Falls

Don’t be the fall guy

Posted by

0


Falls are the greatest health risk for most older adults. Here’s how to protect yourself.

photo of three mature men practicing tai chi outdoors

Every second, someone age 65 or older suffers a fall, making it the No. 1 cause of injury-related death in this age group. According to the CDC, about 20% of falls in adults lead to life-altering changes, primarily from broken bones or head injury.

“The best way to protect yourself is to address the three main physical conditions that contribute to falls: weak stabilizer muscles, poor core strength, and balance issues,” says Carina O’Neill, a specialist in physical medicine and rehabilitation at Harvard-affiliated Spaulding Rehabilitation Hospital.

Stabilizer muscles. The stabilizer muscles keep you upright and allow you to easily change directions. Two essential stabilizers for fall prevention are the gluteus medius (located on the side of the hip) and the gluteus maximus (the largest buttock muscle). “These work both together and independently to allow us to stand upright and stabilize the back and pelvis as we move during activities,” says O’Neill.

Core strength. Core strength is vital for fall prevention, as your body’s core is the epicenter from which every movement revolves. “As we walk, our bodies constantly have to adapt to ever-changing ground levels,” says O’Neill. “Adequate core stability and strength help you better react to these sudden changes and prevent potential falls.” The core consists of several muscle groups: the rectus abdominis (the “six-pack” or “abs”); the obliques, located on the sides and front of your abdomen; and the transverse abdominis muscles, which lie under the obliques and attach to your spine.

Stabilizer and core muscles weaken over time as men naturally lose muscle mass, a condition called sarcopenia. “These muscles further weaken from a sedentary lifestyle or when people follow a regular exercise program that neglects these areas,” says O’Neill.

Balance. Sense of balance naturally wanes over time, as do reflexes and coordination. This makes it easier to topple and harder to catch yourself if you do have a misstep. Another cause of poor balance is deterioration of the inner ear’s vestibular system. It feeds information to the brain about motion, head position, and spatial orientation, and it, too, becomes less effective as we age.

Defense is the best offense when it comes to fall prevention. “Take steps now to address areas that place you at a higher risk for falls,” O’Neill advises. Here are some strategies for shoring up your stabilizer muscles, core strength, and balance.

Headed for a fall? You can check your fall risk with some simple tests. Place one foot in front of the other so the toes and heel touch (like how you would measure distance on the floor) and try to stand without losing your balance for up to a minute. Another version is to walk heel-to-toe, like on a tightrope, for 20 steps. “If you have trouble maintaining balance and stability with either of these, you should discuss it with your doctor,” says Carina O’Neill, a specialist in physical medicine and rehabilitation at Harvard-affiliated Spaulding Rehabilitation Hospital.

Side to side

Side-to-side leg movements, like those you make when playing tennis or pickleball, can strengthen the gluteus medius and gluteus maximus muscles. If you’re not into racquet sports, there are many exercises that work. One is the clam, a simple floor exercise that targets both muscles. Here’s how to do it:

  1. Lie on your right side, your left leg on top of your right, and your knees comfortably bent.
  2. Keeping your feet together, raise your left knee, rotating the left leg until it makes a 90° angle to the right leg (or as high as is comfortable).
  3. Hold for a second and slowly return to the starting position.
  4. Do eight to 10 repetitions to complete one set. Do two to three sets.
  5. Change sides, and complete the same number of repetitions and sets with the opposite leg.

For more of a challenge, wrap a resistance band around both legs above the knee.

Bridge and plank

Bridge and plank poses are two exercises that O’Neill recommends to strengthen your core.

Bridge. Lie on your back with your knees bent and feet flat on the floor, hip-width apart. Place your arms at your sides. Relax your shoulders against the floor. Tighten your buttocks and abdominal muscles, press your heels into the floor, and lift your hips as high as is comfortable, or until they are in line with your shoulders and knees. Hold for a second. Return to the starting position. Do this eight to 12 times. Rest 30 to 90 seconds, and repeat the entire set.

Plank. Lie facedown with your forearms resting on the floor. Tighten your abs and raise your body to form a straight line from your head to your feet. Hold for 15 to 30 seconds. Rest 30 to 60 seconds, and repeat one or two more times. You can also hold the plank from a full push-up position, or on your forearms with your knees on the ground.

Other contributors Health conditions can further contribute to falls. Examples include arthritis (which can cause stiffness in the ankles, knees, and hip), peripheral neuropathy (nerve disease) involving the feet or lower legs, and heart arrhythmia (a change in heartbeat speed or rhythm that can cause weakness, dizziness, or fainting). Vision problems like cataracts, glaucoma, and age-related macular degeneration also can contribute to balance problems.

