditory problems.
• If necessary, use appropriate walking aids and ensure they are used correctly.
• Seek advice from a physiotherapist or occupational therapist for proper assessment and guidance.
• Utilize services and assistive devices that enable you to call for help in case of a fall.
• Ask neighbors, family members, or friends to check on you periodically.

What Is a Fall?

• A fall is an accidental event involving an unintentional change in position or level.
• A person may fall from a standing height or from a bed to the floor, which may result in injury.
• Older adults are at a higher risk of falls for multiple reasons.
• Individuals aged 65 years and older experience at least one falls annually.
• Approximately 5–30% of these individuals sustain a serious injury.
• These rates are significantly higher in long-term care facilities, where fall-related injuries tend to be more severe.
• Among residents of such facilities, approximately 10–25% of those who experience a fall each year suffer serious injuries.
• This increased risk is largely attributable to frailty and physical deconditioning commonly observed among older adults residing in long-term care settings.

Why Are Falls a Serious Health Risk?

• Falls are often underdiagnosed for several reasons.
• Patients may not report fall incidents to their healthcare providers, and healthcare providers may not routinely inquire about a history of falls.
• In some cases, either the patient or the healthcare provider may mistakenly consider falls to be a normal part of aging, which is not the case.
• Falls may result in bleeding, bone fractures, hospitalization, the need for home modifications, or loss of independence in performing daily activities.

What Are the Causes of Falls?

• Falls may result from minor incidents such as tripping; however, they may also occur due to more serious underlying causes, including syncope, seizures or stroke.
• External factors that may contribute to falls include the effects of medications, the need for or improper use of walking aids, and inappropriate footwear.
• The home environment may also increase fall risk if it is not arranged in a manner that minimizes potential hazards.
• There are also internal factors that contribute to falls.
• This may be due to disorders of the nervous system, diabetes mellitus, Parkinson’s disease or cardiac arrhythmias.
• Visual and hearing impairments are also recognized risk factors.
• With advancing age, the body’s ability to regulate blood pressure declines; consequently, blood pressure may drop rapidly upon standing, leading to dizziness and an increased risk of falls.
• Studies have shown that even fear of falling itself increases the risk of falls.

How Does Our Body Maintain Balance?

• Balance is a complex system in our bodies.
• We maintain balance through three main systems working together.
• These systems are vision, sensation from the feet, and the inner ear nerves.
• With advancing age, these systems weaken or may become affected by disease.
• These systems are usually impaired, which reduces the body’s natural defense against falls.
• There are programs and exercises for maintaining balance that can help strengthen these systems.
• There are many causes of falls, which may be internal or external.
• The balance system in our body protects us from falls, but it may become damaged or weakened as we age.

Why Does Blood Pressure Drop Upon Standing?

With advancing age, blood vessels lose some of their ability to constrict as they did previously.

This can cause a drop in blood pressure when changing positions.

For example, when moving from lying down to sitting, or from sitting to standing.

This sudden drop in blood pressure can cause dizziness, which may lead to falls.

The medical term for this condition is orthostatic hypotension.

To avoid this sudden dizziness, it is recommended to stand up slowly, wait for one minute, and then move.

Other ways to reduce this risk include drinking enough water daily, exercising regularly, and avoiding alcohol.

Consume sufficient salt if it does not cause other pre-existing health problems.

Is There a Treatment for Falls?

• There is usually more than one cause of falls.
• An essential part of maintaining your health is understanding your fall risks and trying to prevent them, or at least reduce them as much as possible.
• Studies have shown that assessment and implementation of multiple interventions to reduce these risks decrease both the incidence and severity of falls.
• Examples of interventions that can help reduce falls include:
• Undergoing a comprehensive assessment by a family physician or geriatrician regarding your fall history.
• Reducing medications that increase fall risk, such as those causing drowsiness or low blood pressure.
• Practicing exercises to improve balance.
• Using walking aids correctly if necessary.
• Conducting a home safety risk assessment.
• Treating vision and hearing impairments.
• Managing chronic conditions affecting the nervous system, such as diabetes or Parkinson’s disease.
• Preventing dizziness and low blood pressure by sitting and standing slowly, waiting one minute, and then moving.

Which Medications Increase the Risk of Falls?

Many medications can contribute to falls, but the most important to be aware of are those that lower blood pressure.

Pain-relieving medications from the benzodiazepine class are also well known to increase fall risk.

Examples include lorazepam and alprazolam.

Sleeping pills, such as zopiclone, may cause daytime drowsiness and further increase the risk of falls.

Medications that relax muscles and nerves, such as those known as anticholinergics, are also recognized for exacerbating fall risk, especially in older adults.

Many other medications may have some effect on fall risk, so it is important to consult your prescribing physician.

There is some evidence that antidepressants may also contribute to falls, although they are considered minor risk factors.

Should I Stop Taking Blood-Thinning Medications to Prevent Falls?

• This is a difficult question, and the answer depends largely on each patient’s individual risk of bleeding from a fall.
• In general, it is rarely necessary to stop blood-thinning medications solely because of falling.
• Studies have shown that the risk of complications from discontinuing blood thinners is greater than the risk of falls and bleeding while taking them.
• Each patient and situation must be evaluated individually.
• It is strongly recommended to speak with your physician before making any changes.
• Always ask your doctor what is appropriate for you.
• Your medications may be essential for your health.
• Do not stop taking them until you have consulted your physician.

If I Have Experienced a Fall, Should I Take Vitamin D?

• Evidence shows significant benefit from taking vitamin D if your vitamin D levels are low.
• Supplementation helps strengthen your bones, reducing the risk of fractures in the event of a fall.
• Vitamin D is especially important if you have weakened bones due to osteoporosis.
• The maximum effective oral dose of vitamin D is 1,000–2,000 IU per day.
• You may also need calcium supplements if your dietary intake of calcium is insufficient.
• See the Bone Health section for more details.
• Discuss fall risks with your physician to identify contributing factors.
• Comprehensive assessment by a geriatrician, regular exercise, vitamin D supplementation, and medication review are excellent strategies to reduce fall risk.