When we are young it is easy to blame sudden falls on environmental factors, such as loose carpets, slippery floors, uneven surfaces, or just plain recklessness! But as we grow older, a sudden fall can raise the question that something might be wrong. Loss of balance and mobility are not inevitable as we grow older, but sudden falls in older individuals are a concern because the incidence of balance problems is known to increase significantly with age. The risk for serious injury increases as well. The good news is that many older individuals at risk for falls can be identified and helped.
So how do you know if you are at risk for falling? There are several known risk factors, both related to yourself (physical fitness/ailments, psychological and social factors) and your environment (the surfaces you walk on, obstacles, lighting, etc.), that can increase your susceptibility to falling. Some common indications include symptoms of dizziness or unsteadiness, taking one or more medications, a recent period of bed rest or inactivity, loss of strength or feeling in the legs or feet, or a loss of confidence in your ability to get around. However, there are many other subtle indicators that you or your physician may not even be aware that you have. To complicate the matter, falls are not typically the result of a single cause or risk factor. More often, they are the net result of a combination of factors.
Key physical factors
Balance problems and dizziness are obvious indicators that someone is at a higher risk for falling. It may not always be obvious that your balance is diminished, as unsteadiness may be caused by a number of smaller physical ailments that alone would not cause a person to fall. However, the combination of relatively minor problems can be a significant risk for falling. This is further explained under How To Control Your Balance.
Other key physical factors include reduced muscle strength in the legs and painful or unstable ankle, knee and hip joints, which can impact your ability to support yourself and quickly recover from sudden changes to the surface you are walking on. Limited range of motion and flexibility can make stepping over obstacles and walking on uneven or inclined surfaces more difficult. Weakness, slowing, loss of feeling or coordination as a result of a stroke or degenerative disease, such as Parkinson’s can have a significant impact on your balance and mobility. Even arthritis can be an indicator of fall risk because it can result in poor range of motion, reduced muscle strength, and a loss of sensation at the affected joints. Poor vision and a history of ear infections or inner ear disorders are also risk factors. While having one or two of the above risk factors will not necessarily cause someone to fall, the likelihood of falling increases with the number of risk factors that are present.
Use of medications
The use of multiple prescriptions or over the counter drugs can also increase your risk for falling. It is always important to understand the side effects of any medication you may be taking, both alone and in combination. Be sure to check with your pharmacist or physician if you are uncertain how a prescribed medication will interact with any other medications you are already taking. The most common drugs implicated in fall risk are diuretics, hypotensives, anticoagulants, hypnotics, psychotropics and laxatives. Drugs to treat high blood pressure or heart ailments can cause dizziness and sedatives or drugs to aid in sleeping can impact your ability to maintain your balance.
You might think that someone who leads a relatively inactive lifestyle would have less chance of suffering from a fall because they are not putting themselves at risk. Inactivity, however, is an important risk factor for falling. Prolonged inactivity can actually lead to loss of muscle strength, joint range of motion, and your ability to quickly react to a sudden slip or stumble. Unfortunately, fear of falling itself can cause someone to be at higher risk as they get stuck in a vicious cycle of immobility and progressive de-conditioning weakness from self-imposed mobility restrictions.
Your home and your physical surroundings are filled with things that you may not notice. Rugs and bathmats, uneven or loose steps, cupboards or shelves that are either too high or too low to reach easily, and dim lighting in rooms and hallways are things you may have lived with for many years. These “innocent” things, however, can be detrimental to someone whose ability to quickly recover from a slip or stumble is already compromised.
For example, if you have limited range of motion or balance problems, you may not raise your foot as high as the average person when you take a step, which makes you more likely to trip over a wrinkle in a rug. You may have numbness in your legs or feet and will have more difficulty being able to sense when you have stepped onto a slippery or unstable surface. Or possibly you have poor vision and need more light to be able to see objects clearly. Again, none of these risk factors alone will necessarily cause a fall. It is the combination of risk factors, both physical and environmental, that increases the likelihood that someone will suffer a fall.
Testing your balance
To help determine if you may be headed for a fall, take the Balance Self Test below. If you answer yes to one or more of the questions, you could be at risk. The best way to determine if you have a problem, though, is to talk with your physician who might recommend that you get a balance screening test from a qualified clinician. There are numerous clinical tests that are easily performed that can detect if you have a balance problem. Then there are tests that can tell what is causing the problem. The great news is that if you do have a problem, there is help available. There are many things you can do to reduce your risk for falling. These are discussed under Minimizing Your Risk of Falling. You can also take the Balance Self Test or Find a Specialist who is equipped to assess and treat balance problems.