I fell recently because of my arthritic hip and an uneven sidewalk. I was lucky that I didn't break anything, but I am still in pain and the fall was a couple of months ago. What the fall did was make me more aware of my age (82) which I was really trying to ignore. I no longer run up and down the stairs. I hold on to the stair rail. I turn on more lights to see where I am stepping and I absolutely avoid slippery rugs. I also need to use a cane which helps my balance and eases the pain in my miserable hip. Don't be foolish like me! Don't wait to fall until you correct your bad habits. It is not worth it.
Practice one-legged exercises on a Bosu ball
September is Fall Awareness Prevention Month-October is Physical Therapy Month. See you physical therapist to have a home assessment and exercise prescription to prevent falls!
Sue, DPT
All good advice. I can only add: learn how to fall. There IS a safe way to fall.. There are experts on this & they're mostly in the martial arts fields. I've been looking at videos online for this & will be practicing it at our local Y on the mats as well as on a trampoline.
Surprising there was no mention in the article on what the underlying reason for falls is in the elderly: age related muscle loss and the resulting weakness. Weak muscles mean less stability, and slower reacting reflexes exacerbate the problem.
But, all is not entirely bad news. Since we know muscle weakness is the primary culprit, we also know that strength conditioning exercise (i.e., resistance training/weight bearing exercise) will actively mitigate the risks as we age. (Exercise, is there anything you can't do?) Be strong, and live long!
3
NEST brand smoke detectors ( I’m sure there are others) will light up with movement. They thus serve double duty and give you a light to the bathroom as well as alert to smoke. No need to keep the lights on all night.
Slow down. Pay attention and focus on the one thing you are doing. Don’t let your mind wander while walking down stairs. Mindfulness sounds easy, but it is anything but in our modern, fast-paced society. Learn it.
4
Another excellent column. All good advice. I did not know that single lens are better than progressives (which I wear) or bifocals re falls.
Also, my brother in law has balance problems because he takes drugs for epilepsy and he wears shoes in the house to help prevent him from falling.
Also be careful of a little bit of what I call macho neurosis (usually but not always men). When I was in my sixties I prided myself of still being able to run down the stairs without holding the rail.
I hyper extended my big toe which took a long time to heal.
4
All good advice, except standing on one foot while doing other things. IMO practicing balance daily as part of an exercise routine is essential but it should be done with concentration. Focus on your core while balancing and breathe. You're building muscle memory. Balancing in an absent minded way while focusing on a task seems risky to me. Gear down and move mindfully as you age with grace and balance in all things.
4
Thank you, Jane, for reminding me of Russell Baker,sending sending me back to his obit and amazing humor.
77 now, began practicing Tai Chi just before my 60th birthday. After practicing the 30 minute “long form” every morning for 10 years, I realized doing so had changed the way I move. I move more deliberately now. I do “Tai Chi standing” while waiting in line. Also learned how to get up from the floor from my then 2year old granddaughter. This after 3 total hip replacements. Was doing the Tai Chi again after a month (except the 3rd, no weight bearing for 6 weeks so it took longer). I got lazy for the first year of COVID…felt awful…back to doing it again now…feel great!
1
I was attacked by a territorial dog which led to a fall. The bruises on my legs took a month to heal.
My mother and aunt gave away two dogs that were a tripping hazard when they were in their eighties. Pets are great companions except when under foot.
A dog trainer that came to my house told me to teach my dog to get out of my way all the time. She said, when your grandma comes over with her walker she will need the dog out of the way so she can move. I think the trainer was talking about me! I didn’t ever train the dogs to get up and out of my way “walk through” training, but should have. I have a 95lb. BMD who I have to step over all the time. He loves the kitchen floor.
Use those handrails! I make it a practice even if only with a light touch. And use a walking stick; it helps generally with your gait, and is very useful for uneven spots. My mother was so resistant to using a cane after her hip surgery and preferred to use the walls for balance - couldn’t convince her otherwise of the risk, she wanted to pretend to be much younger.
1
Another addition to an extremely well written and informative article! We have a tendency to “play” as though we are still young, yet our bodies are those of 60-90 year olds. I’ve witnessed more retired people breaking bones playing pickleball, riding bikes and the like. Not suggesting that these activities are harmful but older people do need to be more cautious. As my mother used to say,”An ounce of prevention is worth a pound of cure!’
We have a 55 pound black lab, Lucy, who is a wonderful companion. The problem is that she likes to sleep in our bedroom. Yes, she has a dog bed, but has been known to move around and sleep close to our bed. We don't get out of bed at night without using a tiny flashlight to find Lucy.
5
Spending most of your time at home barefoot helps develop the small muscles of the feet and can increase your ability to balance. Ballet dancers and gymnasts perform barefoot or almost barefoot because the flexibility of the toes provides much better balance than a flat, rigid sole of a shoe. and bare feet do not slip the way the soles of some shoes can on certain floors.
14
Ballet dancers and gymnasts do irreparable damage to their feet. I have seen the broken bones and deeply bruised muscles as well as falling off toenails. They are expected to torture themselves and to dance through the pain. I’m not sure following their example is a good idea for an older person trying to avoid falls and broken toes.
5
Another simple, but oh so important solution; remember to hold on! Never walk up or down stairs, escalators, etc. without holding onto the railing!
7
Helpful article. Please lose the "rule of thumb" phrase, though. Its history is a barbaric one.
3
Consider motion-sensing lights strategically placed, for instance, on the way to the bathroom. Unseen items that could trip a person are more likely to be seen. Above all, consider emplacing grab bars in showers/tubs and beware of throw rugs, even rubber backed ones.
6
I had an 80+ female landlord fall near her inside backdoor. I found her because I went to pay the rent early, otherwise she would have laid there for three days. She couldn't get up. She had no arm or upper body strength. Her son traditionally scoffed at the idea of women, not just older women, doing any kind of exercise.
2
@David It's really a good idea for people like that to get a device that can summon help. It's a call button that can be worn around your neck. I fell once and couldn't get up; now, I wouldn't be without this. It's a tremendous force for peace of mind.
5
Strength and flexibility training are so important!
It's really important to look down rather than ahead especially outdoors, sounds simplistic but works for me.
6
There’s no mention here of remaining active to keep the muscles necessary for balance in shape. There’s also no mention of a good diet including protein to keep those muscles.
5
I second that. Weights & aerobic exercise coupled with increased protein/water/fiber intake can ameliorate the aging body's difficulties growing & maintaining both muscle mass & neurological connections. I would also add yoga. The "youngest" older people I have ever met have always, without exception, been yoga people.
Avoid ladders. Pay someone younger to do the job. My mother could have avoided a traumatic brain injury if she'd done that.
10
The piece of advice my mother's PT emphasized most often after her stroke was "Stand up straight." Head up, shoulders back. It's common to hunch forward when you're afraid of falling, but it keeps you from lifting your feet properly and messes up your balance. It seems to have worked, it's been over three years and no falls.
9
Invest in a suite of smart lighting products such as Hue and you never have to be in the dark. Light bulbs and lamp plugs can be programmed with a phone app to turn on and off with different intensities at different times of day. They can also be controlled with motion sensors and turned on and off with smart switches and smart buttons. For instance, a lamp can be programmed to come on in the evening at reading light intensity and then switch to night light intensity at a specific time and then off. Bathroom, stairwell and hall lights can be placed on motion sensors. Frightened by a noise, a nightstand smart button can turn on all the smart lights in your home and even outdoors and then back off it is just the wind. The possibilities are endless
I worked for a great biopharma company that was very safety-focused and conducted safety meetings on many topics that all employees were required to attend monthly. I thought the meetings were super-useful: not just work-related, but home and age-related safety issues were presented. I recall that at the last safety meeting I ever attended, a video ended with the admonition “NEVER PUT YOUR FEET WHERE YOU EYES HAVEN’T BEEN FIRST”. Obviously I’ve never forgotten it, and in fact evolved to live by it assiduously - almost thoughtlessly.
10
Sadly, if you really want to avoid falls,. you must get rid of. your pet. read the statistics. a leading cause of. injury and. falls.
4
@Me
Getting rid of a pet is terrible advice as a pet can bring so much emotional joy and companionship. A dog can and should be trained to not be underfoot, regardless of an owner’s age. A cat perhaps not so much with training but most adult cats will not get underfoot unless it is time to be fed. For this, the person should be aware. Besides which, when someone is mindful of what they are doing, they are aware of where their pet is.
14
Perhaps a more effective approach is to teach your dogs to follow commands that clear them from your path. My cousin has two huge dogs. She taught them the command “out of the kitchen” meaning clear out of this space now. They know to exit wherever they are and station themselves in the next room without delay. Now cats are a horse of a different color, and I defer to others for ideas. But I stand by those who encourage pet owners to retrain their fur babies rather than parting with them. If you want and can have them in your life, your well-being is so much improved with animal companions.
7
I’m not sure that approach outweighs the emotional and physical benefits a pet brings. I have cats. And I have a whole host of orthopedic issues, some of which increase my chance of falling. And I have fallen many times. However, I have never tripped over my cats. When you have pets you get into the habit of looking before you step - a good habit for anyone with or without pets.
4
A shower chair with padded arms is an accommodation with a hand shower makes falling in the shower less likely. Also a rubber mat under the chair which has rubber tipped legs adjusted to the best height makes lifting yourself up very easy if you have upper body strength. An OT and PT assessment of your strengths and accommodation needs in your home is an eye opener. Listen to their advice and act in it, Do not just nod your head and do nothing thinking you are not ready for these life saving ways.
4
Being the independent woman myself, I hate acknowledging risk as I climb a ladder to change my own outside light fixtures. Add that to your list. We are a stubborn bunch!
4
A few suggestions before climbing that ladder: (1) recruit spotters who at least know you’re headed up the ladder & know to check on you if they don’t hear from you in 30-60 min - though having them hold the ladder is even better; (2) if you have the resources to do so, always wear a charged cell phone or Apple Watch if you’re independence means you’d rather not bother with spotters, or you can’t find one. If you fall (assuming you don’t conk your head & lose consciousness) you can phone for help - even using the watch. I have a Spibelt & am very careful to keep my charged iPhone in it and on my person at all times, having had some scary falls on steps; & (3) seek out a signaling system for neighbors to be able to recognize something may be wrong- for example, my super-independent Gran rose every morning & opened her bedroom shutters before even walking to the bathroom. With Gran’s approval we arranged with neighbors to glance over to check that those shutters were open as a sign of normalcy & to call us if not. It was an unobtrusive safety plan that cost little & gave us peace of mind without interrupting Gran’s privacy or independence. If you fall from that ladder, best to have some sort of system to signal something went wrong.
3
Dear Mayor de Blasio—-you know all those scooters and motorbikes you allowed to infiltrate our city? They are now being freely driven on sidewalks, paths in the parks—-and blast through red lights at intersections where pedestrians are trying to safely cross the street often driven by children. There are going to be many more falls for the elderly and not so elderly and accidents that involve children and pets because of the unfettered and unchecked proliferation of motorized, unlicensed vehicles on the city’s sidewalks. Thanks a lot, Bill.
7
Fall in the Bathrooms where the floors are slick and surface wet can be a dangerous place. The space is small and everything is hard. A fall means good chance that in addition to the impact of hitting the floor; you will hit some part of your body – head, knee, and shoulder – on a cabinet or fixture.
