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Preventing falls as you get older: exercise is the key

Rosie O'Beirne
/
Flickr

Many older people have a great fear of falling – and with good reason. When a senior citizen falls, the likelihood of serious injury is far greater than when a younger person does. And for the elderly, falls can be disabling and even lead to death.

This week on “Take Care,” we interviewDr. Laurence Z. Rubenstein, professor and chairman of the Department of Geriatric Medicine at the University of Oklahoma College of Medicine. Rubenstein has researched and worked extensively on the development of interventions to prevent falls in older adults.

The statistics tell the story. Twenty percent of falls result in some type of injury, according to Rubenstein. The good news is that means in 80 percent of falls, the person is uninjured, and can hopefully learn prevention techniques from the incident. But half of the falls that cause injury result in something serious like a head injury or more commonly, a fractured bone, particularly a hip.

“Hip fractures can be devastating. They generally require a prolonged hospitalization and prolonged rehabilitation. In the frail older population that tends to fracture hips -- the people over 75, and especially over 80 -- the recovery is very complicated, often requiring months of rehabilitation,” said Rubenstein.

Between one-third to 40 percent of people over 80 who fracture their hip are not going to survive the year.

“It can be a life changing, life ending event,” said Rubenstein.

So why are older people more inclined to fall in the first place?

First, environmental factors are important. Tripping over something or slipping on the ice can be common, and people can try to avoid those dangers.

But Rubenstein says the most important risk factors are muscle weakness and deconditioning, problems with balance and problems with inattention and confusion.

Confusion can be caused by dementia or can occur in people who suffer from depression. Also, if a senior is on medication that lowers blood pressure, that can cause confusion.

Problems with balance and muscle weakness are intertwined. And Rubenstein says lack of strength and conditioning is the most important risk factor.

Rubenstein says an easy indicator of weakness in the legs is if an older person can’t stand up from a chair without pushing off with their arms. Those people will have unstable balance and are 4.5 times more likely to fall than someone who has normal muscle strength.

Lack of muscle strength means you can’t recover if you slip on something or trip over something. The strength in your legs and the speed of your reflexes are impaired. A younger person, with better leg strength, who takes a slip on wet pavement or trips on a crack in the sidewalk usually won’t fall, but an older person with slower reflexes will.

“A lot of older people will adapt compensatory gait patterns. They’ll take shorter steps, they will have a wider-based gait to give them more stability. They’ll walk more slowly and will be paying more attention to the ground in front of them so they’ll tend lean forward to look down and be looking down a lot more,” said Rubenstein.

But that compensation can be the beginning of a downward cycle, he said. Eventually by walking more slowly and taking smaller steps, the elderly person perpetuates the decreased strength, because if they are not walking vigorously they are not getting the same amount of exercise they used to. They get weaker, don’t go out as much, and the cycle continues.

Rubenstein says the best thing is to try to break that cycle and to get into a regular exercise program and gain strength. Ideally, you should start an exercise pattern earlier in life and continue it as you get older.

Rubenstein recommends balance training, strength training and conditioning. He says you should exercise consistently three to five days a week for 45 minutes to one hour. He says that amount of exercise has been shown to reduce falls and improve quality of life. It also helps mood, depression and memory.

“Exercise is one of the most important fall prevention techniques.”