Dr. Koby Caplan shares tips to reduce your fall risk

The simple fall is the biggest threat to the independence of many older adults. More than 1 in 4 adults fall each year, resulting in more than 41,000 deaths. Many others are left with a permanent disability or injury that threatens their independence.

In this article, Koby Caplan, MD, a geriatrician with Geriatric Medicine of BCH, describes which of the body’s systems are involved in balance and shares tips to keep you from falling.

What keeps us upright

Have you experienced dizziness after getting up out of a chair? Or, have you felt less stable when walking downstairs? As we age, our sense of balance decreases. Dr. Caplan says this is because the body’s systems that detect balance and stability become less effective and dependable as we age — as early as age 50.

The body’s systems that control balance include our:

• Brain
• Vision
• Ears
• Blood pressure
• Muscles
• Proprioception (sensation of body in space)
• Skin sensitivity

“A simple example, ‘I see a spoon on the floor. I step over it. I have to see it, understand where it is in relation to myself, and coordinate my body to step over it,’ ” says Dr. Caplan.

Impacts on the body’s balance system

The following are examples of things that can impact the body's systems and affect balance.

Brain - Side effects from prescribed and over-the-counter medications or chronic conditions, such as arthritis, stroke and neurological disorders, can affect your brain and central nervous system, increasing your fall risk. Dr. Caplan warns that medications can cause brain fog and lower blood pressure, causing your balance to be off.

Vision - Double vision, blurry vision and light sensitivity can all affect your balance. “As we age, vision loss can creep up on us,” says Dr. Caplan. “It’s important to be sure your vision is up to speed, as you need it to help you stay upright and avoid falls.”

Ears - Imbalance may be experienced in the form of vertigo. “In fact, vertigo is an example of how devastating it can be when just one signal goes wrong. It can feel like you or your surroundings are moving or spinning, even when they are not.” Vertigo exercises can train the brain to ignore bad signals and keep your body upright.

Blood pressure - Low blood pressure can result from medications, dehydration or swelling. “With aging, our arteries become stiffer. This causes low blood pressure and makes it more difficult to move blood to the brain. If you are also dehydrated, it compounds this issue, making it even harder for blood to get to the brain, potentially causing a fall,” according to Dr. Caplan.

Medications - Some medications can cause side effects that affect balance. For instance, some prescribed medications can cause swelling and make your legs heavy, causing balance issues. Dr. Caplan notes, “Overall, medications can be helpful; however, be aware of side effects, and let others know when you’ve started a new mediation. They might notice something in your behavior or balance that you may not notice.”

Pain management - Staying ambulatory is a huge priority, which may mean taking medications for chronic pain and arthritis. “As helpful as they may be, you need to be aware of side effects that can affect balance. You might also consider injections or surgery as an option,” Dr. Caplan says.

“While there are not many treatments for neuropathic pain — pain caused by nerve damage and experienced as numbness or tingling — we can get ahead of it in our younger years. For instance, not wearing high heels, being more aggressive in treating diabetes or blood sugar and better skin care of our feet.”

Urinary symptoms - Jumping from bed too quickly to get to the bathroom can cause low blood pressure, leading to a fall. There are medications to treat urinary urgency, but they may also cause some instability. Dr. Caplan explains that options to help with nighttime urinary urgency might include having a urinal or commode near the bed and adding motion sensing night lights.

Eliminate environmental risk factors

Dr. Caplan warns that you need to recognize your vulnerabilities. Eliminating hazardous conditions in your physical environment and daily activities is an important strategy for fall prevention.

Control your environment by avoiding the following tripping hazards:

• Unstable ground
• Small rugs
• Low tables
• Uncontrolled pets
• Roller chairs
• Ice, snow

He adds, “Take steps to reduce your risk of falls by installing safety features such as handrails to prevent falling down the stairs, slip-resistant carpeting and grab bars in the shower or near the toilet.”

Make physical activity a priority as you age

“Keeping physical activity should be a priority as we age. Every day that we aren’t active, we lose muscle tone and become weaker, which impairs balance. Young or old, we need to find activities that we enjoy,” Dr. Caplan says.

He recommends building the best foundation for balance is by incorporating into your lifestyle cardio workouts;150 minutes a week is the recommendation. “Stretching is important to keep us more flexible and less rigid. It doesn’t prevent falls but does prevent the injury from the fall. Strength training is valuable in helping us to catch ourselves before we fall.”

Click here to view/download a PDF of slides shown during the lecture titled “Protecting yourself from falls.”

Learn more about Geriatric Medicine of BCH.

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