Falls can be dangerous at any age. Babies and young children can get hurt falling off furniture or down the stairs. Older children may fall off playground equipment. For elderly people, falls can be especially serious. They are at higher risk of falling. They are also more likely to break a bone when they fall, especially if they have osteoporosis. A broken bone, especially when it is a hip, may even lead to disability and a loss of independence for the elderly.

Some common causes of falls include

• Balance problems
• Some medicines, which can make you feel dizzy, confused, or slow
• Vision problems
• Alcohol, which can affect your balance and reflexes
• Muscle weakness, especially in your legs, which can make it harder for you to get up from a chair or keep your balance when walking on an uneven surface.
• Certain illnesses, such as low blood pressure, diabetes, and neuropathy
• Slow reflexes, which make it hard to keep your balance or move out of the way of a hazard
• Tripping or slipping due to loss of footing or traction

At any age, people can make changes to lower their risk of falling. It important to take care of your health, including getting regular eye exams. Regular exercise may lower your risk of falls by strengthening your muscles, improving your balance, and keeping your bones strong. And you can look for ways to make your house safer. For example, you can get rid of tripping hazards and make sure that you have rails on the stairs and in the bath. To reduce the chances of breaking a bone if you do fall, make sure that you get enough calcium and vitamin D.

Several factors can lead to a fall. Loss of footing or traction is a common cause of falls. Loss of footing occurs when there is less than total contact between a person’s foot and the ground or floor. Loss of traction occurs when a person’s feet slip on wet or slippery ground or floor. Other examples of loss of traction include tripping, especially over uneven surfaces such as sidewalks, curbs, or floor elevations that result from carpeting, risers, or scatter rugs. Loss of footing also happens from using household items intended for other purposes – for example, climbing on kitchen chairs or balancing on boxes or books to increase height.

A fall may occur because a person’s reflexes have changed. As people age, reflexes slow down. Reflexes are automatic responses to stimuli in the environment. Examples of reflexes include quickly slamming on the car brakes when a child runs into the street or quickly moving out of the way when something accidentally falls. Aging slows a person’s reaction time and makes it harder to regain one’s balance following a sudden movement or shift of body weight.

Changes in muscle mass and body fat also can play a role in falls. As people get older, they lose muscle mass because they have become less active over time. Loss of muscle mass, especially in the legs, reduces a person’s strength to the point where she or he is often unable to get up from a chair without assistance. In addition, as people age, they lose body fat that has cushioned and protected bony areas, such as the hips. This loss of cushioning also affects the soles of the feet, which upsets the person’s ability to balance. The gradual loss of muscle strength, which is common in older people but not inevitable, also plays a role in falling. Muscle-strengthening exercises can help people regain their balance, level of activity, and alertness no matter what their age.

Changes in vision also increase the risk of falling. Diminished vision can be corrected with glasses. However, often these glasses are bifocal or trifocal so that when the person looks down through the lower half of her or his glasses, depth perception is altered. This makes it easy to lose one’s balance and fall. To prevent this from happening, people who wear bifocals or trifocals must practice looking straight ahead and lowering their head. For many other older people, vision changes cannot be corrected completely, making even the home environment hazardous.

As people get older, they also are more likely to have a variety of chronic medical conditions that often require taking several medications. People with chronic illnesses that affect their circulation, sensation, mobility, or mental alertness as well as those taking some types of medications (see above table) are more likely to fall as a result of drug-related side effects such as dizziness, confusion, disorientation, or slowed reflexes.

Drinking alcoholic beverages also increases the risk of falling. Alcohol slows reflexes and response time; causes dizziness, sleepiness, or lightheadedness; alters balance; and encourages risky behaviors that can lead to falls.

The force of a fall (how hard a person lands) plays a major role in determining whether or not a person will break a bone. For example, the greater the distance of the hip bone to the floor, the greater the risk of fracturing a hip, so tall people appear to have an increased risk of fracture when they fall. The angle at which a person falls also is important. For example, falling sideways or straight down is more risky than falling backward.

Protective responses, such as reflexes and changes in posture that break the fall, can reduce the risk of fracturing a bone. Individuals who land on their hands or grab an object on their descent are less likely to fracture their hip, but they may fracture their wrist or arm. Although these fractures are painful and interfere with daily activities, they do not carry the high risks that a hip fracture does.

The type of surface on which a person lands also can affect whether or not a bone breaks. Landing on a soft surface is less likely to cause a fracture than landing on a hard surface.

