Updated August 27, 2021

what questions should I and my family be asking?

• Have I fallen in the past year?

• Why do I think I am falling?

• Am I aware and awake when it happens? Or do I faint?

• Can I describe what I was doing before and after the fall?

• How long was I down for?

• Was the fall witnessed by someone else or not? If so, what do they say?

• Did I feel the room was spinning?

• Did I feel lightheaded or have a headache?

• Do I think there was abnormal muscle movement, slurred speech, or any confusion?

• What new medications or changes in dose did I recently note?

• How much alcohol am I drinking?

• Is my home environment safe or a place that can increase my risk?

• Do I struggle going up or downstairs?

• Am I grabbing onto furniture or edges to walk around because of feeling a lack of balance?

What actions can I take for this agenda?

• Exercise is the number one way to improve your strength and balance to reduce your chance of falling

• Kinds of exercises you can do include group tai chi, strength, and resistance training. These will improve your mobility and reaction time

• Decrease drinking alcohol and maintain a normal body weight

• Evidence also supports dietary calcium and vitamin D intake to improve bone mass and reduce the risk of brittle bones and injuries from falling

• Prevent falls by managing the hazards you have at homes such as slippery surfaces, unmarked edges, lack of handrails, or poor lighting

• Make sure your vision and hearing are at their best. Wear your glasses and hearing aids. See your doctor if you have eye or ear complaints

• If needed, use gait aids and make sure you are using them correctly. Speak to an occupational or physical therapist for advice

• Use services and devices that can call for help when you can’t get up. Ask your neighbors, family, or friends to check up on you from time to time

What is a fall?

• A fall is an accidental change in elevation

• You can fall from standing height or from your bed to the floor and this can cause injury

• Seniors are more likely to fall for many reasons

• 30% of those 65 and greater fall at least once per year and 5% of which have a serious injury

• These numbers are much higher in nursing homes with greater injuries

• There, half fall per year with 10-25% causing serious injury. That’s because older adults in nursing homes are usually frailer

Why is falling a burden?

• Falls are under-diagnosed due to many reasons

• Patients may never mention the event to a healthcare provider. The provider may fail to ask the patient about a history of falls too

• Sometimes, either the provider or patient believe that falls are a natural part of aging which is not the case

falls can cause bleeding, broken bones, needing to be in hospital, changing homes, or losing function

What causes falls to happen?

• Falling can happen from something as simple as stumbling. But it can also be from more serious causes such as fainting, seizures, or strokes

• There are also inside body reasons that cause falls. This can be from problems with your nervous system, diabetes, Parkinson's disease, or an abnormal heart rate. Problems with your vision and hearing are also important risks

• As we age, our blood pressure is also less tightly controlled by our bodies so that when we stand up it can drop quickly causing us to fall

• Studies have found that even the fear of falling increases the risk of falling

How does our body balance itself? How does our body defend itself from falling?

• Balance is a complicated system in our bodies

• Balance is maintained by three general systems that work together. Those systems are our vision, feet sensation, and our inner ear nerves

• As we age, these systems can become weaker or injured from disease

• Usually, it is a combination of these balance systems that are injured that decrease our defense against falling down

• There are balance and training programs that can help strengthen them

there are many reasons as to why you might be falling. there are inner and outer body reasons

our balance system protects against falling but can be injured or weakened as we age

Why does our blood pressure drop when we get up or change positions?

• As we age, our blood vessels don’t sense or ‘tighten’ as well as they used to

• This can cause a drop in blood pressure when changing positions. For example from lying to sitting or sitting to standing

• This sudden drop in blood pressure can also cause one to feel lightheaded or dizzy causing a fall

• The medical term for this is “orthostatic hypotension”

• Ways to avoid this sudden drop and feeling is to get up, wait for a minute, then move

• Other ways to reduce this risk is to drink enough water every day, exercise, and avoid alcohol

• Eating enough salts if it does not cause other health problems you might already have can also help

IS there treatment for falling? How can I reduce my risk of having a fall?

• Usually, more than one cause exists that causes falling

• A key part of your health is finding out what your fall risks are and trying to prevent or at least lessen them as much as possible

• Studies have found that an assessment with many treatments to reduce these risks decreases your rate and risk of falls

• Examples of treatments that can help reduce falls are:

• Getting a thorough assessment by your family doctor or geriatric medicine doctor for your falls

• Decreasing the medications that cause falls such as those that cause drowsiness or lower blood pressure

• Exercise and improving balance

• Using correct gait aids if needed

• Having a home assessment for risks

• Treating vision and hearing impairments

• Treating and controlling long-term (chronic) diseases that affect our nervous system such as diabetes or Parkinson’s disease

avoid feeling dizzy and dropping your blood pressure by sitting up and standing up slowly, waiting for a minute, then moving

What medications increase my risk of falls?

• Many medications can do so but the main ones to be aware of are those that lower blood pressure. Especially the class of drugs known as “Beta Blockers.” Examples are Bisoprolol (Zebeta) and Metoprolol (Lopressor)

• Medications that cause sedation from the class of “Benzodiazepines” are well known to increase the risk of falls as well. Examples are Lorazepam (Ativan) and Alprazolam (Xanax)

• Even sleeping pills such as Zopiclone (Imovane) can make you more sedated in the daytime and increase your risk for falls

• Medications that relax our muscles and nerves such as from the class of drugs known as “Anticholinergics” are also known to worsen falls especially in older adults. Many medicines have some “anticholinergic” effect so ask your prescriber about them

• There is some evidence that the antidepressant medications from the class of “SSRI” can also cause falls although it is a small increase in risk

• Alcohol intake, especially in high amounts, also increases the risk of falling and is an important substance to reduce as well

SHOULD I STOP TAKING MY BLOOD THINNER BECAUSE I AM FALLING?

• This is a difficult question to answer and it depends on the risk of bleeding versus fall injury for each patient

• Overall, it is rarely the case where one needs to stop their blood thinner because they are falling

• Meaning, studies have found that the risk of having problems from stopping your blood thinner is greater than the risk of falling and bleeding if you were to take them

• Again, this needs to be assessed on a patient by patient basis

• We encourage you to talk to your doctor before making any changes

• Stopping a blood thinner when it is needed can be very dangerous if it is essential. Depending on why you are taking it, stopping it can increase your risk of getting a stroke

always ask your doctor what is right for you. Your medications may be essential for you

Do not stop taking them until you talk to your doctor first

since I am falling, should I be taking vitamin d?

• There is evidence showing great benefit in taking vitamin D if your vitamin D levels are low

• Taking them helps strengthen your bones so that if you do fall you decrease the risk of them breaking (fracturing)

• It is very important to take vitamin D especially if you have weak bones from “osteoporosis”

• The maximum beneficial dose of vitamin D is 1000 or 2000 international units by mouth daily

• You might also need to take calcium supplements if you are not eating enough calcium in your diet

• Refer to the “bone health” agenda for more details

getting a thorough assessment by a geriatric medicine doctor, exercising, and taking vitamin d are great ways to reduce falls

What resources can help with this agenda? 

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