The consumer safety specification ASTM F446 - 19 Standard Consumer Safety Specification for Grab Bars and Accessories Installed in the Bathing Area “during reasonable use to assist a person entering, leaving, or moving within the bathing area”, will go a long way to reduce the number of accidents and to decrease the probability of slips and falls.
3
One quibble: why is a fall "humiliating"? It's not. It's just a fall.
10
Excellent article. I only wish I had read it before my fall last Saturday! Bam! Bruised knees, forehead and a black eye! Ouch!
1
@Sue Tobin
Hi Sue,
Please consider getting your yourself checked by your doctor. You hit your head.
I am recovering from a head trauma I and others minimized.
Long story short?
I am now being treated for post concussion syndrome a year after my head trauma. When your brain gets shaken it can either "reset" pretty quickly or begin a cascade of symptoms that can get worse and threaten your ability to live independently.
Post concussion syndrome can happen at any age, but as you grow older it can be more serious.
Sadly, many doctors do not test for this. Read up on concussions before you see your physician.
Take care!
3
Exercise! Practice activities that make you improve balance and reaction time. I bike, walk, and do yoga, but only tennis got me alert and fast enough to remember how to Drop & Roll ( which is, as another posted, a hugely helpful reaction to avoid injury).
1
All good suggestions, but people still fall sometimes, even with all these precautions. They're not enough. People also need to learn to fall as safely as possible.
With a forward fall, our instinct is to put out our hands or arms to break the fall, and that can result in a broken wrist or shattered elbow. Throwing your arms out to the side, getting your knees up and out of the way behind you, and landing softly on your belly minimizes damage. But it does not come naturally, to put it mildly.
The only way to overcome unhelpful instincts is to prove to yourself over and over again that there are ways to fall safely. As you practice, you not only learn the right moves -- you also reduce the anxiety you feel in a place where you don't have ideal conditions, and the terror of that moment when you just took a wrong step and you know you're going down.
2
When I was trail running, I made up the saying, "Look up, fall down!"
2
Metformin does not cause hypoglycemia, that is one of it's several advantages over other drugs commonly used for treatment of Type II insulin resistant diabetes.
The commonly used drugs that do lower blood sugar, the oral hypoglycemics , are glipizide and glyburide. These drugs cause low blood sugar that does increase the risk of falling.
Antihypertensives , that is blood pressure pills, lower blood pressure to the extent that they can cause falling and postural hypotension -- falling when we get up quickly. This cause of falling in older folks gets more common as the big pharmaceutical studies fund studies to keep lowering blood pressure normals. I commonly see patients on three or more such drugs.
3
The new automatic turn on LED stick-on lights, placed on walls, tub edges, etc., in my home have given me great confidence while rambling at night. These are showing up inexpensively - battery operated - on surplus sites and in big box stores. If placed 3-4 feet above floor level, my peripheral vision can mark any obstacles in the way of kitchen/bathroom locomotion. They are dim enough as well to not awaken the cats who will rush to escort - and possibly trip - me.
2
And the last thing (that would guide and teach you how to improve all your balance systems mentioned in the article) would be to see a trained movement and balance specialist aka a physical therapist! As a profession, we constantly lobby for PT to be like a dental checkup 1-2 times a year where your balance systems get a tune-up. We can quantify your fall risk and teach interventions to address whichever specific impairment(s) is most pronounced. Google 'direct access PT' in your state and you can likely schedule a 'fall risk assessment' at your local outpatient clinic this fall. Nurse Kathy is right - most hospitals (and SNFs) have a significant number of patients admitted due to falls - don't be one of them!
8
I fell 2 years ago and broke my shoulder. It changed my life completely. I still have pain and I’m terrified of falling again. I installed hand rails in my bathroom, always hold on to stair bannisters and use a cane or walking sticks when going for walks. Good shoes are a must and no more rushing around.
5
I'm 70 and have been walking my dog about 5 miles a day. Half of the walk is over uneven terrain that is a challenge but improves my balance. In the house we've installed motion and sound activated night lights. Years ago, my mother fell and broke her arm. She never left the hospital. A fall is treacherous and needs to be avoided by taking precautions including exercise.
6
Very careful placement of one's feet is absolutely essential; never walk in a hurry or fail to notice where your feet are planted and what obstacles may be in the way.
It is also a good idea to move objects from high shelves to low ones in order to eliminate having to climb onto step-stools or step-ladders. And speaking of LADDERS, ask your adult or teenage kids to do tasks requiring the use of ladders, or else telephone a local handyman.
My doctor once told me that the number one cause of nursing home placement was falling. If that doesn't scare you, nothing will.
9
I followed the advice to experiment with whether Tai Chi would improve my balance. I have an anoxic brain injury dating from childhood (serious near drowning with coma). I've lived a full and wonderful life with no complaints but have always had poor coordination. At 69 I have had a number of falls ; some with injuries and one requiring an orthopedic surgery to repair my hand 3 years ago. The Tai Chi was not a good idea for me. It was very clear to me that the positions were difficult and not fluid for a person with lifelong coordination issues. I knew that I would land on the floor trying sooner or later. So I withdrew.
On the other hand the horse who can throw me has not come my way. Go figure I guess. I would get on a horse again with reassurances about it's general habits and demeanor. I have abjured bicycles for several years now. I do not go down in the basement when I am tired and am very careful. I keep a land line down there in case of emergency. I am not going to trot around my house and garden burdened by a cell phone. I had a carefree cell phone free upbringing and refuse to be neurotic about it. If I fall I fall . I trust that I would not break every bone and would be able to crawl or lever myself upright some way or another. If not perhaps my time has come.
2
Great article, though if someone is falling they should absolutely see a physical therapist. Many of the items you brought up are important, but Medicare covers physical therapy for people at risk of falling and PTs are essential for helping seniors safely and effectively improve their balance, strength and endurance - especially if pain is a barrier to them exercising.
2
Everybody knows that refusing to ever leave the ground is the surest way to avoid falls.
1
Great ideas in article and comments. Three additional rules I follow in my 2 story house: 1) never go up or downstairs with stuff in both hands; 2) never go up or down stairs without holding onto the railing and 3) install a railing on steps to deck. My mother was never the same after falling down her basement steps.
10
Taking lessons in Alexander Technique is a very effective way for older people to practice better balance and kinesthetic awareness. It is a detailed and accurate education in how your body really works, and how to know exactly how you are coordinating yourself and relating to the surfaces underfoot and around you. You can greatly improve your chances of NOT falling -- and reduce your fear of falling -- with this investment of time.
4
Pushing ninety and taking warfarin so cannot fall. Found my way to a daily routine that greatly strengthened my core. Thirty deep knee bends every morning. I have canes around the house and in the car but never have to use them. This routine also brought an end to lower back pain. The flexing of knees and hips would not have been possible before getting knee and hip replacements--all four joints. I devised a counting routine that blunts the tedium--counting backwards and by differing integers. Carpe diem!
11
I have Multiple Sclerosis that accentuates hazardous falls with imbalance, low foot clearance, fatigue, etc. Many hospitals and the MS Society give classes called "How to Fall." They are great classes and I have avoided certain disasters after I start to fall by turning my head, making sure my hands go down first with upturned wrists and fingers spread open if falling forward, etc. The classes are great.
I also have planned many scenarios of how I could change a fall after the fall begins. I have had dozens of very bad falls, but never broken a bone, injured my face and eyes, or damaged my body permanently. There have been many bruises and a very sore lumbar and neck, but so far I have saved myself from serious damage.
Please take these classes and think ahead about how you could change your movement mid-fall.
5
I was a champ getting the first COVID shot, no side effects. The night of my second COVID vaccination I fainted when I went into the bathroom to get aspirin for a developing headache. We were so concerned with the blood coming from my head that we didn’t pay enough attention to my back. It wasn’t until several weeks later that I was diagnosed with a T11 compression fracture that still hasn’t healed. I am scheduled for a kyphoplasty this Friday, 8 months after the accident. I wish now that I had taken myself to the doctor immediately. I thought that regular exercise and yoga would protect me. After 70, your body just isn’t the same as it was.
3
I started cycling about 10 years ago after watching a workout segment focused on preventing the fall risk to seniors. The key takeaway was building strong legs and good balance.
2
As a Yoga teacher to seniors, I’m surprised by the lack of advice about practicing your balance with supervised exercises. It’s as if we assume we will lose our abilities and need to fix our environment. Both are critical.
4
Dogs.
Muscle weakness due to lack of movement/ strengthening exercises.
2
I always said that Medicare should pay for repairs for seniors that require a ladder. Much cheaper than the hospitalization that occurs after falling off the ladder!
7
My wife has had several falls. She has Sjôgrens/RA which doesn't help.
We have implemented several initiatives to reduce her risk of another fall. These include:
1. Using a walker when she is out
2. Paying close attention to trip hazards--especially in parking lots for concrete barriers, bumps, etc.
3. Using a cane or shopping cart when shopping
4. Installing motion activated lights throughout the house for night time vision
5. installing dimmer lights in bathrooms so lights aren't at full brightness when still sleepy in the night
6. Installing grab bars in the shower
7. Using slip-guards in bathtubs
Most importantly, when I walk with her, I look ahead to warn her of impending hazards--with my infamous "mind your steps" alerts to my wife! She hates it.
Says, I sound like Schiphol Airport in Amsterdam!
5
Just two weeks ago this 86 year old man, in great condition, was getting out of the bathtub shower in Lost Angeles while visiting a friend, and slipped on a very thin cotton bath mat which was on the floor outside the bathtub. On the way down I grabbed the towel rack and pulled it off the wall. I hit my head on the bathtub right near my right eye. The big toe on my left foot was damaged and filled with blood and the right index finger was also damage with blood filling the back of my hand. Surprisingly I was able to drive 7 hours right after this. Not falling is a great Idea.
9
All good ideas. However, at 68, I make a point of *not* using handrails, on the theory that it helps to maintain my balance. I pay attention to where my feet are as I go up and down stairs, but I don't want to get into a habit of relying on a handrail any sooner than I have to.
@Sarah D.
Everyone, at every age, should use a handrail every time!
5
You don’t want to find out it was time to start using the handrails too late. Use the handrail. Be intentional about your strength and balance by doing strength training and balance exercises. You’ll feel the physical improvement and you’ll realize how much risk you were taking.
@Sarah D.
I lightly touch the handrail, gliding over it. I find this approach improves my balance.
1
I broke my wrist early last spring on a patch of ice in my parking lot. I got those Yaktrax things to hopefully avoid it happening again. But I'm still nervous about crossing the lot this winter. And casts and PT aside, my wrist will never be the same.
1
@Tracy
If you can afford it be a snowbird and avoid the ice. Money helps.
I am 88 years old and for a variety of reasons, have very weak legs. One of the problems I face is getting out of chairs, most of which are quite low to the ground. Getting in-- OK, getting out--difficult or impossible. So I picked up 4 or 5 of those flat pillows that people use in tight seats at football games and asked a seamstress to make a flat bag to carry them in. I take the bag everywhere, to restaurants, to church, to classes, etc., and call the bag "my lauching pad". It keeps me just high enough (4" - 5" higher than most chairs) to get out of the seating arrangement without help. I also use two canes, but
the bag is easy to carry anywhere. You might think about
something like this if your legs are weak like mine are.
