It is well known that as the population is aging, there are many older Americans suffering serious injuries due to falls. Available data indicate that in 2012 alone, 2.4 million Americans over age 65 were treated in emergency departments for injuries from falls. During the 10-year period ending in 2012, there were 201,000 fall-related deaths.

There are many contributing factors that account for this, including problems associated with aging. Lack of physical exercise and conditioning causes muscles to weaken, interfering with recovery from missteps and with the ability to rehabilitate after injury. Decreased balance is also a factor, and is itself a complex neurological and muscular phenomenon that can be further impacted by failing eyesight and mental acuity.

An important element of balance is proprioception, which involves messaging from tendons, especially in the legs via nerve fibers and spinal cord to the brain, which then is able to assess the body’s position in space and center of gravity and to trigger compensatory movements. Impairment of this system by aging or neuromuscular illness (e.g. Parkinson’s Disease, multiple sclerosis) poses a serious threat to stability.

What measures can be taken to minimize the risk of falling? Physical exercise is very important to maintain muscular strength and stamina. Physical therapists have many programs which help maintain balance as well as strength and range of motion. Tai chi is especially worthwhile in promoting stability through emphasis on slow, purposeful movement coordinated with breath and balance.

In addition to aging and illnesses, other physiological contributors to falls include alcohol consumption, certain categories of medications, and a drop in blood pressure brought on by dehydration.

Medicines that adversely affect balance include psychotropics such as antidepressants, antipsychotics, opiates and other pain medicines, and benzodiazepines (e.g. Valium, Xanax, Klonopin).

Blood pressure medication, if dosing is not carefully monitored, can lower blood pressure too much and cause dizziness and light headedness, especially upon arising or if the individual is not drinking adequate fluids to stay hydrated.

Sedating medicines, sleeping pills and drowsiness-causing antihistamines increase the risk of falling. Even when taking these at bedtime, there is still a potential falling hazard when visiting the bathroom during the night.

As they grow older, patients and their physicians should review their medications with an eye toward modifying the doses or amount of medications in a safe way. It is a grim fact that 25 percent of elderly patients who sustain a hip fracture die within a year, and survivors frequently have severe problems with ambulation and balance. Those who die usually were sick or frail prior to the fall and preventive measures for these individuals are particularly important.

Falls are also caused by environmental hazards, such as poor lighting (especially on stairs), throw rugs, slick bath tubs, slippery outdoor surfaces and steps, tree roots, and even pets. Not many systematic studies have been reported dealing with ways to alter the physical environment of the home and property to promote fall prevention. However, in September 2014, an article in the British medical journal, Lancet, described a controlled study done in a region of New Zealand, demonstrating simple, cost-effective safety improvements are effective in preventing fall-related injuries.

The author studied 1,848 occupants of 842 different households, randomized to either have had modifications made to prevent falls or left to its usual condition. The modifications included, among other upgrades, indoor and outdoor hand rails, bathroom grab rails, slip-resistant outdoor steps and surfaces, improved outdoor lighting, tacked down carpet edges and non-slip bathmats.

When following-up on the subjects after three years, occupants of the upgraded homes had 26 percent fewer fall-related injuries. All the homes were built before 1980, and the occupants’ age range was broad, with about 40 percent of the participants over age 60. On average, the cost of the modification package was equivalent to $450 U.S. When you consider the cost per injury prevented is $660, that is a small price to pay to avoid catastrophic injury.