- Dr. Bob
Falling: the Gravity of the Situation
It has been my privilege and honor to take care of Brenda in my clinic for quite some time. She has a number of physical ailments, including an old ankle fracture that was repaired with titanium rods, spinal stenosis, some balance problems, and a congenital hearing deficit. Unfortunately, she returned to the clinic this week after falling on her back and sliding down some slick stairs.
I see it virtually every week now in my practice. Seniors like Brenda slip, fall, and injure themselves doing things they have done all their lives, but they find themselves now high-risk due to physical infirmities, the aging process, medication effects, etc.
Any fall we can prevent is a tragic injury avoided. This senior is someone’s grandparent, aunt, spouse, or friend. They are all precious and have their stories to tell. My goal as a chiropractor is to help them live life to the fullest possible extent and continue to be sources of joy and wisdom for the rest of us.
The National Institute of Health (NIH) tells us that one in three seniors over the age of 65 will fall this year, and the risk increases with additional maturity. Annually 1.6 million senior adults go to emergency rooms with injuries from falls, the most frequent cause for injury, both fatal and nonfatal, among seniors.
Fractured bones are among the most likely injuries to occur among seniors of both genders due to the age related loss of calcium from bones (osteopenia or osteoporosis), but this risk is even higher in women. Fractured limbs are common, but pelvic, skull, or spinal fractures are possible. Among the worst of these scenarios is a broken hip because it denies us mobility, which is more than an inconvenience—it may be deadly. Mortality after a hip fracture is about 9%, but if the senior has heart failure, mortality rises to 65% as immobility compounds the issue.
An increasingly common scenario involves anticoagulants and bleeding tendencies. Plavix was recently number three on the top twenty-five best selling drugs in America with over $6 billion in sales. It is almost rare to find a senior who is not taking it. If an anti-coagulated senior falls and sustains a head injury, the result may be not just messy, but very life-threatening.
Most senior adults are very aware of the pitfalls of gravity. Because the incidence of injury is so high, most senior adults know someone who has fallen or they have already fallen themselves. This creates anxiety about the whole issue. Fear of falling is in the back of the mind of most seniors at a time when they should be enjoying life like never before.
Many seniors are embarrassed by this problem. It offends one’s pride to be less independent. It suggests a loss of control of a body that has been someone’s home for decades. While it should not be embarrassing, it should be taken seriously. Once we face the problem, we should prepare for it, as sometimes falls can be prevented by identifying a cause and treating it.
Balance at any age depends on the availability of input from several sources. First, we need sensation from muscles and joints, including the feet, so that the brain understands where the ground is. Second, there are balance organs inside the inner ear that must be functional. Third, our eyes tell us if we are upright by viewing the horizon. And fourth, there is a portion of the brain just above the neck that resembles cauliflower (the cerebellum) that does not initiate motion, but coordinates all of it by receiving input from the first three on the list. If we lose one of these sources of information, we can still maintain balance with a marvelous ability to compensate if the coordination center (cerebellum) is intact.
Dizziness upon standing from a seated or lying posture is common with the aging process. It is exacerbated with certain medications that we use to control blood pressure. Diabetes, inner ear problems, loss of sensation from the feet (neuropathy), high or low blood pressure, dehydration, and other physical conditions may contribute to risk of falling.
How can we prevent falls among seniors? We might look at some practical steps. Most of these are easy and inexpensive to do. Here is a list of things to think about and possible resources.
There are numerous musculoskeletal problems that afflict the aged. Osteoarthritis, spinal stenosis, degenerative joint disease, old injuries, diabetes, circulatory problems, and loss of muscle mass can all affect muscle strength. Many of these issues can be addressed and treated by conservative means so that control and symmetric strength of body parts may be restored. This will affect posture, which also influences balance. Your chiropractor can help you here.
The natural mechanisms that keep blood pressure and blood flow to the brain regulated within very narrow limits lose some efficiency with the aging process, arteriosclerosis, and atherosclerosis. Sometimes we teach seniors new habits of getting out of bed, for example, to compensate for this issue. It is as simple as moving slowly and taking very deep breaths along the way. The movement of the lungs in the thorax provides a secondary pump for blood flow, and we can use it to augment the pressure feeding the brain. Simply put, arise slowly while breathing deeply to maintain your balance.
The sensation from the feet is important in maintaining balance because it tells your brain where the ground is. If there are problems with the nerves in the lower extremities (neuropathies), some or all of the sensation may be lost. This is a serious issue and should be addressed by looking for the cause. Again, conservative care should be the first line of attack. See your chiropractor.
Because horizon sense is so important to balance, poor eyesight can also cause a fall. Your optometrist can help you optimize your vision, but also consider using nightlights to illuminate your way to the bathroom at night. Luminescent tape can be used on doorways to make them easier to spot at night.
Make sure that any spills are cleaned up immediately. In areas that are likely to be wet, such as a bathtub, get some friction strips for the floor to prevent accidental slipping. Use a shower chair in the bath and shower. Consider a seat extender for the commode. You can find these helpful items at your pharmacy or your chiropractor can order them for you.
Your reflexes will slow as you age. This means that if you trip, you will be less able to stop yourself. Look at anything that might be in your way before you go to bed. Remove loose rugs, shoes, clothes, grandchildren’s toys, or anything that might be on the floor in the bedroom. Arrange the furniture so that you have a clear line from the bed to the bathroom before you go to sleep. Have a discussion with your pets about your needs and ask them not to sleep on the floor where you might be walking.
Consider adding hand rails in the bathroom and in hallways in strategic places so that you can use your upper extremities to maintain balance. Place important items that might be needed in the middle of the night conveniently on a bedside table to avoid awkward reaches. Include a flashlight among those items.
No matter what we do to prevent things, accidents do happen, so consider equipping seniors with an emergency call button that can be worn around the neck or carried in a pocket. It can be programmed to call a relative, and ambulance, or the police. Talk to your security company about options.
I could go on for quite some time on this topic because it is such a large issue for every chiropractic clinic. I would conclude with this, however: I mentioned pride above in the context of seniors being embarrassed about falling. King Solomon said that pride, too, goes before a fall. If you are a senior, particularly one who lives alone, put pride aside in favor of safety. Once you fall, it is too late to prevent it.
I think we will be able to help Brenda this time because she apparently did not break any bones. Spinal decompression works well with her as a very low risk intervention for spinal stenosis. We will improve her muscle strength and sensation in the lower extremities. We will get her a walker to use for distributing her weight over a larger area and providing hand holds for steadying herself. She will improve this time. As we work together, she and I will talk more about preventing the next injury. Gravity, after all, is still operant in our world.