Falling down can be quite dangerous and is surprisingly common. Falls are more prevalent in older adults, 65 and up, with 3 million falls seen per year in emergency rooms. As a podiatrist, I see this very often and it breaks my heart to see one of my regular patients come in with a black eye, broken nose, or scraped up face. Secretly I think to myself: “Whew! Could have been worse!” and am relieved not to see a broken wrist, concussion, or skull injury.  Also worrying is the fact that one fall is a big risk factor for another fall. Over the years I have worked hard to create fall prevention plans for patients. But before we go into what to do, let’s discuss why it’s happening.

I think the initial problem is that once you reach 50 years old, it’s more likely that you will take medicines for your heart or blood pressure that can make you dizzy. This can be very subtle, affecting your balance in an almost imperceptible way.

As you get older, you can develop Type II Diabetes. Medicines that lower your blood sugar can cause relative hypoglycemia that, you guessed it, can make you dizzy. Some of the newer meds make you nauseous as well, in order to reduce appetite. If you’ve ever been on a cruise, you already know that dizziness and nausea go hand in hand.

Other issues involved in the risk of falling are muscle weakness from lack of exercise, vision problems, pain in feet, knees, or hips. Then of course there are environmental factors to consider- dark apartments, throw rugs, broken slippers, clutter, and so on. I’ve gone to patient’s apartments, hit the light switch, and nothing happens. I ask the patient: “How many podiatrists does it take to change a light bulb?”

Exercises to Improve Balance: Exercises for balance should be done on a daily basis so muscles can begin to get stronger each day.

Hold onto a countertop or door frame and stand on one leg. Clap your hands and then return them to supporting you. Be careful. You want to challenge your balance, but don’t overdo it. Try to increase the amount of time you can stand on one leg, but keep your hands ready to save you from falling. Joining a t’ai chi class is another option.

Go Outside: Looking at the far horizon and all the layers of objects in between triggers the action of the cerebellum, the part of your brain that reflexively stops you from falling.

This has been well proven in scientific research as well as its opposite premise; that staying inside over time increases your risk of falling. When I asked an older doctor about this many years ago, he told me that staying inside was a form of sensory deprivation which lowers the action of the cerebellum.

Supplements: I recommend taking 2000 u of vitamin D as this has been shown to reduce falls, though you must remember to go outside and get a little sun to activate it.

Another very good supplement is fish oil omega 3 capsules. Omega 3 is an essential fat which your body cannot produce and which supports a healthy brain and nerves. The human brain is fat. No brain, no balance.

Using a Cane: Today I asked a patient to use a cane after her seventh fall in the last two years. She had just gotten back from the hospital after falling in the subway. And yet she was very resistant to the idea of using a cane.

I explained that the cane needn’t even touch the ground. Simply holding it in one hand, without it touching the ground, as a tightrope walker holds a long stick, offers a subtle counterweight that can improve balance. A cane can speak to those around you saying “Give me a seat!” on the subway, or “Clear my path!” on the sidewalk. It can speak to you as well: “Hey, Buddy! Slow down and have a care where you’re going!

Have Confidence: Ironically, the fear of falling can make you fall, such as a stutter step, a moment of hesitation, and the lack of momentum that comes with a slow gait. If you have been sick for a while, bed ridden, or simply inside a lot due to the weather, you can lose your best asset- your confidence.

Please, don’t give up. I have patients in their 90’s that I have helped to get outside and regain their mobility and independence. You can do it, too, by working on it a little bit each day.

Using a Rollator: One day you may need a wheely, push device, or rollator. This is a lot better than not going out!

They are light weight and some models have brakes and a seat. The rollator can help you retain your independence and support your ability to go out.

The Right Footwear: Do you remember when Mr. Rogers came home? He put on his sneakers. That’s a great idea; laced up, thin soled canvas sneakers.

The feel of the sneaker gives the brain proprioceptive, tactile information that goes to your muscle cortex and helps muscles fire faster in response to stimulus. The rubber grip on the bottom also helps prevent slipping. If you don’t like tying shoe laces, you can replace them with elastic laces and use a shoe horn to get your foot in them. Good luck with this! If you work on your balance a little bit every day, you may surprise yourself with the progress you can make.