No More Dangerous Falls
Sometimes a fall is just a minor annoyance, resulting in minor abrasions -- but not always. Falls break bones and tear tendons. Even more worrisome, statistics show that falls are the leading cause of injury-related death among people age 65 and over. This unhappy statistic is partly because older people often have changes in muscle strength, reflexes and coordination. In addition, those with chronic conditions are more susceptible to falling because those conditions may affect balance and certain medications for those conditions can affect balance. But plenty of healthy folks fall as well, including a very good friend of mine who is very active and athletic. If she could fall, anyone can. So, how can you "fall-proof" yourself?
RECENT RESEARCH
In my research, I came across a recent study from the University of Michigan in Ann Arbor about a program called Combined Balance and Step Training (CBST). For this study researchers gathered results from 162 people age 65 and older who were divided into two groups. One group was in a tai chi program, the ancient Chinese mind-body practice... and the other group took CBST. Both groups practiced their particular method three times a week in one-hour sessions over a period of 10 weeks. Interestingly, in spite of tai chi's well established reputation for helping practitioners avoid falls, the CBST group performed slightly better in tests that measured specific abilities that promote fall avoidance. The senior author of the study was Neil B. Alexander, MD, director of the Mobility Research Center at the University of Michigan Geriatrics Center. I called him to find out more about CBST and how it helps people develop fall resistance.
Dr. Alexander first explained that falls generally occur because of a confluence of factors, both internal and external. To explain: You are talking on your cell phone having a heated debate about something and you cross a busy street. You are watching the traffic, but fail to notice the cracked cement on the other side of the street and over you go. A young healthy person might be able to right himself before falling, but that ability decreases with age and not just because of slowed reflexes, says Dr. Alexander. Falling often has to do with not just what you see, but also how you process what you see.
Cognitive decline -- even if mild -- can interfere with visual processing, but so can everyday stress and fatigue whatever your age. The reason: When stressed, your brain may fail to process visual cues, such as something in your peripheral vision that ordinarily you would take note of. Adding to the problem, 9% of people over age 65 have a balance problem that makes them more apt to tip. Dr. Alexander says this is often because of medicine side effects or conditions such as peripheral nerve problems or silent strokes that cause no immediate noticeable symptoms but affect the nervous system over time.
WALK RIGHT
The way people walk -- their gait -- has a great deal to do with how stable they are in motion too. With age, many people start to take shorter and slower steps. (This is also true of people affected by certain disorders such as Parkinson's or osteoarthritis.) But slower steps that are not long enough can make people more vulnerable to falling, says Dr. Alexander. Furthermore, one of the best ways to overcome an imminent fall is to make a rapid step of sufficient length in the direction of the fall, an ability many people lose. Consequently, CBST focuses on teaching participants to take longer steps at a faster speed, exactly the opposite of the shuffle walk associated with some older adults. It's also worth noting that long, fast steps require lifting the feet slightly higher, which provides better toe clearance, which in turn helps prevent a trip over small near-to-the-ground bumps and curbs.
BALANCE RESPONSES
Fall prevention also includes having good balance responses, which means being able to right yourself quickly when you are thrown off balance. To develop these responses, the CBST study group practiced a series of exercises to train them in what Dr. Alexander calls dynamic balance. The following are some examples... a.. Responding to a balance challenge while standing -- for instance, moving the upper body while bouncing and catching a ball. b.. Changing direction while walking, such as walking backward or laterally. c.. Moving from a symmetrical (side by side) to asymmetrical (one foot in front of the other) stance. d.. Maintaining balance while walking on a reduced base of support, such as on a narrowing plank. e.. Braiding/grapevine stepping -- foot in front, foot in back while going sideways. f.. Stepping over small hurdles the height of an average step (about six inches).The group also did modest exercises to increase ankle, knee and hip strength.
PRACTICING AT HOME
Although a CBST program is relatively simple, Dr. Alexander recommends starting such training following a screening by a professional, such as a physical therapist. (These professionals are trained to recognize weak spots and help people achieve their physical goals without causing themselves any injury in the process. He adds that everyone can and should integrate some balance training into an exercise regimen. These need to be more challenging than simply standing on one foot. He advises practicing doing two things at once (catching a ball as you move, for example), walking on something with decreasing support and teaching yourself to take longer, faster steps. Caution: Do not practice any of this without holding on to something stable for support. The idea is learning to prevent falls, not to promote them. Remember, too, that when you are tired, stressed or distracted, your ability to move properly may be hindered -- be especially careful at those times wherever you are. Even better: Be sure you get plenty of rest so your mind and bodily responses are fresh.
THE RIGHT SHOES
One last contributing factor -- what you wear on your feet plays a huge role in whether or not you are vulnerable to falls, says Dr. Alexander. Some soles, such as on sneakers, unfortunately, tend to grip, especially when you change surfaces, say from carpeting to linoleum, or when the surface rises slightly. Wearing sneakers, then, calls for extra awareness. Watch out for the lip (the tip of the shoe where the shoe front meets the sole) of the shoe, and how far it extends in front of your foot. An extended lip easily catches on steps or small hurdles along the way. The worst offenders in the shoe lip problem are sandals and some of the thick-soled shoes that are popular now. As for high heels, well, Dr. Alexander says, one error and you topple. The shoes to look for, then, are those without much lip but with a good fit to provide good support to the foot and ankle (making slippers a no-no). Soles should not be so thick it decreases the sensory input to your foot. If shoes have a slippery sole, scratch them up with a metal brush or the like before you wear them. Shoes without laces (fixation) or slip-ons without a back can also increase risk. Finding the right shoes takes some sleuthing, but fortunately there are many that fit the bill and are even fashionable enough to have you looking good while keeping you safe.
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