Preliminary research suggests that by wearing trochanteric (hip) padding, people can decrease the chances of fracturing a hip after a fall. The energy created by the fall is distributed throughout the pad, lessening the impact to the hip. Further research is needed to fully evaluate the role of these devices in decreasing the risk of a hip fracture following a fall.

Many things can cause a fall. Your eyesight, hearing, and reflexes might not be as sharp as they were when you were younger. Diabetes, heart disease, or problems with your thyroid, nerves, feet, or blood vessels can affect your balance. Some medicines can cause you to feel dizzy or sleepy, making you more likely to fall. Other causes include safety hazards in the home or community environment.

Scientists have linked several personal risk factors to falling, including muscle weakness, problems with balance and gait, and blood pressure that drops too much when you get up from lying down or sitting (called postural hypotension). Foot problems that cause pain and unsafe footwear, like backless shoes or high heels, can also increase your risk of falling.

Confusion can sometimes lead to falls. For example, if you wake up in an unfamiliar environment, you might feel unsure of where you are. If you feel confused, wait for your mind to clear or until someone comes to help you before trying to get up and walk around.

Some medications can increase a person's risk of falling because they cause side effects like dizziness or confusion. The more medications you take, the more likely you are to fall.

The fear of falling becomes more common as people age, even among those who haven't fallen. It may lead older people to avoid activities such as walking, shopping, or taking part in social activities.

But don't let a fear of falling keep you from being active. Overcoming this fear can help you stay active, maintain your physical health, and prevent future falls. Doing things like getting together with friends, gardening, walking, or going to the local senior center helps you stay healthy. The good news is, there are simple ways to prevent most falls.

Although most serious falls happen when people are older, steps to prevent and treat bone loss and falls can never begin too early. Many people begin adulthood with less than optimal bone mass, so the fact that bone mass or density is lost slowly over time puts them at increased risk for fractures.

Bones that once were strong become so fragile and thin that they break easily. Activities that once were done without a second thought are now avoided for fear that they will lead to another fracture.

Steps to prevent fragile bones

• Consume adequate amounts of calcium and vitamin D (see “Recommended Calcium and Vitamin D Intake” chart).
• Exercise several times a week.
• Ask your doctor about a bone mineral density test.
• Ask about medications to slow bone loss and reduce fracture risk.

I’ve already had a fracture. Is it too late to talk to my doctor about osteoporosis?
It is never too late. Ideally, you should talk to your doctor during your recovery about whether you might be a candidate for an osteoporosis evaluation. But even if your fracture has healed, you can be evaluated and begin taking steps to protect your bones now.

What kind of doctor should I see about getting an osteoporosis evaluation?
Many different kinds of doctors can evaluate and treat osteoporosis. You might start with your primary care doctor or the doctor treating your fracture. He or she probably can conduct the evaluation and may then refer you to a specialist, such as an endocrinologist or rheumatologist, if you require treatment.

What does an osteoporosis evaluation involve?
One thing your doctor will do is ask about your medical history and lifestyle to determine whether you have risk factors for osteoporosis. Some of the factors that increase the risk of developing osteoporosis include personal or family history of fractures; low levels of the hormone estrogen or testosterone; and the use of certain medications, such as glucocorticoids or anti-seizure medications, that may contribute to bone fragility. Your doctor also may want to test your blood or urine and may suggest that you have a bone mineral density test.

What is a bone mineral density test? Is it painful?
A bone mineral density (BMD) test is the best way to determine your bone health. This test can identify osteoporosis, determine your risk for fractures (broken bones), and measure your response to osteoporosis treatment. The most widely recognized BMD test is called a dual-energy x-ray absorptiometry, or DXA test. The test is painless, a bit like having an x-ray, but with much less exposure to radiation. It can measure bone density at your hip and spine and takes only 15 minutes to complete. For a DXA test, you will be asked to lie on a table while a machine above you measures your bone density.

Falls can often be prevented. Learn steps older Americans can take to protect their vision and reduce their chance of falls.

More than 12 million Americans aged 40 years and older experience vision impairment, and with an aging American population this number is expected to double by 2050. Each year, one in four Americans 65 and older experiences a fall, the leading cause of injury among older adults, and impaired vision more than doubles this risk. Falls often result in serious injuries, decreased mobility, and loss of independence.

Preventing Falls

Doing just one of the following could prevent a fall:

Do exercises to improve strength and balance, such as tai chi.

Wear sturdy, nonslip footwear that fits correctly to help with balance and mobility, and reduce injury to ankles.

