Understanding why we fall when we get older and how to mitigate the risks

Falls are the most common reason older adults are hospitalised, but there are ways to build strength and prevent them

Falls are the most common cause of fractures among older adults, and often lead to reduced mobility, loss of independence, and hospital admission

Age brings many health concerns, but the fear of falling almost certainly increases with each passing year. Already the most common reason for older adults to be admitted to the hospital, falls are on the rise. Ireland has one of the fastest ageing populations in Europe, and recent statistics from the Irish Longitudinal Study on Ageing (TILDA), published in the journal BMJ Open, revealed how falls are taking their toll on society, with one in eight older people in Ireland requiring medical attention for a fall each year.

As the most common cause of fractures among older adults, falls are a leading contributor to reduced mobility, loss of independence, and hospital admission — and the reality is that without intervention, those who fall once are at significantly increased risk of doing so again.

Dr Ruth McCullagh, a senior lecturer and a physiotherapist based in the School of Clinical Studies at University College Cork, says the impact can be devastating.

Ruth McCullagh: ‘Exercises can be practised at home but you need to be guided by a specially trained professional.’ Picture: Eddie O'Hare

“In Ireland, there are an average of 27,000 calls from older people who have fallen each year,” she says. “Of those, about 80% end up going to hospital.”

Fractures or head injuries are common after a fall.

“Soft tissue and skin injuries are also a risk the longer people are lying on the floor unattended,” she says, adding that gaps in medical specialists to deal with falls are not helping the long-term prognosis.

All of this is why McCullagh is spearheading the rollout of the FaME (Falls Management Exercise) programme in Ireland. This 26-week course aims to reduce falls and their impact on health by teaching participants how to get up from the floor independently and by teaching postural stability techniques to prevent falls.

“Qualified practitioners combine strength and balance training with safe floor-rise practice, using soft mats, in a safe environment,” she says. “Not all exercises include balance, which people sometimes assume is the only important factor in fall prevention, as you do need a combination of strength exercises using a resistance band and functional balance work for the outcome to be effective.”

FaME participant session. Photos by Alex Wilkinson Media

Currently, the FaME programme, originally the brainchild of Dawn Skelton, a professor of physiotherapy at Glasgow Caledonian University, is available in pockets of Cork, Kerry, Mayo, Sligo, Galway, and Dublin. “We are trying to scale this up so that it will be available in more areas,” McCullagh says.

According to the TILDA findings, over half of older adults attending emergency departments after a fall were prescribed medications known to increase falls risk, including drugs affecting balance, alertness, or blood pressure and more than one in five did not have access to a specialist falls assessment clinic.

Here’s what we need to know about falling as we age:

Why do we fall when we get older?

Balance deteriorates as we get older, but many other factors also affect fall risk. A loss of muscle mass, known as sarcopenia, that starts from midlife onwards, can reduce strength, predisposing us to falls. In our younger years, we each have about 70,000 specialised nerve cells — motor neurones — in the lower part of the spinal cord that connect with our leg muscles to control balance and movement. By age 75, 40% of these motor neurons have been lost, resulting in lower levels of coordination and balance across all levels of physical fitness.

Will balance training help?

Good balance is one aspect of falls prevention training. Standing on one leg as you move around to reach for things or crouch down is a good starting point.

“It needs to be functional balance work,” McCullagh says. “So, when on one leg, you should extend an arm or leg, bend down or crouch on the supporting leg.”

A 12-year study examining the relationship between balance and mortality in a group of 1,702 people aged between 51 and 75 concluded that an inability to stand unsupported on one leg for 10 seconds was associated with an 84% raised risk of death from any cause.

Can I do the FaME exercises at home?

Strength and balance maintenance work can be practised at home, but McCullagh says the FaME programme does need to be guided by a specially trained professional. “The evidence suggests you can’t really improve your balance on your own if it is very poor to start with,” she says. “You are much better off going to see someone who can help to train it properly.”

She suggests speaking to your GP, who can recommend a relevant local exercise class or physiotherapist.

Are only the elderly at risk of falling?

We tend to think of the people at risk of falling as old and frail. In fact, falling down is the number one reason for trauma death and trauma injury at any age. “The risk of falling at any age is about 30%,” says McCullagh. “If you are in a room full of adults of any age, approximately one third of them will have fallen at some point in the past 12 months.”

Our balance ebbs and flows and is influenced not just by muscle strength and coordination but by hormones, how tired and stressed you are in any given moment, by what workout you did that morning, even by what you are wearing on your feet.

Studies by scientists at Manchester Metropolitan University have shown that even the fastest and fittest masters athletes need to work on balance and strength to prevent falls. “It is the consequences of falls that are more severe as we age,” McCullagh says. “In our 20s and 30s, we bounce back up, but we don’t in our 60s and 70s.”

Practice getting up by yourself

All adults over the age of 50 should practice getting up from the floor every two weeks. “It’s a learned action, and the more you know you are able to get up, the better your confidence will be if you do experience a bad fall,” says McCullagh. “You will never fall in exactly the same way, so practice getting up from different positions.”

What if I do fall?

Falls can be distressing. “Catch your breath for a few minutes as nothing worse is going to happen in that time,” says McCullagh. “If you can roll over and get onto all fours, crawl over to something sturdy that can support your weight, such as a coffee table or a sofa.”

Then turn around so you are aligned with the furniture and bend your strong knee with your stronger foot on the floor. “Try to tuck the foot of your weaker leg underneath the body so that you stand up on the pads of your foot.” Place both hands on the floor and push up to get yourself off the ground.

Keep your phone about your person

If you are elderly and fear falling, your mobile phone can be a lifesaver. “Keep it on your person in the house or, if you have an alarm button on your wrist or neck, make sure it is working by testing it every couple of weeks,” McCullagh says. “The alarm systems are waterproof and robust so keep them on even in the shower.”

If you are on your own and can’t get up, try banging for help with your fist or a stick on a hard surface. “The noise can help to draw attention,” McCullagh says.

Don’t try to lift someone who has fallen

When we fall, the first thing we try to do is push ourselves up again. “That hand push from the floor is really important, but if people try to help you by scooping in from underneath your arms, it prevents you from using your hands.”

Rather than hoiking or lifting someone up, try to guide them off the floor. “If you try to lift them, you could end up injuring yourself as their bodyweight will be heavy,” McCullagh says.

For more information

• see: ucc.ie/en/fameireland/
• see: exa.mn/falls-prevention