Invest in strength to avoid falls
As a father with young children, I enjoy watching my kids play and have fun. Sometimes there is a fall or tumble but fortunately, they are small and flexible so ground level falls aren’t usually serious, just a few minor scrapes and bruises. On the other hand, when I slipped on the stairs a while back, I had some large bruises to deal with. The situation gets even more serious for my older patients whose bones aren’t as strong as they once were.
Preventing falls as we age comes down to a little bit of safety precaution and a focus on maintaining strength and balance that help you avoid falling and the consequences such as broken bones and hospitalization. Even if you’ve lost some strength and balance, simple physical conditioning like walking daily can help you regain and sustain the strength and balance you need to stay on your feet.
A few years ago, one of my patients slipped and broke her femur, requiring hospitalization and surgery. Afterward she needed physical therapy and went to stay in a rehabilitation facility, but after several weeks it was clear she would need longer-term nursing care. She had to move out of her town to a nursing facility closer to relatives. It took more than a year for her to improve to the point that she could rejoin her local community. The lesson is clear: falls can lead to serious health problems and disrupt the lives we have built for ourselves. So, how do we avoid falls?
The best way to prevent a fall is through strength and balance, which can help us be steadier and recover quickly if we do slip or stumble on an uneven surface. Maintaining these physical abilities is a bit like maintaining a garden. It takes attention and upkeep. Let a garden go too long and weeds get a foothold. The longer it is neglected the more work that is required to get it back to its former state.
So, is all hope lost for those of us who haven’t been able to stay active? Of course not! Life happens.
Many of my patients have lost physical conditioning after an injury or a hospital stay. I encourage them to begin or continue the work of regaining their strength and balance. It will take time, and I remind them to start small. An athlete training for a marathon doesn’t start by running 26.2 miles. A deconditioned patient may be in a different starting point compared with someone training for a marathon, but the principle is the same. Our muscles need small incremental challenges for growth. Before walking down the road, one might need to first walk down the block, and before walking down the block, first walk to the end of the driveway.
Walking daily is a great way to stimulate the muscles in your legs and core. This seems obvious but often we don’t consider the balance and strength conditioning we get from walking regularly. In some situations, walking might not be the right exercise. Many of my patients report losing conditioning because hip or knee pain is preventing them from walking. Others have become so out of strong physical condition that they feel unsafe walking. In these situations, I tell them not to “force it.”
There are lots of ways to exercise. Using a pedal exerciser is a great way to begin strengthening the legs and core muscles from the comfort and safety of one’s own living room. Walking through a pool or participating in a water exercise class is a great option because buoyancy of the water removes the danger of a fall while working on strength and balance.
It can be difficult to come up with an optimal and individualized plan, but you don’t need to do this alone. Your medical provider can help. They may also recommend working with a physical therapist who can assess your current abilities and how best to improve them with specific exercises and frequencies. Occupational therapists can help too. They may assess for specific actions like moving from a chair to standing. They can recommend techniques to improve safety, teach family members how to help and suggest equipment that may help. Many health plans include a fitness membership as well.
Simple changes in your home like removing trip hazards such as loose rugs and cords and wearing stable shoes, even indoors, is a good idea for all older adults. If you have had falls or close calls within your home, there may also be a role for a home safety evaluation. These visits involve looking at steps and thresholds in the home that might be fall hazards and how to mitigate the risk. They also look for opportunities to be proactive by providing supports like handrails in the shower or bathroom space. These interventions can help to prevent a fall and improve patients’ functionality within their own home.
Patients sometimes tell me they are hesitant to use assistive devices like handrails, canes and walkers when needed because they don’t want to become dependent on them. However, I don’t see that patients become dependent on these devices. Many use them while recovering from a surgery or an injury; then as their strength and balance improves, can put them away. On the other hand, when patients decline to use devices that are indicated they often take the risk of a serious fall or they avoid activity, preventing them from gaining the strength and balance necessary to reduce the risk of falls. Assistive devices are not a substitute for muscle or balance, they are a safety net and a tool to improve mobility without compromising safety.
There are a few other common factors in tripping or falling, including our habit of multitasking while walking—texting or talking on the phone when you’re moving around can lead to not paying attention to where your feet are going. You may be taking a medicine that can increase your fall risk; talk with your provider about what the options are. If you take blood pressure medications, check that it isn’t making your blood pressure to drop too low.
Take note and extra caution if you haven’t gotten enough sleep or if you have had alcohol, as even small amounts can affect your balance and reflexes. Be cautious if your vision is declining or you walk around in the mornings without your glasses. If you have fallen, tell your care team.
It's normal to get a little less steady as we age, and falls can be more serious. But taking action to maintain balance and strength will help you avoid falls and the injuries that come with them so you can keep doing the things you enjoy.
Peter Barkett, MD, practices internal medicine at Kaiser Permanente Silverdale. He lives in Bremerton.
This article originally appeared on Kitsap Sun: Invest in strength to avoid falls
