All About Falls and Elders – Part 2 of 2
Tuesday, 02 August 2011
Yesterday, we discussed the facts and statistics of falls and elders. One that stood out for me is that two-thirds of those who experience a fall will fall again within six months which, obviously, increases the potential for injury or death. So today, we'll look at the causes of falls and what can be done to prevent them.
(NOTE: I realize this is a very long post, but most of it is easy-to-read lists. I've pulled information from many sources – books, websites, scientific studies, etc. - too many to link to them all. I've tried to keep it to the best available advice.)
There are so many causes that it is amazing the statistics among elders are not higher/worse than they are. The causes can be divided into two main categories: medical and environmental. Let's take them one at a time.
SOME MEDICAL CAUSES OF FALLS
• Loss of balance due to age-related decline
• Loss of balance due to diseases, disorders or conditions such as inner ear infections, Meniere's disease, meningitis, stroke, Parkinson's disease, multiple sclerosis and brain injury, among many others
• Side effects of some medications for depression, sleep problems, high blood pressure, diabetes and heart conditions can affect balance
• You can be more likely to fall if you take four or more medications
• Changing medications can make you more prone to falling
• Poor eyesight
• Poor hearing
• Foot pain, corns, bunions
• Poor muscle tone
• Low blood pressure
Regarding osteoporosis, it has not been determined whether brittle bones break after a fall or if a stress break causes a fall.
Three symptoms of some of the causes are vertigo, dizziness and loss of balance. I'll discuss prevention of age-related loss of balance at the end of this article, but it should go without saying that if you experience any of them, you should see your physician. Also:
PREVENTION OPTIONS FOR MEDICAL CAUSES OF FALLS
• If you are living with any of the diseases or conditions mentioned, balance issues should and probably are part of your care. If not, bring up the issue with your physician
• Regularly review your medications with your doctor or pharmacist for side effects or interactions
• When a new drug is prescribed, be sure to ask about side effects that can affect your balance or cause dizziness
• Have your vision checked once a year
• Have your hearing checked every two years
• Consult your physician or a podiatrist for foot pain problems
• Take regular exercise to help prevent muscle weakness
Low blood pressure can cause dizziness or vertigo when you get out of bed or rise from a chair. The only symptom that might lead to a fall that I've experienced so far is periodic dizziness on getting out of bed. A simple solution is to make it a habit to sit on the side of the bed until it subsides in a few seconds.
And for dizziness when standing up from a chair, you can brace the back of your legs against the chair until you feel ready to walk.
When seeing a physician regarding recent falls or having experienced dizziness or vertigo:
WHAT TO TELL YOUR PHYSICIAN
• Describe the exact nature of the fall and how you felt just before it occurred, and when the dizziness or vertigo occur
• Bring a list of all the medications you are using and have used recently
These two things will be a big help in determining the cause and finding a solution.
The causes over which we have the most control are environmental – indoors and outdoors – usually from impediments in our path. If your balance is shaky or if you are prone to dizziness or vertigo, it is essential to have a clear path.
And don't forget that our reflexes are no longer as reliable as when we were younger.
Outdoors, winter weather can be treacherous with ice and snow on the sidewalks. So:
OUTDOOR PREVENTION OF FALLS
• Always wear skid-proof shoes or boots
• For icy conditions, crampons are a big help
• If there are steps to your porch, be sure they are cleared, use snowmelt and consider installing slip-resistent treads
• Install handrails along all steps and stairs
• Repair cracks and abrupt edges in walkways
• Keep pathways clear of rocks, tools and yard debris
• Be sure outside lights are adequate
• If your doctor wants you to use a cane or a walker, learn how to use it and then use it all the time
• Stay home until spring (just kidding, but only sort of)
Among elders, falls are the most common fatal injury in the home. At least one-third of falls in elders involve environmental factors at home, a place that is fraught with danger in every room and hallway. But there is a lot you can do to be safer:
FALL-PROOF YOUR HOME
• Always wear shoes with non-skid soles
• Backless slippers are easy to walk out of and lose your balance. If you must wear them, find those with backs and non-slip soles
• Avoid shoes with extra-thick soles
• Remove all throw rugs. I mean it. Get rid of them
• As much as I dislike it, consider wall-to-wall carpeting. It goes a long way to preventing falls from slick floors
• Do not leave stacks of newspapers, magazines and other clutter on the floor to trip over
• Improve lighting so there are no dark halls and corners
• Install nightlights to guide you to the bathroom
• Do not use wax or polish on floors; if you must, use a non-skid variety
• Immediately wipe up all spills
• Use a sturdy step stool to reach items on high shelves
• Place frequently used items on low shelves that are reachable without a step stool
• Do not stretch electrical cords and cables across any pathway. If they need to be strung along a wall, tack them to the baseboard
• Install grab bars in your toilet, bath and shower areas
• Use non-skid mats in tubs and showers
• Use non-skid mats for the bathroom floor
• Install handrails on both sides of stairs
• Install non-slip treads on stairs
• Be sure stairwells are brightly lit
• Install light switches at the top and the bottom of stairs
• If you are concerned about falling out of bed, install side rails (hat tip to Elaine of Kalilily)
• Remove caster wheels from furniture
• Arrange furniture and tables so they are easy to walk around without bumping into them
Undoubtedly, I have missed some good advice. Feel free to add more in the comments.
