In the United States, someone aged 65 or older is treated in an emergency department every 11 seconds for a fall-related injury. Even though most falls in older people are caused by a mix of problems, heart problems are often present.
According to a 2022 scientific statement from the American Heart Association, falls are a common yet underrecognized risk among people with heart disease. A fall can result in broken bones, concussions, and other serious—and sometimes fatal—injuries. Even if you only get minor bumps and bruises from a fall, the fear of another one can reduce your quality of life. That is why it is critical to be aware of the potential causes and ways to reduce your risk.
Dr. Lewis Lipsitz, chief of the Division of Gerontology at Beth Israel Deaconess Medical Center and professor of medicine at Harvard Medical School, says that falls caused by heart problems can be put into two groups: those caused by a temporary loss of consciousness (called fainting or syncope) and those caused by long-term damage to blood vessels.
Concerns about low blood pressure
"Syncope frequently occurs as a result of a temporary decrease in blood flow to the brain, leaving your brain cells without enough oxygen to keep you conscious," he explains. Low blood pressure (hypotension) is frequently to blame, particularly for a condition known as orthostatic hypotension, which refers to a drop in blood pressure that occurs when you stand up. It's more likely to happen if you haven't been drinking enough water or if you've been taking too much medicine to lower your blood pressure.
The blood vessels stiffen as you get older, and the body's system for monitoring and maintaining normal blood pressure becomes less sensitive. These modifications make older adults more susceptible to low blood pressure. When it comes to blood pressure, the general consensus is that the lower the number, the better. However, a systolic pressure (the first number in a reading) of less than 110 may be too low to maintain adequate blood flow to the brain, according to Dr. Lipsitz. (A healthy blood pressure reading is less than 120/80 mm Hg.)
Additionally, blood pressure medications that might aggravate orthostatic hypotension are more frequently used by older people. According to Dr. Lipsitz, a "start low, go slow" approach to blood pressure medications can help you avoid this problem.
Problems with valves and beyond
Sometimes people faint because their hearts are unable to pump enough blood to the brain. One possible cause is a stiff, narrowed aortic valve (aortic stenosis), which regulates the flow of blood from the heart to the body. However, electrical issues that disrupt the heart's normal rhythm are more common. Sometimes the issue is simply that the heart beats too slowly (bradycardia). However, atrial fibrillation—a rapid, irregular heart rhythm that causes the upper chambers of the heart to quiver ineffectively—can also impair blood flow to the brain. Around 9% of people over the age of 65 have atrial fibrillation, which is associated with a fivefold increase in the risk of stroke — yet another condition linked to falls. Some strokes cause one-sided weakness and balance problems, which can lead to a fall, and stroke survivors are especially vulnerable to falls.
According to Dr. Lipsitz, blood vessel damage brought on by poorly controlled blood pressure—often in conjunction with other cardiovascular disease risk factors—also adds to the burden of falls among older people. "Chronic high blood pressure damages the tiny blood vessels that feed the front part of the brain, which controls gait and balance," he explains. The damage, known as cerebral microvascular disease, can be seen on an MRI scan and manifests as a sluggish, shuffling gait. "People who walk slowly fall more often, and they frequently show signs of microvascular brain damage," explains Dr. Lipsitz.
The bottom line:
Keeping your blood pressure under control throughout your life can help you avoid falling. Dr. Lipsitz recommends getting tested for orthostatic hypotension if you have an unexplained fall (or if you ever feel dizzy or lightheaded when you stand up). Fainting in the elderly should be evaluated for heart disease because it is sometimes the first sign of a previously undetected heart condition. For more tips on how to avoid slips and falls, go to /P to order the online book Preventing Falls by Harvard Health Publishing.