March 17, 2023 — When Senate Minority Leader Mitch McConnell (R-KY) fell recently at a dinner event in Washington, D.C., he unfortunately joined a large group of his senior citizen peers.
This wasn’t the first tumble the 81-year-old has taken. In 2019, he fell in his home, fracturing his shoulder. This time, he got a concussion and was recently released to an in-patient rehabilitation facility. While McConnell didn’t fracture his skull, in falling and hitting his head, McConnell became part of an emerging statistic: one that reveals falls are more dangerous for senior men than senior women.
This new research, which appeared in the American Journal of Emergency Medicine, came as a surprise to lead researcher Scott Alter, MD, associate professor of emergency medicine at the Florida Atlantic University College of Medicine.
“We always hear about lower bone density rates among females, so we didn’t expect to see males with more skull fractures,” he said.
Alter said that as a clinician in a southern Florida facility, his ER department was the perfect study grounds to evaluate incoming geriatric patients due to falls. Older “patients are at higher risk of skull fractures and intercranial bleeding, and we wanted to look at any patient presenting with a head injury. Some 80% were fall related, however.”
The statistics bear out the fact that falls of all types are incredibly common among the elderly: some 800,000 seniors wind up in the hospital each year due to falls.
The numbers show death rates from falls are on the rise in the senior citizen age group, too, up 30% from 2007 to 2016. Falls account for 70% of accidental deaths in people 75 and older. They are the leading cause of injury-related visits to emergency departments in the country, too.
Jennifer Stevens, MD, a gerontologist and executive director at Florida-based Abbey Delray South, is aware of the dire numbers and sees their consequences regularly. “The reasons seniors are at a high fall risk are many,” she said. “They include balance issues, declining strength, diseases like Parkinson’s and Alzheimer’s, side effects of their medications, and more.”
In addition, many seniors live in spaces that are not necessarily equipped for their limitations, and hazards exist all over their homes. Put together, and the risks for falls are everywhere. But there are steps seniors, their families, and even middle-aged people can take to mitigate and hopefully prevent dangerous falls.
Staring Early
While in many cases the journey to lessen fall risks begins after a fall, the time to begin addressing the issue is long before you hit your senior years. Mary Therese Cole, a physical therapist and certified dementia practitioner at Manual Edge Physical Therapy in Colorado Springs, CO, says that age 50 is a good time to start paying attention and addressing physical declines.
“This is an age where your vision might begin deteriorating,” she said. “It’s a big reason why elderly people trip and fall.”
Additionally, as our brains begin to age in our middle years, the neural pathways from brain to extremities start to decline, too. The result is that many people stop picking up their feet as well as they used to do, making them more likely to trip.
“You’re not elderly yet, but you’re not a spring chicken, either,” Cole said. “Any issues you have now will only get worse if you’re not working on them.”
A good starting point in middle age, then, is to work on both strength training and balance exercises. A certified personal trainer or physical therapist can help get you on a program to ward off many of these declines.
If you’ve reached your later years, however, and are experiencing physical declines, it’s smart to check in with your primary care doctor for an assessment. “He or she can get your started on regular PT to evaluate any shortcomings and then address them,” Cole said.
Cole said when she’s working with a senior patient, she’ll test their strength getting into and out of a chair, do a manual strength test to check on lower extremities, check their walking stride, and ask about conditions like diabetes, former surgeries, and other conditions.
From there, Cole said she can write up a plan for the patient. Likewise, Stevens uses a program called Be Active that allows her to test seniors on a variety of measurements, including flexibility, balance, hand strength, and more.
“Then we match them with classes to address their shortcomings,” she said. “It’s critical that seniors have the ability to recover and not fall if they get knocked off balance.”
Beyond working on your physical limitations, taking a good look at your home is essential, too. “You can have an occupational therapist come to your home and do an evaluation,” Stevens said. “They can help you rearrange and reorganize for a safer environment.”
Big, common household fall hazards include throw rugs, lack of nightlights for middle-of-the-night visits to the bathroom, a lack of grab bars in the shower/bathtub, and furniture that blocks pathways.
For his part, Alter likes to point seniors and their doctors to the CDC’s STEADI program, which is aimed at stopping elderly accidents, deaths, and injuries.
“It includes screening for fall risk, assessing factors you can modify or improve, and more tools,” he said.
Alter also recommended seniors talk to their doctor about medications, particularly blood thinners.
“At a certain point, you need to weigh the benefits of disease prevention with the risk of injury if you fall,” he said. “The bleeding risk might be too high if the patient is at a high risk of falls.”
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Joan Klemp