Fear of Falling? The Key to Preventing This Common Injury

Why the idea of falling is always on my mind.

By

Sally Koslow

 
Published April 10, 2025

Fifty years ago, Erica Jong wrote Fear of Flying. I have a different dread: fear of falling. Partly, it’s the humiliation that spooks me, since few things scream old faster than landing on your butt. The pain and suffering that a stumble may trigger, however, goes beyond embarrassment.

Consider former U.S. House Speaker Nancy Pelosi, who tripped and broke her hip as she maneuvered a marble staircase on a state visit to Luxembourg. Several weeks later after Pelosi, then 84, was airlifted to Germany for a hip replacement, she returned to Congress on a walker.

I kissed the ground myself as I recently left a packed subway. In my hand were freshly baked lemon bars I was valiantly trying to hold onto while traveling to a party. When I arrived at my stop I felt a shove, then another. I attempted to grab something — anything — to stay upright.

But next thing I knew I was staring up at a circle of concerned faces asking “You okay?” I was thanks to the Michelin Man padding of my puffy coat, though my pride and lemon bars were in critical condition.

This wasn’t my first fall. On an exceptionally windy day last week in Manhattan, I turned a corner on a street facing the Hudson River and was hit with a blast of air so powerful I felt like Dorothy in The Wizard of Oz. I was pushed backwards. I stumbled and landed 10 feet way in a flowerbed. In addition, while traveling in Portugal last year, I stood up abruptly in a restaurant. I felt the room swaying and collapsed. I tried to overlook my pain but later saw a doctor who told me I’d broken several small metatarsal bones. For the rest of the winter my footwear featured an orthopedic sandal.

Fear of falling is now always on my mind. On a recent vacation, our whole family rented an Airbnb with a seven-story spiral staircase that lacked a railing. This so terrified me I crawled up and down the stairs, forever destroying the delusion that I remain forever young.

When I admitted to friends of a similar age how petrified I’ve become of falling, I discovered it’s a near-universal terror. Rightfully so. According to the Centers for Disease Control and Prevention, falls are the leading cause of injury for adults age 65 and older. Every year, one in four older Americans, or a staggering 14 million people, report falling

Women are more vulnerable than men to falling-related injuries, especially related to hips, wrists and spines, because after menopause we experience reduced muscle mass and bone density. At 49 my doctor told me I had the strong bones of a teenage gymnast. Yeah me! It must be thanks to those four glasses of milk my mother forced me drink every day. But I’m no longer gloating. Twenty-five years later those bones are far from ready for the Olympics.

Fortunately, I don’t suffer from osteoporosis. But, according to the National Bone Health & Osteoporosis Foundation, approximately half of women over the age of 50 will suffer an osteoporosis-related fracture in their lifetime. This, since the disease reduces estrogen levels, which contributes to lower bone density. The foundation’s research says that a woman's risk of breaking a hip, a common post-fall consequence, is equal to her combined risk of breast, uterine and ovarian cancer.

What can we do to prevent falls? Plenty.

1. Wear the right shoes. I’m talking to me and to the world’s Carrie Bradshaws, she of the glorious shoe wardrobe. Were Carrie still dashing around in stilettos, Sex in the City would probably be set in a hospital’s orthopedic wing. High and/or spindly heels may give us ooh-la-la legs and extra inches, for those of us who are vertically-challenged. But such shoes do us no favors. When walking, exchange them for sneakers, low heels or flats with non-slip soles and good arch support. (And if you want to switch into heels, tote those along in a bag when you arrive at your destination.)

2. Stay active. Fear of falling can lead to reduced physical activity, which weakens muscles and increases your risk of slipping. Strength training, balance exercises, yoga, Tai Chi and pilates can help.

3. Get checked out. Ensuring good vision and hearing and monitoring bone density are crucial as is getting enough calcium and vitamin D to keep your bones strong. If you wear bifocals, be careful when you walk down stairs, because such lenses can you distort your sight. Speak with a doctor about potential side effects of drugs that may cause dizziness or drowsiness. And maintain a healthy weight: being too thin puts your bones at risk.

4. Don’t smoke and limit alcohol use. Tobacco and alcohol may decrease your bone mass and increase your chance of fractures.

5. Fix home hazards. Replace rugs that skid and tidy up loose electrical cords.. Keep your lights bright and, in the bathroom, consider adding grab bars and non-slip mats, which are also good in the kitchen.

6. Watch your step. Be cautious on uneven sidewalks, ice, packed snow and wet leaves. Use a cross-body bag, fanny pack or backpack so that hands are free to hold on to railings.

7. Keep a phone handy. Even better, consider investing in a smartwatch with fall detection; should you trip, the watch contacts emergency services.

 

Do you have a fear of falling? Let us know in the comments below.

 

Sally Koslow has published seven books she thinks make perfect summer reading. Please check them out at sallykoslow.com.