The numbers are staggering. Sandra Martin writes in The Globe and Mail: "The World Health Organization estimates there are 646,000 fatal falls each year — only road traffic accidents top falling as the cause of death from an unintentional injury." And a 2019 study published in the Journal of the American Medical Association finds the risk for older Americans dying from a fall has doubled since 2000.

My mom's life was almost ended and was totally changed by a fall. My aunt died last week from a fall. Sandra Martin explains what so often happens:

We all know that nightmare scenario: Granny falls in her kitchen, nobody finds her for three days, she is admitted to hospital for surgery and acquires an antibiotic-resistant infection. By the time she is discharged several months later, she needs a walker and is deemed too frail to live alone. Her family institutionalizes Granny in a "safe" residence that soothes their anxiety, but robs her of independence, speeds her decline into fractious dementia and results in many more hospitalizations at a huge cost to the health system.

There are so many reasons that older people fall. Harvard Health Watch spells it out:

Why does our fall risk rise as we age? Each of the systems that keep us upright and balanced — including the brain and central nervous system, vision, and muscles — loses a small amount of function with age. The sensory information entering our eyes and ears takes longer to travel to our brain for processing, making us more likely to become off-balance. "And when we trip, our reaction is slower at older ages, so we can't 'catch' ourselves and prevent the fall," Dr. I-Min Lee, professor of medicine at Harvard Medical School, says. All these changes combine to increase our risk.

But this isn't just a problem of aging; It's a problem of design.

As the 70 million baby boomers get older, this is going to be an increasingly serious problem. However, there are many things that we can do to make falls less frequent and less deadly. We can also stop ignoring the incoming wave of aging boomers and think about the crazy things we do that make falls more likely.

Things that make me crazy: Terrible bathroom design.

Kohler blue bathroom This crazy Kohler bathroom is a design for disaster. (Photo: Kohler)

The majority of falls take place in the home, and the majority of those take place in the bathroom. That's why I get so mad about the bathroom trends shown at CES this year; more of those silly, thin-walled free-standing tubs. There is no sill to sit on so you can swing your legs around; there's no place to put a grab bar. It isn't just old people — anyone of any age could slip and fall getting in and out of this.

And seriously, what's with that animal skin on the floor? And the lighting so faint that anyone would trip on the dead thing? If this is Kohler's idea of the bathroom of the future, we are in big trouble.

The New York Times explains:

According to the Centers for Disease Control and Prevention, every year about 235,000 people over age 15 visit emergency rooms because of injuries suffered in the bathroom, and almost 14 percent are hospitalized. More than a third of the injuries happen while bathing or showering. More than 14 percent occur while using the toilet. Injuries increase with age, peaking after 85, the researchers found. But injuries around the tub or shower are proportionately most common among those ages 15 to 24 and least common among those over 85. People over 85 suffer more than half of their injuries near the toilet.

So people of all ages are slipping in the shower, falling when they stand up from the loo, and all we get are Alexa-enabled toilets? (I suppose you can yell, "Alexa! Call an ambulance!")

Terrible senior sprawl

The villages The Villages, where at least you can drive a golf cart. (Photo: Google Maps)

There is obviously a large group of people of all ages who need to live on one level, but what we're getting now is senior sprawl — subdivisions of big, single-floor houses at such low density that everyone has to drive everywhere. When in fact, Harvard Medical School says "Exercise is a proven way to prevent falls, by strengthening the muscles that keep us upright and improving our balance." They go on to recommend that you "walk, bicycle, or climb stairs to strengthen the muscles of your legs and lower body." Instead we seek houses with no stairs in neighborhoods where you can't walk.

After my friend P had his heart attack, one of the first things they did for rehabilitation was to put him on a Stair Master. Yet there's this obsession about designing houses without stairs just in case people need a wheelchair.

We can design houses to be adaptable, and make provisions for future chair lifts by building straight and wider stairs, or elevators by stacking closets, but don't promote senior sprawl. Exercise is critical.

Terrible urban infrastructure and maintenance

Atlanta sidewalk How are you going to walk on this sidewalk in Atlanta? (Photo: PEDS)

About 70% of Americans live in suburbs where it's hard to walk and impossible to cycle. In many cities like Atlanta (pictured above), the city doesn't even take responsibility for maintaining the sidewalks, and many are impossible to use. How is anyone going to walk on that?

snow in Toronto And how is anyone supposed to walk on this? (Photo: Lloyd Alter)

Or where I live, where people who live downtown have to shovel their own sidewalks, while people in the suburbs don't. So you get sidewalks like the one above. At least the snow is softer when you fall.

seniors waiting to cross street They sure don't look like they're Snapchatting. (Photo: Garry Knight/Flickr)

And then there is traffic light timing and intersection design. Everyone says "make eye contact" with drivers, but many older people have to look at the pavement when they are walking and shouldn't be rushed across the street. That's when they trip and fall.

Terrible consideration of older people during construction

sidewalk replacement in Toronto How is anyone supposed to get around this? (Photo: Lloyd Alter)

When fixing the street last year, these workers shut off the sidewalk and a full lane of traffic so they could conveniently park their trucks and a trailer right in front. Meanwhile, the seniors living in a building just a block away were told to walk on the other side, even though they had to cross all this traffic and a streetcar right-of-way, which cannot be done safely. This just shouldn't be allowed.

Stairs at 401 bay street Toronto How is someone supposed to get down these stairs safely? (Photo: Lloyd Alter)

This is where my mom fell, where grey granite stairs have construction hoarding above and no handrails because bikes are locked there. But when I complained, they just asked: How old is your mom? However, when you start multiplying this kind of situation by hundreds of times, it starts looking very different. And that's what is coming fast as the baby boomers get older.

This is going to cost us all serious coin if we don't fix it

When 70 million baby boomers enter their 70s and 80s over the next 10 to 15 years, this is going to become a serious health crisis. In 2013, falls among older adults cost the U.S. health care system $34 billion in direct medical costs. According to Johns Hopkins,

On average, the hospitalization cost for a fall injury is $34,294 (in 2012 dollars). According to the CDC, falls are the leading cause of injury death for Americans 65 years and older. Each year, one in three adults 65 and older falls at least once. Approximately 30% of hospital patient falls result in physical injury, with 4% to 6% resulting in serious injury – with fractures the most common. As many as 20% of hip fracture patients die within a year of their injury.

Imagine what these numbers will be like when all the boomers are over 65. That might well be 20 million falls every year, probably more deaths than from cars or guns. So many that nobody will be able to roll their eyes and just say "it's old people."

You can blame the victim, and say old people will fall because they're old and frail, or you can recognize this as a design problem, a maintenance problem, and a soon-to-be a very big problem as 70 million boomers reach this critical point in their lives.

Editor's note: This story has been updated since it was published in January 2019.

Lloyd Alter ( @lloydalter ) writes about smart (and dumb) tech with a side of design and a dash of boomer angst.

Falls may soon be the biggest cause of death
This isn't an aging problem, it's a design problem.