13
Use a cane
3
There are some very helpful suggestions in here that I had never thought of. Thank you.
4
Great article. I have a few more tips.
Home stairs = after knee surgery, a PT told me to back down them to take laundry or other items downstairs. I back down a few, bounce the laundry basket down a few toward me and repeat till I'm at the bottom.
Thresholds between rooms = when I stumbled several times on mine, I pulled them out. My granddtr "installed" cheerful duct tape where they used to be and no more tripping.
Gardening = I bought a garden cart to carry soil and tools around the yard, and I use it as a 3rd leg for stability where needed.
Falls = Figure out how/if you can get yourself back up BEFORE it happens. The only dependable way for me these days is to scoot to downward stairs and let my arms hold a rail or shelving while my bottom pushes me up.
Cell phone = never ever be without it. Mine is attached to me before I get out of bed and through the day using a case with a large waistband clip. And always make sure it's charged.
Talk about your limitations with trusted friends and family. So often we feel ashamed that we aren't what we used to be. Get over it: they know that we're old so let them help you make the best of what you can still do.
7
Several years ago I was watching an interview with "Judge" Judy Sheindlin and she said "if you want to live a long healthy life - don't fall".
As a CNA student this article and the accompanying comments section are so helpful! Thank you NYT.
2
I will show this article to my husband (who has already fallen numerous times), but he will probably reject the advice. I've been recommending some of these things for years, but he won't cooperate.
He has cancelled appointments for hearing aids twice and won't get rid of his clutter. He has not had his eyes checked in years.
How do you fix stubbornness?
11
@Stubborn spouse
You don't. You remove the clutter. You add the railings. You buy the alert system. You make sure the cell phones are charged.
This resonated for me because my grandmother died from complications from a fall. She fell I believe from the bed and broke her femur. I am always looking for ways to safeguard my mom who has a very cluttered bedroom and now wakes up to use the washroom at least once a night.
4
99.9% agree. But nixing barefoot excursions in one's own home, especially in the middle of the night? Nope. I never feel more grounded than when there's nothing between my flesh and the floor.
15
I am 75 and blind in one eye which means I have no depth perception and fall far too often. I have hit the cement frequently, especially misjudging curbs, so far I have not broken a bone. What I do have is excellent reflexes and although barked-up, I have managed to catch myself and get my hands out in front of me. I never walk with my hands in my pockets or I would land flat on my face. I am being much more mindful around curbs these days, I know my luck will soon run out.
3
I too have visual impairments that lead to poor depth perception. I have taught myself a few tricks that were then verified by a mobility coach. I would suggest you find a mobility professional to coach you. They aren’t just for totally blind people.
2
An excellent and very timely column. I would add that diabetic neuropathy, common in the elderly, is also a major fall risk. I speak to my diabetic patients regularly about this and am surprised how few were aware of it.
6
One very important fall preventer not mentioned is the installation of hand-holds in doorways with steps. These don't have to be the ugly metal tube things. You can get teak single boat handrails on Amazon that are perfect hand holds for door ways. Install in the left hand side of the door frame facing the door. The height depends on the person. As the sailors always say, always have one hand on the vessel.
8
Handrails handrails handrails. They are my friends. That and a small flashlight I always keep in my purse to illuminate steps etc at night.
2
Cats are a huge fall risk. Every cat I've had, God love them, seem to have no concern for their physical safety and are willing to walk in front of me or even between my feet, causing me to trip unless I keep my eye on their whereabouts. My cat is black, and therefore hard to see at night. It doesn't help that he accompanies me on trips to the bathroom at night and rests on a dark Persian carpet, which he visually 'disappears into.' My only recourse is to turn on a bright light when I get up at night now.
11
Pay attention. Never assume you won't slip or trip.
Even if you feel sprightly and have good balance, always hold onto a handrail going up or down stairs. Even the most physically fit person can have a freak trip on a stairs...loose shoe lace..simply not paying attention...something slippery on the stairs, etc.
Put a rubber mat or else rubber strips on the floor of your shower/bathtub.
The only kind of truly safe stepstool is the type that has a high handle at the top of the stool (waist-high, if not higher), so that while you are reaching with one hand, your other hand is firmly gripping the top bar of the stepstool.
Yoga, tai chi, wobble boards (or else just balancing exercises while standing on a pillow) all help with balance.
Throw pride out the door. If you are having balance issues, use a cane, fabulous walking stick or a walker.
For strong bones, weight bearing exercise (and that includes walking, which puts weight on your hip joint). Remember that calcium intake is only as meaningful as your Vitamin D levels. The two must go hand-in-hand. 15 minutes outdoors (with no sunscreen) per day, provides sufficient Vitamin D. Otherwise, i.e., during the winter months, take a Vitamin D supplement.
Natto is believed to also help with strong bones. Studies done of different populations/regions within Japan suggest that those who eat natto had better bone health.
6
my brother-in-law at 74 was dealing with some rare kind of dementia and fell a couple of times. the last fall involved a subdural hematoma and he passed away. i have taken a couple of heavy falls, actually more than a couple, over the last couple of years. i'm constantly aware that a ruptured disk, which thankfully has stopped giving me painful symptoms, has affected how i feel my feet, and i don't seem to walk the same anymore. i can trip over anything. today i dug out a newel post to put on the stairs on the back porch. not taking chances where i cn avoid them.
5
I brought my mom from the US to live with me here in Cyprus after she kept falling down and breaking bones. Yes the main reason was different dogs she owned. She’s got a walking cane and gets in the pool some but won’t get a mobility cart. Afraid she will fall again. I hired a companion and driver to take her around and a housekeeper. Kind of surreal to take her across the globe but it was crisis time. Sad when all your friends and siblings have died and you have outlived three husbands. Big responsibility but she’s glad she’s not living in a nursing home. Now we’re getting a new puppy to boost her mood. This breed is less hyper than the others she had.
6
Exercise, exercise, exercise! If you are not used to moving about, your muscles will weaken until they are no longer functional. We sit too much. We avoid standing and walking. The largest, strongest muscles in the body are in our legs yet we still use our arms to help us sit down or walk up and down stairs. That contributes to the weakening of your leg muscles. Strength in your legs is the key to maintaining your balance. Challenge yourself physically and do it regularly. Learn the difference between discomfort (which causes most people to decide to stop moving) and pain. The world is your gym. Use it! If you are averse to moving your body, you are courting future disability.
18
When I’m out walking I have a habit of moving trip and slip hazards out of walking paths or sidewalks. EG: sticks and rocks go off the side of the path, an old battery or similar gets tossed in a trash can. Pay it forward!
4
Years ago, I asked a 95 yo woman for a piece of advice on longevity.
"Get down on the floor daily. You never know when you'll need to get yourself up."
I followed her advice. (I also wear gripper socks to bed, have nightlight everywhere, but still had a fall. As our bathroom was awaiting a plumber, I used the guest bath and slipped on a fresh puppy pad.) No one's perfect.
When I fell onto my left hip, I could get myself onto all fours, but could not get up! Then I realized that, at 74, NO ONE can unless they can bear weight on both legs!
Fortunately, my husband came to my aid. My ample rear and industrial strength thighs protected my hip during my "Bone Stress Test." I had a gimp leg for a good month and a half, and five months on, I still hurt.
My message: if you live alone, have some sort of call device on your body. Without my husband, I'd have been hard -pressed to crawl back to the phone ten feet away.
9
It's not "died of complications from a fall". It's "lost his gravitational battle".
2
@Spensky
Sadly the outlook for seniors who break a hip or leg from a fall is not good. Many die within a year or two.
How about taking those R/X's whose side effects might be "drowsy" at night, not morn. Also sleep better.
2
Waking in the middle of the night to visit the bathroom poses its own variation of the fall ... be cautious, sit on the edge of the bed prior to standing and moving ahead., then move slowly and cautiously ... And, most assuredly, night lights along the way. If blaring white night lights cause you to awaken from a deep sleep, make use of red night lights ... still provide nighttime lighting, yet not blaring white light to wake you up.
3
I always use a flashlight when I have to get up at night.
Breaking my foot while walking to the mailbox several years ago forced a realization that I had a form of osteoporosis and that a fall could really do damage.
I have regular bone scans but I'm not currently on any osteo meds.
I use a cane and am as careful as a self-described doddering old fool can be, specially when others urge me to move faster.
I discovered, when researching my hobby of Midwestern American art pottery some years ago, that famed Rookwood potter Ketaro Shirayamadani died as the result of a tragic fall (https://cincinnaticum.blogspot.com/2010/12/experimental-video-killed-pottery-star.html).
After a lifetime of working out and running, I now do light housework and cook...motion is lotion as the VA doctors tell me...but slowly and with, I'd like to think, some rational thought.
Thanks for allowing comments.
5
@Sean
Try bone broth. Really, that’s the name. Costco sell the organic, no sugar, no salt version, a six pack, naturally.I use it rather than water to simmer raw vegetables such as kale, other high calcium greens. Also, perhaps invest in calcium-magnesium-zinc pills, available at Trader Joe’s or by mail.
1
For me it was always look out for our dog, she was a quiet, beautiful, lovely black rescue and I fell over her twice. Look out for your animals on the floor.
9
I'm surprised "don't take risks" isn't mentioned. Don't climb ladders and reach beyond what is safe.
All too often, it's about hurry and stress.
Also, several elderly people I know had falls at curbs or entrances to busy transit situations, where they felt pushed to "perform better". Of course, this is not necessarily the victim's fault, but the frequency of these falls is staggering.
6
A quad cane, with four points of contact with the ground, is much more steadying than a regular stick cane.
For use in the house, rubber band a shower cap or plastic bag around the bottom of the quad cane, so you don’t track dirt from outside through the house.
2
My mother-in-law fell at least once a month during her nineties (the last eight years of her life) - somehow she was never injured! She would laugh and say her extra weight protected her. She was taught the balance exercises but wouldn’t do them - “I don’t exercise”. She took no meds. We worried that our local fire department would refuse to come and pick her up after so many calls! They were so patient with her.
She died in hospital 22 days after her last fall - we still don’t know if she hit her head in the fall or if it was a recently discovered brain tumor that caused her to fall.
I guess at age 98 a person can make their own health decisions, but I’m very thankful she didn’t linger in a nursing home after a broken hip - that was my own mother’s sad fate.
5
Slipped on a wood floor wearing socks and cracked a rib on the arm of my couch. No lie.
Some trip hazards are beyond a person's immediate control, though. My recently renovated local supermarket features a new floor. I tripped because it was laid over an improperly cut drain mid-aisle and it's the only rise around. Small, unseemly and fast changes in grade can also be a menace.
A local sidewalk also has a water valve fully two inches below the surface of the walk. A least everyone in the neighborhood now knows about it after an orange cone was placed there.
Thank you, Ms. Brody. Good stuff here, again.
6
As a (now retired) community health nurse providing long term in-home case management to frail low income seniors at risk for nursing home placement, two things stood out
1) falls cannot be prevented. All humans at all.ages who get out of bed and move about will fall. It's a matter of reducing the risk of falls. Many activities (weight training, plyometrics, walking) in a controlled setting show improvement in balance and stability; the last time I researched some years ago tai chi remained the only activity that in real life correlated with a reduction in falls
2) a subset of my elders had a lot of falls without injury at home. They tended to relax, go with it, slide to the floor.
