Health & Family

A fall can have far-reaching effects

Although statistics show that most falls occur in the home and that older people, especially those with chronic illnesses or failing senses, are the most frequent victims, there is no shortage of such mishaps on the streets.

It is all too easy to be taken unaware, as I discovered on a Sunday in January. The temperature was above freezing when my friends and I started our exercise, undeterred by light rain.

Suddenly, though, the ground beneath our feet was no longer terra firma but sheets of ice that formed when the rain hit the colder-than-air sidewalk. And suddenly I was on the ground.

I escaped with a bruised hip, but the next day, I encountered two men who had broken arms when, unaware of the ice hazard, they ventured out to buy bagels for breakfast.

Even being prepared for the risk of losing one’s footing on slippery surfaces is no guarantee you will remain upright. I have tried shoes with every kind of sole, and finally resorted to ice cleats to attach to my boots when I trek over snow-covered ice so puppy Max can run loose in the park every morning.

But it can be easy to fall even when streets are dry, as my friend Lynda Gould of Manhattan can attest. At 63, she tripped on a subway grate and broke her elbow. Two years later, while rushing to move her car, she caught her rubber-soled shoe on a slight bump in the pavement, fell and broke her hip. And four years after that, on a dry day in mid-March, she caught her foot in a tree guard, fell and broke her shoulder.

“I tend to drag my feet and catch them on things on the sidewalk, especially when I’m tired. Also when I’m distracted,” as when a nattily dressed woman caught her eye, Gould, now 71, said. “In addition, my balance is not good.”

She’s done some tai chi, which is excellent for improving balance, and has worked on a balance board with a physical therapist. At her doctor’s suggestion, she will now take lessons with a Pilates instructor.

And I hope she’ll take my advice as well: to stop rushing so much, consciously pick her feet up even when tired, and always – always – watch where she’s walking. Friends wonder why I often find money on the street. It’s because I keep one eye on the ground in front of me.

Ailments affect falling

Fall injuries requiring medical attention rise from age 18 on, peaking at 115 per 1,000 adults 75 and older.

Dr. Laurence Z. Rubenstein, chairman of geriatrics at the University of Oklahoma College of Medicine, reports that those 65 and older constitute about 13 percent of the population but account for 75 percent of all deaths caused by falls. About 40 percent in this age group fall at least once a year; 1 in 40 ends up in the hospital, after which only half are still alive a year later.

Among the factors that account for this grim data are underlying ailments, including osteoporosis; age-related physiological changes like slowed protective reflexes; sensory losses like poor eyesight; medication side effects; a stiffer, less coordinated gait; loss of muscle tone and strength; a drop in blood pressure upon arising; and environmental hazards like icy or uneven sidewalks and loose rugs.

Strength and balance

Another factor is fear of falling, especially common among those who have already suffered a bad fall. Fear can become a self-fulfilling prophecy that, by curbing activity, can lead to a loss of muscle tone, balance and bone density and increase the chance of a disastrous fall.

“In the short run, fear can be protective if it helps you avoid hazardous situations,” Rubenstein said. “But by limiting one’s activities and exercise, fear can result in weakness that actually increases the risk of falling.”

“In the worst-case scenario,” he added, “the fear can become a real neurosis where people are afraid to go out of the house and thus become isolated, weaker and ultimately more prone to falls indoors as well as out.”

Maintaining muscle strength with advancing years is critical to reducing the risk of falls, Rubenstein said.

So is improving balance. “Some age-related loss of balance is inevitable, but some is reversible,” he said. He suggested a balance self-test: With someone ready to steady you if needed, stand with feet together and eyes closed. How long before you begin to lose your balance? Can you do it at all?

Or stand on one leg behind a chair without holding on. If you cannot remain stable for 30 seconds, you need help with balance. Now try it with your eyes closed. A normal 25-year-old can do it for about 30 seconds, while a 65-year-old may last only 5 seconds.