Everyone falls, but this is most frequent at the two extremes of life: under the age of three and over the age of 70. In the interim, people fall less. Even if they slip, they can recover unscathed as their reflexes are better and they can get hold of something and correct themselves. In older people, with less muscle strength and a slower reaction time, falls are complete and dangerous. Seventy per cent of the elderly die as an aftermath of the first fall. Thirty per cent suffer fractures, sprains, head injuries or painful bruising. Sixty per cent of the survivors become “recurrent fallers” with three or more potentially fatal episodes during the next year. Even if recovery is complete, 90 per cent suffer from a psychological fear of falling, leading to fear of movement, loss of independence, poor quality of life and isolation.
Poor vision is a common cause of accidents. Ageing decreases vision. Perception of objects and adaptation to light and darkness are faulty. The eyesight should be checked every year, spectacles purchased and timely cataract surgery performed, if required.
Hearing too is essential for balance and safety. With age, in addition to the loss of hearing that occurs naturally, there may be a build up of hard earwax blocking the ear and affecting balance. Applying a few drops of baby oil to the outer ear canal regularly and not using ear buds (which may accidentally push the wax in) will go a long way to preventing this.
Body weight should be maintained so that the body mass index (BMI) — the weight in kilograms divided by height in metre squared — is 23. If it is less than 20, the chances of a fracture are greater, with no protective pads of fat to cushion the bones. If it is greater than 23, the chances of osteoarthritis and loss of balance are greater.
The elderly tend to walk slowly, stooping at the head and shoulders. Arm swing is decreased and there is more side to side movement. This leads to subtle alterations in the centre of gravity and a tendency towards loss of balance. The propioceptors (sensors that respond to stimuli) also react slowly, contributing to falls. To correct this, practise walking consciously correcting these defects. Also, stand with both legs planted firmly on the ground, close both eyes for a minute, and then balance on one leg with the eyes still shut. This helps in maintaining a sense of balance.
Footwear slips if it is too large, the straps are not firm and the soles are smooth. These defects have to be eliminated.
Bathroom floors can be slippery and treacherous. The tiles should be rough, not glazed and smooth. Handrails should be fixed near the toilet and shower to aid in getting up from the squatting position. Lighting in the bathroom should be bright and the switch near the door.
With ageing come diseases like arthritis, foot deformities, stroke, Parkinson’s and other tremors, epilepsy, dementia and peripheral neuropathy (numbness of the feet). These complicate other long-standing illness like diabetes and hypertension. Multiple diseases require treatment with a “polypharmacy” of drugs. These medications can contribute to giddiness and falls. Drugs for controlling high blood pressure may cause “postural hypotension”, a condition in which the blood pressure is apparently normal and well controlled on lying down but drops on standing. This is because the body does not compensate for the postural change and bring the pressure to normal levels quickly enough. Diabetic medication may cause sugar levels to drop precipitously, causing a loss of consciousness and a fall. Sometimes, elderly patients are placed on antidepressants or sedatives. They may fall off the bed, or, if they wake up suddenly in the night, they may be confused and disoriented.
The following risk factors triple the chances of a fall. Just remember “I hate falling”.
I — Inflammation of joints (or joint deformity)
H — Hypotension (orthostatic blood pressure changes)
A — Auditory and visual abnormalities
T — Tremor (Parkinson’s disease or other causes of tremor)
E — Equilibrium (balance) problem
F — Foot problems
A — Arrhythmia, heart block or valvular disease
L — Leg-length discrepancy
L — Lack of conditioning (generalised weakness)
I — Illness
N — Nutrition (poor; weight loss)
G — Gait disturbance
To estimate you’re chances of a fall, sit on a stool, get up without assistance, walk 10 steps, return to the stool and sit again within 10 seconds. If you can do this, your muscle strength, power and coordination are good and you are not likely to fall.
To prevent falls, exercise aerobically by walking 40 minutes a day. Balance can be improved with regular yoga. Exercise improves muscle and bone strength and dissipates the force of an impact during a fall. It lessens the chance of fracture by 60 per cent.
As the Indian population ages, we have to concentrate on measures to ensure that the elderly are not bed ridden and a burden to their younger caregivers. Be it at 50-60 or 80, age is no bar to exercising.