In Sight

Reducing the Risk of Taking a Fall

A dangerous fall does not have to be an inevitable part of aging.

Prevention—Sadie Armstrong participates in a balance class at Holy Cross Hospital's Senior Source center, Silver Spring, Md. Photos: Matt McClain / The Washington Post.


Daphne Brown, 65, was putting away the dishes in her Washington, D.C., kitchen when she fell to the floor. Susan Le, 63, who has trouble walking due to arthritis, hurt her leg when she tripped on a pile of leaves in Silver Spring, Maryland. And late one night when no one was around, Jean Esquivel, 72, slipped on the ice in the parking lot outside her Silver Spring apartment.

Falls are the leading cause of injuries for adults 65 and older, and 2.5 million of them end up in hospital emergency departments for treatment every year, according to the Centers for Disease Control and Prevention. The consequences can range from bruises, fractured hips and head injuries to irreversible calamities that can lead to death. And older adults who fall once are twice as likely as their peers to fall again.

Despite these scary statistics, a dangerous fall does not have to be an inevitable part of aging. Risk-reduction programs are offered around the country, including several at hospitals.

To reduce the odds of falling again, Brown, Le and Esquivel signed up for “UpRight! Balance Training,” a free 12-week exercise class held at Holy Cross Hospital’s Senior Source center in Silver Spring, and run by instructor Judy Cooper. Those who are too unsteady may be advised to get physical therapy or discuss other fall-prevention options with their doctors.

“It definitely made me think first and to make sure I felt comfortable taking my next step,” Brown said after one of the group’s final sessions. Participants took turns, while instructors spotted them, crossing over an imaginary river that the instructor had created with blue yoga mats covered with exercise platforms, small barbells, inflatable cushions and other objects representing rocks and tree branches that they stepped on to get across.

Le nearly tripped on her second turn through the obstacle course. The experience reminded her “to take things slowly, because I walk a lot and have to watch where I step,” she said.

“The fear of falling is real, but people can change it”

After decades of walking and rushing, they were learning to be more aware of their surroundings, to watch their posture, maintain their balance and to master a flight of stairs even with less-than-perfect knees. To confront the stairs, they practice going up using their stronger leg first and going down with the weaker leg first. Stepping sideways is another strategy and has the added advantage of allowing the person to hold onto the stair railing with both hands.

Under the careful eye of instructors, members of the class practiced stepping off a riser while holding an oversize exercise ball—to simulate a laundry basket—going down steps facing forward and backward with eyes open and then closed. They also tried walking in a straight line while reading a book. Everyone wasn’t able to do these tasks, and that was part of the lesson.

At the Senior Source Center, Bobbi Cohan, in white jeans, does leg-lifting exercises during an "UpRight! Balance Training" session. The class helps people learn how to prevent falls and tries to improve their balance. Photo: Matt McClain / The Washington Post.
At the Senior Source Center, Bobbi Cohan, in white jeans, does leg-lifting exercises during an “UpRight! Balance Training” session. The class helps people learn how to prevent falls and tries to improve their balance.

“If you’re aware of your limitations, you are much less likely to fall, because you know what to avoid,” Cooper said.

It’s also important not to be overly cautious, said Thomas Gill, a geriatrician and professor at the Yale School of Medicine and one of three principal investigators for the $30 million federal STRIDE study, the nation’s largest investigation of how to prevent injuries from falling. When older people become afraid of falling, they may cut back on physical activity and eventually grow weaker.

“Paradoxically, that puts them at greater risk of falling,” Gill said. “The fear of falling can be a dysfunctional response, and there is strong evidence that it is a fairly powerful risk factor for serious fall injuries.”

Another free class at Senior Source, “A Matter of Balance,” helps people cope with the fear of falling by discussing how to make their homes safer and how to recognize and modify such risky habits as walking into a dark room or not immediately wiping up a spill on the kitchen floor. Boston University researchers developed the class in 1995, and it is available in 40 states. In a 2015 study, researchers found that people who completed the “Matter of Balance” sessions reduced the number of falls and injuries and saved an average of $938 a year in medical costs.

Despite the need for and success of such programs, some experts are concerned that more people don’t participate. “A huge amount of work has gone into fall-prevention research, but many people who could benefit don’t get to [these programs],” said Nancy Latham, director of the STRIDE study, which is recruiting 6,000 patients at 10 health-care systems sites around the country, including Johns Hopkins Medical Center in Baltimore. The study will test the effectiveness of a “falls care manager,” who helps patients enroll in prevention programs like “A Matter of Balance” and addresses problems that can increase the risk of falling, from medications to footwear.

“The fear of falling is real, but people can change it,” said Kristen Wheeden, who taught the “Matter of Balance” class last month. “Instead of saying, ‘I can’t do this, no way, I’m going to fall,’ let’s make it so you can, let’s find a buddy system, let’s go out at a certain time of day, and let’s make your world safe.”

This article was produced through a collaboration between The Washington Post and Kaiser Health News, an editorially independent news service that is a program of the Kaiser Family Foundation.