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Why you fall-and what you can do about it

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Falling has become a major health issue for many older adults, but there is much you can do to reduce your risk.

When we were kids, falling usually meant a skinned knee or a scraped elbow. But with age, taking a tumble can have graver consequences, including hip fractures and traumatic brain injuries. Each year, one in three seniors falls, and one in five of those falls results in a serious injury.

Falling is more than a way to get hurt; it may also be a sign that you’re losing skills needed to maintain mobility, explains Dr. Jonathan Bean, an associate professor of physical medicine and rehabilitation at Harvard Medical School. “That’s why falls are part of a larger concern, because they can set people down the path to disability,” he says.

Falls result from the convergence of several risk factors. Some—like poor balance or failing vision—have to do with your physical condition, and others—like icy sidewalks or uneven terrain—come from the environment. The good news is that there is a lot you can do to reduce both types of risks.

How do you know if you’re at risk for falling?

If you’ve had a couple of falls—especially falls that you find hard to explain—it’s probably reasonable to assume that you’re at risk for more. Health care providers have several tests they can do in the office to assess your risk of falling. A recent study of 755 Boston-area adults over 70 indicated that a simple test called the “chair stand” is the strongest predictor of falls. It involves sitting in straight-backed chair and rising to a standing position without using your arms. Taking longer than 16.7 seconds to complete five repetitions of the exercise indicates an increased risk of falls, especially in people who have fallen previously. If you and your doctor determine that your risk of falling is high, you may be referred to a rehabilitation or exercise facility for strength and balance training.

Getting strong to prevent falls

Research has shown that for mobility problems, the types of exercise that are most beneficial are those that focus on progressive training for strength (force) and power (force plus speed). Having strong, powerful muscles is key, and so is where those strong muscles are located. It may be natural to think that a sturdy pair of legs will shore you up, but having a robust torso is even more important. And strengthening your abdomen, back, and hip girdle—the core muscles—is not so much a matter of achieving a flat stomach as gaining the ability to sit up straight for longer periods of time. This doesn’t mean isolating specific muscle groups and per-forming exercises to strengthen them, but finding exercises that work on several muscle groups at a time. In other words, you want to do exercises that use the muscle groups required for the things you do in real life.

Dr. Bean likens this to sports training. If you’ve injured your shoulder, you can do specific exercises to strengthen it, but ultimately you’re going to have to practice swinging the racket if you want to get your tennis game back. “For many older adults, the ‘sport’ is living independently, so the exercises need to be close to the kinds of activities you need to do to stay independent—getting out of a chair without using your arms, climbing stairs, or reaching a high shelf,” he says.

Surprisingly, walking isn’t one of those exercises. Although it’s great for improving aerobic capacity and lowering the risk of several degenerative diseases, it hasn’t been shown to reduce the risk of falling. In fact, people who are at high risk for falling increase their risk of subsequent falls by taking walks. However, there is some evidence that activities like yoga and tai chi, which improve balance and coordination as well as core strength, may help to prevent falls. It makes sense that they might. Many of the movements—lunging, stepping, turning, and reaching—are similar to the movements we need to remain independent. A few small studies have shown that learning tai chi also increases confidence and reduces the fear of falling.

Whatever exercise regimen you choose, it’s important that it be progressive, Dr. Bean emphasizes. That means that your routine should become increasingly more challenging, because you won’t make any gains if you stay at the same level.

“Your effort doesn’t have to be off the charts,” he says. If you assign a 10 to your absolute limit, you should strive to put in a 6 or 7 effort every time. Once you reach the point where it takes only a 4 or 5 effort to complete an exercise, you should find ways to increase the effort—either by doing more of the exercises in the same time period or substituting a more challenging exercise.

Health issues

Some health-related issues can increase your risk of falls. These are of particular concern:

Chronic pain. Pain is a risk factor for falling. Painful joints, a sore back, or an aching neck can distract you from noticing hazards in your path. They can also hamper your mobility, throw you off balance, or make it difficult to maintain your balance. It’s important to talk to your doctor about pain medications that won’t increase your risk of falls. Over-the-counter pain relievers such as nonsteroidal anti-inflammatory drugs (aspirin, ibuprofen, and naproxen) or acetaminophen may be reasonable short-term options.

Poor vision. Being unable to see clearly is a great impediment. It’s easy to trip or lose your balance when you can’t make out the edge of a stair or recognize an object in your path. Wearing reading glasses or new multifocal lenses when walking can increase your risk of falls by affecting your depth perception. Have a vision exam annually, and consider single-vision lenses if you need to have your distance vision corrected.

Foot problems. As your contact with the ground, your feet are central in preserving your balance. It’s important to see a podiatrist if you have foot pain from any of the myriad conditions that commonly cause it—corns, calluses, bunions, arthritis, ingrown or fungal toenails. It should go without saying that a comfortable, supportive shoe is essential. If you are at risk for falls, avoid high heels at all costs. And if you have neuropathy, a walking stick can help you “feel” the ground beneath your feet.

Medication side effects. Once you have fallen, it may be time to take stock of all the medications—both prescription and over-the-counter—that you are using. Bag them up and take them to your next primary-care appointment. Many types of drugs increase the risk of falling, so it’s important to review all of yours with your doctor.

Dealing with the environment

For people over 65, most falls happen at home. But a few simple measures can minimize your risk.

Improve lighting. See that every area is well-illuminated and that wall switches are accessible. Use nightlights to mark hallways and the bathroom. Ropes of LED lights can be used to outline stairs.

Provide handholds. Install grab bars in the bathroom. See that stair railings are secure.

Remove obstacles and hazards. Clear clutter from the floors. Move furniture to create a wide berth when you pass from room to room. Keep cords and cables near the walls where you can’t trip on them. Use double-sided tape to secure area rugs, and stick on decals for traction in the bathtub.

See to your soles. Shoes with ridges and treads on the soles are essential for outdoor activities. Hiking boots and sneakers are good options, and many dress shoes now have nonskid rubber soles. If you must walk on ice, consider getting a pair of crampons that attach to your shoes or boots. Indoors, if you have wood or tile floors, it isn’t a good idea to pad around in stocking feet. If you want to go shoeless, slip into a pair of slippers with textured soles and good support.

What is your risk for falling?

Question

Points for a “yes” answer

Have you fallen in the past year?

2

Do you use a cane or walker to get around safely?

2

Do you sometimes feel unsteady when you are walking?

1

Do you steady yourself by holding on to furniture?

1

Do you often have to rush to the toilet?

1

Do you have difficulty stepping onto the curb?

1

Are you worried about falling?

1

Do you need to push yourself out of a chair?

1

Have you lost some feeling in your feet?

1

Do you take medication that makes you feel lightheaded?

1

Do you often feel sad or depressed?

1

Total

If your score is 4 or higher, discuss your risk with your doctor.

Source: Centers for Disease Control and Prevention; Rubenstein LZ, et al. “Validating an evidence-based, self-rated fall risk questionnaire (FRQ) for older adults,” Journal of Safety Research (Dec. 2011), Vol. 42, No. 6, pp. 493–9.

Posted by: Dr.Health

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