Balance for Life

Avoiding Falls is a Key to Staying Healthy for Seniors



“I’ve fallen and I can’t get up!” While the famous line and the cheesy production values of this infamous television commercial might be funny to some, the issue it addresses is very serious — and, at times, fatal.

Falls are no laughing matter for senior citizens; they are the sixth leading cause of death among older people, taking more lives than diabetes. For many, the fall itself isn’t what proves to be life threatening, but the aftermath. Balance problems tend to arise after the age of 75, and falling can lead to months of being bedridden after an injury. “A hip fracture is particularly dangerous because it’s a major fracture and will always require surgery to repair it,” explains Dr. Kenneth Brummel-Smith, Charlotte Edwards Maguire professor and chair of Florida State University’s Department of Geriatrics.

Hip surgery itself has many risks, and the prolonged bed rest afterward poses another serious threat: pneumonia. The long period of inactivity also weakens muscles, increasing the risk of a future fall. Other dangers include kidney damage from broken- down muscle tissue and pressure sores.

Even those who fall and suffer no injuries tend to see a lasting effect — a heightened fear of falling in the future. This fear can be paralyzing, often causing seniors with previously active, healthy lifestyles to greatly reduce their activity levels to prevent another fall. Brummel-Smith points out that this is a counterproductive action that weakens muscles, actually increasing the risk of falling.
Active living communities are one option for seniors who feel daunted by living alone, where a fall can mean days of being unable to move to get help.

David Kerns, who lives at the Westminster Oaks community, suffered a fall in September 2011. Ninety-four years old at the time, he was walking home from working in the garage. Carrying two heavy bags, one per hand, he stopped to get the mail. But after bending over to put down the bags, he lost his balance and fell forward onto his left arm, hitting it so hard that he bent the top of his humerus.

He quickly called an emergency nurse who works in an adjacent building who brought him up for evaluation and sent him to Tallahassee Memorial Hospital. In the following days, Kerns was checked into Westminster Oaks’s Health Center, where he stayed for about a month as he recovered with the help of physical and occupational therapy sessions.

Since his fall, Kerns still goes for walks and works in the garage like he used to, but now he makes sure to plan ahead so that people know where he is going. The support he feels from the community formed between residents and staff at Westminster Oaks has been invaluable in recovering from his fall. “There’s just all kinds of people that will help you along,” he says. “You’re thankful ... that somebody’s going to take good care of you.”

Over the years, increased awareness about the dangers of falling has led many to look into how to build and maintain good balance to secure their safety and independence. Don Rapp, a local balance expert and author of “Become Your Own Balance Coach,” a kinetic arts balance manual, urges that it is never too early to start thinking about balance: “You can start any time; even a little bit is better than nothing.”

Rapp’s approach to balance is to start simple and work up. His exercises might seem very simple; it might not immediately seem important to be able to balance a ruler across one finger, but Rapp stresses that the systems behind that simple trick are also the systems that allow us to stand and walk properly.

Balance is a combination of primarily three tools: our vision, our vestibular system and our somatosensory system. Vision allows us to see and position ourselves relative to our surroundings; the vestibular system (generally based in the inner ear) tells us at what angles our body is positioned; and our somatosensory system tells us where our body parts are positioned in space and in what formations they are.

As vision deteriorates with age, the other two systems are forced to compensate. Rapp’s approach is to control and exercise the systems we are able to train. “The thing to do before you lose your eyes,” he explains, “is to get the somatosensory system and the inner ear up to top functioning before you lose that so there can be an integration.”

In addition to balance exercises, Rapp stresses the importance of an active lifestyle and the avoidance of being sedentary for long periods of time. Even if your physical fitness is not great or you are afraid of putting stress on your body, there are plenty of lower-impact exercises that improve balance.

“One [exercise] that’s been studied a lot is tai chi, where you’re moving really slow and you have to force yourself to balance. Those maintain those complicated neurologic interconnections so they decrease the falls,” Brummel-Smith suggests. Lifestyle changes don’t have to be major — even minor adjustments such as sitting on an exercise ball or even standing for some periods of time instead of sitting in a desk chair can make a difference.

There are several ways to see if your balance is not where it needs to be. Brummel-Smith explains that one of the best ways is to use the “Get Up and Go” test. Start seated in a regular chair and time yourself. Stand up without using your hands, then walk at a normal pace for about 30 feet. Turn around and come back, sitting down without using your hands. This should take about 15 seconds. “If a person can’t get out of the chair without using their hands, and if they can’t make it that fast they’re at high risk for falls,” says Brummel-Smith.

Another, simpler test that Rapp suggests to determine how much you rely on your vision for balance, is to stand up straight and tall and close your eyes. If you start to wobble or feel unstable, your balance is too dependent on your eyesight.

Seniors who feel unsure about their balance might also benefit from a cane, which can provide another base of support if used correctly. Canes purchased at drugstores or retail stores are often adjustable, so it is important to remember to test and adjust the length so that the cane works properly. Brummel-Smith instructs that it is also important to remember to carry the cane on the side of the good leg, not the bad leg.

Although it might seem trivial, footwear is also very important. Seniors should choose good shoes that have good traction. Running shoes and shoes with knobby soles are best avoided in favor of smoother soles. Good shoes not only provide grip for stability, but also support improved posture.

Another way to reduce the likelihood of falling is to make small changes in living spaces. Good lighting, a floor free of wires, rugs and loose items, securely nailed down thresholds and an elimination of clutter can make a huge difference. Another thing to consider is that pets tend to get underfoot and can pose a risk.

Regardless of strength and preparation, accidents still happen. After a fall it is crucial to listen to the body. If anything peculiar happens during or after the fall, including loss of sensation in the feet or inability to determine their position, unconsciousness or tremors, Brummel-Smith says it is important to see a doctor even if there was no injury. He also suggests reviewing current medications, because many medications such as anti-depressants, tranquilizers and sleeping pills affect the brain and can harm balance.


DIY Balance Exercise

For sharpening your system

  • Balance a ruler on four fingers, then three, then two, then one.
  • Roll a newspaper into a cone and balance it on your fingers as it leans on a corner for support, then a flat wall and then nothing.
  • Roll a newspaper into a baton and pass it around your body with your eyes closed.
  • Make an alligator mouth with your arms, with your top hand holding a tennis ball. Bring your top hand down and your bottom hand up, handing off the ball as they switch places. Then start tossing the ball from hand to hand as the arms cross, giving the ball air time.

For strengthening your system

  • Stand at attention, spine straight, shoulders back and relaxed, neck extended toward the ceiling and look straight ahead.
  • Stand up from a chair and sit back down. Repeat.
  • Put a can of food or soup in a plastic bag, hook it over your foot and extend your leg while sitting down.
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