Tai chi

According to O’Neill, one of the best ways to improve balance is practicing tai chi. The ancient Chinese martial art consists of slow controlled movements focusing on weight distribution and rotation. Numerous studies have supported its use to improve balance and coordination and reduce fall risk among older adults and others at high risk for falls, like stroke survivors.

Another exercise for improving balance is one-legged standing. Stand on one leg for 30 to 60 seconds, using a counter or the back of a chair for support as needed. Switch legs and repeat. Go back and forth between the two poses several times.

Falls Can Kill You. Here’s How to Minimize the Risk.

Posted by

0


Falls Can Kill You. Here’s How to Minimize the Risk.

Falls are the leading cause of fatal and nonfatal injuries among older adults. Every 19 minutes in this country, an older person dies from a fall.

 

 

Every day, I scan the obituaries to see why or how people die. You might call it morbid fascination, but I attribute it to the combined influence of my age (77) and my profession (health reporting). Obituaries give me ideas for Personal Health columns like this one that might help others — and me — avoid a preventable ailment or accident and premature demise.

One of the most frequent causes of death listed for people my age, as well as some younger and many older folks, is “complications from a fall,” the explanation given for the death last month at 93 of Russell Baker, the much-loved Pulitzer Prize-winning humorist and columnist for The New York Times.

Falls are the leading cause of fatal and nonfatal injuries among older adults. Every 19 minutes in this country, an older person dies from a fall.

To be sure, nearly everyone falls now and then, and some falls are unavoidable. But falling is not an inevitable consequence of aging. Most age-related falls are preventable once you know why they happen and take steps to minimize the risk for yourself, relatives and friends whose age or health status renders them especially vulnerable.

More than a quarter of individuals age 65 and older fall each year, and falling once doubles their chances of falling again, according to the Centers for Disease Control and Prevention. A fall that may be run-of-the-mill for a young person (as in the lyric “Pick yourself up, brush yourself off and start all over again”) can be very dangerous for the elderly.

One fall in five among older adults results in a serious injury, and older people are less able to recover from the trauma physically and emotionally.

Although broken bones are usually regarded as the most common serious consequence of falls, even if no fracture occurs, a fall can result in irreversible harm to an elderly person’s health, social interactions and psychological well-being.

A frequent aftermath when older people fall is a heightened fear of falling, prompting them to limit their activities and cause further physical decline, depression and social isolation, which in turn can hasten death.

Many factors common among older people can increase the risk of falling: medical and orthopedic problems and the medications taken to treat them; physical changes that impair balance, gait and muscle strength; sensory declines in vision, hearing and awareness of body position; and pain that distorts body movements.

At the same time, there are ways to minimize the chances of a dangerous fall, starting with regular exercise to maintain leg strength, balance, endurance and coordination that can help you “catch yourself” and avoid a fall if you should trip. Tai Chi is an excellent, low-impact way to improve balance. Also, practice standing on one foot when you brush your teeth, wash dishes or prep a recipe. You might also get Carol Clements’s new book, “Better Balance for Life,” that details a 10-week plan for improving stability.

Get your eyes checked at least once a year or more often if you have a gradually worsening condition like cataracts or macular degeneration. Don’t delay recommended cataract surgery; blurry vision can foster serious stumbles. Regularly update your prescription for corrective lenses. Older people often do better with single-focus lenses, which may mean two different pairs, one for distance and another for reading, rather than one pair of progressive or bifocal lenses.

Also get regular hearing checkups and consider hearing aids if needed. You don’t want to be startled into a fall by someone or something approaching from behind.

Have your doctor review all your medications, both prescription and over-the-counter, for their ability to cause dizziness or drowsiness. Wherever possible, eliminate or lower the dose of those that are potentially troublesome.

Dr. Leslie Kernisan, a geriatrician in the San Francisco Bay Area, lists these medications that may be especially likely to create a fall risk: psychoactive drugs like benzodiazepines (e.g. Xanax and Valium) and sleep medications like Ambien and Lunesta that affect the brain; antidepressants like Prozac, Zoloft and Elavil; medications that lower blood pressure, including Flomax and related drugs used to improve urination; medications that lower blood sugar, including metformin; and anticholinergic drugs like Benadryl, “PM” versions of over-the-counter pain relievers, the muscle relaxant Flexeril and the bladder relaxants Ditropan and Detrol.

Last, but by no means least, do a thorough evaluation of the fall risks in and outside your home environment. Get rid of clutter — no books, papers, clothing or pet toys left on the floor or furniture that partially obstructs paths to the bathroom, bedroom, kitchen or front door. Install railings on stairways — and always use them — and grab bars around the shower or tub and toilet.

Evaluate the safety of floors and floor coverings, including throw rugs (a big no-no), loose carpets and raised ledges between rooms. Use a top quality nonskid mat in the shower. Repair all broken or uneven stairs and flooring. Keep electric and phone cords off the floor. Wipe up all spills immediately.

