Are you headed for a fall?

Every 11 seconds, someone age 65 or older is treated in an emergency department in the United States for a fall-related injury. While most falls in older people result from a combination of underlying issues, heart-related problems are often in the mix.

In fact, falls are a common yet underrecognized risk among people with heart disease, according to a 2022 scientific statement from the American Heart Association. An unexpected tumble can lead to broken bones, concussions, and other serious — sometimes fatal — injuries. Even if you sustain only minor bumps and bruises from a fall, the fear of a future fall can lower your quality of life. That's why awareness about the possible causes and ways to minimize your risk is so important.

Falls that result from cardiovascular causes can be divided into two main categories: those related to a temporary loss of consciousness (known as fainting or syncope) and those that result from long-term blood vessel damage, says Dr. Lewis Lipsitz, chief of the Division of Gerontology at Beth Israel Deaconess Medical Center and professor of medicine at Harvard Medical School.

Low blood pressure concerns

"Syncope often occurs because of a temporary drop in blood flow to the brain, which leaves your brain cells without enough oxygen to keep you conscious," he says. Low blood pressure (hypotension) is often to blame — especially a phenomenon called orthostatic hypotension, which refers to a drop in blood pressure that happens when you stand up. It's more likely to occur if you haven't been drinking enough fluid or are taking too much of a drug that reduces your blood pressure.

As you age, blood vessels tend to stiffen, and the body's system of monitoring and maintaining normal blood pressure becomes less sensitive. These changes make older adults more vulnerable to low blood pressure. With blood pressure, the general message is the lower, the better. But a systolic pressure (the first number in a reading) below 110 may be too low to maintain good blood flow to the brain, Dr. Lipsitz says. (Normal blood pressure is less than 120/80 mm Hg.)

Older people are also more likely to take blood pressure medications that might exacerbate orthostatic hypotension. A "start low, go slow" approach with blood pressure drugs can help you avoid that problem, says Dr. Lipsitz.

Valve-related problems and beyond

Sometimes people faint because their hearts can't pump well enough to deliver sufficient blood to the brain. A stiff, narrowed aortic valve (aortic stenosis) is one possible cause, as this valve regulates the flow of blood from the heart to the body. Electrical problems that disrupt the heart's normal rhythm are more common causes, however. In some cases, the problem is simply that the heart beats too slowly (bradycardia). But atrial fibrillation—a rapid, irregular heart rhythm that causes the heart's upper chambers to quiver ineffectually — can also hinder blood flow to the brain. About 9% of people over age 65 have atrial fibrillation, which is linked to a fivefold risk of stroke — yet another condition connected with falls. Some strokes cause one-sided weakness and balance issues that can trigger a fall, and stroke survivors are especially prone to falling.

Chronic damage

Blood vessel damage spurred by poorly controlled blood pressure (often in tandem with other risk factors for cardiovascular disease) also contributes to the burden of falls among older people, says Dr. Lipsitz. "Chronic high blood pressure damages the tiny blood vessels feeding the front part of the brain that control gait and balance," he says. The damage, called cerebral microvascular disease, is visible on an MRI scan — and manifests as a slow, shuffling gait. "People who walk more slowly fall more frequently, and they often also show signs of microvascular brain damage," says Dr. Lipsitz.

Bottom-line advice

Careful blood pressure control throughout life can have a big impact for preventing the risk of falling. If you have an unexplained fall (or if you ever feel dizzy or lightheaded when you stand up), get tested for orthostatic hypotension, Dr. Lipsitz advises. Older people who faint should be assessed for heart disease, as fainting is sometimes the first sign of a previously undetected heart condition. For more tips for avoiding falls, see the Harvard Health Publishing online guide, Preventing Falls (to order, go to /PF).

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