What you can do to prevent a deadly or disabling fall

If you've ever fallen flat on your face, as I have, you know how devastating a fall can be. Three times in the past two decades, I've landed on my nose, tripped (literally) by a sidewalk or stair that was unusually lumpy or high. Amazingly, I've broken no bones, though twice my face looked like I'd walked into a meat grinder.

Falling can happen to any of us at any time, but the likelihood increases with age. Each year, a third of people 65 and older fall, mainly inside or near their homes. Two-thirds who fall once will fall again within six months. One in 40 are hospitalized. Of those who are hospitalized, only half are alive at the end of the year. Falls are the leading cause of death from injury among people 65 or older, accounting for nearly 500 deaths among older adults in 2005 in our state, 15,000 in our nation.

But it's not death that worries me. It's long-term disability. According to the experts, the most profound effect of falling is the loss of independent functioning. About 50 percent of older people who sustain a fall-related injury are discharged to a nursing home rather than their own home.

Then there are the costs. They're enormous — $27.3 billion nationally in 2003 to care for fall-related injuries, rising to an estimated $43.8 billion by 2020.

But even if you're not badly hurt, one of the worst effects of falling, as I can attest, is the fear of falling. The psychological impact can become its own prison.

Here's the punch line: Much of this is preventable.

"Falls are not a normal part of the aging process," says Dr. Elizabeth Phelan, director of the Fall Prevention Clinic at Harborview Medical Center and a UW assistant professor of medicine. "While some risk factors are more common as we get older, we can reduce the likelihood of falling by taking preventive measures."

Steps you should take

The top risk factors: being female (though men are more likely to die from a fall); having fallen in the past year — especially if medical attention was required; having problems with gait and balance when you walk (may require professional evaluation); vision problems, like cataracts or macular degeneration; taking numerous medications that interact or make you wobbly; and living in a home with trip hazards, which almost all of us do because we're not trying very hard to avoid these problems.

From my research and personal experience, I've come to believe that falling is as much a public health menace as smoking or drunken driving. The consequences are often just as life shattering, expensive — and avoidable. In a rapidly aging nation, it's time to embark on a major public-education campaign to prevent falls. Then, we must each take personal responsibility to protect ourselves from falling.

Prevention isn't brain surgery, but it takes some effort. There are four critical elements:

• Regular exercise for balance, strength and flexibility. Strong muscles help you keep your balance as you move, and a strong core (your trunk) keeps you upright and more likely to correct your balance if you trip. No one is too old or frail to exercise, yet only 31 percent of older Americans are regularly physically active today. Being a couch potato is a major reason so many older people fall and hurt themselves.

• Ask your doctor or pharmacist to review your medications (over-the-counter and prescription) to reduce their side effects and interactions. Of particular concern are psychotropics, diuretics, anti-arrhythmics and digoxin.

• Have your eyes checked by an eye doctor once a year.

• Reduce the hazards in your home. Improve the lighting, get the clutter off the floor, add handrails in the bathroom (the most dangerous room in the home), get rid of slippery rugs.

For further ideas ...

"Although many studies have occurred to show what causes people to fall," says Phelan, "very little effort has gone into translating this body of evidence into practice. We're seeing more and more people coming to us with injuries from preventable falls."

This is beginning to change. The University of Washington's Fall Prevention Clinic — possibly one of only a handful of such centers in the nation was set up to assess older people for fall risks and improve their safety. This month, the University of Washington is holding free public fairs at 10 locations around Puget Sound to educate the public about fall prevention.

Each site will offer ideas and hands-on demonstrations of fall-prevention strategies, including home safety, exercise, medication management and vision checks, plus professional evaluations of balance and gait.

These fairs will be held at Harborview Medical Center, UW Medical Center and senior centers in Seattle, Maple Valley and Edmonds on Sept. 20. In Mount Vernon, a fair will take place Sept. 21. For specific times and locations, visit www.harborview.org (type "fall prevention fairs" in the search window at lower left) or call 206-598-5395.

There's a wealth of information on the Web about fall prevention. A good place to start is the Fall Prevention Center of Excellence at the University of Southern California in Los Angeles at www.stopfalls.org.

Liz Taylor's column runs Mondays in the Northwest Life section. With 30 years experience in the field, she writes and lectures on a host of aging topics. E-mail her at or write to P.O. Box 11601, Bainbridge Island, WA 98110. You can see all of her columns at www.seattletimes.com/growingolder/.