Good lighting, solid railings on stairs, removing clutter and rugs ... these are some common tips medical experts cite to help older people reduce their risk of falls. But there are other, less obvious ways to help prevent falls, which send 2.5 million older people to emergency rooms every year. About 700,000 need to be hospitalized.
Being on the lookout for hidden health problems that could precipitate a fall may help prevent broken wrists, legs, hips and head injuries that threaten seniors with long-term disability and loss of independence.
Click through to find out about the little-known health hazards behind many falls -- and how to avoid taking a spill that will end in a hospital visit:
"Over the years, I've been struck by the fact that some of the more serious infections I treated were in people who came to the hospital because they fell," said Dr. Farrin Manian, an infectious disease expert and an inpatient clinician educator in the Department of Medicine at Massachusetts General Hospital, in Boston, and a visiting associate professor at Harvard Medical School.
Manian said that while a fall brought these patients to the emergency room, many had vague early signs of an infection, such as weakness or a low-grade fever. It spurred him to conduct a study which he recently presented at an annual scientific conference sponsored by the Infectious Diseases Society of America.
He and colleagues analyzed the emergency room records from 161 patients who went to the hospital because they fell but who were later diagnosed with an infection. Forty-four percent had a urinary tract infection, almost 40 percent had a bloodstream infection, 23 percent had a lower respiratory infection and almost 6 percent had a heart valve-related infection. A coexisting infection was not suspected in 40 percent of the patients, because typical infection symptoms -- fever, rapid heart rate, and low white blood cell count -- weren't often present on initial evaluation, said Manian.
"The types of bacteria that caused bloodstream infections were somewhat surprising to us, with Staphylococcus aureus, a virulent germ, found to be the most frequent cause," he said. About a third of patients had documentation of weakness, lightheadedness, confusion, or fever before the fall, but the actual number may be higher, according to Manian. Until further studies are performed, he said patients and families should be more attentive to the signs and symptoms of infection in the elderly, and seek medical advice early when in doubt.
"Ultimately, it would be great if we could catch infections early and potentially prevent many of these falls," Manian said.
Loss of sensation
The senses lose their edge as people get older, said Dr. Arun Karlamangla, a geriatric medicine specialist and researcher at Ronald Reagan UCLA Medical Center.
"Sensitivity to stimuli goes down with age. All systems are aging and over time, things get less effective. These are usual changes with aging." One unexpected spot: the feet. "Your ability to sense the unevenness in the floor goes down, to sense the change between a hard surface and a soft one," he said.
Dr. Cathleen Colon-Emeric, an associate professor of medicine at Duke University Medical Center where she is a geriatric and internal medicine specialist, recommended, "Wear relatively thin-soled shoes so you can feel the floor better." Shoes with rubber, anti-skid soles, such as Keds, might help you feel the nuances in the ground beneath your feet, she said.
Weak leg muscles
"Muscle strength goes down over time. The thighs especially lose strength," said UCLA's Karlamangla. But that doesn't have to be the case, he said. "Keep walking, keep exercising, keep up good posture."
Duke's Colon-Emeric said muscle weakness can also come from not eating enough protein, which is vital to muscles. Other nutrition issues can impact strength, too. "Vitamin D is also important for muscle function. We often check vitamin D levels and may recommend vitamins D supplements to try to prevent falls," she said.
Seniors on Medicare interested in becoming more fit can participate in the SilverSneakers program, said Colon-Emeric. It offers users free access to more than 13,000 gyms, YMCAs, and other fitness centers across the country, and services are focused on the fitness and health needs of older adults including improving balance, flexibility, and strength.
Vision diminishes in middle age and beyond, so it's important to go for regular eye checks so that your glasses are up to date, Karlamangla said. But what some might not realize is that certain types of glasses with progressive bifocal lenses may hinder safety rather than help.
"Some people wear these transition glasses. They can hurt older people, though. They're great for reading but it's the lower part of the glasses which, when you're walking, are not for distance. When walking, you need to be able to see the floor. Instead, get a second pair of glasses -- one for reading and one for walking," he said.
Parkinson's, Alzheimer's, stroke, and other neurological conditions can impact balance. Those suffering with memory loss, such as Alzheimer's, often have gait disorders, and judgment can be impaired, increasing the risk of falls, said Colon-Emeric.
Thyroid conditions and vitamin B deficiencies can have the same effect, so it's important to see a doctor if any of these conditions exist and ask about getting a screening for fall risk. Discuss interventions such as physical therapy, which can help with balance, strength, and flexibility.
"Medications are a really big factor in falls," said Colon-Emeric of Duke. Which drugs can be the biggest instigators? "Any medications that cause drowsiness. Painkillers, especially when you first start taking them, and when combining medications with other medications," she said.
Antidepressants, anxiety medicines, sleep medicines -- all of these can increase the chance of falling. Even some over-the-counter drugs people don't typically think of as being unsafe can lead to falls, said Colon-Emeric, including Benadryl and any of the "PM" medications. "Those will tend to make people very woozy and can make blood pressure drop," she said.
Some drugs used to treat overactive bladder, enlarged prostate, and hypertension can be problematic as well.
"Some meds we give for hypertension, blood pressure medicines themselves, they're safe. But it's when you're first starting them that you're at a higher risk for falls," Colon-Emeric explained.
She noted that blood pressure drops when you stand up and said, "Older adults aren't able to regulate their blood pressure as well as younger people. If a patient experiences a drop in blood pressure upon standing up, medication can be changed or compression stockings may help."
Karlamangla said a list known as the Beers Criteria may come in handy when it comes to medication use in the elderly. This month, the American Geriatrics Society released its second updated and expanded Beers Criteria list which details potentially inappropriate medications for older adults.