Prevent Falls: Know the Risk with Heart Disease

The risk of falling increases with age – and represents a leading cause of injury, disability and even death in older Americans. Factors that could contribute to this increased risk include changes
in eyesight, hearing, reflexes and loss of muscle mass – all of which may come with aging. For people with cardiovascular disease, the risks are even higher. In fact, according to a report in AHA/ASA’s Circulation: Cardiovascular Quality and Outcomes, 60 percent of people with heart disease are at a moderate or high risk for falls. This increased risk may be caused by certain medications, low blood pressure, cardiac arrhythmias, increased frailty and fainting. Other health conditions such as diabetes or problems with your thyroid, nerves, feet or blood vessels can also affect your balance and lead to a fall. But, falling doesn’t have to be an inevitable aspect of aging. Falls can be prevented by understanding risk factors, taking safety measures within the home, remaining physically active and more.

Staying Safe at Home

Preventing slips, trips and falls as you age starts with taking a careful look at your living environment to identify and eliminate potential hazards.

• Secure electrical cords, and keep floors and stairwells free of clutter. Don’t use throw rugs or small area rugs.
• Be sure to secure and use stair railings. Add non-slip rubber tread to steps.
• Keep frequently used supplies and items within easy reach (between waist and shoulder height). If you must use a step stool, use one with a bar to hold onto.
• Never use a chair as a stool.
• Install grab bars in bathrooms and showers. Consider adding a shower seat. Place nonskid mats, strips or carpet on all surfaces that may get wet.
• Place a sturdy chair in your bedroom so you can sit while getting dressed.
• Check for adequate lighting – particularly near steps and hallways. Install nightlights as needed to ensure safety.
• Use assistive devices such as a cane or walker to support activities of daily living. 

Aging Gracefully in a Strong Body

Exercise is an important part of improving safety. Walking, aquatic exercise, balance and strengthening activities can help reduce your risk. If you’re not sure where to start, ask your doctor for a referral to physical therapy for exercises individualized to you (see sidebar below on WakeMed’s program!). There are also simple exercises to do at home. However, it’s important to take it slowly and ensure steadiness when engaging in them:

• Sit to stand: Sit in a sturdy chair. Practice standing up and sitting down 10 times in a row.
• Heel raises: Hold onto the kitchen counter with both hands. Rise up on your toes and slowly lower 10 times.
• Side leg kicks: Hold onto the kitchen counter with both hands. Slowly kick one leg to the side. Repeat on each side 10 times. 

Medications Increase Risk

The following medications have been shown to increase risk of falls. If you’re on these medications, ensure you’re taking extra precautions to reduce your risk of falling.

• Arrhythmia medications
• Antidepressants
• Antipsychotics
• Anti-anxiety medications (benzodiazepines) such as lorazepam and nonbenzodiazepine, sedative hypnotics such as zolpidem
• Diabetes medications
• Diuretics
• High blood pressure medications including beta-blockers, ACE inhibitors and angiotensin receptor blockers (ARBs)
• Opioids
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Selective serotonin reuptake inhibitors (SSRIs)

Focus on Footwear

Wearing the right shoes can help reduce your risk of falling. Rubber shoes that fit well, bend, bounce and grip are ideal. Avoid super sticky waffle grip running shoes as they can be too gummy and cause tripping. Avoid loose-fitting shoes – a good pair should enclose the heel and fit firmly around the foot to hold them in place. Avoid high heels altogether, except a block heel for a rare special occasion. Avoid walking around the house in bare feet or socks – wearing shoes or well-fitting slippers is safer. 

Having Crucial Conversations

Too often, the risk of falls is often overshadowed by other medical concerns. Talking with family, friends and health care providers is the best way to improve your safety.

“This time of year, you expect to have a wonderful fall season, but as you mature, be careful not to have an injury due to an unexpected fall,” said Dr. Sydney Short, WakeMed Heart & Vascular - Cardiology. “I find in my practice that older adults are hesitant to talk about falls, specifically with their family members or doctors. They worry about losing their independence. But, having these conversations helps patients maintain their independence and quality of life – and even save lives. Opening up about falls and addressing the risks can help older adults stay active, healthy and able to do the things they enjoy most.”

Research even shows that minor falls not associated with significant injury can lead to a fear of falling and functional decline in seniors – which can have a real impact on quality of life. Bottom line? If you’ve fallen, or are at risk for falls, take the first step by talking to your doctor and your loved ones about reducing your risk.

This blog is adapted from Heart to Heart Magazine. Subscribe today.