Every year, about 2 million Americans experience a traumatic brain injury (TBI), typically in the form of a concussion. While concussion victims usually make a full recovery, TBIs cause about 100,000 deaths in the United States annually.
Even when a TBI is not fatal, brain damage can impair physical abilities, including the ability to walk and stand. A TBI can also make it difficult to communicate, to reason, and to form and retrieve memories. About 5.3 million Americans live with disabilities related to a TBI.
Accidental falls are the second leading cause of serious brain injuries, following death by suicide but ahead of injuries sustained in motorcycle accidents, car crashes, and assaults. TBIs are responsible for about a quarter of all injury-related deaths in the United States.
Brain Injuries in Older Adults
The CDC characterizes brain injuries as America’s silent epidemic because the injuries are not usually visible. Older adults are disproportionately the victims of traumatic brain injuries. Recent research confirms that people who are 75 or older suffer the highest rates of TBI-related deaths.
Accidental falls account for more than half of all TBI-related hospitalizations and deaths of older adults. About 80,000 older adults are examined in emergency rooms every year after experiencing a TBI. About three-quarters of those examinations result in hospital admissions.
Adults between the ages of 65 and 74 are about twice as likely as younger people to be hospitalized after a fall, while people 75 or older are three times as likely as any other age group to be hospitalized after falling. Unfortunately, older adults who are hospitalized for TBIs are at risk of falling again during their hospitalization, often while trying to get out of bed or when using the bathroom.
Health conditions associated with age increase the risk of experiencing a fall-related TBI. Diabetes mellitus, for example, almost doubles the risk of falling in older adults.
The Importance of Balance
Poor balance is one factor that accounts for higher rates of falling as people age. Unsteadiness may be linked to an underlying health condition that needs treatment. Inner ear infections, nerve and thyroid disorders, vision problems, and heart disease can all cause vertigo and other balance problems. Medications can also contribute to impaired balance.
Even the healthiest adults lose muscle mass as they age. People generally lose 3-8% of their muscle mass during each decade after they turn 30. The rate of decline increases after age 60. The loss of muscle mass affects strength and stability, increasing the likelihood of falling as people grow older.
Physicians recommend that individuals begin to conduct regular self-assessments beginning at age 50. A person who can balance on one leg for ten seconds is probably fine. It’s wise to stand next to a wall during that test so that support is available if needed.
Another assessment begins by standing after being seated in a chair, starting a timer, walking ten feet, then turning and walking back to the chair. If that exercise takes more than fifteen seconds, the risk of falling is very high. If it takes less than ten seconds, the risk of falling is substantially less.
Guarding Against Falls
Falls that are caused by tripping on an uneven surface or slipping on a wet or icy surface can happen to people of all ages. Those falls are especially dangerous, however, for seniors. Keeping a vigilant lookout for hazardous conditions is the best way to avoid those falls.
One way to protect against falls in the home is to remove tripping hazards, such as loose rugs and cords stretched across a floor. Another is to assure that lighting in living spaces is bright. The addition of grab bars to bathrooms reduces risk in the room where falls most commonly occur.
The risk of falls associated with the loss of muscle mass can also be mitigated. Roopa Anmolsingh, a geriatrician at Cleveland Clinic, cautions against the “misconception that part of getting old is, you’re going to fall. It isn’t true.” Dr. Ammolsingh argues that exercising to maintain or improve balance is the key to maximizing independence and reducing the risk of falling as people age. While a lifetime of physical activity is the best way to slow the loss of muscle mass, Dr. Ammolsingh says it is never too late to start exercising.
Tai chi and yoga are among the best exercises for older adults because movements are slow. Exercises are most effective when they become a routine part of life.
Balance exercises have the added benefit of training the mind to react to a loss of balance and correct a stance or take other action to avoid falling. Even shifting weight from one leg to another while waiting in a line can help keep muscles strong, but experts recommend engaging in daily, repetitive exercises to achieve the greatest benefit.