As a longtime martial artist whose practice involved being thrown a hundred or more times per class, I thought, can we play with aikido-judo style falling to make it senior friendly and reduce the risk of injury from falls.
We can and did. There are small but successful programs in the USA and Europe. Participants learn safer ways to simply walk and be in their environments and practice relaxed falling and rolling until it becomes an enjoyable reflex.
4
Thanks, Jane. At 71 I still play 6 am full court basketball with younger guys, today I played sitting out only two games until 7:45. And last year I bicycled 4,000 miles, all solo after March, riding safe suburban streets on bike routes here in Austin.
When I have a doctor visit they ask "Have you fallen recently?" and I answer with "Does it count if it was in a basketball game?"
3
@Cycle guy ,
My father's wife fell when she was 69 and broke her kneecap. It was at the beginning of a five-mile hiking trip, she was wearing a backpack, and she landed on a granite outcropping. But every doctor and every PT initially assumed that she was a frail, elderly woman who tripped on a throw rug.
After you hit 60 you don't have "accidents", you have "fall risk." Before 60 you can fall and injure yourself a dozen times without a single doctor mentioning fall risks, even when they should.
When using a walker with a seat, do not drape a sweater or jacket over the seat. It can slip off and cause a fall.
2
Excellent advice. And I was not surprised to see Flexeril listed. A while back, my well-meaning doctor switched me from Soma to Flexeril for controllingoccasional muscle spasms, because he thought Soma had problematic breakdown products. The only thing that broke down was me. It caused severe hypoglycemia (which explains the relatively large proportion of "dizziness" side effects). The hotel physician who examined me opined, after reading the blood sugar level, "You're supposed to be unconscious." Like walking on slippery glass. Tizanidine now, and zero problems.
3
I don't know what's in the book that was mentioned, so maybe its in there, but the major reason people "lose their balance" and fall as they age is not due to leg muscles weakness, it's due to weakness of the hip flexors.
I saw this first hand with my own mother, who, in her 80s, began to "totter." Thankfully, I came across Tufts University professor Miriam Nelson's book, "Strong Women Stay Young."
Within a week of starting Nelson's tested (and simple and quick) exercise routine, my mother started walking straight again - within two weeks, she walked like a young person. When she went away to visit family for a few months, she came back unstable. We went back to the book, and very quickly, she could walk a straight line again.
There are specific exercises to strengthen the hip flexors. Nelson's book is well worth getting.
Of course we need to make sure we don't have loose rugs or other things to trip on, that medications aren't making us dizzy, etc. Keeping our bodies in shape, however, does a great deal to protect us from many problems.
10
I suppose this may be implicit in what Jane Brody has written, but I will say it explicitly nevertheless: always take your time when getting to your feet. Never take the first step until you feel as balanced and stable as possible. Identify the place you will reach out for if you begin to lose your balance. And consider keeping a cane, a walking stick, or a walker close at hand.
Since I'm writing mainly to folks more or less my own age, I expect they won't mind if I conclude with an old bromide: An ounce of prevention is worth a pound of cure!
7
A tip given to me by an orthopedic surgeon neighbor: never walk with your hands in your pockets, especially when there's ice and snow on the ground. While it's true that you could break your wrist as you try to break a fall, that is better than falling on your head and you try to get hands out of pockets.
5
I am 75, have osteoporosis and like backpack and hike to stay in shape. I use trekking poles. These have helped me to break many falls kept me out of a nursing home.
4
We hate to think cane, but if we call it a walking stick it sounds better. I believe that this is the single most important item in fall prevention especially for outdoor activities. A mention that the bathroom is the most dangerous room in the house should encourage our children to have installed all appropriate safety devices available.
3
I'm not sure I qualify as giving advice as a 60-year-old skateboarder but.... I know A LOT about falling (it is the first thing I teach young and old skaters) having fallen thousands of times. It requires some forward momentum: Practice roll-falling leading with your shoulders on to grass, sand, thick rugs - anything soft - maybe even into a pool. This gets you comfortable with the motions and trains you about how to distribute the impact over many parts of your body instead of one. You may be surprised how quickly this becomes intuitive/automatic which is key, because, ideally the roll-fall happens before you consciously know you are falling. When I fall on pavement, I start to roll before I even get scared. I may have a few minor bruises and scrapes, but then I'm back on my board in no time.
7
@Charlie Samuels:
And Tai Chi. Great advice!
3
For nighttime wear, I (no affiliation with the company) highly recommend Bombas' gripper socks, which are like the socks hospitals offer patients, but so much better as to be virtually a different product. They provide stability even on wood floors, feel great, fit well, and foster good sleep.
4
I fell on the same (bottom) step of the stair case in my house -one time resulting in a terribly painful rotator cuff injury and the other a break in a tiny bone in my knee. PT both times for the awful pain. Now ... I actually count when walking down the stairs ! One, two, three, four. One, two, three, four. One, two, three, four, five. And, I try to keep my reading glasses off when walking around. Be well, everyone!
5
Another thing that helps me: when walking,try to keep your eyes on the horizon as much as possible. Your inner ear is the mechanism that controls balance. Keeping it level helps the mind tell the body which way is up.
1
@RCS
If you look only at the horizon, you will miss a problem right in front of you.
Much as I dislike missing the view, I always look down, a few feet ahead.
2
People on blood thinners need to be particularly cautious. I used to tell my husband (on warfarin) who kept falling off his bicycle "you're just one fall away from a nursing home".
3
Thank you for these good reminders. We had the luxury of designing our house when we were decades younger. We made good decisions because we knew where we were headed. We knew two elderly folks who died from falls that could have been prevented. So far, we've been lucky. My motto: Watch your step.
2
Another important tip is to accept assistance / help when needed. We have lost relatives who, post surgery, have taken blood thinners and then got up in the middle of the night to go to the bathroom and fell in the bathroom. When someone is on blood thinners, a fall that causes bleeding is deathly dangerous. It can be embarrassing, but older people post surgery NEED to let someone help them to the bathroom, especially at night. Having a relative staying with an older relative post-surgery and a simple bell by the bed to indicate needing help to the bathroom could be a life-saver.
2
When articles refer to Tai Chi I wonder if they don't mean Chi Kung which is a much easier and less complicated practice.
Chi Kung is the mother of Tai Chi and is easy to practice since it does not teach a form that has to be done in a particular sequence. Chi Kung is great for balance, flexibility, strength and range of motion.
4
@Mary Dimock:
Great point. Also called Chi Qung or Chi Qong.
Chi Qong is a faster, decidedly more martial movement. Tai Chi is slower and reflective. You can not relflect when you need a defensive tactic.
2
@Mary Dimock:
I think Tai Chi is older.
1
Several studies have found that Tai Chi prevents falls, but have not found the same benefit in Chi Kung. Wikipedia articles on both practices list the relevant research.
1
Almost 4 months ago I stepped back off the grass from picking up after my dog, fell to the left and fractured my foot's 5th metatarsal. I'm still healing and still wondering how this could happen to someone as healthy as physically active as me even though I'm 59. But I now watch for any uneven surface I walk on.
2
Keep the foot elevated higher than you think you should. I Broke third metatarsal years ago, slow to heal.
1
Thanks, Jane, for your very informative article. I haven’t read all the comments, so I’ll just go ahead and post this. The Times published an article on January 2, 2018, about a Dutch program designed to teach seniors safe ways to fall. I think this is a great idea.
4
Thank you, Ms. Brody. This column is so important!
Two family stories: my aunt was on a step ladder, and not thinking to change into her non-skid soles, she got up there wearing regular shoes. When she fell back, she broke her leg. Second story: my uncle was just talking away, not noticing the escalator was about to end. He turned his head towards a friend for a few seconds—he fell flat on his face on the floor, injured his shoulder and face, and was chair bound for weeks!
Even as we age, we rush too much. Why? Have patience with yourself, and slow down. Your life is worth it.
2
fall from small heights such as steps is more frequent than the ladders as the seniors are not frequent climbers. placing your hand over the side rail when you walk down the stairs or escalator is a very helpful tip which I have been doing since I started to collect the SS checks. holding on to something such as a cane or side rail is a defeat of admitting your age but is it the honorable thing to do to keep yourself safe.
2
How many people have fallen--as I have-- because their vision was obscured by wearing a mask?
3
A mask is better than dying of covid.
4
Never and I’ve worn them for many years working in the hospital. Get a good quality mask and wear it to keep everyone safe!
5
@Tom Paine:
You wear a mask over your eyes, Tom?
4
Very helpful article. Thank you.
To the long list of medications that could impair balance, one's sense of equilibrium, I would add blood thinners, a medication commonly prescribed to slow down clotting.
In the current spike in attacks against Asians, there is a well known case in SF of an elderly Thai man, taking a morning walk in his middle class neighborhood. Seemingly from nowhere, a surveillance video shows a good sized, young man running towards him and then shoving him to the ground. The older man fell, hitting his head on the pavement. He died from uncontrolled bleeding in his brain. He had recently had cardiac surgery and I wondered whether he had been put on blood thinners.
Last night I listened to a NYT Magazine (8/18/21) reading of the circumstances of his assault and death and learned he had, indeed, been on high dose anticoagulants.
As it happens, I am home recuperating from knee surgery. I am on two 81 mg aspirin a day for 28 days to prevent blood clots, which are known to be a complication of surgery on long bones. The tragic details of the death of the Thai gentleman remind me to be extremely careful against falls while on blood thinners. I am not in need of sedating pain killers, but if I were, that would surely increase the odds of a dangerous fall.
2
Great advice! One more tip - if you have a cat, pay close attention to its movements, especially when you’re about to do something it likes, like feed it or open the door. In an instant, it can dash between your legs or run in front of you! And hold on to all railings - that’s what they’re there for!
6
As hard as it is for this New Yorker, one of my newer rules as I age is to (try really hard) not to run for an approaching subway or bus. It’s harder than one might think. There will always be another subway or bus coming. Eventually.
8
My grandmother died from a fall. Took her a week. Never woke up.
In her case, the apartment building manager had decided that waxing the steps to the front door was a good idea.
2
No one had mentioned “foot drop” a condition that impairs your ability to lift the front of your foot and is a risk for falls. It’s a symptom that can be caused by a wide range of conditions, commonly by lumbar (L5) nerve impingement, peroneal nerve damage, diabetic peripheral neuropathy, but also from autoimmune or brain conditions too.
I have been able to “catch” myself at least once a day when I stub my forefoot, but walking with a cane makes me feel more secure.
By and large, people have been nice to a woman in her 50s on a cane although it does bring aging into sharper focus.
7
So important! Expanding on the cognitive impairment nexus, foot dragging can be early signs of dementia. My father was dragging his foot slightly for years, and then it started catching on the ground occasionally. We didn’t realize what was really going on, and my mom sent him to a physical therapist, a trainer, and an Alexander Technique expert. All were to no avail, because what was happening was the brain signals couldn’t get to the foot.
The poor man also got foot drop. Back surgery with heavy anesthesia accelerated the incipient dementia. Then the dragging foot caused two hip fractures and two more surgeries. He never talked much after that, and that was the end of walking. It’s now been eight years of misery. Not that it could have been avoided, but if we had known the signs, my mom might have lessened her frustrated chastising and we could have started some medicine.
