Do not fall and if you fall, do not fracture

A healthy 72-year-old, a friend’s mother, stepped outside the home into a gap between two paver stones on the footpath, stumbled, fell, broke her hip, was operated within 48-hours but just couldn’t get back to her normal routine, deteriorated physically and mentally and died 14 months later.

This is not an uncommon story. Many of you have likely already faced such situations, either with yourselves or with elders in the family and realized how devastating falls and fall-related injuries and their aftermath can be.

Almost 1/3rd of people above the age of 60 fall at least once in their lifetime and some, multiple times. There are now almost 91 million people (9.1 crores) in India, which means that a large number of people are at-risk for falling and fall-related injuries and complications. For example in 2019, 2.2 lakhs (220,000) people died of falls and fall-related complications [1], which is likely an underestimation.

As part of our atmasvasth quest to live long, healthy, we need to not fall and if we fall, not fracture.

Today’s focus is just on falls prevention. I will discuss the issue of improving the density and quality of our bones, another day.

There are many guidelines and suggestions, some based on data and some on common sense telling us what to do to prevent falls. These can be broadly classified into

1. Physical activity
2. Personal measures
3. Home measures

Physical activity

Physical activity, as I keep repeating ad nauseam, in any form, is the one magic pill that makes a difference. For falls prevention though, strength and balance training have to be part of the physical activity routine. Tai-chi has been proven to reduce the incidence of serious, injurious falls [2] and hence, logically, even yoga should help. Though yoga has been found to improve balance [3], studies showing its efficacy in reducing the incidence of falls are lacking, a deficit that will hopefully be addressed in the near future. So, if you regularly practice yoga, as I do, please continue to do so.

Personal measures

The following need to be addressed:

1. Vision and hearing: We should be aware of what is happening around us.

2. Medications: All medicines that can lead to falls should be reviewed. Many people, by the time they reach 65-70 years of age, become victims of polypharmacy, taking multiple drugs for multiple problems, whether needed or not. Not just for falls prevention, but even otherwise, every couple of years, it is a good idea to review the list of medicines and reduce them to the lowest number needed to maintain optimal health.


3. Hypotension and giddiness, especially postural: If we lose balance or become giddy when getting up suddenly from bed or from the toilet seat, we should learn to take it slow and easy during these activities.

4. Supplements: Vitamin D and calcium supplements help when there is deficiency, but not otherwise.

5. Canes and walkers: They make a difference [4]. The problem is that those who are currently over 70 years of age, have a marked antipathy to using them for a variety of socio-cultural reasons, a problem that needs to be addressed gently and tactfully.

6. Avoidance of dangerous activity: The last two parents of friends who fractured had similar stories. They were climbing on footstools to reach out for something in the kitchen and fell and fractured. I am not even talking of dangerous activities like skiing or skating…even climbing onto ladders or unstable stools, trying out new dance steps (one parent during a wedding sangeet started dancing vigorously, slipped, fell and fractured), aggressive yoga postures…as we age, we need to understand the limitations of our bodies and behave accordingly.

Home measures

These involve assessing the home for fall risks (e.g. slippery floors, placing railings in the toilets and bathrooms, replacing worn out carpets, etc) as well as addressing issues in the buildings (e.g. lack of guide rails, good lighting, etc) and instituting measures to improve our surroundings to reduce the risk of falls. It is a good idea, every now and then to do a quick recce of our homes and surroundings to make sure they are fall-proof.

So, how does all this affect you and I? In our atmasvasth quest to live long, healthy, you need to make sure you do not fall and if you do fall, that you do not land up with serious injury. Physical activity helps build muscle strength and improves balance. You should check your vision and hearing, reduce unnecessary medications, use canes if needed, avoid stupid dangerous activities and ensure that your home and surroundings are “fall-proof”.


1. Kaur R, et al.. Natl Med J India. 2020 Jul-Aug;33(4):195-200

2. Li F et al.. JAMA Netw Open. 2019 Feb 1;2(2):e188280

3. Youkhana S et al. Age Ageing. 2016 Jan;45(1):21-9.

4. Luz C et al.. Gerontologist. 2017 Apr 1;57(2):211-218



Views expressed above are the author’s own.


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Sagar Biswas

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