Falls can be complicated and often prevented. The injuries that result from falls are many, and frequently are responsible for loss of independence. A reason for a fall may not be as simple as losing your balance. Balance is critical, but when we couple falls and illness, or we combine falls and the elderly, the question gets more complicated, and there may not be just one easy answer.
First, do not believe that people fall just because they are old. Living in Florida, I have had the personal experience of working with patients ranging in age from 50 to 100. It’s not unusual to have patients in their 80s and 90s be independent, live alone, and continue to drive safely. One thing I know for sure — there’s always a reason that a person falls. A fall due to an actual loss of balance can happen to anyone. Whether you’re the patient, caregiver, or a therapist, you need to be an active participant to figure out the potential reasons for a fall, and follow up with your doctors to define treatment options for your condition.
Balance is best understood by realizing that our muscles provide our support system, and we’re able to keep our balance because our muscles work in concert with each other. Agonist and antagonist muscles act in opposite directions. For example, your back muscles and your abdominal muscles must be strengthened to achieve muscular balance. When the agonist produces an action, the antagonist opposes the action. Stability is the result.
So in a perfect world, our muscles support our bones in harmony when we’re standing, and adjust when we take on different postures — walking, moving forward to stand from a chair, getting out of bed, getting on and off the toilet, and so on. Physical and cognitive problems influence balance and falls.
You should consider these six things before assuming someone falls due to “old age.” 1. Vision. Limitations in vision can impact the accuracy of steps, determination of curb or threshold heights, and depth perception.
2. Joint pain. If you’re having arthritic pain in a hip, knee, or ankle, you may unconsciously or consciously shift your weight to the stronger side to reduce pain. This causes a problem with balance and can cause damage to the “good side” due to overuse and inflammation.
3. Coordination. If you notice a change in your coordination, how you’re walking, or a worsening of posture (more bent over), these things contribute to balance. When a person shuffles when they walk or stops picking up their feet when they step, that could be a sign of a change in their neurological status. It could be as simple as sensory changes developing in the legs or as complicated as an evolving change in their neurological condition. These changes need to be evaluated by a neurologist.
4. Blood pressure. Most people talk about high blood pressure because it’s common. Monitor your blood pressure at home. If you experience weakness in the legs, lightheadedness, and/or dizziness while walking, check your blood pressure. It may be low, and it might be contributing to falls. Check blood pressure while sitting, and then stand. Wait 3-5 minutes before checking blood pressure in standing so that it will be more accurate. If you take it immediately upon standing, you won’t get an accurate reading of your blood pressure. Report these problems to your doctor.
5. Changes in metabolism and the endocrine system.
If you have diabetes or any other physiological condition that affects your blood sugar and/or endocrine function, follow your physician’s orders to maximize internal stability. You can become light-headed and dizzy and fall when these systems are not under good control.
6. Benign paroxysmal positional vertigo (BPPV).
BPPV is characterized by intense sensations of dizziness, or of a feeling that the inside of your head is spinning. Characteristically the sensations occur when the position of the head is changed because of crystals in your head that are out of place. There are exercises that help to put the crystals back in place, and treatment is usually very successful. Your physician can direct you to resources. If your doctor tells you to go to physical therapy for BPPV, make sure to ask the recommended therapist if they are experienced with this condition. Not all therapists are trained in this type of treatment, so it's best to ask. Successful management of any change in your medical status will require that you become a good “detective” for yourself and your loved ones. Pay attention to how someone loses their balance and how they fall. For example, if someone consistently falls backward, rather than forward or sideways, that is important for your neurologist to know.
If you feel you need to use medical equipment such as canes or walkers for support, keep in mind that you don’t want to miss an opportunity to figure out why you’re experiencing unsteadiness. Ask your doctor whether there’s an underlying issue that can be treated. This also goes for people who must hold on to the backs of chairs or kitchen counters. If you have to reach out for something to stabilize yourself, ask yourself why. Falls can be fatal, especially in the senior population. Get to the bottom of the reason for your unsteadiness. Don’t let anyone tell you that your balance problems are “expected” in people “your age.” Learn how to be your own advocate and get some answers!
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Written by Sally Thimm, OTR/L, president of Sallycares.com, an online resource for patients and caregivers.