I have a weak ankle, degenerative disc disease between L4 and L5, and peroneal nerve issues, I am very frightened of falling. I’m careful, but after reading the article, I see several problems in my house. I will start following more of Ms. Brody’s advice!
P.S. Watch your cats - you can get entangled in them very easily as they dash by!
5
Impossible to be too careful for someone as my wife who has a falling disease aka late stage Parkinson's ,she falls 2-3 times a day truly, she has been doing this for 16 years and has more or less found a way to go down easily. Impossible to tie her to a special walker she is supposed to use 24/7. No one can be sure what to do for her as she can walk ,she has been on Reclast which in her instance has helped her with Osteoporosis ,yes she suffers a double whammy. a disease that makes her fall and bone thinning. I have the home clear of obstacles and rubber matted to absorb impact from her falling. She falls when she thinks she can walk ,half the time this works for her and the other half she is down on the ground ,it's a big problem when one is elderly and has a disorder that makes one fall down.
4
So sorry — thank you for your loving care! This is in my future and I have no spouse or children. I am scared!
5
@ Joy
I feel your frustration, and your concern is understandable.
Parkinson’s is getting more attention in recent years, and there is still no cure. Regarding your situation, I hope you’ve considered hiring in-home Health Aides, when the time comes… they can provide life-saving care, and can work limited hours, according to your needs and budget. Sometimes they freelance, but many Aides work with an agency. These aides can prepare meals and offer light housecleaning. Unfortunately, Medicare does not cover this type of care. I hope you will also consider using a walker or a cane, when the time comes. There are no easy answers.
I wish you the best.
4
Whenever a friend of mine has a fall, I always ask: "What happened?"--and make sure that I am expecially careful not to repeat their mistake.
For example, one friend fell when, after digging up a small weed from her garden, she neglected to fill in the small hole with dirt. The next day she twisted her ankle and fell due to that hole. (I no longer have small holes in my yard.)
Another fell when she spilled a bit of water in the kitchen, but headed to bed, certain it would evaporate by morning. It didn't, and she slipped and broke her spine. (I now wipe all spills.)
Another was taking a walk and looking up to see if she could spot her apartment in a tall building. She didn't see a roll of fencing on the sidewalk in a construction zone, fell over it, and injured her back. (I always look down.)
Today in a parking lot a man engrossed in his cell pho ne almost walked into my slow moving car. (I never have been THAT careless!)
7
@ Oxford96
Very wise thinking, and I try to do the same. Several elders in my own family have taken bad falls.
Your final thought about the cell phone use… it also happened to me recently. I was adjusting my car, so that I could park better. I was less than 10 feet from a walking tenant, who had stopped mid step, to check her cell. She appeared oblivious to my car, even thought my motor is loud enough to be noticed. After I sat there for 30 seconds, she casually looked up, and I waved. She slowly walked out of the way. She offered no apology, and she did not appear flustered.
2
I have learned to hold on to something or brace myself when putting on pants. That avoids teetering on one leg trying to insert the other one. Even better, sit down and get both legs in before standing.
2
@ExitAisle Putting on pants and don't want to fall? Lean on the wall, which will keep you stabler.
I sit on the edge of the bed for a minute or two before getting up. This prevents dizziness.
I pull a small cart behind and to the side of me when I walk to the grocery store. I grip it if I start to stumble over something. It also prevents people walking or on bikes from suddenly brushing past me from behind.
Don't climb up on anything unless someone is in the house, and, preferably do not climb up period. Go to the gym or hire a personal trainer for a few sessions to recommend muscle strengthening exercises especially for the legs and stability of the knees. Learn some exercises (at the gym from a personal trainer or at home from a personal trainer) to improve balance. Good shoes and always wear them or good houseshoes. Hold on to the wall or a handrail when going down stairs, even two or three steps. Look at the way ahead and anticipate perils of stumbling. Eat well, get plenty of sleep.
7
One of Jane's comments: "... soles with good grips are essential. Throw away or give away any footwear that may cause you to catch a foot."
Dear Jane: Those two sentences can be contradictory. "Good grips" are often the shoes with smooth sticky rubberish (some kind of plastic, of course) soles. I had a shoe grip the floor enough to make me stumble, fall, and break my hip last March. Six weeks in hospital and in-patient rehab before I got to sleep in my own bed again. Good-gripping soles can be harmful, especially with oldsters like me who have other problems such as foot drop, weak legs, and bad balance. So please notice that grippiness must be weighed against smoothness of gait. Good grips (sometimes) cause bad falls.
21
Carrying bulky packages or objects, like a laundry basket, that block your line of vision of where you are stepping can be hazardous, especially when descending stairs.
9
-ALL- my cats are double belled. It is very important to keep tabs on them when we're going up/down the stairs!
3
I walk every day to keep active, often with my dog. One hazard not mentioned is icy sidewalks and traffic. 2 days ago while walking our dog a visible icy section of sidewalk and traffic 12” away combined to result in my falling to the ice covered walkway, hard.
I am almost 70 and have learned thru my life in the trades, if you have no choice and are going down, tuck your elbows in and roll with it. Not all falls can be prevented, you can fall from a sitting position.
Prevent trips and slips, stay active, enjoy life and watch out for Fido.
7
I live in a European city. It is quite common here to see even seniors of advanced age (80 ) out and walking about doing their errands on their own. They wear spiked shoes when it’s icy out. They frequently use trekking poles for balance even when the weather is lovely. It makes me happy seeing old folks out and about and getting on just fine. Even with the poles or whatever else they need to do so. Makes me hope I’m like them when I’m their age. I hope any older folks reading this feel the younger folks rooting for them and I hope they feel proud that they’ve managed to be independent for so long, not embarrassed that they might need a little assistance from some equipment to do so.
41
@PB
What a pleasant comment! Thank you.
12
An important thing I've learned is not to be ashamed of being old and physically needy (I'm 83). I use a walker all the time and do not hesitate to ask strangers to help me up or down a curb, etc. and the answer seems always to be "I'll be glad to help you". In fact people often ask me if need help. Remember most people are good!
35
@Sea Nymph One of the perks of being a woman in a "patriarchal" society! People will always ask a woman if she needs help more quickly than a man - and men will admit to needing help or asking for it less often out of a lifelong habit concerning what is viril or not.
Reminds me of a lady I knew who kept telling me that she simply strikes up conversations with people all the time - and that I should do likewise to break the sense of isolation. I pointed out to her that two women open up to each other more easily, and if a woman approaches a man there is rarely a problem, but if a male stranger tries to chat to a woman in a park he is almost certainly going to be less welcome than a person of the female gender!
I am 61 and I am a fly fisherman. Scrambling over riverside boulders and wading rivers is a great way to stay spry and be mindful of balance, yet every summer I take a tumble, or two or three. I want to keep flyfishing for as long as possible. I also want to guard against a serious fall. I guess the best intention when fishing is to slow down and be super careful.
6
Clearing sidewalks when it snows or ice builds up is not taken seriously enough. This is the cause of most falls among the people I know.
5
I’m 40 and I took a tumble this week with my 3 month old in the ergo and weighted down by a diaper bag prepared for nearly disaster. It was absolutely terrifying. Luckily, we are both ok and my knee which bore the brunt of it is only bruised. I’m so grateful for the boomers passing by who came to my rescue.
8
Progressive lenses can be especially dangerous when descending stairs or walking near curbs.
10
The 2 old people in my life (one is 86 and one is 87) refuse to believe that they can and will fall (again). They have each suffered through the myriad consequences of falls, including long stays at rehabs. I have taken up the rugs ,installed grab bars and yammer at them endlessly. They do not believe that they are old and they hate using walkers: I understand that both of them will keep falling and all I can do is take them to the ER and bring our own pillows (our ER has no pillows) so I leave a few in my car. And each will probably die from the consequences of falling.
7
A friend of mine gave his elderly mother an old life jacket to wear in the house if she felt unstable- it was low enough to pad the hips during a fall. And it kept her warmer too. That’s my plan for protection when my balance gets poor.
3
My 60ish super-fit spouse (avid back country hiker, scrambler of mountainsides and long-time skier) recently slipped and fell down an entire flight of stairs while in an AirBnb rental in the UK. The culprit? Polished wood stairs and feet in socks.
Seeing the entire fall, I was terrified that he was dead or gravely injured. Fortunately, he only broke bones in one hand, but even that is taking several months to heal and won't ever be the same.
It's been a wake-up call that even very fit, active people can have accidents. Stairs are a particular worry, but another we've encountered frequently in our travels is the slippery-bottomed shower, many of which have no grab bars, even in good hotels (especially outside the U.S.). It's especially awkward to get in and out of those set above a bathtub, which is a common set-up.
After a particularly treacherous bath tub experience in London this year, I bought a small rubber mat to take with me whenever I travel -- often hotels, motels, BnB's and AirBnb's don't bother to supply one. It's a pain to cart around in my one small suitcase, but it feels more important than any other travel accessory.
24
Great idea!
1
@Nelle Engoron Just put a towel or hand towel on the on the shower floor and stand on it. It works the same way.
Bare floors are SLIPPERY. My father's traction is much better when he's upstairs at night. The upstairs including his bedroom has wall to wall carpeting.
2
As a Vestibular Audiologist, I would add that if you experience dizziness, consult with a healthcare professional specialized in Vestibular Disorders. Being dizzy makes one 12 times more likely to fall. Some types of dizziness can be readily treated, while others may need medical management and/or vestibular rehabilitation exercises. In any case, addressing this symptom is essential in falls prevention.
8
In discussions with my Tai Chi classmates, we wondered....what kind of slippers does Ms. Brody wear? We've been thinking bare feet are best....
14
Night lights can be so helpful. We found some small motion sensor lights that we placed in the bathroom. The yellow light does not startle or interfere with getting back to sleep. Great tip from our handyman. Made by Mr Beam.
After a fall from my bike at age 68 with a mild concussion I learned that I could enjoy the glass of wine less often. Will it help maintain my brain? Not sure but I am less fatigued in the morning and it helps with weight control. Still on a bike, graduated to round handles with age 70 coming up.
4
I heard about fall training courses, kind of, "if it happens minimise the impact", a bit like sportsmen do when they know a fall is inevitable. Recommended?
3
Most falls can be prevented! Learn how to prevent falls by attending a Community Fall Prevention Program. Check with your Area Agency on Aging Office (AAA), www.n4a.org/ for an OAA grant funded, 4 week, "Evidence-Based, "A Matter of Balance: Managing Concerns about Falls" Fall Prevention Program for seniors 60+y/o in your community. I instruct this program in Florida. This program looks at falls from various aspects including: lessening your fear of falling, addressing environmental hazards, how our fall-ty habits can contribute to falls... The program includes easy, chair-based exercises you learn in class and practice at home to improve muscle strength, increase flexibility, balance & mobility. The only true way to improve balance is to exercise but the right kind of exercise! Check with your physical therapist. Try a Beginning Tai Chi program which starts at the beginning. Jumping into a continuing Tai Chi class will only overwhelm you. Try various Silver Sneaker Classes which are designed for seniors. Think of exercise or "healthy movement" as another medication you have to take just like your daily meds! It is that important if you wish to stay functionally independent! Regardless of your age, your health issues...everyone can get stronger and improve their balance with exercise! But, you have to make the effort! Look for other evidence-based programs in your area: www.ncoa.org/healthy-aging/falls-prevention/falls-prevention-programs-for-older-adults-2/
12
Thank you for a wonderful article. Most of us don't realize that falls are the main reason older adults lose their independence. We aren't made aware of that fact or of the availability of evidence-based programs, like tai chi, that have proven to be effective in reducing our fall risk. Thank you for putting it in print. It could save lives.
