Older men at higher risk as dangerous falls increase for all older people
March 17, 2023 — When Senate Minority Leader Mitch McConnell (R-KY) recently fell at dinner in Washington, DC, he sadly joined a large group of his elderly peers.
It wasn’t the 81-year-old’s first fall. In 2019, he fell at home, fracturing his shoulder. This time he suffered a concussion and was recently transferred to an inpatient rehabilitation center. While McConnell didn’t fracture his skull, falling and hitting his head, McConnell has become an emerging statistic: a statistic that reveals that falls are more dangerous for older men than for older women.
This new research, published in the American Journal of Emergency Medicinecame as a surprise to lead researcher Scott Alter, MD, associate professor of emergency medicine at Florida Atlantic University College of Medicine.
“We always hear about lower bone density levels in women, so we didn’t expect to see men with more skull fractures,” he said.
Alter said as a clinician at a South Florida facility, his emergency department was the perfect study ground to assess incoming geriatric patients for falls. Older patients “are at higher risk for skull fractures and intracranial hemorrhage, and we wanted to look at any patient with a head injury. However, some 80% were related to a fall.
Statistics confirm the fact that falls of all types are incredibly common among seniors: some 800,000 seniors end up in hospital each year due to falls.
Figures show that death rates from falls are also on the rise in the older age group, up 30% from 2007 to 2016. Falls represent 70% accidental deaths among people aged 75 and over. They are also the leading cause of injury-related visits to emergency departments nationwide.
Jennifer Stevens, MD, gerontologist and executive director at Florida-based Abbey Delray South, is aware of the disastrous figures and regularly observes their consequences. “There are many reasons why older people are at high risk of falling,” she said. “They include balance issues, decreased strength, illnesses like Parkinson’s and Alzheimer’s, side effects from their medications, and more.”
Additionally, many seniors live in spaces that are not necessarily equipped for their limitations, and hazards exist everywhere in their homes. Together, and the risk of falls is everywhere. But there are steps seniors, their families, and even middle-aged people can take to mitigate and hopefully prevent dangerous falls.
While in many cases the journey to reduce fall risk begins after a fall, the time to start addressing the problem is long before you reach your senior years. Mary Therese Cole, physical therapist and board-certified dementia practitioner at Manual Edge Physical Therapy in Colorado Springs, CO, says turning 50 is a good time to start paying attention to and coping with physical declines.
“This is an age when your vision can start to deteriorate,” she said. “It’s a big reason older people stumble and fall.”
Additionally, as our brain begins to age in middle age, the neural pathways in the brain at the extremities also begin to decline. The result is that many people stop lifting their feet as well as they used to, making them more likely to stumble.
“You’re not old yet, but you’re not a spring chicken either,” Cole said. “Any problems you have now will only get worse if you don’t work on them.”
A good starting point in middle age is therefore to work on both strength training and balance exercises. A certified personal trainer or physical therapist can help you follow a program to stave off many of these declines.
However, if you’ve reached your senior years and are experiencing physical decline, it’s a good idea to see your primary care physician for an evaluation. “He or she can get you started with a regular PT to assess the gaps and then address them,” Cole said.
Cole said that when she worked with an elderly patient, she would test her strength to sit down and get up from a chair, do a manual strength test to check the lower extremities, check their stride and ask about conditions like diabetes, previous surgeries, and other conditions.
From there, Cole said she could write out a plan for the patient. Likewise, Stevens uses a program called Be Active that allows him to test seniors on a variety of metrics, including flexibility, balance, hand strength, and more.
“Then we pair them with courses to fill in their gaps,” she said. “It is essential that older people have the ability to recover and not fall if they are out of balance.”
Beyond working on your physical limits, it’s also essential to take a good look at your home. “You can have an occupational therapist come to your home and do an assessment,” Stevens said. “They can help you rearrange and reorganize for a safer environment.”
Common household major fall hazards include carpets, lack of nightlights for middle-of-the-night bathroom visits, lack of grab bars in the shower/tub, and furniture blocking walkways. .
For its part, Alter likes to refer seniors and their doctors to the CDC STEADI program, which aims to prevent accidents, deaths and injuries among the elderly.
“This includes screening for fall risk, assessing factors you can change or improve, and more tools,” he said.
Alter also recommended seniors talk to their doctors about medications, especially blood thinners.
“At some point you have to weigh the benefits of disease prevention against the risk of injury from a fall,” he said. “The risk of bleeding may be too high if the patient is at high risk of falling.”