AGE-RELATED LOSS OF BALANCE
To varying, individual degrees, all our senses diminish as we age and balance, controlled in the inner ear, is no exception. If your day-to-day balance is slipping and you are free from ear problems and medical conditions that can contribute to loss of balance, there are other ways to help improve and maintain it.
EXERCISE. Keeping muscles as strong as possible will improve balance. Any activity that keeps you moving, including walking, will help.
STRENGTH TRAINING helps maintain balance and mobility which are good for preventing falls. You can ask your physician for information about local programs for elders, and the Centers for Disease Control has a website of easy strength training exercises for older adults that you can do at home.
The Eldergym Website has a set of exercises specifically for BALANCE TRAINING that you can do at home.
There is increasing scientific evidence that an ancient Chinese martial art – a gentle one called TAI CHI - works well for maintaining and increasing both strength and balance thereby helping to prevent falls.
In one study from 2004, after four- and eight-week courses of intensive training in tai chi, elders showed significant improvement in stability compared to the control group:
“These improvements were maintained even at follow-up 4 wk afterward. Furthermore, the improved balance performance from week 4 on was comparable to that of experienced Tai Chi practitioners.”
Although I cannot find the references now, I have read that a few health insurance companies are beginning to cover tai chi as a prevention strategy. One of them, Avmed, offers a 30 percent discount on tai chi classes.
For nearly a year, I've been attending a tai chi class. For financial reasons, I've cut it down to once a week but I practice at home four or five days a week. It's become habit now and I miss it when I skip a day or two.
As always, check with your physician before beginning an exercise program, particularly if you have been inactive.
I hope these two posts have helped you understand how devastating falls can be for elders but that there is a lot you can do - medically and environmentally - to keep yourself as safe as possible from them.
At The Elder Storytelling Place today, Johna Ferguson: Collections
Great post! I'd also strongly recommend yoga, which builds strength and balance.
Posted by: Duchesse | Tuesday, 02 August 2011 at 05:45 AM
How did I leave out yoga - it was on my list. Thank you, Duchesse, for having my back.
Posted by: Ronni Bennett | Tuesday, 02 August 2011 at 06:27 AM
Just ordered a BETTER tub mat.
And, we'll begin, yet again, to do our tai chi!
Posted by: notdotdot | Tuesday, 02 August 2011 at 07:06 AM
This is really helpful. I just had a fall a couple weeks ago. I've had trouble with my balance since my stroke over 30 years ago and I've yet to hear a doctor express concern over balance.
Posted by: Kay Dennison | Tuesday, 02 August 2011 at 08:12 AM
I second you on the Tai Chi. It not only improves balance but also flexibility. It's good for building bone density too.
For low blood pressure, one tip is to drink more. Being dehydrated can add to dizziness on standing.
Posted by: Virginia | Tuesday, 02 August 2011 at 08:26 AM
Extremely informative post! Tai Chi was ranked highly in a study that came out a few months ago about recommendations for exercises for seniors.
Posted by: EPOCH Senior Living | Tuesday, 02 August 2011 at 12:15 PM
I agree--very informative posts. I don't do tai chi, but I walk and also volunteer at a cat adoption center. Climbing around cleaning cages and chasing kitties in the play area seem to do the job for me. However, I also plan to check out the balance exercises at Eldergym you mentioned. Thanks!
