From time to time here on the AgingOptions Blog, we like to revisit important topics we’ve covered before. Today’s article from NextAvenue is a good example – a strong and personal warning, written by journalist Leida Snow, against the very real danger of falls. The danger of falling while coming downstairs, taking a walk, or tripping over the cat may seem like the stuff of jokes, but the hazard is very real, as many seniors learn from harsh experience. Falls are also costly: the CDC pegs the medical cost of falls suffered each year by U.S. adults 65 and older at more than $50 billion.

We also like this article because it includes specific tips on how to avoid falls, along with links to information sources that can help keep you or an aging loved one safe. With that in mind, we suggest you lay aside the “it-can’t-happen-to-me” attitude and take a look at what NextAvenue has to say.

As We Age, Falling Becomes a Scary Prospect

“When we fall as kids, we’re told to pick ourselves up and start over again,” Snow writes in her NextAvenue piece. “As we grow older, the issues around falling turn darker. Many older adults grow fearful, seeing scary ads for alarms to engage if we fall and can’t get up. If people knew all the facts, they’d be even more concerned.”

What Snow is alluding to are the potentially catastrophic consequences for older Americans who fall. While some falls are minor, others can be fatal. In fact, the CDC has reported that falls are the leading cause of injury-related death among older people, thanks typically to poor bone health, leading to fractures.

Claire Gill, CEO of the Bone Health & Osteoporosis Foundation, says that 54 million Americans have low bone mass, and that “Studies suggest that approximately one in two women and one in four men age fifty and older will break a bone due to osteoporosis.”

9 Steps to Take to Minimize Risk Factors

Most falls take place in and around the home, but that doesn’t mean we should just treat them as inevitable. The risk can be minimized if we’re aware of our surroundings. Snow gives the following nine steps to minimizing fall risk: 

1. Eliminate clutter, throw rugs and poor lighting. If you need to get out of bed at night, turn on a light and move slowly.
2. Add grab bars in the bathroom.
3. Make sure handrails are easily accessible for any stairs. When facing stairs anywhere, always use handrails, no matter how few steps are involved.
4. Strengthen your hands. Try using a power ball or a grip strengthener.
5. Check balance issues. An appointment with a qualified neurologist may be required.
6. Check your vision. A new eyeglass prescription can be a lifesaver.
7. Check your footwear. Look for shoes that provide enough support.
8. Eat a Mediterranean-like diet rich in olive oil, fish and nuts and including supplementary vitamin D3.
9. Add physical exercise to your routine. Walking on a regular basis has profound health benefits and “physical activity can reduce morbidity and mortality,” according to arecent study in The Lancet medical journal.

Everyone Has a Story About Falling

Sadly, falling is so common that every person Snow spoke to about this subject during the writing of the article had a story about it. Some of the stories were sadly abrupt: for example, a 50-year-old man who fell and did not survive. Some are more protracted, like a woman who fell several times, improved with rehab each time, and then finally fell, hit her head, and passed away.

“One story from someone I spoke with was especially poignant,” Snow writes. “When Evan Houtrides got a late-night panicked call from his 83-year-old father, osteoporosis was the furthest thing from his mind. His dad fell and couldn’t get up. There was surgery for a broken hip, and then rehab. Things seemed to be on the mend, but then it happened again. Again, there was surgery and rehab, but the slowing down was huge, the cognitive impact was noticeable. Houtrides said the doctor believed the bones broke first, and that the breaks caused the falls. Houtrides’ dad was once the producer of a major television show. Now he requires 24-hour care.”

I Resisted Osteoporosis Medication — Until I Fell

But perhaps the most effective story is the one Snow experienced herself.  For the longest time, doctors told her that she should be on medication for osteoporosis. Snow refused. “The drugs offered promised to stop bone loss but made the bones brittle,” she writes. “A friend took the same drugs and broke several bones when she fell. She believed the breaks were more serious than they would have been had she rejected the suggested medications.”

But then it happened. “In 2019, I tripped on a loose rug going up two steps at the theater. I told the story as a humorous anecdote: ‘I got into a fight with a rug,’ I’d laugh, ‘and I lost.’”

But it wasn’t really a laughing matter. Snow was bruised all over, including her face, and was fortunate that nothing broke. “But the event got my attention,” she writes. “I began to research falls, and osteoporosis. I found that the newer medications didn’t only stop bone loss, they remodeled or encouraged bone growth. Still, I hesitated. Why don’t people do what works? There are valid reasons.”

Osteoporosis is a “Silent Killer”

For one thing, current medications for osteoporosis do have possible side effects, including the potential for unusual thigh bone fractures and fatal strokes. The medications are also costly, with out-of-pocket monthly costs—even with insurance—reaching into the thousands of dollars.

“Moreover,” Snow writes, “until there is a medical emergency, osteoporosis is a silent killer. Any aches and pains may just be dismissed as age related. Even though I’d had the requisite bone density scans that showed I was at risk for severe fractures, there was an element of disbelief. After all, I’d once been a professional dancer. I’d seen x-rays of my feet that showed strong bones, thick and dense. So, I resisted.”

What finally changed Snow’s mind? Two different physicians, an endocrinologist and a cardiologist, assuring her that the risk of fractures outweighed any risk from the medication itself, and that such fractures were far more likely to be fatal.

“So I’ve finally begun treatment — decades after I first was warned,” Snow writes. “I hope I am not too late.”

Information and Resources Readily Available

Self-assessment is a good beginning, so Snow recommends that the first step is to arrange for a bone density or DEXA scan. (DEXA means “dual energy X-ray absorptiometry” – considered the best scanning technology.) It is a painless low dose x-ray that will reveal an overall picture of your bone health. In her article, Snow also gives an exhaustive list of resources which we are including because we feel they could be helpful. 

“There are many resources available with information about risk factors, fall prevention and more,” Snow writes, and provides the following links:

• Bone Health & Osteoporosis Foundation
• Milliman Report: Medicare Costs of Osteoporotic Fractures
• JAMA Evaluation of Fall Prevention & Management for Older Adults
• NIH/Circumstances & Causes of Fall Deaths Among Older Adults

To learn more about current medications, Snow suggests:

• Mayo Clinic
• National Institutes of Health/National Library of Medicine

“The websites of the individual medications mention extreme possible side effects,” Snow cautions. “The official  Evenity website, for example, warns of increased risk of heart attacks. Consider the risk versus benefit. Here’s where talking to a doctor you trust becomes all important.”

What About the Cost?

There’s no way around it: the cost of pills and at-home injections can really add up, and the bills are only partially covered by Medicare. Details depend on where the drugs are administered.  “For the most severe cases, because the injections are administered in a medical setting and the provider accepts Medicare assignment, the patient isn’t responsible for the higher amount,” Snow writes.

But the question really boils down to this: can you risk a fatal fall? What is it worth to protect yourself from that kind of injury?

“Fractures can and do lead to problems with mobility, depression and loss of independence,” Snow writes, to conclude her article. “The  American Academy of Orthopedic Surgeons says death following fractures is a documented reality. Bone health is vital to our overall health, well-being and longevity.”

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(originally reported at www.nextavenue.org)