You're welcome to visit us here at the StepWISEnow Balance Fitness Studio in Westchester County, NY where we provide a range of balance fitness programs (Tai Chi for Arthrits and Fall Prevention, A Matter of Balance: Managing Concerns about Falls, Line Dancing, Zumba Gold etc.) so that participants can improve their balance skills, learn how to prevent falls and cope with the fear of falling. Many falls can be prevented!
2
Be careful stepping down from sidewalks to the street. My foot slipped, I fell and tore the quadricep tendon away from the bone of my right leg and broke my arm. It has taken over a year to recover.
6
Yes! I pause as much as I can before stepping off a curb. The curb-cuts for people with disabilities are wonderful, but you can get so used to them that you fall when you step off a curb that doesn’t have one.
1
I wish this country would learn (are you listening Advertising Agencies) that getting older is a normal part of life and not a horrible thing to push off as long as possible.
Of course we all want to feel young, act young, live life to the fullest but why is it bad to be 70 and act young?
AARP is the only organization I have come across that tries to help us change the way we think about aging. When is the rest of America going to catch up? We have more older people today than we ever have in this country and if we don't soon change the way we approach aging it isn't going to be good for all of the younger generations trying to keep parents healthy and well.
Just last night my boyfriend got a call from his 77 year old mom that she had fallen yet again. You should have seen the look of fear and worry in his eyes as he rushed out from our visit to see if she was truly alright.
Preventing the mindset this woman has, that nothing can be done about getting old and just accepting frailty, "life is for the young" so needs to be addressed.
8
It's worth noting that in high-quality assisted living places, flooring is wall-to-wall low-pile (often commercial grade) carpeting over a substantial carpet pad. At her place, my elderly mother slipped out of a chair or bed a few times and never broke anything. I partly credit the soft landing. This is a universal design feature we all should adopt as we age, at least in the bedroom (out with the hardwood floors and area rugs!).
16
Wonderful column!
Now I've made many changes to prevent any falls.
Thanks for the valuable help!
8
Good article - full of helpful and important advice. Want to add a couple of things. We loose height as we age and I’ve found It helpful to hem my pants to prevent feet getting twisted up in excess fabric and falling. Also practicing yoga is good for everyone, including those of us who’ve been around eight decades. I’m 81 and practice at home daily, from 20 to 60+ minutes, depending on my schedule. A yoga practice develops balance, flexibility, strength and induces calmness and mindfulness. It prepares your body and mind to do all the other activities in your life better. Plus - you’ll feel so good!
12
I am 65 and I recently took 2 falls but luckily 1) fell into a bunch of snow and 2) fell onto the fake Christmas tree, that hadn't been put away yet. Each fall was caused when I was trying to bring in too many grocery bags at one time. It was something I had always done in the past.
Now I am very conscience of carrying a lighter load even if it means more trips to the car or to the other side of the house.
Something that works for me, but might not be for everyone, is to watch my feet when I am on stairs. Doing that helps me more aware of what I am doing and keeps me at a slower, safer gait.
9
I have a visual impairment. when my beloved tabby cat passed away I eventually got another kitty. But I was realistic- I got s largely white cat so I could easily see him against my dark floors and rugs (a throw rug, gotta change that). It’s all in the details.
11
Just retired, but have researched and experienced gradual loss of balance from mid 30s til present mid 80s. Semi-circular canals are not as quick to send neural signals to CNS as we age due to aging of fluid and cilia. So I now take extra time and less risks when skiing, bike riding, walking (using hiking sticks), and even lawn bowling. And reaction time does slow gradually as we age from 60s to 90s. Lm, professor emeritus USF, now Inactive Psychologist, fellow APA & ASP.
8
I love this piece. I'm posting copies of it at ankle height for the cats to read. Alas, I just reinforced the stereotype of "old woman with cats." Jane's writing puts to rest the dismissal of "seniors" by younger Americans.
12
Excellent advice! For 10 years I applied the Feldenkrais Method of "Awareness Through Movement" to help seniors in 6- and 10- class series in a non-academic course I developed called "Keeping Your Balance." Retired now, your article provides me some good updates (I can use on myself). In my own way---ancillary to the actual movement practices---I used to cover the same topics you have in your article. Rightly or wrongly, however, I more or less reversed the order in which you have addressed them. I suppose I thought it best to start with the simplest-to -understand, least sophisticated, and easiest-to-alter factors first. Be well and keep teaching!
4
Curiously absent from most such articles, perhaps because they are so obviously self-inflicted, are alcohol and increasingly THC. Both seriously impair judgement and balance.
17
Yes, watch out for small pets, and also children! My 2-year-old granddaughter took me out by grabbing my legs when i was cooking thanksgiving dinner a couple years ago. Everyone was ok but it could have been really bad for both of us!
5
YOGA! I'm 73 and have been taking yoga classes about 3 times per week since I turned 65. Classes at my local fitness club are free through my Medicare managed care program. Yoga has been great for my balance, flexibility, strength, and even endurance (depending on how aerobic the class is). I'm surprised at how few men, particularly older guys, are in my classes. Fine with me as I often find myself surrounded by pretty women whose presence inspires me to do my best! I suppose many men think that yoga is for sissies. With attitudes like that, it's no wonder that women outlive us.
13
Yes yoga! Older adults often have trouble balancing because they stop practicing. Think about how young children are always playing with balancing. When we practice balancing we get better at it!!
1
A great read, as everything Mrs. Brody writes, practical, informative and witty. Her work should be translated regularly to all the other languages the Times has services on. Too bad there is no Italian-NYT, where people fall more than average.
4
As a physical therapist, who works with geriatric patients to improve their balance, I am happy to see an article that brings attention to this topic. I am a little surprised, however, that they suggest for someone with potentially compromised balance to attempt a challenging task at home. If someone truly feels off-balance or having difficulty walking, they should seek an evaluation by a physical therapist. There are many of us in the physical therapy world who are well versed in analyzing gait patterns as well as examining strength deficits to determine how that may lead to a balance dysfunction.
There are many components including flexibility, strength, sensation, circulation, past medical history, and vestibular system status that may determine how and why a person may be at risk for falls. While this article does a great job at explaining all the best ways to alter your environment to decrease risk for falls, I feel readers should be recommended to contact their doctor to seek physical therapy if they are currently fearful of falling.
13
Seems to me that suggesting the fall-prone practice standing on one foot while engaged in another activity is asking for trouble. I think it's an exercise best done with full attentiveness. I'd hate to lose my balance with a toothbrush in my mouth or a chef's knife in hand.
An otherwise helpful column.
16
@V. Whippon I thought the same thing when I read the recommendation to try toothbrushing on one leg. Just looking for someone to choke to death if they fall whilst brushing their teeth.
5
The best place to learn how to balance one's self is the NYC subway. Just make sure to start when you are young.
13
I love reading insightful and helpful articles like this. I'll keep this one in my bookmarks for future reference as I'm concerned about when my parents (they're in their early 60s) will get to the point where they're unable to move as freely as before. I live far away from them and can't be around to help so falls and injuries have been on my mind lately. They are quite stubborn and my father in particular is in denial about getting old, so I have a feeling they might dismiss this article but nonetheless I'll share it with them (can't hurt!). I'd rather know I tried to warn/help them than do nothing and keep this valuable information and tips for myself for when I "get there" one day.
1
My method is to practice balancing on one foot on the ball of the foot. I also do leg presses.
3
This might have been said in the many comments, but it is something I need to do more of: Turn enough lights on in the house so you can see where you are going! In my overzealous attempts to save energy, I often walked around in dark rooms. I have stubbed toes, stepped too hard on the cat, and banged into things. I have never fallen, but I think that’s just luck.
16
Agree - I was raised to be frugal, and my big house has many rooms. Light up your life !
4
It's horrible that on such a critically important topic, one must struggle to find sOME pathway to contribute to the issue, .. especially when one is a physician wishing to espouse 'common sense' behaviors that might lessen the incidence of such potentially catastrophic events as 'fallilng' .. and 'dying' ...
Msg me if you want my input ...
otherwish , i give up ..
j. a. , MD
1
Never walk a step with your hands in your pockets. Get good gloves.
6
Does trying a pogo stick at age over 50 and being flung off of it count? Thank goodness there isn't a video of that :-)
4
I had the honor to work with an inventor who helped develop air bags for protecting people in vehicle crashes during the 1970's. at the end of his career he was hoping to use airbag technology to protect against falls. His name was Dr. Carl C. Clark. Now there are patents on various devices. See
https://patents.google.com/patent/US5500952A/en
2
On every article the NYT prints related to health and growing older, the comments are just about as enlightening as the article. My contribution this time is that I've learned from bad eyesight that if you don't want to fall down look where you were going and keep your mind on your primary task.
10
Excellent tips.
1
Yes, the comments are as useful as the original article.
To which I recommend Apple Watch SE with cell coverage — if only for the fall detection.
I use trekking poles when walking outside. They help with stability, take pressure off your legs and back, and give you an upper body workout
4
And as we get older, let's not be so vain that we feel like we cannot use a cane. My dear mother died at age 87 from a fall and TBI that would not been nearly as serious if she would use her cane. She thought it made her look "old" and felt like "I don't need it", but if Mom had been realistic, it would have saved her life. Though I walk fine at age 63, there are certain places with unsure footing where I take a cane, and it has kept me from some severe falls.
6
5 years ago, I was in the crawl space of my basement pulling out decorations for the holidays. I dropped the base of a metal christmas tree to the floor, so I could climb down the ladder. I put my foot on the ladder and it tipped over and toppled to the floor and landed on the 2ft metal rod protruding from the tree base. The rod slid through my upper torso like a hot knife through my Superior Vena Cava and both lungs I broke my wrist in the fall trying to catch myself. Spent the month of December in the hospital fighting for my life all because I was rushing around and didn't ask for help. I was 45 yrs old at the time. It happens when you least expect it.
13
At 75, male, I pick up cycling again in 2016. I do walk, slow jog and swim but cycling is engaging!
Don't fear fears, encourage courage and adventures, balance like standing one leg is good for stretch and sureness of balance. Cycling is good becuase you exercise, balance, multi-task with sensory endowments, fresh air and sunlight, see
new sights, be always careful and aniticipative what's ahead; life is great if we preatise self control.
5
"Only the paranoid survive - to 95."
I gave up my bike at your age.
3
This is an interesting and useful article. However . . .
The author writes, “falling once doubles their chances of falling again.”
The article does not give any indication or mechanism by which a first fall would actually contribute to the chances of a second fall (such as, for instance, causing an injury that increased the odds of the second fall).
That statement therefore seems to confuse correlation with causality. Would it not be more accurate to write, “people who have fallen once are twice as likely to fall again as are people who have not fallen.”
Here is an example. Harry is healthy. He has never fallen. Dennis suffers from dizziness. He falls in January.
Dennis is twice as likely as Harry to fall in March. It may not be because Dennis has fallen; it may well be because the cause of the first fall (in this case, Dennis’s dizziness) persists.