Get a dilated eye exam at least once a year to reduce the risk of irreversible vision loss and update glasses if needed.

Talk to your doctor about evaluating risk for vision impairment and/or falls and how to prevent falls. Health care providers should review medications periodically to see if side effects, such as drowsiness or dizziness, could increase the risk of falls.

Make the home safer:

• Remove throw rugs or use double-sided tape to keep them from slipping.
• Make sure all rooms and hallways are well lit and have easily accessible switches or motion sensor lights.
• Install handrails on stairs and grab bars in the bathroom/shower.

Know the Risk

Older adults with impaired vision or who are at risk for vision impairment often have other chronic illnesses, such as diabetes, stroke, and heart disease, which also increase the risk of falling. These chronic conditions are associated with use of prescription drugs that have side effects, such as dizziness and muscle weakness, which can increase fall risk. Furthermore, older adults with vision impairment can be socially isolated and may take on physical tasks they cannot easily perform alone, increasing the risk of injury from falls and making it more challenging to get help if they do fall. Additionally, insulin use is associated with an increased risk of hypoglycemia (low blood sugar), which is often accompanied by blurred vision, dizziness, and weakness, further increasing fall risk.

Falling and vision impairment are among the most common fears for older adults. If you are afraid of falling, you are not alone. Falls are preventable, and strategies for reducing risk and slowing progression of vision impairment may help prevent falls and related consequences for older people. Therefore, older Americans should make sure to take the necessary steps to protect their vision and reduce their chance of falls.

If you take care of your overall health, you may be able to lower your chances of falling. Most of the time, falls and accidents don't "just happen." Here are a few tips to help you avoid falls and broken bones:

• Stay physically active. Plan an exercise program that is right for you. Regular exercise improves muscles and makes you stronger. It also helps keep your joints, tendons, and ligaments flexible. Mild weight-bearing activities, such as walking or climbing stairs, may slow bone loss from osteoporosis.
• Have your eyes and hearing tested. Even small changes in sight and hearing may cause you to fall. When you get new eyeglasses or contact lenses, take time to get used to them. Always wear your glasses or contacts when you need them If you have a hearing aid, be sure it fits well and wear it.
• Find out about the side effects of any medicine you take. If a drug makes you sleepy or dizzy, tell your doctor or pharmacist.
• Get enough sleep. If you are sleepy, you are more likely to fall.
• Limit the amount of alcohol you drink. Even a small amount of alcohol can affect your balance and reflexes. Studies show that the rate of hip fractures in older adults increases with alcohol use.
• Stand up slowly. Getting up too quickly can cause your blood pressure to drop. That can make you feel wobbly. Get your blood pressure checked when lying and standing.
• Use an assistive device if you need help feeling steady when you walk. Appropriate use of canes and walkers can prevent falls. If your doctor tells you to use a cane or walker, make sure it is the right size for you and the wheels roll smoothly. This is important when you're walking in areas you don't know well or where the walkways are uneven. A physical or occupational therapist can help you decide which devices might be helpful and teach you how to use them safely.
• Be very careful when walking on wet or icy surfaces. They can be very slippery! Try to have sand or salt spread on icy areas by your front or back door.
• Wear non-skid, rubber-soled, low-heeled shoes, or lace-up shoes with non-skid soles that fully support your feet. It is important that the soles are not too thin or too thick. Don't walk on stairs or floors in socks or in shoes and slippers with smooth soles.
• Always tell your doctor if you have fallen since your last checkup, even if you aren't hurt when you fall. A fall can alert your doctor to a new medical problem or problems with your medications or eyesight that can be corrected. Your doctor may suggest physical therapy, a walking aid, or other steps to help prevent future falls.

Whether you are at home or somewhere else, a sudden fall can be startling and upsetting. If you do fall, stay as calm as possible.

Take several deep breaths to try to relax. Remain still on the floor or ground for a few moments. This will help you get over the shock of falling.

Decide if you are hurt before getting up. Getting up too quickly or in the wrong way could make an injury worse.

If you think you can get up safely without help, roll over onto your side. Rest again while your body and blood pressure adjust. Slowly get up on your hands and knees, and crawl to a sturdy chair.

Put your hands on the chair seat and slide one foot forward so that it is flat on the floor. Keep the other leg bent so the knee is on the floor. From this kneeling position, slowly rise and turn your body to sit in the chair.

