A Fear of Falling

January 27, 2014

Most of us have taken a fall at one time or another. If we were lucky, we suffered nothing but embarrassment. Unfortunately, as we get older, the odds of falling and getting hurt get stronger. According to the Centers for Disease Control and Prevention (CDC), one of three adults 65 and older falls every year. One-third have moderate to severe injuries that include cuts, broken bones or head trauma.

A broken hip can be considered a very serious fall-related injury. It's can limit a person's ability to move around and live independently and may even lead to death. The rate of hip fractures increases exponentially with age. For instance, people 85 and older are 10 to 15 times more likely to fracture a hip than people 60 to 65.

Risk factors for falls and broken hips

  1. Age. With age, and even more so with inactivity, bone density and muscle mass decrease. Vision and balance problems often develop and people are slower to react if they feel unsteady or start to fall.
  2. Sex. Women are two-thirds more likely to suffer a fracture because of a fall than men of the same age. Because the drop in estrogen levels during menopause accelerates bone loss, women are more prone to develop osteoporosis or brittle bones. Men can also have osteoporosis, but far less frequently than women. The U.S. Preventive Services Task Force recommends that all women 65 and older have a DXA scan to measure the bone density in the hip and spine, areas most commonly affected by osteoporosis.
  3. Chronic medical conditions. Osteoporosis tops the list, but other conditions can also lead to fragile bones.
    • Osteoporosis
    • Overactive thyroid
    • Diabetes
    • Arthritis/li>
    • Parkinson's disease
  4. Certain medications. Cortisone medications, such as prednisone, can weaken bone if taken long term. Other medications may cause dizziness.
  5. Nutritional problems. Lack of calcium/vitamin D in younger days can lower peak bone mass later in life. Eating disorders, such as anorexia nervosa and bulimia, can deprive the body of essential bone building nutrients.
  6. Physical inactivity. Lack of weight bearing exercise, such as walking, may lower bone density and weaken bones.
  7. Tobacco and alcohol use. Either can lead to bone loss.

An interesting phenomenon that may also increase the risk is the fear of falling, which may occur as the result of a previous fall or simply because some people feel more vulnerable as they age. According to the CDC, "This fear may cause them to limit their activities, which leads to reduced mobility and loss of physical fitness, and in turn increases their actual risk of falling."

Anatomy of the hip

The hip is a ball and socket joint that allows us to move in all directions. The ball is the head of the femur (thighbone) and the socket is a hollowed out portion of the pelvis called the acetabulum. The joint is surrounded by ligaments,muscles and a soft tissue envelope that contains a lubricating and nourishing fluid.

If you break your hip, the primary treatment goals are to limit pain and return you back to your normal level of activity. Most of the time, surgery is necessary. The type of surgical procedure depends on where the break is located.

Surgical options generally range from using special screws, pins, nails ,or plates to stabilize the injured bone to replacing some of the joint components. If just the head of the femur is replaced, it's called hemiarthroplasty. When both the ball and socket are replaced, it's called a total hip replacement.

Even though the risk of falling and breaking a hip increases with age, it is possible to do a number of things to reduce the risk.

How to prevent falls

  • Regular medical check-ups with your primary care physician
  • Exercise regularly to increase leg strength and improve balance.
  • Review all of your medications with your doctor or pharmacist.
  • Wear glasses as needed and have regular eye exams.
  • Get up slowly from sitting or lying down to avoid dizziness.
  • Reduce clutter at home. Remove lose wires and cords.
  • Use assistive devices when needed.
  • Install grab bars in the bathroom.
  • Use non-skid mats or rugs.
  • Make sure stair treads and railings are secure.
  • Keep stairwells, hallways and entrances well lit.
  • Install a night light in your bedroom and bathroom.
  • Wear low-heeled shoes with rubber soles.
  • Clean up spills immediately.
  • Keep your intake of alcoholic beverages to a minimum.
  • Consider wearing hip pads or protectors

Hip fractures are a significant health care problem in the United States. By 2040, researchers estimate the numbers will exceed 500,000. Most broken hips happen because of a fall – most of those falls happen in the home – many could be prevented. Do what you can right now to lower your risk.