Why older Indians are more prone to dangerous falls

medium119482281Ramachandran R was an active 82-year-old doing brisk morning walks and gardening in the evenings. Till he tripped over his sleeping Lhasa Apso during a midnight bathroom visit and suffered a fractured hip in August last year. After surgery and many sessions of physiotherapy, he quit all outdoor activities. Saradha, 84, was cleaning her dining table when she fell and fractured her femur. Though the bone has healed since, she refuses to walk without a walker even within the house.For older folks, falls are serious and even when the injuries heal, they can lead to a confidence crisis. According to the US Centres for Disease Control and Prevention, more than one out of four adults who are 65 and above suffers a fall every year, and falling once doubles the chances of falling again. In India, most hospital records show fall cases among senior citizens are growing by the year. “Even a minor fall can put them at great risk of injury, immobilise them, and cause serious health issues. It’s the second leading cause of unintentional injury deaths worldwide,” says geriatrician Dr S Deepa, director of the National Institute of Ageing in Guindy, Chennai. In the past year, it has reported 237 fracture cases due to falls in those over 60. “All these people fell inside homes,” she says, adding that generally 6 out of 10 falls in the elderly happen at home — in bathrooms, kitchens, or balconies.Why do older folks fall?“Multiple chronic conditions such as diabetes, hypertension, cardiac or kidney disease, and the use of multiple medications are among the highest contributing factors,” says Dr Deepa. With increasing age, the risk of falls also rises — around 25-30% of people aged 60 have accidental falls, and the figure rises to 35% for those aged 70-80 — says Dr Manjari Tripathi, head of neurology at the All India Institute of Medical Sciences (AIIMS), New Delhi. “Physical strength reduces as we age and posture changes shift the body’s centre of gravity, with weakened reflexes compromising balance,” she points out. medium119481244Other risks include a slower walking pace and neurodegenerative conditions like Parkinson’s disease, decreased bone density and diminished muscle strength, particularly in women’s quadriceps, leading to unstable walking patterns. “Apart from balance and gait problems, the main cause of frequent falls is age-related loss of muscle mass (known as sarcopenia) and blood pressure that drops too much when you get up from a lying down or sitting position (called postural hypotension),” says Ruchi Kishore, a Mumbai-based pilates instructor and wellness coach who has a lot of senior citizens among her clientele.Making homes senior-friendly How do they keep their balance then? “One can install parallel steel bars at hand-holding height along walls at 1ft intervals for the person to hold on to while walking,” says Dr Tripathi. For severe balance issues, she recommends using a tripod stick for walking.Dr Suranjit Chatterjee, senior consultant at Indraprastha Apollo Hospitals, Delhi, believes frequent vision and hearing tests can identify spatial orientation issues that might cause falls. Also, doctors should regularly review medications of seniors to identify those that might cause dizziness or affect balance. “They must wear non-slip footwear. Unstable surfaces should be avoided. Educating both seniors and carers about fall prevention, and prompt reporting of balance issues, weakness or dizziness, is crucial for reducing incidents,” he says.Rise of fall clinicsMany hospitals treating elderly patients now have fall clinics, some even offering services to screen for ‘dark or danger spots’ at home. They typically suggest handrails on staircases and inside bathrooms, elderly-friendly toilets, path lights in bedrooms, and anti-slip tiles. “Even healthy senior citizens are susceptible to accidents. When the elderly fall, fear sets in and there is decreased mobility. This can be even more dangerous,” says Dr AB Govindaraj, a senior orthopaedic from MGM Healthcare, Chennai. In fact, many older adults fear falling even if they haven’t fallen before, says Kishore. “This fear may make them avoid basic activities such as walking, shopping, or having an active social life. But staying active is crucial to keep your body healthy, and it actually helps prevent falls.” ShowQuotesThe importance of exerciseAs muscles atrophy with age, physical activity is imperative for senior citizens to prevent falls, says Dr Chatterjee, adding, “One should focus on improving strength, balance and flexibility through yoga and chair exercises. Leg and core strengthening routines are particularly beneficial.” Dr RK Pathak, a 73-year-old orthopaedic surgeon based in Mumbai, began pilates classes with Kishore a little more than a year ago, egged on by his daughter. “I did balance routines which I found to be very good. I had begun to slouch a bit and pilates helped improve my posture. It also increased my mobility, muscle power and stamina. As a doctor, I would recommend pilates to all senior citizens as it’s an excellent routine for the four things we need the most — posture, reflexes, balance and muscle power,” he says.Video courtesy: Ruchi Kishore medium119522752Lessons on fall managementWhat if you still fall? “If a fall is unavoidable, try to let your body go limp, and keep your knees, wrists, and elbows loose and bent. Drop whatever you have in hand. Tuck in your chin and throw your arms up around your ears to protect your head,” says Dr Govindaraj. After the fall, one must stay calm, take deep breaths, and call for help if the pain is severe or if they are dizzy.