Are Falls Inevitable for Older Adults?

Aging doesn’t have to result in a fall, but unfortunately, it often does. In fact, according to the Centers for Disease Control, falls among adults 65 and older caused over 36,000 deaths in 2020, making it the leading cause of injury death for that group. Falls also are responsible for at least 300,000 hip fractures each year and they are the most common cause of traumatic brain injuries in the U.S.

Emergency departments recorded more than 3,000,000 visits as the result of falls in 2020, and $50 billion in medical costs.

Clearly, falls are a big deal for an aging population. Research has identified many risk factors for falling, including:

  • Lower body weakness.
  • Vitamin D deficiency (that is, not enough vitamin D in your system).
  • Difficulties with walking and balance.
  • Use of medicines, such as tranquilizers, sedatives, or antidepressants. Even some over-the-counter medicines can affect balance and how steady you are on your feet.
  • Vision problems.
  • Foot pain or poor footwear.
  • Home hazards or dangers such as broken or uneven steps, and throw rugs or clutter that can be tripped over.

Most falls are caused by a combination of these risk factors. The more risk factors a person has, the greater the chances of falling.

Some of these risk factors can be changed or managed. For example, if a woman falls because she is wearing heels, she may need to consider wearing flat, rubber-soled shoes. In the home, throw rugs should be removed to prevent trip hazards, and railings and grab bars should be installed to provide assistance and stability.

Those with difficulties with balance and dizziness problems are at greater risk of falling than most people. That’s because normal balance depends on three primary body systems working in perfect harmony—the inner ear, vision, and proprioceptors, or the sense of the position and movement of the body in space. When any one of these three systems malfunctions, balance can be affected.

What does the inner ear have to do with dizziness and balance?

According to the Vestibular Disorders Association, the inner ear is a complex structure of fluid-filled tubes and chambers. Specialized nerve endings inside these structures sense the position and movement of the head and detect the direction of gravity. Signals sent from the nerves of the vestibular system are critically important to the brain’s ability to control balance in standing and walking. They also control movements of the eyes that make it possible to see clearly while moving.

Anatomical studies have shown that the number of nerve cells in the vestibular system decrease after about age 55. Blood flow to the inner ear also decreases with age. When the vestibular system is damaged, an individual may experience dizziness and balance problems. However, the gradual loss of vestibular nerve endings with aging can result in balance problems without any associated dizziness. This type of slow loss of vestibular function may be first noticed as difficulty walking or standing, especially in the dark while on soft or uneven surfaces (such as thick carpet or on a trail).

A decline in balance from inner ear function may be caused by a number of conditions including normal aging, benign paroxysmal positional vertigo (BPPV), infection, Meniere’s disease, or diminished blood flow to specialized nerve cells.

In addition, certain medications such as some antibiotics for severe infections and chemotherapy may damage the inner ear, resulting in temporary or permanent hearing loss, impaired balance, and trouble seeing clearly while in motion. Feelings of dizziness, vertigo, imbalance, and disequilibrium may indicate that the inner ear is not functioning correctly.

What should I do if I’m dizzy or fall?

Any time you are dizzy or fall, you should report it to your primary care healthcare professional who can help determine next steps in diagnosis and treatment. They may find a medical problem or medications are interfering with balance.

For example, you may need to visit your eye doctor to make sure your glasses are the correct prescription. If you have bifocal or progressive lenses, you may want to get a pair of glasses with only your distance prescription for outdoor activities, such as walking. Sometimes progressive lenses can make things seem closer or farther away than they really are, which is especially risky when walking down steps or slopes. It is also important to be screened for diabetes, cataracts, macular degeneration or neuropathy.

In some cases, an individual may be referred to an audiologist who specializes in dizziness or balance/vestibular disorders for a comprehensive evaluation. This specialist can help determine the cause of the problem if it’s related to inner ear function.

Balance disorders are often accompanied by changes in hearing and/or ear function. These changes can be obvious or hardly noticeable by the patient. Danielle Dorner, Au.D., is a vestibular disorders specialist with Associated Audiologists. She is highly experienced at performing comprehensive testing of the outer, middle, and inner ear. These dizziness and balance tests include audiologic, tympanometry/immittance, and otoacoustic emission evaluations.

If she determines that the issue is caused by an inner ear problem such as BPPV, she can treat it. Or, if she determines another medical issue may be the cause, she can make a referral to the appropriate specialist.

Schedule an appointment with our vestibular disorders specialist.