By Dr. Mercola
When you're young and middle-aged, you don't give much thought to falling, but as you get older your muscle and bone mass decrease and the senses that guide your balance — vision, touch and proprioception — may all start to deteriorate, and this can make you unsteady on your feet.
Falls in people aged 65 and older are quite common. The latest data from the U.S. Centers for Disease Control and Prevention (CDC) states that more than 1 out of 4 older Americans falls each year, and once you've fallen, you double your chances of falling again.1
A fall in your golden years can come with steep consequences. Each year, 2.8 million older adults are treated in emergency rooms due to falls. More than 800,000 of them are hospitalized as a result, typically because of a head injury or hip fracture.
In fact, 300,000 older adults are hospitalized in the U.S. each year due to hip fractures, more than 95 percent of which are caused by falling (and particularly by falling sideways).
Falls are also the most common cause of traumatic brain injuries and account for $31 billion in direct medical costs annually.
Falls in the Elderly Can Trigger a Downward Deterioration in Health
While many falls are not serious, about 1 in 5 leads to a broken bone, head injury or other serious injury.2
Even if you recover from the fall-related injury, those who fall can also develop an intense fear of falling again, which leads them to limit their activities, increases weakness and in turn raises their risk of falling even more.
For this reason, falls can make it difficult to live independently and may increase your risk of premature death. Adding to the problem is that many people do not tell their loved ones they've fallen out of embarrassment or fear that they could lose their autonomy.
Dr. Gisele Wolf-Klein, director of geriatric education at Northwell Health in Great Neck, New York, told CBS News:3
"Elderly patients tend to not report falls to their families, or even doctors. A fall is a very frightening thing that you keep quiet about.
They think if they mention it that it'll start the ball rolling — the move to a nursing home, or the need for aides to help out in the house — and that they'll lose their independence."
In 2014 alone, the CDC reported that older Americans suffered from 29 million falls and a related 7 million injuries. In addition, CDC data suggests that 27,000 falls in the U.S. each year have fatal consequences.4
Aging itself is a risk factor for falls, especially if you're not active, but there are additional factors that further increase your risk, including:5
✓ Lower body weakness
✓ Vitamin D deficiency
✓ Difficulties with walking and balance
✓ Use of certain medications, including tranquilizers, sedatives and antidepressants
✓ Vision problems
✓ Foot pain or poor footwear
✓ Home hazards (throw rugs, clutter or uneven steps)
Optimizing Vitamin D Levels May Reduce Falls and Related Fractures
Vitamin D deficiency is rampant among the elderly. Researchers estimate that half of the general population is at risk of vitamin D deficiency or insufficiency, but among seniors that estimate reaches as high as 95 percent.
Vitamin D deficiency, in turn, is associated with muscle weakness that may be associated with a feeling of heaviness in the legs, tiring easily and difficulty climbing stairs and rising from a chair.6 Low vitamin D levels are also associated with an increased risk of falling in the elderly.7
Optimizing your levels, via safe sun exposure or supplementation, appears to be a simple way to lower your fall risk (while also imparting additional health benefits).
Research shows, for instance, that supplementing with vitamin D in one elderly group improved muscle strength, walking distance, functional ability and body sway, with researchers noting:8
"These findings and the observed improvements in bone density after vitamin D supplementation provide an explanation for the association between vitamin D supplementation and fewer falls and nonvertebral fractures in elderly people."
Previous research also suggests vitamin D has a beneficial effect on postural adaptations involving muscles and the central nervous system, which may explain the association between higher vitamin D levels and decreased rates of fall and fractures.9
Exercise Helps Reduce Falls and Fall-Related Injuries in the Elderly
Preventing falls is one of the primary reasons why exercise remains so important as you get older, as physical activity is known to significantly reduce your chances of falling. Further, if you do end up falling, research shows that regular exercisers are less likely to be injured as a result.
Older adults who took part in an exercise program were 37 percent less likely to be injured during a fall compared to non-exercisers, one study found.10
This included a 61 percent lower risk of having a fall-induced broken bone and a 43 percent lower risk of sustaining a fall-related injury serious enough to require admission to a hospital. The exercises included an emphasis on balance training along with strength and functional training and even Tai Chi.
It's likely the regular exercisers were not only better able to response physically to a fall but may also have been quicker mentally, allowing them to perhaps reach out and grab a railing for support and thereby suffer less injury.
Separate research has shown, for instance, that eight weeks of balance training reduced slips and improved the likelihood of recovery from slips among the elderly.11
Other research, which noted that "altered balance is the greatest collaborator towards falls in the elderly," found balance training is effective in improving functional and static balance, mobility and falling frequency in elderly women with osteoporosis.12
The ability to balance on one leg is also an important predictor of injury-causing falls,13 so if you know that you'd be shaky if you tried to stand on one foot, you're at an increased risk of being hurt in a fall and should start appropriate exercises immediately.
7 Exercises to Improve Balance and Coordination
If you're not actively working on improving your balance and coordination, you should be, especially if you're middle aged or older. Even if you're new to exercise, I believe it's virtually never too late to start.
My mother didn't start working out until she was 74 years old, and she continues to train regularly, as you can see in the video above. While many seniors benefit from strenuous activities such as high-intensity regimens and strength training, there are options even for people who are frail or confined to a wheelchair.
Below are seven simple, basic exercises you can do to help improve your balance and coordination, thereby reducing your risk of falling. They work to counteract some of the prime reasons why seniors fall, including poor balance and coordination, weakness in your hips and legs, poor posture and reduced ability to lift your feet, which can lead to stumbling.