If you are hurt or cannot get up on your own, ask someone for help or call 911. If you are alone, try to get into a comfortable position and wait for help to arrive.

Carrying a mobile or portable phone with you as you move about your house could make it easier to call someone if you need assistance. An emergency response system, which lets you push a button on a special necklace or bracelet to call for help, is another option.

Individuals can protect bone health by following osteoporosis prevention and treatment strategies:

• Consume a calcium-rich diet that provides between 1,000 mg (milligrams) daily for men and women up to age 50. Women over age 50 and men over age 70 should increase their intake to 1,200 mg daily from a combination of foods and supplements.
• Obtain 600 IU (International Units) of vitamin D daily up to age 70. Men and women over age 70 should increase their uptake to 800 IU daily.
• Participate in weight-bearing and resistance-training exercises most days, preferably daily.
• Talk with your doctor about having a bone mineral density (BMD) test. The most widely recognized BMD test is called a dual-energy x-ray absorptiometry, or DXA test. It is painless, a bit like having an x-ray, but with much less exposure to radiation. It can measure bone density at your hip and spine.
• Talk with your doctor about possibly beginning a medication approved by the U.S. Food and Drug Administration for osteoporosis to stop bone loss, improve bone density, and reduce fracture risk.

People need to know whether they are at risk for developing osteoporosis or whether they have lost so much bone that they already have osteoporosis. Although risk factors can alert a person to the possibility of low bone density, only a BMD test can measure current bone density, diagnose osteoporosis, and determine fracture risk. Many different techniques measure bone mineral density painlessly and safely. Most of them involve machines that use extremely low levels of radiation to complete their readings. Sometimes, ultrasound machines, which rely on sound waves, are used instead.

Individuals may wish to have a BMD test to determine current bone health. Today, Medicare and many private insurance carriers cover bone density tests to detect osteoporosis for individuals who meet certain criteria. Talk with your doctor about whether or not this test would be appropriate for you. Falls are serious, but simple, inexpensive steps can be taken to reduce your risk of falling and of breaking a bone if you do fall.

Six out of every 10 falls happen at home, where we spend much of our time and tend to move around without thinking about our safety. There are many changes you can make to your home that will help you avoid falls and ensure your safety.

In Stairways, Hallways, and Pathways

• Have handrails on both sides of the stairs, and make sure they are tightly fastened. Hold the handrails when you use the stairs, going up or down. If you must carry something while you're on the stairs, hold it in one hand and use the handrail with the other. Don't let what you're carrying block your view of the steps.
• Make sure there is good lighting with light switches at the top and bottom of stairs and on each end of a long hall. Remember to use the lights!
• Keep areas where you walk tidy. Don't leave books, papers, clothes, and shoes on the floor or stairs.
• Check that all carpets are fixed firmly to the floor so they won't slip. Put no-slip strips on tile and wooden floors. You can buy these strips at the hardware store.
• Don't use throw rugs or small area rugs.

In Bathrooms and Powder Rooms

• Mount grab bars near toilets and on both the inside and outside of your tub and shower.
• Place non-skid mats, strips, or carpet on all surfaces that may get wet.
• Remember to turn on night lights.

In Your Bedroom

• Put night lights and light switches close to your bed.
• Keep a flashlight by your bed in case the power is out and you need to get up.
• Keep your telephone near your bed.

In Other Living Areas

• Keep electric cords and telephone wires near walls and away from walking paths.
• Secure all carpets and large area rugs firmly to the floor.
• Arrange your furniture (especially low coffee tables) and other objects so they are not in your way when you walk.
• Make sure your sofas and chairs are the right height for you to get in and out of them easily.
• Don't walk on newly washed floors—they are slippery.
• Keep items you use often within easy reach.
• Don't stand on a chair or table to reach something that's too high—use a "reach stick" instead or ask for help. Reach sticks are special grabbing tools that you can buy at many hardware or medical-supply stores. If you use a step stool, make sure it is steady and has a handrail on top. Have someone stand next to you.
• Don't let your cat or dog trip you. Know where your pet is whenever you're standing or walking.
• Keep emergency numbers in large print near each telephone.

If you have fallen, your doctor might suggest that an occupational therapist, physical therapist, or nurse visit your home. These healthcare providers can assess your home's safety and advise you about making changes to prevent falls.

Your Own Medical Alarm

If you’re concerned about falling, think about getting an emergency response system. If you fall or need emergency help, you push a button on a special necklace or bracelet to alert 911. There is a fee for this service, and it is not usually covered by insurance.