Preventing Falls

Some new recommendations regarding fall prevention (meaning “falling down” rather than the season Fall) have recently been published in the Journal of the American Medical Association (JAMA).  This has been a topic of previous blog posts here and elsewhere, but new guidelines were issued in April 2018 by the U.S. Preventive Services Task Force (USPSTF) so it seems worth revisiting.  The USPSTF is a group of nationally recognized experts on evidence-based medicine and primary care appointed by the government’s Agency for Health Care Research and Quality (AHRQ).

The USPSTF conducted a review of 62 studies evaluating various interventions among older adults at risk for falls.  They found that of the interventions studied, exercise tops the list by “significantly reducing the risk for experiencing a fall”.  Although specific types of exercise were not highlighted, group exercise was included in the majority of the studies reviewed.  According to the review, “initial, exploratory analyses suggest that group-based exercise (vs individual-based exercise), [including] multiple exercise components (vs single exercise component), and . . . strength or resistance exercises . . . were more likely to be associated with a greater reduction in falls and number of persons experiencing a fall.”

The reason for the effectiveness seems to be the strengthening effects of exercise.  But I would add some additional possibilities, particularly relevant to yoga, Pilates, Tai Chi and other practices which focus on connecting mind to body.   These include an emphasis on training your mind as well as your body to pay attention to what’s happening right now in this moment.  Practitioners are encouraged to learn how their bodies work and to gain greater awareness of their surroundings as they move through space.  We call that “proprioception.” Balance training is also inherent in all of these practices in addition to strength training.  Also, group exercise has the added benefit of a social component.  This may seem like it would not be relevant to fall prevention, but I would contend that it has an impact on all aspects of one’s life, including continued mobility both physical and mental.

Falls are something we all worry about, especially as we age, but they can be devastating at any age.  According to USPSTF

“Falls are the leading cause of injury-related morbidity and mortality among older adults in the United States. In 2014, nearly 29% of community-dwelling adults 65 and older reported falling, for a total of 29 million falls. Of these, more than one-third necessitated medical treatment or restricted activity. There were an estimated 33,000 fall-related deaths in 2015”

Anything we can do to strengthen our resources against this danger is certainly worthy of our attention.  This provides just another piece of evidence to recommend regular exercise for everyone.  It’s never too late to start.  No matter how inflexible or out-of-shape you think you are, if you can move and breathe, there is some form of exercise that you can do.  Starting is the hardest part.  That requires a decision.  Every journey begins with the first step.  Take that first step and then add to it.  Gradually.  Start slowly and keep moving.  You’ll improve if you stick with it.  You might still experience a fall, but by building your strength, you may also find that you recover that much more quickly.  That’s certainly worth the effort.


Fear of Falling

Winter has only just begun and already I’ve heard about several incidents of injuries from falls, at least one of them serious.  Of course, anyone can fall at any time of the year, but it seems like winter is a particularly dangerous time when ice and snow accumulate all around us. Some falls result from what we call “black ice”.  This is that devilish condition when a thin layer of ice on asphalt is invisible to the eye.  When encountered it can cause supports like feet, bicycle tires or even autos to slide perilously.  Another insidious form of hidden ice occurs frequently in my area where daytime sunshine causes standing snow to melt and then refreeze when the sun goes down and temperatures fall.  This condition can be particularly precarious when another layer of snow falls on top obscuring the ice layer below so you don’t know where it is until you step on it.

Although older adults seem more prone to falls, and many studies show that the consequences of falling for older adults can be particularly dire, no one is immune from falls.  There are many articles featuring suggestions for preventing falls.  All you have to do is Google “Fall Prevention” and you will find examples.  But I would like to focus on the causes that I see most frequently and that I think can be at least partially addressed with training.  First and foremost is failure to pay attention.  Our modern lifestyle seems to encourage hurrying.  We worry about slowing down when there are people behind us.  Or making that car wait for more than a few seconds while we cross a street.  Something distracts us and we forget to pay attention to our surroundings.  Have you ever been looking down at your feet (or your cell phone) and suddenly been hit in the head with a tree branch?  Admittedly I’m guilty of that one.  So the first piece of advice I would give is slow down.  Look around you in all directions.  Be aware of your surroundings.  Make sure your next step is on firm ground.  Sometimes I will take my foot and just slide it back and forth in front of me to make sure my next step is not on ice.  That car that’s waiting for you to pass is most likely not going to run you over.  And no matter where you’re going, the extra few minutes will not make any difference in the long run.  Unless they save you from injury.  Then, in fact, the extra few minutes might make a huge difference!

The second most frequent cause of falls I’ve observed or heard about is not taking proper precautions.  For example, not wearing appropriate shoes.  You think “I’m only going out for a few minutes.  I can make it in my high heels.”  Perhaps that’s a little extreme, but you get the picture.  You get away with it once and think it won’t be a problem the next time.  And maybe it’s not.  Until it is.  Wouldn’t it be better to just take that extra few moments to be safe.  I could go into a big rant here about the footwear industry and how it encourages us (especially women) to wear inappropriate shoes, but I’ll save that for another time.  Suffice it to say that most of you know what works in these situations.  It often comes down to the choices you make.  It’s also important to remember that just because you’ve been careful to clear your own walkways, this may not be the case everywhere you need to go.

There are many reasons why people fall.  Some of them are related to physical conditions or side-effects of medication.  If you have these types of concerns hopefully you will get professional advice on how to deal with them.   But so many falls result from preventable circumstances that it’s worth another reminder.  This provides yet another reason to tout the benefits of movement practices.  Mind-body practices like yoga, Pilates and others can help you to learn to pay more attention to the way you move.  These practices help encourage strength, flexibility and balance.  We think of balance as being able to stand on one foot.  But practicing balance exercises can also be a way to strengthen the muscles that will help you catch yourself and avoid falling.  Or help you get up if you do fall.  Holding onto something because you fear falling might be helpful, but wouldn’t it be better if the muscles that support you were stronger.

Mobility has been described as more than just being able to move, but also maintaining strength through a full range of motion.  Stability is the quality that enables one to retain or regain position when impacted by an external force.  So, for example, if you’re standing and something pushes you, you’re ability to recover your position would be a way to measure stability.  So you can see how mobility and stability go hand in hand.  Then there is flexibility which might be described as the quality of being able to bend without breaking.  Clearly all of these traits are also necessary components for good balance.  If you feel stronger and more stable you will also gain confidence.  Fear can make us tense.  Tension makes us brittle and rigid.  Rigidity is the opposite of flexibility. Tension zaps energy and strength.  So learning to relax can be as important as all the other elements of balance.  Breathing practices, also an important component of mind-body practices such as yoga and Pilates, can help relieve tension and encourage relaxation.  They also help you slow down and recognize that few circumstances merit the hurrying we often feel is so necessary.

Finally, being in good physical condition might not prevent a fall, but it will certainly help you recover from one.  And cultivating more conscious awareness of your mind and your movements can help you in all aspects of your life.   If you haven’t tried it yet, it’s never too late.  If you can move and breathe, there is a practice for you.  Take the time to find one.  You won’t be sorry.  And it just might save you from yourself.