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Knight Ridder Newspapers
WASHINGTON - Falls - the leading cause of accidental deaths at home, according to a new study - may have more to do with a person's health than with physical hazards such as steep stairs and slippery tubs.
"People tend to think it was just one thing that made them fall," said Dr. Dorothy Baker, a Yale Medical School researcher who studies falls and fall-related injuries. They generally blame not their physical condition but "environmental risks - dip in the lawn, caught my heel, didn't see the last step," she said.
In fact, Baker continued, a fall typically "isn't just one issue. It's a conspiracy of things coming together at once." Frail bones, poor eyesight, bad balance, weak muscles and slow reflexes all contribute to falls, researches believe.
About 6,000 people a year die from accidental falls in the home, according to a report released this week by the Home Safety Council, a nonprofit group whose sponsors include home-products companies such as Lowe's, GE and Electrolux. Of Americans who die from falls, three-quarters are older than 65.
Falls are also the chief cause of hip fractures, which cost many seniors their independence because recuperation is at best slow and challenging. One in five elderly people who fractures a hip dies within a year, according to the Centers for Disease Control and Prevention in Atlanta, mostly from complications arising from being bedridden.
Caring for victims of falls costs about $20 billion annually, according to the CDC.
It's an especially important problem for older Americans because many risk factors in fatal falls naturally increase with age.
The body's ability to handle a fall shrinks substantially with age, said Dr. Joseph Zuckerman, chair of the education committee of the American Association of Orthopedic Surgeons. In addition, drug interactions and low blood pressure may cause dizziness or fainting that trigger a fall. Weak leg muscles may cause people to totter, and poor eyesight can cause them to make missteps.
"It's hard for us to recognize how much more careful we need to be as we get older," Zuckerman said.
That said, research into the causes of falls deserves more attention, the Home Safety Council concluded.
Because emergency room staffers who treat serious falls aren't in a position to determine how they happened, the cause of the fall is unknown for nearly two-thirds of all deaths from falls.
Aging women, who suffer more often from osteoporosis, are more likely to be injured in falls, studies show. Men, who suffer more often from chronic illnesses, are more likely to die.
While experts say that having banisters on both sides of stairs, taking up throw rugs and wearing shoes rather than slippers or socks all help prevent falls, they advocate a combination of home fixes and attentiveness to personal health. Among the recommendations:
-Exercise. Researchers favor lower-body exercises and balance-control regimens such as tai chi or ankle conditioning. Walking helps, too.
"Weakness in the legs and balance problems are probably the No. 1 risk factors that people can try to control," said Dr. Judy Stevens, an epidemiologist and falls specialist with the CDC.
-Medication reviews. Stevens suggests asking a doctor or pharmacist to review medications for risky drug interactions and assure dosages are right. Drug interactions and improper dosage can seriously affect balance and alertness.
Taking four or more prescription or over-the-counter drugs raises the risk of falls, in large part because it raises the risk of unwanted drug interactions. Tranquilizers, antidepressants and sedatives are also heavily linked to falls.
"The safety margin of taking medications narrows a little bit as you get older," Zuckerman cautioned.
-Eye exams. The CDC says vision problems can increase the risk of falling by as much as 60 percent, and so doctors recommend regular eye exams, especially for older adults.
Older people also tend to need more light to see clearly, the CDC's Stevens said. That means installing maximum-wattage lights in high-traffic areas such as stairwells and halls. Experts also advise adding nightlights to areas frequented at night - bathrooms, for instance, and the kitchen.
-Medical exams. Some chronic conditions and illnesses, such as diabetes and Parkinson's disease, can affect balance and increase the likelihood of fainting. A history of stroke can increase a person's chance of falling. Post-fall checkups are important, too, because people who have fallen before are more likely to fall again.
-Home modification. Adding stair railings and "grab bars" next to toilets and bathtubs, taping down or taking up loose carpets, raising low sofas and beds, keeping electrical cords from underfoot and laying non-slip mats or decals in tubs and showers all help.
Overall, "the more risks you eliminate, the lower your chances are of falling," said Yale's Baker.
(c) 2004, Knight Ridder/Tribune Information Services.
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