Posted by: Elizabeth Rogers | Tuesday, 02 August 2011 at 12:22 PM
Two exercises good for balance are: 1) Stand with your back to a corner (not touching) with a chair in front. Feet together, hold your arms straight out in front. With your eyes closed hold position for the count of 100 (or as long as possible before losing your balance.) 2) Stand with your feet one in front of the other with one heel touching the toe of the other. With eyes open hold the position (not touching the wall or chair) for the count of 100. (Or as long as possible before losing your balance)
I got these exercises from physical therapy. The corner and chair are just a backup in case your lose your balance).
Posted by: Darlene | Tuesday, 02 August 2011 at 01:17 PM
That certainly sounds like something I could do.
I'm going to try it.
Thanks,Darlene, and thank you,Ronni for the other information you have given us today.
Isn't it a relief to think about something other than the debt ceiling, the tea party and John Boehner? PHEW!!!!
Posted by: Nancy | Tuesday, 02 August 2011 at 02:12 PM
Very informative! Many thanks for giving so much space to this. I go to an over 50s class and out trainer keeps reminding us that it is flexibility and strength not aerobic fitness which determine the quality of our lives , whether we remain independent or having to go into residential care.
I would add swimming to the list though I realise this might not be an option if don't have access to a swimming pool in your area.
Posted by: Ann Shaw | Tuesday, 02 August 2011 at 02:38 PM
Swimming and yoga have helped me a lot.
Posted by: Hattie | Tuesday, 02 August 2011 at 04:05 PM
Discuss possibility with your Dr. for a referral to Physical Therapy (must have a Doctor's order just like a prescription for medicine.) Many P.T. programs can devise a balance plan specifically for the varying needs for each individual(might be in conjunction with other P.T. interventions.) P.T. depts. often have a balance machine on which a person stands and it can be programmed for various movements challenging the individual at appropriately increasingly difficult levels. They provide additional exercises appropriate for different individual's needs that can then be performed independently long after formal therapy sessions ends-- such as Darlene describes was provided to her.
A family friend who lived to 103, final years alone after her husband died, had vertigo due to aging problems affecting her middle ear and balance. She had to use a walker those last years. She continued her walking habit at decreasing distances -- finally to the patio's perimeter, then the interior length of her mobile home. She also constantly had to relearn movements -- no fast ones or rapid head turns. Also, had to sit briefly when she arose after lying down before standing (as you described, Ronni,)then a brief wait before initiating walking after she stood.
You are so correct, Ronni, if someone has been recommended to use a walker, USE THE WALKER to avoid falling.
When I was engaged in theatre training during college in my young single years, we learned how to take a stage fall without injury -- collapse relaxed from the feet up, accordian style. I took a wicked potentially bone breaking fall twenty years ago -- lost my balance when in an awkward position from which I could not recover. The second I realized I was falling I went with the fall, collapsing as I described, minimizing the result -- no broken or fractured bones, just some significant deep tissue bruising which was bad enough.
My mother had a stroke affecting primarily her balance mechanism resulting in her being unable to detect where she was in space -- could have fallen over backwards easily. She religiously used her walker all the time for several years, never fell, and lived alone independently in her mobile home until other medical issues necessitated a change.
Another family member had a brain aneurysm, was told to use a walker, but misguidedly chooses to stagger, and I do mean stagger with lurching as he reaches out to chairs, tables, walls to keep from falling. He's stubbornly adamant he's training his brain motor mechanism to regain his balanced walking ability. His brain damage is permanent and he will not regain that skill -- he's past that point in recovery. I expect any day to hear he's fallen, broken a hip, had head trauma or other -- scary to watch him move.
Posted by: joared | Thursday, 04 August 2011 at 12:56 AM
The potential for falls can come from the distant past. In my case: I broke my ankle at 17 while playing softball in gym class. Back then, people wore plaster casts for six weeks or so (now, orthopedists try to get you walking much earlier) and used crutches. When the cast came off, I was shocked to see how withered my lower leg had become.
Favoring that weak leg set me up for a lifetime of left-side atrophy. Another fracture and three bad sprains with falls over 20 years (1983-2003) finally sent me to PT, where they explained I had impaired proprioception, which is the ability to locate your body in space. That leads to all kinds of balance and strength problems that require focused attention to repair.
So, think back to injuries sustained while you were young and healthy when you consult with docs or physical therapists.
Posted by: Lee | Thursday, 04 August 2011 at 09:50 AM