Marlene, at age 81, was reasonably healthy and had an active social life with a group of women who got together for meals several times a week. Then one day her coat got caught on the back of a restaurant chair, pulling her to the floor, breaking her hip. After several hospital stays, followed by rehabilitation, Marlene fell again and never fully recovered from the disability. She eventually entered a nursing home.
About 35 to 40 percent of Americans age 65 and over fall each year. It’s the most frequent cause of injury for them, and it’s often serious, resulting in hospitalization or death.
“Those who have never fallen may have a false sense of security. Those who have suffered an injury in a fall frequently become overly frightened of a second fall, foregoing many of their usual activities and inadvertently setting themselves up for a continuing spiral of disability,” says Coeta Ogle, RN, Community Outreach Coordinator at St. John’s Regional Medical Center.
At any age, a fall is an accident – by definition, unpredictable. But there’s no denying that falls become more common with advancing age, and, as a result, there is much that can be done to head them off. Specialists have pointed to identifiable risk factors that are of two general types:
- intrinsic risks, or those associated with aging and medical conditions
- extrinsic risks, having to do with the person’s environment
In reality, most falls involve both intrinsic and extrinsic factors, often interacting with each other.
Although falls become increasingly common with each year after age 65, age is usually less a factor than fitness and strength. One study found that older women who had a physically active lifestyle were 36 percent less likely to suffer a hip fracture than similar women who were sedentary.
Frail seniors like Marlene, on the other hand, are at risk of freak accidents. And those who try to protect themselves after a first fall are likely to become even more frail.
Moderate intensity exercise or any regular physical activity can improve balance, strength and reaction time. Strength training is particularly beneficial, especially when it is combined with routines stressing balance – such as one-legged curls and exercises using a balance ball.
One recent study found Tai Chi to be an exceptional exercise program for improving functional balance and preventing falls in the elderly. Ogle agrees saying, “the steady movements and choreography of Tai Chi are a great way for people to improve balance and overall health.” Ogle coordinates a Tai Chi class offered through St. John’s and says “most of the participants are elderly and they feel stronger and more healthy after a class.”
By limiting range of motion, arthritis can have a detrimental effect on balance. Any disorder that changes gait pattern can make it difficult to maneuver steps or even lead to a fall on rough pavement.
Studies have indicated that neuropathy in the legs, common among diabetics, is a frequent cause of falls. The solution for all of the above is to follow treatment recommendations faithfully and avoid worn out or poorly fitting shoes.
Visual impairment – whether from cataracts, macular degeneration or decreased visual acuity – can affect gait as well as field of vision and sensitivity to contrast. Regular eye exams and changes of eyeglass prescription are important. Cataract surgery should be performed sooner rather than later.
Medications such as those used to treat high blood pressure and certain medical conditions can cause postural hypotension – a drop in blood pressure when getting up too quickly from bed or a chair that causes dizziness and sometimes loss of consciousness. The solution is usually to wait a few minutes after getting up before starting to walk. A medication review might also be called for.
“Nutritional deficits including lack of vitamin D and calcium can accelerate bone thinning and increase the risk of a fracture after a fall,” says Ogle.
Most seniors have one or more conditions that make them vulnerable to a fall. Women are at an increased risk because they live longer and are more likely to be frail or have loss of bone density. Because of these intrinsic factors, it’s smart to lower your risk by eliminating hazards in your environment.
For anyone at high risk of a fall, a home hazard evaluation by a physical or occupational therapist is well worth the expense. Some insurance plans pay for such an evaluation.
Of all the strategies for preventing falls, exercise is the best. “Even aside from strength and balance, regular physical activity is good for the cardiovascular system and improves mood, confidence and quality of life,” says Ogle. Group exercise programs even provide social interaction. Ogle adds, “even when a fall seems inevitable, such as a slip on the ice, well toned muscles can limit the injury potential.”
For more information on St. John’s Tai Chi or Fall Prevention classes, call Referral One at (417) 625-2000.
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