If Dennis had not had the first fall (perhaps his wife caught him, or perhaps his children were visiting and fetched what he would otherwise have gone to retrieve for himself), he would still be just as likely—that is, twice as likely as Healthy Harry—to fall in March.
6
Good grief.
8
When in doubt using trekking poles when walking outside. Also highly recommend that you also use gloves. When you fail your hands will reach out and having trekking gloves means that they meet the concrete, not the palms of your hands. There are multiple manufacturers of poles, but by far the best gloves are Leki Master Shorts.
4
My wife has a brain disorder that makes her fall w/o warning the best we can do with her neurologist advice over the years is teach her how to fall from a neur smart physical therapist sort of as a dancer or acrobat(or Chevy Chase!) might do and she has never had a broken bone from falling.
6
At the age of 57, I tripped over an ottoman while walking in my living room in the dark. I hit my leg while going down and developed an extensive DVT. Hence, I now take blood thinners. I fell on my face while on vacation a few months later and broke my arm, but felt very lucky that I didn’t hit my head and develope a bleed. At the relatively young age of 59, I am terrified that I might fall and hit my head. I used to walk outside with my black lab all winter and now we rarely leave the yard. Thank You for addressing the subject of falls as this is a serious fear that many of us live with. Maybe some time you will write an article addressing the best kind of walking sticks that are on the market. I have heard stories about the fact that some of them can collapse or break, and that could be catastrophic.
10
The emphasis today on hardwood floors is not good for those at risk of falls. Carpet is not slippery and provides a bit of cushion in case of a fall.
13
Pets are probably responsible for many of the worst falls, but I would never recommend that a pet should be given away to avoid falls.
This excellent article had me nodding continually in agreement with the recommendations for exercise that improves balance, vision and heating checks, getting rid of clutter, proper footwear, etc.
Then I look at the steps up to my front door, the stairs I climb up and down several times a day to reach bedrooms and storage. I look at my love of going barefoot whenever possible.
Finally, I look at my beloved dog who loves to get underfoot.
What to do!?!
6
Excellent advice! Just want to add one more element that caused me to fall 6 times in one year, even though I was jogging several miles every other day, doing weights and also crunches. The unexpected item that caused me to fall was a pair of sunglasses that must have been too dark. I finally figured that they must be the problem, and bought a new pair. Hadn't fallen before those very dark shades, and, happily, haven't fallen after I changed them several years ago.
16
Tripping/falling for no apparent reason? Check your vitamin D level. We farm and I'm always on uneven ground, climbing fences, and yet seemed to be tripping over my own feet. Vitamin D level was eventually checked and was 7 (low end of normal is 21). Wish it had been checked before I fell in such a way that I ended up with 2 rotator cuff repair surgeries, and all the drugs that go along with that.
4
You brought out some very important points. Accenting care outside the home is important too! Years ago I was trimming branches off a tree, and I fell off a ladder. Shattered my ankle, three surgeries, long recovery process, and a grim prognosis from the orthopedic surgeon. Thankfully, through great physical therapy, all the grim predictions were not a part of my reality moving forward - which were wearing a brace, using a cane, and arthritis. It was a long time to recover, and I am able to walk without a cane or brace and also have no arthritis too. Stay safe, if you fall, get the best physical therapy you are able and do everything you are told by the physical therapist.
13
Jane - great article as usual! I am a statistic to support your story as I fell off a ladder in my home two months ago and fractured my heel. I am so fortunate that I didn’t hit my head first- who knows what would have happened! You provide in your article great advice regarding making sure we all have strong balance etc - those suggestions are essential. I would add that we also should never climb a ladder alone no matter our age. After this accident I will never use that ladder again alone!!!
6
How is it that your listed every idea under the sun, but forgot the one thing that has been proven to make all the difference? Physical therapy and especially balance physical therapy is the exact thing that addresses not only all the risk factors you mentioned, but also addresses underlying problems that can put them at risk for falls.
4
Not mentioned in these data & discussion is how often a fall is not a specific cause of death but rather is a sign of progressive decline- kinda like circling the drain. The fall is not the cause of death but rather a symptom of imminent demise. Elderly hip fractures can look about the same on x-ray, yet about half will be dead in six months with even perfect care.
14
Falls are the second accidental killer in the US (similar percentages in Canadian studies). Eliminating hazards is a great step but there will always be uneven sidewalks, ice, etc. One thing people can do is learn to fall safely when (not 'if') it happens. Martial arts studios are a good place to start, particularly those that teach Judo and Aikido, which are not striking arts. Make it clear to the instructors what you are there to learn and you may find they already have the program you need. Campaign for someone to teach a community education class on safe falls. It's much better to learn the skills on a mat than on your way to the floor unexpectedly.
9
I teach tai chi to older adults. (I'm one of them.) It took me a year to learn to balance on one foot while brushing my teeth. I teach the older adults, 'practice balancing on one foot, in a year,I didn't need to hang on to the countertop.' I now tie my shoes like a teen age boy, standing on one foot. Every adult can have a better quality of life if they would only invest in themselves NOW. I highly recommend tai chi.
22
Great idea! Your comment has inspired me!
2
Well it's a good thing I have a lot of clutter in my house. If it's dark, like in the morning, I know I have to be careful and can easily walk that narrow maze.
1
Perhaps you are like a neighbor of mine, who eventually sold her place. She was overly fond of everything. There were cartons of stuff but she could’t find necessities. She could not tolerate throwing away things. I never realized how lonely she was. Her stuff, even unseen and not used, were her “friends.”
My solution is to be generous. Clothes and objects go to Goodwill or the Salvation Army, or to a local children’s charity. Declutter, and enjoy walking, with a cane perhaps, for support, not cartons.
1
I'm 55. I still have good balance from when I was a serious ballet student years ago. But I fall literally on my face on a regular basis. A year ago I tripped over my dog, fell on my face and broke my wrist. Within the 5 months prior to that I had fallen twice - on my face, again. This year I have fallen twice - both times more sideways than forward, so I was pretty much okay. I am terrified of falling again! I worry that the next time my teeth are going to get smashed. I wear flat shoes all the time, and I have fallen in different shoes every time. Interestingly, some boots that I have with a bit of a heel I never trip in. I have a bit of a theory that it might have something to do with the way I walk, that I don't lift up my toes as much as other people, but that I have to do it when I have those boots on. whatever the case. It's awful. It was kind of funny way back when, but it certainly isn't now! pretty soon I'm going to start walking down the street with a helmet and a mouth guard on...
8
Just a thought.... since you were a serious ballet student, maybe your feet are everted/turned out (and possibly your entire leg, starting at the ball and socket hip joint). Perhaps doing some physical therapy to get your feet to be parallel and point straight ahead would help with your foot strike and your gait.
3
Good luck.
I find it's important to stay paranoid.
3
Linda, have you considered getting checked out by an MD? It’s not normal for a person as young as you to be having frequent falls. Something doesn’t sound right.
4
I am in the age category you speak of with regard to falls. I have found a strength and conditioning program that has improved not only my bone density but also my balance. I was disappointed in your omission of strength and conditioning as a necessity. Core strength is key to balancing and being able keep from falling.
25
I made a new rule a while back- never ever walk on stairs without holding a railing, and if none, at least touching or sliding my hand along the wall. Never carry things in both hands. No exceptions.
25
Agree. I want to add at my health club I never touch the railing as they are dirty from germs. Instead I slide my forearm as I climb stairs.
3
@Linda. What us the problem with carrying things with both hands? Is it that you won’t have a free hand to break your fall?
agree.
As a 70 year old who is also sightless in one eye, my risk of falling is exacerbated by my lack of depth perception. I make it a rule not to tackle uneven surfaces like stairs and on boarding planes, boats, busses, etc., without three points of contact: both feet and holding onto something or someone. Vanity be damned, I may look feeble doing so but I don’t want to fall.
19
Thank you! I just showed this to my husband who, at the age of 70 takes some of the medications you listed yet believes it's still somehow OK to get up on the roof. He won't listen to me, but hopefully this will be the wake up call he needs.
16
Ladders can cause anyone to fall.
They don't discriminate!
2
Thank you Ms. Brody. I speak only for myself on the leeward slope from the summit of old farthood (NYT, may I write that?), From experience I agree; falling is bad news.
Falling from a bike is much worse news. If you love cycling, don't stop doing it, but remember that your Tour de France days have probably become a Tour de Chance.
Take it from pizza-face here: be careful out there.
18
Number one on my list, pick up your feet!
13
It would be helpful to know when a rug is a "throw rug."
2
@Seattle A 'throw rug' is any rug you can pick up--that is, any rug that is not fastened to the floor like wall-to-wall carpet.
The increased risk of causing a fall is that your toe can catch the edge of the rug, or that the rug might slip underneath you.
I don't know whether door mats count as throw rugs. We have one in our house that probably presents a risk of causing a fall, while our other door mats have flat rubber edgings that keep them tight to the floor.
2
I am 73 and have had peripheral neuropathy for many years now. The result of having majority of my nerves damaged in my feet, ankles, and calves is constant severe pain and numbness that makes my balance extremely precarious. Every time I enter a store I proceed with dread hoping I don’t fall and make an old fool of myself. Moral of the story...whatever you do, don’t get old.
3
Disagree. I find the alternative is worse.
6
An important rule is to “Never walk with your hands in your pocket.”
11
Dear Ms. Brody,
Thanks very much for your helpful article.
4
Where’s tech? Had 96 yr of dad for his last 3 yrs. Started first thing to do makeshift guardrails. Used wooden sawhorses meant to use w/ a tabletop. Lined these along his path between rooms. There were chairs turned backwards,he could reach methodically as he walked along.Worked well, but where’s the tech? No catalog or store has anything, we have to devise.We can use inflatable pool mattresses along route to the bathroom. Dollar store pool noodles can be used as visual guides, and to soften sharp edged tables. We should survey each room.Furniture you bought 50 years ago is not what you need now. Is not. Take phone pics of what furniture should be replaced. Photograph kitchen sink area, make modifications to cupboards. I want a walk-wedge. I want a small ramp I can use for top shelves, not a step stool, a ramp with a handrail. Guess I'll have to commission it, nobody has thought of it. We're not doing this right because we're not sharing information. Gilded Age—walking stick was height of fashion, we need to bring it back. Use an aluminum walking stick, like a ski pole, telescopes to preferred length. A walking stick provided focus for user, one step at a time. Be it resolved: buy your loved one a cane, don’t ask—-buy. And please, let’s talk about this stuff. Get kids involved, do phone camera pics of every room and discuss—-what can we do better? I have 13 steps to upstairs room. Those last 2 hurt.I installed a grab bar. Easier, and now I think: how clever.
19
Helpful column as usual. One point that might have been mentioned is slow down, don’t hurry. I find most of my near-falls happen when I rush to do something, a result of moving too fast and also concentrating on the task at hand, rather than how I’m getting there to accomplish it. As a person who has always been impatient and in a hurry, it’s difficult to be mindful of the necessity of slowing down with age, but I’m slowly learning to take more time in order to prevent mishaps. I recommend to all.
469
@Nancy "Slow down, you move too fast....gotta make the morning last...."