Five of the exercise are done while seated while two are done while standing. For the seated exercises, begin seated in a chair that won't move or slide easily. Start slowly and only proceed to the next exercise once you've mastered or are comfortable with the previous one.
1. Toe Taps on Cone: Place a plastic cup, opening down, on the floor between your feet. Starting with your right leg, lift your leg up to gently tap the top of the cup with your toes, then place your foot on the opposite (left) side of the cup. Lift your right foot back over the cup, and set it down on the right side. Repeat 10 times with each leg, alternating sides.
2. Seated Leg Lifts: Lift your right leg with the knee bent at 90 degrees. Hold your leg up with your foot about 6 to 10 inches off the floor for five seconds. Repeat 10 times, then switch legs and do 10 repetitions on the other side.
3. Seated March: While seated, march your legs 20 times, lifting your feet at least a few inches off the floor. Be sure to focus on maintaining good posture while marching.
4. Hand-Eye Coordination and Balance: Place a plastic cup (opening facing down) in your right hand. Stretch your arm out in front of you while balancing the cup in your open hand.
Slowly move your arm out to the side and back to center. Repeat 10 times with each arm. When you're comfortable with this exercise, you may try doing it with your eyes closed. Be sure to remain seated, and if necessary, have someone help keep you upright, and/or be ready to stabilize you if you get dizzy.
5. Seated Arm Reach: While seated, simultaneously lift your right arm up high and raise your left leg, knee bent. Hold for a few seconds, then alternate sides. Repeat for a total of 20 times.
6. Side Leg Raise: Stand behind a chair, with one or both hands on the back of the chair for support. (Alternatively, keep one or both hands on the counter). Lift your right leg out to the side. Repeat 10 times for each leg. If you're comfortable, do the exercise without holding on to the chair or counter.
7. Staggered Stance Balance: Place your right foot forward and your left foot behind, then slowly shift your balance from your front leg to your back leg. Repeat 10 times, then switch leg positions, placing your left foot forward and your right foot behind. If needed, do this exercise standing next to a chair, or between two chairs, with the backs of the chairs toward your body, so you can grab on to them for support.
Strength-Training Exercises for Seniors
Without intervention, you can lose an average of nearly 7 pounds (3 kilos) of muscle per decade.14 If you stop working your muscles (or neglect to start), the consequences of age-related muscle loss (sarcopenia) are steep and include increased risk of falls and fractures.15
The following exercises are suitable for many seniors who are just starting out with strength training. If you're more advanced, see my previous strength training for older adults article. There are exercises for seniors with limited mobility too, but the exercises below will represent a good starting point for those at a beginner's level of fitness.
Knee Extensions With or Without Weights
Knee extension exercises will help strengthen your knees, which will improve your balance and reduce your risk of falling. Strengthening your knees will also allow you to walk and climb stairs with greater ease and comfort.
- Sit on a chair with your back straight and knees bent
- Slowly extend your right leg out in front of you and hold for a few seconds before lowering it back to starting position
- Repeat with your left leg
- Do 10 repetitions on each leg
For a more advanced version, strap an ankle weight around each ankle. Aim for a weight that is heavy enough to where you cannot do more than 15 repetitions per leg. As you get stronger, you can add more weight to keep it challenging.
Partial Squat and Half-Squat Against a Wall
Squatting exercises increase hip flexibility and strengthen your hip flexors and quadriceps, which will improve both your walking ability and your ability to stand up from a seated position.
It also improves your overall balance and stability, reducing your risk of falling. For the beginner's version, stand up using a chair for support, and perform a standing partial squat as demonstrated in the ElderGym video above. Remember to push your buttocks out as you bend to maintain a straight back posture, and do not bend your knees past your toes.
Once you're comfortable with that, try doing a half squat against a wall. This can be a more challenging move — especially if you get all the way into a seated position — so you may want to make sure you have someone there to assist you.
- Stand with your back leaning lightly against a wall, with your legs slightly wider than shoulder width apart
- Bend your knees, sliding your buttocks down the wall. Keep your knee cap in line with the middle toe of your foot, and do not bend your knee past your toes
- If your strength allows, place your feet a bit further out from the wall and lower yourself down into a seated position, as if you're sitting on an invisible chair. Hold this position for a few seconds before raising yourself back up
- Repeat 10 to 20 times
Once you can do 20 repetitions, you can increase the difficulty even further by holding a dumbbell in each hand.
For the bicep curl, make sure you're using a weight that is appropriate for your current level of strength. If you're just starting out, a 5-pound dumbbell in each hand may be appropriate. You want the weight to be heavy enough that by the time you complete 10 to 12 reps, you feel like you can't keep going.
- Sit with good posture in a chair (remember to engage your core by imagining your sternum moving back towards your spine, to stabilize your posture); one dumbbell in each hand, palms facing forward, shoulders relaxed and elbows close to your body
- Focusing on your bicep muscle, bend your arm at the elbows and lift the weights about three-quarters of the way toward your shoulders. Avoid rotating your shoulders forward, and keep your elbows fixed at your side
- Breathe out as you lift the weight, and breathe in as you lower them
- Do 10 to 12 repetitions
When you exercise as an older adult, you're gaining the ability to live independently and fully, something that can be taken from you if your body becomes too frail. If you're just starting out, consult with a personal fitness trainer who can instruct you about proper form and technique. He or she can also help you develop a plan based on your unique fitness goals and one that is safe for any medical conditions you may have.