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.
I have sometimes wondered if people fall because they are getting close to death. It’s impossible to test, but as the post remarks, it seems reasonable to think it isn’t the fall itself that’s the problem
What happens with falls is that if people go to hospital because they have broken something and end up in a bed then their muscles often deteriorate such that when they leave hospital they are substantially more frail than before the fall and this accelerates deterioration.
Certainly that is the case sometimes. But the statistic I’ve seen that was shocking was something like 50% of the people who fall and break a hip are dead within 2 years. As @John_Hemming has suggested, the deterioration is rapid, especially with bed rest. This is part of the reason companies are trying to identify compounds that maintain muscle mass (during immobility)… like this drug: Rejuvenate Biomed’s drug combination (metformin & galantamine) shows promise in sarcopenia in Phase 1b trial
An interesting thing from BSRA was exercise the day before hospital reduced muscle loss, but 48 hours before had no effect. No good for falls though
It suggests a habit of exercise is useful, but we knew that. 
Good point wrt bed rest.
That’s true as far as it goes — but if that were all there were, you’d predict that age-specific rates of falls and deaths from falls would remain steady (or improve, granted that today’s elderly are in many ways in better condition than those of prior generations). Instead, as the story says, death rates from falls among those over 85 jumped from 92 per 100,000 in 1990 to 339 per 100,000 in 2023.
Agree…one needs to move upstream in this process. Its not only sarcopenia evn though it is a major player.
It is a combination of sarcopenia, foot reactivity(aka fast twitching muscle fibres which degrade with age), coordination(neuro muscular) to avert a potential fall and of course to prevent bony injury ( aka osteoporsis-free bones) once fall has occured.
No wonder a 10 second one-leg standing test is proxy for longevity alongside the hand grip test. Grip test represents muscle strength. One leg standing test represents neuromuscular coordi ation to swiftly react once you are off balance and potentially avoid an injurious fall!
Could it be under reported in the past? (92 per 100,000). Also, Covid comes to mind. It did not affect the elderly in 1990.
I am not saying drugs cannot cause it. I am saying it happens also without drugs.
I doubt it was underreported: you can imagine falls being underreported, but when someone dies, it seems unlikely that they’d misclassify a fall (though perhaps it’s tricky if they’re counting deaths months later as being consequences of the fall — but I’d think those would be classified as contributing rather than proximal causes). COVID is definitely not the explanation: per the graph, they’ve been rising rapidly since about 1995.
One small possible confounder specific to the 85+ group is that there are proportionately more people at the tail end of “85+” than there were in the past, whereas the age groups by decade are more or less fixed and directly adjustable by population size.