Washington (AFP)

Climbing on a stool, going to the bathroom at night, going out without his cane: more and more old people fall and the risk of dying after a fall has doubled in the over 75 years in the United States since 2000, reports a study Tuesday.

The figures confirm a trend also observed in Europe: in the United States, between 2000 and 2016, the absolute number of deaths due to falls among people over 75 has tripled (from 8,613 to 25,189 deaths).

Of course, the elderly population has increased but even taking this into account, the mortality rate after a fall for each age group after 75 years has doubled in men and women, according to the study published by the Journal de the American Academy of Medicine (Jama).

"Nearly one in three people over 65 falls each year," says Dr. Marco Pahor, director of the Institute of Aging at the University of Florida, in an editorial. "Falling is a potentially catastrophic and deadly event for the elderly".

Beyond the risk of death from head trauma or haemorrhage, if a hip, knee or ankle is fractured, the event may mark the beginning of a vicious cycle: hospitalization, loss of independence, rehabilitation in a center and lasting effects on morale and mental health.

A person who breaks his hip in five will never walk again, according to Atul Gawande, doctor and author of the book "Being Mortal".

In US hospitals, fall-related expenses are among the top categories.

"Falls represent an increasingly major epidemic among older people," Pahor told AFP.

- Fewer tablets -

In the Netherlands and Spain, where falls have been studied recently with the same method, the trend has been similar since 2000. In France, the problem is described as a "major public health problem".

The reasons for the rise are still poorly studied. But geriatricians have ideas.

It is possible that today's seniors are more active than those of yesterday. Increasing obesity may also play a role as it weakens muscles.

Most of all, doctors are bitterly observing that modern medicine has improved the treatment of chronic diseases but has neglected to focus on the lives of people in old age.

That's what George Taller, a geriatrician who manages the home visiting program at Medstar Hospital in Washington, thinks.

One of his favorite methods to reduce the risk of falling is simple: "deprecate". Studies have shown that from four drugs per day, disorientation and loss of balance increased significantly.

"We are very good at writing prescriptions for drugs but much less when it comes to removing them, even when they are no longer useful," Taller told AFP.

He gives the example of one of his patients whose ankles were swollen. Instead of prescribing a daily diuretic, which might dehydrate her, he told her to take it only when it was really necessary, when the ankles swelled up.

There remains physical exercise, which another study published by Jama demonstrates the effectiveness.

In this experiment conducted in Florida, relatively small (about 300 septuagenarians), the researchers tested the rehabilitation program Otago: fifteen exercises on the knees, ankles, hips ... and balance (walk back, stand on one leg ...), repeat three times a week, with 30 minutes of walking twice a week.

As a result, participants who took part in the program fell less during the study period than a control group.

Past studies have not found a similar effect but, in total, the research seems to confirm the benefits of exercise, when followed with discipline.

What intrigues researchers is that physical activity helps people but apparently does not increase their muscle mass.

"We do not really know why," says Taller. "People are more aware of their body and their space, they feel better when they exercise." And they fall less.

? 2019 AFP