Lest we fall…

“Like steps of passing ghosts, The leaves, frost-crisp’d, break from the trees And fall … “ wrote Adelaide Crapsey (1878-1914) in her poem ‘November Night’.

Unfortunately, most falls are not so poetic and can be downright dangerous as we age. Statistics compiled for people 65 years and older show that 20% of all falls have serious consequences, such as brain injury or broken bones (fractures). In particular, hip fractures often mark the start of a downward spiral in the elderly, and 95% are caused by falls.

In fact many falls are preventable. Therefore, Thetford’s tireless Community Nurse, Sunny Martinson, invited the physical therapist and falls prevention specialist Dawna Pidgeon to give a presentation on that topic last Wednesday at the Thetford Center Community Association. About 25 people attended.

Dawna was emphatic that falls, though common, are not a normal part of aging. However, you are at higher risk of a fall if you are aged 65 years or older, have had a previous fall, or suffer from muscle weakness, poor vision, dizziness, or a chronic medical condition. Fear of falling and problems with balance and gait also put you at risk.

Those are intrinsic risks that come from your own body. There are also extrinsic risks from outside the body, the proverbial “stumbling blocks” inside and outside the home that can include loose or uneven floor mats; pets underfoot; lumpy, potholed, or debris-strewn paths; inadequate lighting; lack of handrails on stairs… the list goes on. Alcohol can be a factor in falls, as is taking four or more medications. Psychoactive medications for depression, anxiety, and sleep disorders are also risk factors. And poorly-fitting footwear or untied shoelaces can trip you up, too (no high heels please!).

It sounds obvious that a fall is the result of losing control of balance. However, balance itself is controlled by three major systems of the body — the eyes, the feedback mechanism of proprioceptors in muscles, joints, and skin, and a part of the inner ear known as the vestibular system. These all send signals to the brain that coordinates them into balance.

Try closing your eyes and standing on one leg, and you’ll quickly appreciate the role that vision plays in balance. The eyes have a key role in coordinating the other two systems. Anything that distorts the ability to see our surroundings clearly, such as blurred or double vision, or even bifocal or trifocal lenses, can affect balance. It’s important to keep up to date on eye examinations and report any problem with balance to your optometrist.

Like the eye, the ear is a very complex organ that plays a critical role in balance. Feelings of dizziness and vertigo, when everything seems to be spinning, originate with the inner ear. Disorders in this location account for about half of all dizziness cases and can cause sudden onset of dizziness and vertigo. Anxiety and stress are the most common causes of dizziness that do not originate with the inner ear. Low blood pressure may also cause dizziness, faintness, and lightheadedness. Diagnosis of the root cause of these symptoms requires a visit with a doctor or a screening at Dartmouth’s Aging Resources Center.  

There are several things you can do at home to improve balance. One is to work on tuning up the coordination of the inner ear with the rest of the balance system. This can be achieved through simple exercises, like standing in a safe place such as a corner with one foot in front of the other, standing on one leg, and walking while turning your head to the left and then right.  As these become easy, the challenge can be increased by wearing dark glasses to reduce visual input and put more focus on the inner ear and muscle-joint systems, and then adding head movements on top of this.

Interestingly, a large analysis of many studies showed that a daily vitamin D supplement actually reduced the incidence of falls. This appears to work because vitamin D increases muscle strength by regulating protein synthesis that builds and repairs muscle fibers. It also controls the actual contraction of muscles through its effect on cellular calcium transport. And that is before including the important role played by vitamin D in calcium uptake into bones. Conversely, individuals with low vitamin D levels tend to be weaker, slower, and exhibit poor balance.  

But there’s no escaping the fact that the most important factor is to maintain muscle strength through regular exercise. The risk of a fall can be reduced by 50 hours of exercise total, in stints twice a week for 6 months. The key thing to achieve is a feeling of muscle fatigue rather than a certain number of repetitions, though in general exercise regimens call for 2 sets of 8-10 repetitions of an exercise. If it feels easy it’s a sign to increase the number of repetitions, or if the exercise uses weights, to increase the poundage.

The “Use It or Lose It” site at Dartmouth Health provides a free download of strengthening exercises to print out and an on-line video.

Locally, the Better Bones program in Thetford offers exercise routines with weights on Tuesdays and Thursdays at the TCCA (Thetford Center Community Association) building at 9:00 a.m.

Another great offering is the Tai Chi class on Friday at 8:45, also at TCCA.  Tai Chi is balance and strength training all rolled into one. It has been proven to reduce falls by over 50% and falls with injury by 75% when practiced diligently twice a week.

Finally, winter is coming, and with it the onset of slippery footing. A well-shoveled and sanded walkway goes a long way to preventing falls, as do trekking poles or canes with ice grips. And don’t forget footwear traction devices with the caution that they must never be worn on linoleum or tiled surfaces as they will slip and slide with disastrous consequences.

The Dartmouth Centers for Health and Aging offers many services, including  “A Matter of Balance,” a proven, award-winning program that decreases the fear of falling and allows increased activity levels. It includes group discussions, ways to reduce the risk of falls around the home, and an exercise program. To use these resources contact FallsPrevention@Hitchock.org; 603-653-3415.

Thanks to Community Nurse Sunny for bringing this important talk to senior residents. We hope there will be fewer, or preferably zero, falls going forward.