For a while, walking the dog felt hazardous.
Earl Vickers was accustomed to taking Molly, his shepherd-boxer-something-else mix, for strolls on the beach or around his neighborhood in Seaside, California. A few years ago, though, he started to experience problems staying upright.
“If another dog came toward us, every single time I’d end up on the ground,” recalled Vickers, 69, a retired electrical engineer. “It seemed like I was falling every other month. It was kind of crazy.”
Most of those tumbles did no serious damage, though one time he fell backward and hit his head on a wall behind him. “I don’t think I had a concussion, but it’s not something I want to do every day,” Vickers said, ruefully. Another time, trying to break a fall, he broke two bones in his left hand.
So in 2022, he told the oncologist who had been treating him for prostate cancer that he wanted to stop the cancer drug he had been taking, off and on, for four years: enzalutamide (sold as Xtandi).
Among the drug’s listed side effects are higher rates of falls and fractures among patients who took it, compared with those given a placebo. His doctor agreed that he could discontinue the drug, and “I haven’t had a single fall since,” Vickers said.
Public health experts have warned of the perils of falls for older people for decades. In 2023, the most recent year of data from the Centers for Disease Control and Prevention, more than 41,000 Americans over 65 died from falls, an opinion article in JAMA Health Forum pointed out last month.
More startling than that figure, though, was another statistic: Fall-related mortality among older adults has been climbing sharply.
The author, Thomas Farley, an epidemiologist, reported that death rates from fall injuries among Americans over 65 had more than tripled over the past 30 years. Among those over 85, the cohort at highest risk, death rates from falls jumped to 339 per 100,000 in 2023, from 92 per 100,000 in 1990.
The culprit, in his view, is Americans’ reliance on prescription drugs.
Osteoporosis, however, is a disease of aging which results from the failure of osteoblasts (the cells that rebuild bone) being created whilst osteoclasts (which destroy bone) continue being created. The result of this is weaker bones which means if people fall the outcome is worse.
It happening does not require prescription drugs.
The other main aspect of frailty is sarcopenia.
Then beyond that is balance which is why the sit to rise test is a good test.
Maria Fiatarone Singh, the famous pioneering geriatrician researcher, made an interesting observation in a podcast interview I posted in a thread I started some time ago. The podcaster mentioned the well known fact that falls in the elderly result in a subsequent sharply higher odds of death following within a year or so. She addressed that by saying that this was entirely due to other factors than the fall. The fall was followed by rapid death only in those individuals who had some significant co-morbidities, and the fall simply pushed them over the edge, because they had no reserves or margin of error. Falls in elderly people who were otherwise in reasonable health did not show a similar death outcome. It’s a skewed, confounded statistic.
This is the danger of only looking very shallowly at correlations, as Peter Attia does when he rails on and on about the need to fanatically focus on fall prevention because of the fall = death statistics in the elderly. Obviously, falls are not desirable and it’s good to prevent them, but the real focus should be on health in general, because falls only really matter if you are otherwise compromised. Focus on preventing that compromised condition, and the dangerous downstream effects of falls will naturally disappear. The real goal is not so much to prevent falls as to prevent the consequences of the fall, you should be able to fall and recover from a fall. The ability to recover from stress and adverse events is the hallmark of health, not the avoidance of stress, because sometimes adverse events are unavoidable. Youth means an organism that is able to maintain homeostasis after any perturbation, when you are no longer able to return to homeostasis is when you decline and die. Keep youthful and alive and spring back from any fall.