Chapter 14: Fall Prevention

14

Here's a simple truth: a weak bone that never gets hit won't break. For older adults, preventing falls can matter as much as building bone density.

The Numbers That Matter

• Over 95% of hip fractures are caused by falls
• More than 1 in 4 adults over 65 fall each year
• Hip fractures have a 20-30% one-year mortality rate

You can have moderate osteoporosis and never break a bone—if you don't fall.

The Big Three Risk Factors

1. Weak Muscles and Poor Balance

This is the biggest one. Age-related muscle loss (sarcopenia) makes you less stable and less able to catch yourself. The fix? Strength and balance training—it's the single most effective fall prevention intervention.

2. Medications

Many common drugs increase fall risk:

• Sleep aids and sedatives
• Blood pressure medications (dizziness when standing)
• Antidepressants and antihistamines
• Opioid pain medications

Ask your doctor to review your medications specifically for fall risk. The more you take, the higher the risk.

3. Home Hazards

The bathroom is the most dangerous room. Other culprits: loose rugs, poor lighting, cluttered floors, stairs without handrails, and cords across walkways.

What Actually Works

Exercise (Most Important)

Tai chi is particularly effective—studies show it reduces falls by 20-40%. Also helpful:

• Leg strength exercises (squats, lunges)
• Balance exercises (single-leg stands)
• Core strengthening

Aim for 2-3 sessions per week.

Home Modifications

Bathroom: Grab bars near toilet and in shower, non-slip mats, good lighting.

Stairs: Handrails on both sides, good lighting, no loose carpeting.

General: Remove throw rugs, keep walkways clear, use night lights.

Medical Check-ups

• Annual vision exam
• Vitamin D level (deficiency affects muscle function, not just bones)
• Blood pressure check for drops when standing (orthostatic hypotension)

Footwear

Wear low-heeled, well-fitting shoes with non-slip soles. Avoid walking in socks on hard floors.

After a Fall

If you've fallen once, you're more likely to fall again. Tell your doctor even if you weren't hurt, and try to understand why it happened.

Ironically, fear of falling increases fall risk—it makes movements tentative and reduces activity. The solution is building confidence through exercise, not avoiding activity.

The Bottom Line

The best fracture is the one that never happens.

Key points:

• Strength and balance training is the most effective intervention
• Review medications for fall-risk side effects
• Make simple home modifications, especially in the bathroom
• Stay active—avoiding movement makes things worse

A comprehensive approach addresses both bone strength AND fall prevention.