Ambulance

2 Steps That Could Keep You Out of the ER

AmbulanceWe’ve all seen the cheesy television commercial where an elderly man or woman is lying on the floor in pain and utters the classic advertising line, “I’ve fallen and I can’t get up.” While the presentation seems comical, the subject is hardly a laughing matter.

Each year, millions of U.S. adults are admitted to hospital emergency rooms for injuries resulting from falling. While the majority of these fall-related hospital visits occur in adults who are over the age of 65, loss of balance control starts to creep up on us before we reach our golden years.

I notice this most often when I’m following my young children around and they hop up on a curb and walk along with no balance issues. When I try to attempt the same ground-level tightrope act, I find I am not nearly as good as I used to be (or at least think I should be) at staying on the curb without having to step off to regain my balance.

Why Are Falls More Common as We Age?

First and foremost, many of us become more sedentary as we get older. As a result, our muscles, joints and cardiovascular system weaken, and the combination of these factors affects our ability to properly establish and maintain balance. Plus, most of us don’t engage in daily tasks that require practicing good balance, and we start to see our coordination decline.

In addition, some health conditions that emerge as we age increase the risk of falling. For example, a 2010 study showed that type-2 diabetics were significantly more at risk for falls than healthy adults of the same age due in part to slower reaction times and greater postural sway when at rest.[1] While the authors of the study speculated that low blood sugar levels might cause these two fall risk factors, scientists are currently unsure about the precise mechanism that causes diabetics to exhibit greater balance issues.

Separately, in a 2005 study of adults with arthritis, researchers found that 33 percent of study participants had fallen at least once within the previous 12 months. The researchers speculated that the increased prevalence of fall risk among those with arthritis is in large part due to impaired mobility as a result of decayed joints.[2]

The same type of balance issues exist in other chronic conditions like osteopenia, osteoporosis, obesity and impaired vision.

Further still, certain prescription medications are known to affect balance. For example, drugs that regulate blood pressure and blood sugar can contribute to fall risk. The same is true of certain sedatives and antidepressants.

And, yes, believe it or not, recent research has shown that vitamin D deficiency is strongly correlated with increased risk of falls. You see, muscle fiber function and muscle strength are somewhat reliant on adequate levels of vitamin D. According to a recent review of studies examining the connection between vitamin D and falls, researchers discovered that in people who are deficient in vitamin D, the specific muscle fibers that the body recruits first to prevent a fall are atrophied.[3]

What’s the Best Medicine for Preventing Falls?

In looking at a wide range of fall-risk related research, the No. 1 recommendation for reducing fall risk is exercise. Specifically a combination of resistance training (weight lifting), stretching and balance exercises. In the various health condition populations mentioned above, some combination of these exercise methodologies has been shown to reduce the risk of falling by as much as 50 percent.

For example, in the diabetes related study mentioned above, researchers reported that diabetic participants who engaged in a combination stretching/resistance training program focused on increasing strength and flexibility of the lower limbs, abdominal and back muscles significantly reduced fall risk. In particular, diabetic study subjects experienced significant improvement in strength of key muscles used in balancing the body and in reaction time to visual stimuli. 

The typical resistance training program evaluated in other fall-related studies generally includes the use of strength training machines where the resistance can be adjusted and the range of motion limited to avoid injury. The resistance training protocols followed in most of these studies involves upward of 10 different machine exercises (a handful of upper body focused machines and a handful of lower body focused machines) where exercisers performed 1-2 sets of 10-12 repetitions on each machine at a moderate resistance level (i.e., not too easy, not too intense) with one to two minute rests between each set, two to three days per week.

Tai ChiThe Chinese martial arts form known as tai chi has also shown promise in improving balance and strength among those at risk for falls.

One recent study examined the balance/strength benefits received by older study subjects (average age 69) who participated in a tai chi program 30 minutes per day, five days per week over a four-year period as compared to a control group of similar-aged adults and a control group of younger participants (average age 28) who did not engage in tai chi over the four-year period.

While the young participants exhibited better balance stability and dance-step reaction time when tested at the end of the study, the older tai chi practitioners exhibited balance stability and dance-step reaction time much closer to the younger participants than the older control group who did not practice tai chi.[4]

Going Beyond Exercise

Beyond exercise, the next best step we can take is to make sure we are receiving at least 1,000 IU of vitamin D daily. A review of fall-related research indicated that one recent study showed that consuming 700-1,000 IU of vitamin D per day reduced risk of falling by 19 percent, and an earlier study showed 200-1,000 IU of supplemental vitamin D daily reduced falls by 14 percent.[5]

You can achieve this amount easily and safely through a vitamin D dietary supplement (look for vitamin D3 in the form of cholecalciferol).

If you prefer to receive vitamin D naturally, go outside into direct sunlight with multiple areas of your body exposed to the sun (without sunscreen to block UV rays) for 30-45 minutes per day. If you’re concerned about skin damage, there is no need to concentrate your time in the sun all at once. If you divide it up into three 10-15 minute exposures you’ll absorb the same amount of vitamin D as you would with 30-45 minutes of straight exposure.

Vitamin D is also fortified into a range of food products. Realistically, though, if you’re concerned about the risk of falls and you suspect you aren’t getting enough sunlight or eating enough foods that are fortified with vitamin D, a supplement is cheap insurance. It’s very inexpensive and safe for most people at dosages up to 2,000 IU (the upper daily limit recommended by the National Academy of Sciences).

Finally, if you take prescription medications and you’ve been experiencing balance issues and/or have found yourself taking more spills lately, it is also a good idea to discuss your concerns with your physician to determine if one or more of your medications makes you more susceptible to falls. While your physician may not be able to tailor your medications to specifically avoid fall risk, he or she can at least alert you to the specific medications that present the greatest risk.

Don’t Wait Until It’s Too Late

The takeaway here is that whether you are 45 or 65, injuries related to falls can have a permanent life-altering, and in some cases, life-ending impact. To reduce the odds of this, it is in your best interests to begin and maintain a program of resistance training that includes stretching and balance exercises. An easy way to construct such a program is to visit your local health club or community center and speak with a certified fitness instructor. They can not only devise a safe and effective program for you, they can also show how to perform each exercise, and if you’re so inclined, supervise your training sessions.

And as we described above, adding a daily vitamin D dietary supplement has been shown to reduce fall risk in those who are deficient in this vital nutrient.

If you’d prefer to find out whether you are vitamin D deficient prior to taking a supplement, ask your doctor to order a vitamin D test to detect the amount of the nutrient circulating in your blood. The test results will provide a reference range indicating whether your vitamin D level is low, normal or high. From there you and your doctor can determine whether a vitamin D supplement is needed and what dosage is most appropriate for you.


[1] Morrison S, et al. Balance Training Reduces Falls Risk in Older Individuals With Type 2 Diabetes. Diabetes Care. 2010 April; 33(4): 748-750.

[2] Armstrong C, et al. Occurrence and risk factors for falls in rheumatoid arthritis. Ann Rheum Dis. 2005; 64: 1,602–1,604.

[3] Rastogi Kalyani R, et al. Vitamin D Treatment for the Prevention of Falls in Older Adults: Systematic Review and Meta-Analysis. J Am Geriatr Soc. 2010 July; 58(7): 1,299–1,310.

[4] Wong AMK, et al. Is Tai Chi Chuan effective in improving lower limb response time to prevent backward falls in the elderly? Age. 2009; 31: 163–170.

[5] Bradley SM. Falls in Older Adults. Mount Sinai Journal of Medicine. 2011; 78: 590-595.