The fear of falling increases the risk of doing so as people will try to avoid certain tasks causing further declines in strength, balance and moresimonkr/Getty Images
When you trip and fall in your twenties, thirties, even into your forties, it’s often a minor incident. You might walk away with a few scrapes and bruises or a strained muscle. As you get older, taking a tumble can have more significant consequences, such as bone fractures or breaks, which can take longer to heal.
In Canada, falls are the leading cause of injury-related hospitalizations and injury deaths among those 65 and over. But you can start taking steps now, no matter your age, to minimize your likelihood of falling as you get older and to minimize injury if you do fall.
Why we fall in older age
As you get older, a number of factors come together to increase your likelihood of losing balance. This can include diminished eyesight, hearing and proprioception (your sense of your body’s movement and position in space), and slower reflexes. Conditions like diabetes can cause dizziness, and certain medications can cause drowsiness, which impairs alertness.
To recover from losing your balance, you need quick, explosive strength, but as we age, our muscles start to lose size, strength and power, explains Dylan Kobsar, an associate professor of kinesiology at McMaster University.
And there is another risk factor: fear. “Some people will stay away from activity for fear of falling and that actually increases their risk of falling,” says Nikki Fraser, a Toronto-based exercise physiologist.
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That avoidance can lead to further declines in strength, balance and sensory feedback, says Kobsar. “Fear can also change the way we move,” he says. “People often become more rigid and cautious, which reduces adaptability and responsiveness.”
When your brain is so focused on anxiety around falling, that also pulls focus away from completing complex motor tasks. And fear of falling is in itself a risk factor for diminished quality of life and loss of independence.
Fractures and breaks are among the biggest concerns from falls in older adults, and that’s largely because of weaker and more brittle bones. But unlike muscle loss, bone loss is harder to spot.
“Osteoporosis is a silent thief,” says Fraser.
Around 2.3 million Canadians are currently living with osteoporosis and one in three women and one in five men will break a bone due to osteoporosis in their lifetime.
What you can do to prevent falls and minimize impact
Even if you’re decades away from older age, you can prevent many falls before they happen by starting now. Getting a bone density test or a DEXA scan starting at around 30 to set a baseline can help you track changes as you age, says Fraser.
It may seem obvious but the most important step you can take is simply being active. The more you shy away from the activities that feel risky, whether that’s walking on a snowy surface or lifting your heavy grocery bags from the floor to the counter, the more out-of-practice you become and the more daunting it will feel when similar situations arise that are beyond your control.
Around the age of 30, most people begin losing mass at a rate of about three to five per cent per decade, but adding resistance training to your exercise program can stave off some of that loss, which in turn can improve balance and stability and increase bone density. Choosing the right amount of resistance will be relative to your level of ability. You do, however, have to challenge yourself.
Once you can execute an exercise with no weight and good form, you can begin adding resistance using the Reps in Reserve scale (RIR). For example, if you want to reach eight repetitions in a set, use a weight heavy enough that when you reach eight reps, you feel like you could do two or three more. If you think you could do more, increase the weight. If you can’t imagine doing even one more rep, drop it down.
These two simple exercise positions will help with mobility and movement
Between the ages of 30-60 you should be adding high-velocity training as well, says Kobsar. That can be plyometric exercises – short, explosive movements – but it can also look like moving a weight more quickly through the lifting phase of an exercise (think: pressing dumbbells overhead faster or pulling a kettlebell deadlift from the floor at a quicker tempo).
After 65, in addition to focusing on building lower body strength and balance, add functional movements like sit-to-stand from a chair, step-ups or wall squats, Kobsar suggests. Dedicated balance training, even something as simple as standing with your eyes closed, then on one foot, or on an unstable surface like a pillow can improve your control and confidence.
“The most important thing is to gradually progress and change yourself safely,” says Kobsar. “Whether you’re 30, 60 or 90, consistent effort leads to measurable progress.”
Try to engage in some kind of strength training three times a week for approximately 30 minutes. If that’s too much, start with what you can. “Something is always better than nothing,” says Fraser.
And while ideally you would get and stay active a few decades before falls become a major concern, there’s never a bad time to start. “That’s the beauty of exercise,” says Fraser. “It’s literally never too late.”
Alyssa Ages is a journalist and the author of Secrets of Giants: A Journey to Uncover the True Meaning of Strength. She is also a strongman competitor and endurance athlete, as well as a former personal trainer and group fitness instructor.
