Here's what an expert on accidental falls does every day to prevent them

A single fall can define how we’ll age, representing a key “inflection point in later life,” according to a study of 2,454 men and women ages 65 or older, published this month in the Journal of the American Medical Directors Association.

About 20 percent of the people in the study experienced a first fall within two years of joining the study. For many, that fall’s effects lingered for months or years, nearly tripling their chances of needing ongoing care, either at home or in a facility, and making future falls more likely to cause fractures and lead to emergency room visits.

That inaugural fall often initiated a persistent downward “domino effect” on older people’s health and quality of life, the study concluded.

Which is why Nathalie van der Velde, one of the study’s authors, is so intent on lessening the impacts — literal and figurative — of falls among older people. A professor of geriatric medicine and falls prevention at the Amsterdam University Medical Center in the Netherlands, she studies and works with older people at risk of falling, co-chairs an international group of scientists writing the World Guidelines for Falls Prevention and Management and is a founding member of the World Falls Prevention Society.

To learn more about falls and how to avoid them, I caught up with van der Velde to talk about how older people can make their homes safer, when to do a medication audit, at what age fall risks rise — spoiler: decades before 65 — and why, having turned 51 this year, she stands on one foot while brushing her teeth and avoids bifocals outside.

This interview has been edited for length and clarity.

Can I start by asking about your parents? Are they living? Do you advise them about fall prevention?

They are and I do. Some years ago, my mother had problems with dizziness and even losing consciousness and falling. Her cardiologist was giving her medication and was really, really happy with her low blood pressure. But what happened was that sometimes, especially at night, it was so low when she got up that she would fall or faint. This was hard for me, because, even for someone in the health care field, you don’t want to overrule somebody else. It took some time and discussion with the cardiologist to find the right doses and types of medications for my mom, but in the end, we did. And that really changed everything. She could again do what she’d always done: go on long walks and do the other things she loved.

Are there lessons in that experience for the rest of us?

For sure. One is that, at least once a year for an older person, there should be a medication assessment review. Maybe the physician can look at alternatives or different dosages. Another is to be honest. My mother didn’t want to tell the cardiologist she was falling. People often won’t say anything because they’re afraid they’ll be put in a care home or think it’s just part of aging. But the physician or carer isn’t going to know what’s going on if you don’t tell them. In the end, my mother did tell the doctor, but only because I told her to.

When should most of us start thinking about our fall risk?

Probably now. We always think our elderly neighbor is the only one prone to falling. But for most of us, we’re at the top of our fitness, strength and balance up to age 30 and then everything in your body starts to decline. By the age of 50, we know the risk of falling starts to go up, especially for those who are sedentary or taking many medications.

A basic question, but why do older people typically fall in the first place?

For a healthy young person without any disabilities, it takes a major disturbance to trip and fall and land hard. But in older people, much smaller disturbances end in falls and injuries. Medications make them dizzy or arthritis makes their mobility worse or they’re wearing inappropriate footwear or they have poor vision. A fall in an older person could also be a symptom of an underlying condition, such as cardiovascular disease, which should be evaluated.

You mentioned footwear and vision. Are there simple ways to reduce fall risk at home?

Don’t have unnecessary hazards. The Centers for Disease Control and Prevention has checklists online for what to do around the house. Use nonslip footwear. Check the lighting. Drink enough fluids. Avoid alcohol. Don’t stand up too quickly. Get your vision corrected if needed. Cataracts influence fall risk. But be careful with bifocals. If you wear them outside and need to climb stairs or step onto or off a curb, you usually look through the reading part of the lenses and don’t have good depth perception. We know people who use regular glasses outside instead of bifocals fall less.

What about exercise?

Mobility is the most important treatable fall risk factor, and exercise is the best way to stay mobile. Work on your strength, work on your balance, and keep a good general level of fitness. Go for walks. There are also supervised exercise programs designed to help the elderly prevent falls. A really famous one is Otago [developed by the New Zealand Falls Prevention Research Group] or StrollSafe [developed at New York University]. But there are others. Ask at a local senior center. An older person should have a full physical assessment before joining any exercise program.

How can the rest of us exercise to prevent falls? What do you do?

I’m taking my own advice. Before, I mostly did strength exercises, like push-ups, but now I also do balance training in my morning routine. There are many ways to incorporate balance training into your day. Stand on one leg when you’re brushing your teeth. I do that. It’s a good one. Also practice getting up from the floor. Which is hard, by the way. And I need reading glasses now but won’t get bifocals because I’ve seen so many people fall because of them.

What about wearables? I have a smartwatch that can alert someone if I fall. Is that a good idea?

Absolutely. If you’re alone and fall, that’s a way to get help. But we also know that after a first fall, especially with an injury, some people get really fearful about another, which can limit their social activities and what they do outside. That can have a big impact on their health and quality of life. A wearable can be a way to feel more secure about going out and doing things. It’s also a way for carers to be less frightened. Because if I can give one piece of advice to carers, it’s don’t stop your loved one from moving about and doing things. The worst thing you can do is get them in that circle of inactivity, losing muscle strength, losing balance. Then their fall risk is even higher. Whatever your age, the key to avoiding falls is to stay active. Find something you enjoy doing, whether it’s walking or cycling or whatever, and just keep doing it. Don’t lose your strength and balance because getting them back is so much harder than keeping them.

It’s also important to tell your physician what is important for you. There have been studies showing many older people say staying independent is more important to them than anything, even staying alive. Your physician should know what’s important to you and your quality of life.

Do you have a fitness question? Email [email protected] and we may answer your question in a future column.