December 5, 2011

Avoiding Falls: Here's What I'm Doing. What about You?

My Parkinson's support group spent part of our meeting discussing falls, a major concern for those with PD. But we aren't alone; about a third of us over 65 will fall each year, often with serious consequences.

Falls are the leading cause of injury-based deaths among seniors, and that percentage has risen sharply in the last decade.

Outcomes Linked to Falls

The Center for Disease Control reports these common aftermaths:

  • Twenty to thirty percent of those who fall suffer moderate to severe injuries such as lacerations, hip fractures or head trauma. Those injuries can make it difficult to get around or live independently, and increase the risk of early death.
  • Falls are the most common cause of traumatic brain injury.
  • Most fractures experienced by seniors are caused by falls. The most common are fractures of the spine, hip, forearm, leg, ankle, pelvis, upper arm, and hand.
  • Many people who fall, even if they aren't injured, develop a fear of falling that may cause them to limit their activities, which in turn leads to reduced mobility and loss of physical fitness. With reduced fitness, the likelihood of falls increases.

How I Cope With The Risk of Falling
Dementia tops my list of health fears. But falls are a close second. My version of Parkinson's Disease doesn't involve tremors, at least for now. A big concern is my diminished sense of balance. This awareness made me abandon my biking, a major pleasure of my adult life. I've substituted long walks, which I'm enjoying almost as much. I can't afford to let an injury caused by a fall interfere with my new exercise regimen.

As a result, I signed up for BIG, an exercise program of exaggerated movements designed specifically for people with Parkinson's. BIG was developed by the same group -- Lee Silverman Voice Therapy -- who created the LOUD program to help improve voice volume and clarity.

I'd been certain my BIG program was helping, a feeling confirmed when vertebrae injuries from my August auto accident curtailed my exercises, and I felt the resulting impact. Last month, my back doctor gave me the OK to resume most of the exercises. I hope I'll be cleared to begin doing all of them soon.

Getting that OK to resume the exercises and actually doing them are two different things. So I've developed a gimmick that also helps address another of my concerns: spending too much time glued to my desk chair. Recent studies have shown that too much sitting is bad for your health, even if you also get plenty of exercise.

When I sit down at the computer, I activate a timer to ring in 25 minutes. When it goes off, I get up and exercise. When I sit back down, I set the timer again. And so on. This system isn't perfect. If I'm really absorbed with something on the computer, I'm likely to ignore the buzzer.

One of the key things I've learned from my Parkinson's support group is the importance of pausing before doing anything new, and thinking about it. This consciousness is especially important when movement and balance are concerned. I try to pause before changing direction while walking, since sudden changes in direction have resulted in my "closest calls." When I stand, I try to make sure I'm centered properly before taking that first step.

Testing Your Balance
Here's a quick, easy test to check your balance: get up from a chair, walk ten feet, turn around, walk back and sit down. Any irregularity or weakness should cause concern.

More Than Exercise May Be Needed To Counter Poor Balance 
Much of what follows comes from the work of Dr. Mary Tinelli, director of the program on aging at the Yale School of Medicine. She received a MacArthur Fellowship "Genius Award" in 2010 based in part on the work she has done on aging, and particularly on preventing falls.

Our ability to balance is influenced by many factors, including vision, gait, inner-ear functioning, blood pressure, muscle strength, and posture.     

"It's important to understand that the risk of falling isn't simply a function of aging, but rather the effect of illnesses and impairments common to older adults," Tinelli says. "In general, the more chronic health conditions you have, the more likely you are to fall."

For example, diabetes can weaken vision and desensitize nerves in the feet. Depression can increase the risk of falling, although researchers aren't sure exactly why this happens. Drugs for hypertension can cause dizziness or a drop in blood pressure when standing up. "In fact, a lot of medications affect balance; many drugs that target the brain increase your risk of falling," Tinelli says. Sleep aids are among the worst offenders.

Steps You Can Take To Reduce The Risk of Falling
Check Your Meds:  If you suspect your medications or supplements are making you dizzy, light-headed or sleepy, ask your doctor or pharmacist for a drug review. 

Get an Eye Exam:  Poor vision increases the risk of falls. Be aware that bifocals and progressive lenses can impair your ability to detect obstacles and judge depth. (I've worn progressive lenses for years and can't imagine pitching them now.)
Check your balance:  If you are having balance issues, see your doctor. Balance can be affected by a variety of conditions, such as inner ear problems, allergies, a head injury, or problems with blood circulation.

Exercise:  Physical activity is one of the best ways to prevent falls. My BIG exercises help me, and so do other balance exercises I've discovered -- like standing on one foot for as long as I can, walking heel-to-toe across the room, and getting up and down from my chair ten or 20 times. Strength training, stretching, yoga and tai chi are often recommended. I plan to see if my local senior center offers tai chi.

You might want to check out the Exercise Guide from the National Institute on Aging.

Check your home: Nearly half of all falls happen around the home. Pick up items on the floor that you or others might trip over. Be sure that electrical or phone cords aren't risks for tripping. Get rid of throw rugs unless you use double-sided tape to secure them. 

In the bathroom, use a non-slip rubber mat or self-stick strips on the floor of the tub or shower. Have grip bars installed in the shower and by the toilet.

Make sure lighting in the house is good. Use plug-in night lights in the bathroom and hallways. 

Put handrails on both sides of a stairway. I did this a couple of years ago and am very glad I did.

Organize your kitchen cabinets so that everything you use frequently is within reach without having to use a step stool. 

For  more help on checking out the home, see "Preventing Falls at Home" from the government's Eldercare Locator.

Using Canes or Walkers: Believe it or not, the improper use of canes or walkers sends around 47,000 seniors to emergency rooms each year. A physical therapist can help. The Mayo Clinic offers good slide shows on choosing and using canes and walkers.

Shoes:  Rubber-soled, low-heeled shoes are the best anti-slip/trip shoes for seniors.

Finally, if falls are a continuing worry, consider getting a personal emergency response system. These programs offer a small pendant or wristwatch-like gadget with an SOS button you can use to call for help. These systems cost about $1 a day. Check out Life Alert or Philips Lifeline.

What Has Worked for You?
Preventing falls is a major concert for most of us. I'd love to hear any tips or suggestion you have. Just click the comment button.                                                                

1 comment:

Di said...

My foot neuropathy has increased my dread of falling...never sure just where my foot is being placed when I walk.  Big news is that I feel much more confident since I have begun using Nordic walking poles as aids, plus they give me a bit of upper body workout.  I highly recommend them for anyone who would like a more secure walking aid than canes or walkers (I've used both and much prefer the walkiing poles.)