Why Are More People Are Falling Over Earlier In Life?

When did you last fall over? It’s something we associate with the very old or the young, but in the last 20 years more there’s been an increase in middle-aged people seeking medical attention as a result of falling with studies showing a sharp increase in falls after the age of 40. Falls used to start to be a problem at age 65, but in the last 20 years we’ve seen that creep earlier and earlier, and now more people in their late 40s and early 50s are seeking medical help because of falls.

There are no definitive reasons as to why these rates are rising, although some researchers speculate it could be due to our increasingly sedentary lifestyles making us less steady on our feet and poor nutrition throughout our life.

Transmission Collection by Erik Bjerkesjo

Falling is a Sign of Poor Physical Health

Despite what people think, falls aren’t something that ‘just happen’ because you’re getting older and they’re not ‘inevitable’; they are preventable and studies are indicating that middle-age could be the critical life stage for interventions to prevent them. When people have lost the strength to absorb impact or don’t have the reaction speed needed to protect themselves when they fall, they can sustain serious injuries or even die. Falls can create serious long-term health problems and, if our reflexes have diminished, inappropriately landing can cause significant injuries and a loss of confidence which can have devastating long-term effects, reducing mobility and even resulting in a decreased quality of life.- people can hit their head or land in a way that results in serious damage. Once there is a fear of falling, this creates a vicious circle which seriously impedes someones quality of life, they become cautious, anxious and are unable to enjoy activities in the way they used to.

People are starting to fall and break their wrists in their 40s when it used to be the 60s and hip fractures were most common seen around 75 - 80 but now there’s an increase in hip fractures from our late 50s.

Are you balanced?

A lot of people’s solution to deal with poor balance is to avoid putting themselves in situations that create uncertainty and test them. However, avoidance isn’t a great coping strategy and leaves us less resilient and more vulnerable to things happening in the future. Declining mobility and increasing balance issues are not a sign you’re getting older, they’re a sign you need to challenge yourself to improve these traits.

Any unexpected or unexplained falls are a warning sign your stability has decreased and also that you need to work on your balance. There are three types of sensory input we use for balance - visual information about our surroundings, our vestibular system which is the fluid-filled canals of our inner ears and proprioceptors which send signals from our joints (especially our ankles, knees and hips). Our brain has to collate and coordinate information from all of these inputs and decide the most appropriate balance-recovery reactions such as grabbing a handrail, putting our arms out to absorb impact or taking a step. The problem with this is if you haven’t used these unconscious reflexes for years, like most things left unused, they become rusty and in need of tuning up. Just because we developed the correct movement pattern for falling by doing it over and over as children doesn’t mean we’ll retain that over the decades without revisiting it and the more sedentary we are, the more likely we are to have slower reactions.

Facts on falls

The fall rate in the 40-plus age group is up by as much as 20% on the previous generation
Approximately 10-20% of falls result in fractures
1 in 3 adults aged 50 and over dies within 12 months of suffering a hip fracture
1 in 2 women and 1 in 5 men in the UK will experience a fracture after the age of 50
Three times as many women in their 50’s suffer serious, complex wrist bone fractures when compared to men. In their 60s, women are 5 times more likely to suffer these kinds of fractures compared to men

Falls are the second-leading cause of accidental death worldwide
One American study found fatal falls are rising sharply for those aged between 45 and 64, jumping by 44% between 1999 and 2007
Falls are estimated to cost the NHS more than £2.3bn a year and the annual total cost of fragility fractures to the UK has been estimated at £4.4bn
Over 3 million people in the UK have osteoporosis and are at much greater risk of fragility fractures. Fragility fractures are fractures that result from mechanical forces that would not ordinarily result in fracture, known as low-level (or ‘low energy’) trauma

Causes of falls

There’s no single cause for falling, however it is more common in people who have poor motor function, reduced mobility, who are taking certain prescription drugs or suffer from multiple medical conditions. Environmental circumstances can increase the risk for falls - slipping in the bathroom, falling down the stairs or wearing socks on wooden floors create situations where falls are more likely to occur. Lifestyle choices also increase the likelihood of suffering a fall, such as physical inactivity (balance or strength problems), diseases of affluence (obesity, arthritis, diabetes), poor nutrition and poor sleep quality. Biological ageing can also have an impact, when it comes to vision and mobility issues, but people often disproportionately blame their age instead of looking at other factors.

