10.10.1: Falls and Fractures

A fall to the ground might seem like a minor thing - after all, children fall down and get up multiple times a day. Yet as an adult, and particularly an older adult, falls can become a much greater risk for a severe injury. And falls are quite common as we get older: over 25% of adults over the age of 65 fall each year, yet less than 50% of those that fall tell a doctor about it. Emergency departments see over 3 million falls annually, and 1 million older adults are hospitalized from one. Falls can cause bone fractures (often in the hip or wrist) and traumatic brain injuries (TBI) (CDC, 2024b). All told, falls are the leading cause of injury-related deaths for older adults.

The risk for falls increases due to a few aging-related factors, many of which can be prevented. As we get older we tend to lose muscle mass, which if it is severe enough is called sarcopenia. With this loss of muscle comes a loss of strength, balance, and motor control - all of which can increase the risk of falling. But even though some declines in strength and balance are to be expected with age, sarcopenia is much more common in those with low physical activity and a sedentary lifestyle (HHS/OASH Office on Women’s Health, 2023). A lot of muscular strength and muscle mass can be maintained with strength training. Practicing Tai Chi has also been extensively studied as an effective fall-prevention strategy, specifically for improving balance and coordination (Chen et al., 2023).

Similarly, bone mass declines with aging, particularly the center “spongy” bone in our long bones. If bone loss is severe enough, it can eventually lead to osteoporosis, which significantly increases the fracture risk if a fall does occur. People with smaller frames tend to be at a higher risk of osteoporosis, as are women after menopause. The drastic decrease in estrogen experienced during menopause is associated with a steeper decline in bone mass. While physical activity, especially strength training and impact exercise (like running and jumping) can certainly increase bone mass in children and adolescents, it is becoming clear that exercise only delays the decline in older age. In other words, it is much harder (or perhaps impossible) to increase bone mass in our later years, but we can definitely hang on to more of what we built in our youth (Foreman, 2020).

Other risk factors for falls include having a chronic condition such as hypertension which can affect balance and cause dizziness, particularly when standing up from a seated or lying position, or being on medication that can affect balance. Lower acuity in sight or hearing can also cause trips and falls, as can cognitive impairments. It is extremely important to maintain an environment that supports an older person’s functional capacity, with floors clear of clutter, ramps or few level changes, and railings to provide support (CDC, 2024c).