Although you can slip and fall at any point in life, it’s more common with age. More than 1 out of 4 older adults take a tumble each year, and about 20 percent of these falls lead to injuries such as broken bones, according to the Centers for Disease Control and Prevention.
A host of aging-related changes may be at fault. “We lose muscle strength and flexibility, and our senses become less sharp,” says Anne Vanderbilt, a nurse practitioner at the Cleveland Clinic’s Center for Geriatric Medicine. Vision and hearing can become less sharp, reducing awareness of fall hazards.
Chronic conditions such as arthritis can affect balance, as can certain meds, says Audrey Chun, vice chair of geriatrics and palliative medicine outpatient services with the Mount Sinai Health System in New York City.
Age also affects your vestibular system, the area of your inner ear that helps you maintain balance, says Greg Hartley, an associate professor of physical therapy at the University of Miami Miller School of Medicine in Coral Gables, Fla.
But there’s plenty that you can do to reduce the risk of falls.
Four quick tests at home can help you gauge your balance, says Richard Marottoli, medical director of the Dorothy Adler Geriatric Assessment Center at the Yale-New Haven Hospital. Have a sturdy chair or person nearby to hold on to if you need some support.
Stand in place with your feet together.
Move one foot forward so that the instep is next to the other foot’s toes.
Return to the original position, then place the toes of one foot behind the heel of the other foot.
When back in the original position, stand in place on one leg, then the other.
Ideally, you should be able to hold each move for 10 seconds. If not, or if you have any concerns, tell your doctor. They may refer you to physical therapy or screen you for conditions such as diabetes, stroke or Parkinson’s disease. And note that your doctor should inquire about balance at annual wellness visits.
Doctors suggest the following to improve your stability.
Review your meds annually. “The most common offenders are those that affect your level of alertness or your blood pressure when standing up,” Marottoli says. These include some medications for high blood pressure; anxiety, such as diazepam (Valium); an overactive bladder, such as oxybutynin (Ditropan); and antihistamines such as diphenhydramine (Benadryl).
Your best bet is to follow the CDC’s advice and go over everything you take regularly — prescription and over-the-counter products, including supplements — with your doctor or pharmacist each year. In addition, “if you feel foggy/groggy or off-balance after starting a new medicine [or increasing a dose] or dizzy or unsteady on standing up, make sure to let your clinician know,” Marottoli says.
Get your eyes and ears checked. Research suggests that poor vision doubles the risk of falls for older adults. And a 2020 study published in JAMA Otolaryngology-Head & Neck Surgery found that hearing problems, especially among older people, impair balance.
“When you have vision or hearing loss, your brain has to work harder to compensate, which means you have less cognitive reserve to focus on balance,” says Debra Rose, director emerita of the Center for Successful Aging at California State University at Fullerton.
The American Academy of Ophthalmology recommends that all adults over age 65 see an eye doctor every year or two. And the American Speech-Language-Hearing Association says that people should be screened by an audiologist every three years after age 50.
Improve your strength. Our muscles typically shrink about 3 to 8 percent per decade after age 30 and weakening accelerates after age 60. Strength, endurance and flexibility are key for good balance, Chun says. So older adults should do exercises that target one or more of those every day, Hartley says.
Strength training that includes squats, lunges or standing exercises can help by challenging muscles in your legs, back and abdomen that are important for stability. Research shows that simply getting out and walking is helpful. Yoga is also a good option.
A 2023 review published in the Annals of Internal Medicine found that older adults who did yoga were stronger and had better balance — as well as more endurance and a faster walking pace — than those who didn’t. Another 2023 review found that the mind-body practice of tai chi improved balance and reduced fall risks in older adults, too.
Get the right footwear. It’s important because it provides a stable base for your feet, legs and body. To help your toes grip the ground more firmly, Marottoli recommends shoes with a wide toe box. He suggests footwear with soft but supportive insoles, a closed back, and laces or a fabric-fastener closure like Velcro, for added stability. Avoid heels higher than an inch or two, sandals and flip-flops.
Build your confidence. Up to 60 percent of older adults are concerned about falls even if they’ve never had one. But this can limit your activities significantly, according to a study published in BMC Geriatrics in 2021. “Unfortunately, this creates a vicious cycle: People are afraid to move, so they lose even more muscle strength and their balance worsens, which makes them even more fearful,” Hartley says.
If you’re experiencing something similar, take walks only where you’re familiar with the terrain for the time being. And consider doing exercises that carry little risk of falling, like swimming, pool aerobics and stationary cycling. These can increase lower-body strength, which aids balance. If you still feel apprehensive after a month, a physical therapist can screen you for problems that may be affecting your balance (and confidence) and work with you on a plan to get you moving with more ease.
Fall-proof your home. Nearly 80 percent of emergency room visits for falls by older adults are the result of accidents that happen at home, according to a 2021 study published in the American Journal of Lifestyle Medicine.
To ensure that your home is as safe as possible, the CDC recommends the following steps.
Keep your floors clutter-free.
Get rid of throw rugs.
Add grab bars in the bathroom.
Install handrails on all staircases.
Make sure that your home is well lit.
This includes adding lights at the top and bottom of all your staircases and night lights in hallways, especially those that lead to bathrooms.