Environmental

Uneven pavement or sidewalks
High or broken street curbs
Poor lighting
Icy pavements or black ice
Inappropriate footwear

Medical

Joint and muscle problems
Difficulties walking
Visual impairment
Nervous system disorders
Medications that cause dizziness

Falls Are a Future me Problem

If it’s true, that the best way to predict the future is to create it, then a lot of us are doing this by kicking the can down the road, to avoid uncomfortable or bad things so our future self has to deal with them.

Many of us grew up as sedentary children, unable to play outside and stuck in our houses playing computer games or on our devices. We don’t know what the effects long-term will be, but it doesn’t take many guesses to assume it’s not going to be particularly beneficial. Although problems set up in childhood aren’t our fault, it’s important that we address them. Balance is something we learned unconsciously when were young, however we wouldn’t have learned it as well if we were sedentary and this means we haven’t built a solid foundation of movement and nervous system integration which act as protective mechanisms and keep us safe from harm. If you’ve never learned to fall in many different places and different ways, you’re not going to have that ability. Physical inactivity causes a huge loss of strength and balance and anyone who sits for more than 8 hours a day is at 30 to 50% greater risk of frailty later on in their life, which comes with falls and balance problems.

Rising levels of obesity of all ages is also thought to contribute to falls happening earlier because being overweight affects stability and balance. Diabetes is also linked with a higher risk of falling, because the condition causes reduced sensations of the extremities.

The other important element to this is maintaining bone density throughout our life. Movement is the catalyst to lay down bone density as I wrote in a previous post:

Our bones tell the story of ‘use it or lose it’ because the more physical activity we do, the denser and more mineralised our bones become.

When people complain that they have grown weaker, when they struggle to open jars and have poor grip strength, these are warning signs telling you to change course. These issues are not set in stone and bone density can be built up again over time. Women, especially, are vulnerable to fragility fractures and osteoporosis after menopause due to changes in their hormonal production coupled with the fact they exercise significantly less throughout their adult lives than men do, so they are less likely to have maintained bone density through movement and activity.

Do your future self a favour and make sure you are moving well and are also eating well because studies are now finally showing that nutrition aids recovery and, at the time of a fracture, poor nutrition reduced people’s ability to walk unaided six months afterwards, compared to those with good nutrition.

falls don’t have to happen in the first place

Healthy lifestyles promotion targeting people aged 40 and older should take place with the aim of preventing or delaying the onset of ill-health amongst older people. Two key health-related behaviours for healthy ageing are maintaining adequate nutrition and physical activity across all domains - aerobic, strength and balance.

This study showed that middle-aged adults who engage in ‘leisure-time physical activity’ reported fewer falls and fall-related injuries and when the University of British Columbia offered a fall prevention home-based strength and balance retraining exercise program, after 12 months falls reduced by 36%.

Prevention is better than cure

Use a cobblestone tray
Learn to fall - there are many sports like martial arts which teach it and more community outreach from healthcare are offering people ways to learn how to fall safely
Use a balance beam
Train yourself out of using the handrail when walking up and down stairs.
Go barefoot at home
Find an evidence-based falls prevention programme through your healthcare provider

Squat more and sit on your sofa less
Get up and down off of the floor without using your hands
Stand on tiptoes
Stand on one leg cleaning your teeth or when waiting for the kettle to boil
Find a sport or activity such as boxing, parkour, dance or martial arts which uses a lot of dark zone movement, is unpredictable and challenges the system
Stand up and walk around regularly throughout the day

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Evidence-Based Falls Prevention Programs

CDC - Facts About Falls

Elderly people who worry about falling may actually double the chances that they will take a tumble, research has suggested.

Children who spend too much time on their phone are at serious risk of hip fractures in 40s as sedentary lives cause weakened bones, study says