Invest in the best lighting you can afford. I leave several lights on 24/7 wherever darkness can spell danger and I replaced those bulbs with long-lasting, money-saving and brighter LEDs. At the very least, keep a night light on between the bedroom and bathroom or place a flashlight next to your pillow or bed and use it if you get up in the dark.

Make an honest assessment of your footwear. Shoes should fit well and be comfortable and supportive. Low heels and soles with good grips are essential. Throw away or give away any footwear that may cause you to catch a foot. I recently donated a brand-new pair of costly UGG boots for just this reason.

Never walk around in socks or stockings. Wear slippers that are not slippery. Mine are the last thing to come off when I get in bed and the first thing I put on before my feet hit the floor in the morning or during the night. A barefoot or sock-clad trek to the bathroom is a lousy idea. Two of my friends broke toes that way.

Outdoors, use footwear appropriate for the weather and surface conditions. And always look where you’re going — not at your cellphone or a distraction across the street. My rule of thumb: I walk looking about 10 feet ahead of me to anticipate trip hazards. Anywhere and any time your stability is uncertain, use a walking stick (or two), a cane or a walker.

Think you’ll be painfully embarrassed? Think how much more humiliating and painful it will be if you fall.

Aggressive BP Lowering Linked to Falls in Older Patients

Posted by

0


For older people being treated aggressively for hypertension, an easing of blood pressure targets might reduce recurrent falls, new research shows.

Kenneth Boockver

“An increased risk for falls is a concern for older adults who pursue aggressive targets for lowering high blood pressure,” said Kenneth Boockvar, MD, from the Icahn School of Medicine at Mount Sinai in New York City.

“I am both a geriatrician and a researcher, and a lot of my research questions come from my own practice,” Boockvar said here at the American Geriatrics Society 2018 Annual Scientific Meeting.

“I was seeing this, and teaching that blood pressure treatment might be harmful in some patients, but when you review the literature, it’s still a matter of controversy as to how aggressively you should treat blood pressure in older adults,” he told Medscape Medical News.

A systolic pressure of 120 mm Hg or below is normally considered an agressive target.

To examine the association between falls and aggressive blood pressure targets, Boockvar and his colleagues examined Veterans Affairs data on 19,297 residents of VA nursing homes who were 65 years and older and had been treated with at least one of the common hypertension drug classes from 2010 to 2015.

The team identified veterans who had fallen in the 3 days after a systolic blood pressure reading no higher than 120 mm Hg, which suggests that they were receiving aggressive blood pressure management.

They then looked at whether treatment had been eased — with a dose decrease or the discontinuation of a medication — in the 7 days after the fall, and assessed the 30-day risk for subsequent falls.

Fall Risk

The median nursing home stay of the 3436 veterans who fell was 611.5 days.

Of the 730 falls that were preceded by a systolic blood pressure reading of 80 to 100 mg Hg, 245 veterans (33.6%) had had their antihypertensive treatment eased.

Of the 1528 falls that were preceded by a systolic reading of 101 to 120 mg Hg, 381 veterans (24.9%) had had their treatment eased.

Age and physical function were similar, whether or not treatments had been changed. However, Elixhauser Comorbidity Index score was higher with medication easing than without (6.4 vs 5.9; P = .004), and the rate of dementia was lower (53% vs 61%; P = .008).

In addition, the risk for 30-day subsequent falls was lower after treatment changes.

Table. Effect of Treatment Reductions on Subsequent Falls

Systolic Pressure (mm Hg) Falls After Eased Treatment, % Falls After No Treatment Change, % Relative Risk P Value
80–100 11.0 18.1 0.61 .013
101–120 12.9 17.6 0.73 .030

 

Alayne Markland

“This study has implications for veterans in long-term care, and may have an impact on residents in other long-term care settings,” said Alayne Markland, DO, from University of Alabama at Birmingham.

“However, the findings will need to be replicated in women in long-term care settings, given that veterans are predominately men,” she pointed out.

“But clinical trials are expensive, and in the absence of money to do such research, using these administrative data really does give us a great hint about de-escalation,” she told Medscape Medical News.

Thuan Ong

Long-term residents of nursing homes “often have functional impairments, frailty, and a high burden of comorbidity,” said Thuan Ong, MD, from the University of Washington in Seattle.

“This is an important, vulnerable population that randomized controlled trials exclude. Hence, clinicians have little data to inform their clinical decision making,” he told Medscape Medical News.

“Although data on orthostatic blood pressure measurements were not obtainable because of the study design, the study’s underpinnings highlight the fact that falls and their consequences can be as catastrophic as a cardiovascular event. Balancing the two clinically important outcomes requires a patient-centric approach,” he pointed out.

 

For all book lovers please visit my friend’s website.
URL: http://www.romancewithbooks.com