41
@Nancy
My most recent fall (which required arm surgery) happened as a result of the "perfect storm" of a terazzo floor, gum-soled loafers, and walking too fast while frettiing about how late I was to an appointment. Speed plays havoc with proper heel-toe gait: it leads to intermittent shuffling, which causes skidding if wearing smooth leather soles or "catching" if wearing grippy rubber ones. I once fractured a metatarsal bone without even falling: I was wearing Crocs while walking too quickly down a shiny tiled corridor, and my foot "caught," propelling me forward. I was able to stop and stay upright, but the force stress-fractured the bone. B'bye, Crocs.
33
Maybe it’s just me but I find myself rushing to do something because I’m afraid I’ll forget what I wanted to do if I don’t get to it fast!
42
I had a bad fall 4 years ago at age 80. At the hospital, many tests were performed, and the conclusion was that I was badly dehydrated, which caused me to black out, and then to fall.
This should also be taken into consideration: drink lotsa water!
611
Syncope with collapse. One drops like rock and hits the ground like a falling rock.
9
@Caroline VanTrease And, make sure that your sodium levels don't drop to the point of hyponatremia. I collapsed from that condition. Keep water and sodium in balance. https://en.wikipedia.org/wiki/Hyponatremia
8
@Caroline VanTrease Both my husband (mid 70s) and brother (late 60s) have recently ended up in the hospital from falling. My husband was very dehydrated due to low potassium in his blood. They gave him intravenous potassium before releasing him. Now he takes potassium pills prescribed by his doctor and regularly eats bananas in the morning,. My brother was not dehydrated but the doctor still recommended that he make sure that he drinks milk every day as recent research shows it to be much better for hydration than just plain water. Both my husband and brother have medical conditions that affect balance so they still have to be very careful when walking or getting up from a seated position but they can lessen the likelihood of a fall if they make sure they are hydrated.
4
I think older people fall because they are too proud to use a cane, a wonderful walking and balance tool. Yes, as a person in my late 50s and early 60s I have experienced prejudice, skepticism, and ridicule (from friends, no less) for using a cane, but I walk with my back straight, my head held high, and without a limp. I may be degenerating faster than my contemporaries, but you will not see me falling unexpectedly.
13
I am very afraid of falling . After injuring my hip and shoulders in falls , I have decided to limit the chances of falling each day . I have employed the use of s common dolly , one that could be used to move furniture and such .
I now scoot around my Manhattan loft on s nice padded dolly . I get things done . And I stay in shape .
Once you have things lowered to a proper level around the house , life on a dolly can be safe and rewarding . Not to mention the ease of floor cleaning from such a convenient position.
5
You forgot a major and well documented public health risk - alcohol consumption.
10
Heel to toe walking on street avoids tripping on sidewalks not properly aligned.
2
Many spectacular falls for my Mom over the course of a decade. The one with the most serious consequences was from picking up the giant neighbor cat "Big Man" to put him outside for the night. We came home to find her on the floor, with a broken hip. The doctors declared it a break that could be pinned, rather than needing a full replacement. The less invasive operation sounded good at the time but what we did not fully appreciate was that she would be unable to put weight on the pin for a full 8 weeks. This left her pretty much bedbound, in a short term care home with PT scheduled twice a day. She had the other, unbroken hip replaced about 15 years prior to this fall and was up and walking the next day. In hindsight we should have pushed harder for a replacement rather than repair; the recovery time would have been much easier and could have been done at home. She did indeed go downhill from that relatively gentle fall and was dead within a year.
10
Also -- watch very carefully in stores, especially when entering them. I so often notice the edge of a carpet slightly curled or otherwise uneven, or an imperfect threshold and I immediately bring it to someone's attention.
8
As a facial trauma surgeon who frequently treats elderly patients that fall, I can tell you that all of the fall prevention in the world won’t stop many of these patients from knowingly taking risks. And the primary risk is just being on your feet.
Most fatal falls in the elderly are from “ground level” and are in or around the house and yard. Many have told me “I have to keep walking or my life is over anyway”. It’s hard to argue that point.
Don’t we all want to die with our boots on?
Dead is dead, whether it was a heart attack, cancer or a fall. At some point it isn’t reasonably preventable any longer.
By that logic, many choose their exit....
9
I am an active certified alpine ski instructor at age 86. I live to ski well, not fall. Balance can be learned and sustained. We don’t quit skiing because we are old, we get old because we quit skiing.
17
Not sure how helpful the section in the article "...psychoactive drugs like benzodiazepines (e.g. Xanax and Valium) and sleep medications like Ambien and Lunesta that affect the brain; antidepressants like Prozac, Zoloft and Elavil; medications that lower blood pressure, including Flomax and related drugs used to improve urination; medications that lower blood sugar, including metformin..." is; does one avoid these drugs and be anxious, depressed, or have high blood pressure? Please don't answer that there are other drugs that can be substituted, because for many, if most people, that isn't true. Maybe just be more careful?
5
@David Hughes
Many of the drugs listed are overprescribed and habituating. It’s good to think about that, even if the result is being anxious for a bit as the body adjusts to the absence. You know withdrawal.
I have noticed that people who take Xanax and Prozac have a lot more accidents, even at a younger age.
5
be more careful or perhaps use a lower dose. often these drugs are used at dose that is much higher than what is needed
1
The only thing that can help a senior person retain or regain muscle mass and bone density is strength training. There's nothing dangerous about strength training if it's started slow, with regular increases in weights over time. Tai chi, walking, all those things are better than nothing but will not preserve muscle mass and bone density. Strength training will.
20
Oh, I do all that and more, but nothing could prevent the hit-and-run guy on a bicycle who turned the corner and knocked me down when I was crossing at a green light.
21
Some good advice here. Over the past 15 years, I've had at least three falls, one very serious and two not so. Now at 83 and fall-free for a half-dozen years, I follow many of the suggestions noted. One that I would emphasise more strongly is focusing on your proposed path. Don't distract yourself with talking, or texting or sightseeing. I'm always surprised at what I notice that I could trip over if I were not paying attention. (This also applies to my driving - works for me.)
18
Surprised you did not mention statins. So many older people I know of, especially men, have suffered falls from weakness in the legs soon after their doctors insisted they begin taking statins, when they had not been on any other medication. I’m not convinced the tests pharmaceutical companies did with otherwise healthy inmates revealed the true nature of statins’ side effects.
28
When getting out of bed, or getting up from having been sitting for a while, it's a good idea to stand and get your balance before taking your first step. Be sure your weight is evenly distributed on both feet, etc. That's what was told to my mother when she was in rehab after her stroke about 10 years ago. She had to learn to walk all over again
I find doing that useful, too, when I'm groggy or feeling a bit stiff.
34
Some people child proof. I father-in-law proof my house whenever he visits. He's 87, reasonably healthy, thinks he's invincible, but is slowing down. In my own family, I've seen how one fall can lead to severe decline, or even death. So I roll up and hide the throw rugs, put a night light in his bathroom, and he doesn't notice the corner guards. I rest better knowing I've removed some of the risk. Granted, my efforts are moot if his much younger wife won't persuade him to stop driving.
9
I'm 71, and have fallen many times. On one occasion, twice within 20 minutes. In a hospital! Luckily, without very serious results.
Because of these accidents, I now go barefoot at home 100% of the time, even when my feet are really cold. I feel, and believe I am, much more secure with nothing at all on my feet. If I could, I would go barefoot outdoors, too.
Humans have done so for 99% of our history, and our feet evolved without being covered by anything at all.
16
@Matt Olson
Great point Matt. My 84 year old father is short, and for his entire life he's worn shoes with as "tall" a sole as he could find, even going so far as stuffing the heels with lifts to make him that much taller. I've thrown every shoe like this away and have insisted he go barefoot whenever he can so he actually feels what's happening in his feet when he walks.
10
Have you thought about comparing fall rates in Western countries with those in Asia? I read in the NYT about 10 years ago that the rates of osteoporosis were much lower in Asian countries then they were in North America because there were many more cobblestone walkways in Asia, which resulted in greater balance by the elderly.
8
One of the most complicating factors with falling is loss of flexibility due to being overweight. An oversized belly makes bending difficult and getting up from lying on the ground difficult. It also inhibits the ability fall without injury like rolling forward and back on to one’s feet. When a person attempts to break a fall straight armed, the result can be torn rotator cuffs and months of recovery. Rolling can disperse the force and avoid serious injury but requires fairly good fitness.
3
As long as people continue to remain active and try to move about with their full range of motion, their bodies will retain resilience. Injuries heal slowly and a lot of sitting and rest during the day will lead to weakening. To retain adequate strength, balance, and agility probably means moving with some pain. As long as the pain does not represent greater injuries or becomes an impediment to movement one should try to tolerate it. One must always know one’s limitations and try to extend them with care. The worst thing one can do is to lounge about doing little.
9
@Casual Observer When my late mother was unconscious in an ICU 13 years ago and we were starting to discuss rehab one of the drs. told me each motionless day in the ICU would require a week in rehab. I agree it's important to remain as active as possible.
13
In Europe, learn to fall by falling is a maxim embraced not just by parents but by insurance companies as well. Insurance companies encourage playground and school grounds to be as uneven as possible bc it develops a child’s coordination and balance. A small child is closer to the ground so falling is less consequential and through repeated practice will eventually learn to fall correctly or not at all. It is not just the coordination and balance they develop with the uneven ground but it’s learning how to look simultaneously at the ground and where you’re going to notice changes in terrain. Uneven ground also stimulates your vestibular sense which is the awareness of your body in space. The more stimulation your body gets as a young child (running, climbing, spinning, hanging upside down, preferably from playing from hours on end and not in organized sports) the better your vestibular sense and less likely you are to fall and hurt yourself as an adult. Children are being crippled in modern American society by the even surfaces in indoor playgrounds, rubberized outdoor playgrounds, and diminished outside play. The author of this article forgets that humans evolved for thousands of years without luxury of many of the things she suggests.
9
Why do you continue this advice to stand on one foot while brushing one's teeth (also advised in your 30-day challenge)? The bathroom is one of the most dangerous places for a fall. Standing on one foot that might lead to a wobble and a fall against hard tile, ceramic tub, sink, or shower, can be deadly.
42
@D The point is to just stand on one foot for as long as you can. A better place might be in a dining or living room, with your hands near the back of a chair you can grab if necessary.
8
@D
And usually while brushing your teeth you are in front of a sink or counter which you can use for stability.
2
It would help if Medicare covered eyeglasses. I see plenty of older people wearing (and driving while wearing) glasses that needed to be changed years before, but they can't afford new ones.
62
@Linda I am a licensed and certified Health Insurance Agent who specializes in Medicare. I've been on Medicare for five years. While Original Medicare does not cover vision (except a pair of glasses after cataract removal), most Medicare Advantage Plan include vision care, dental care and hearing care plus many more benefits. My plan includes annual eye exams and glasses prescriptions, an eyewear allowance and lenses including no-line bifocals. Medicare's Annual Enrollment Period begins October 15, 2021 and ends on December 7, 2021 for enrollments effective 1/1/2022. You can research options on www.medicare.gov starting 10/1/2021. You contact a licensed and certified agent who can assist you in fully understanding your options. Agents are not allowed to charge for their services - if you enroll with their assistance, agents are paid by the plan providers.
My parents both died within 2 weeks of their falls, one was 62, one at 85.
Thank you for this article, packed with advice.
25
Not mentioned in the article is that the elderly should wear a medical alert device especially if they live alone. Falling while living alone can be fatal.
28
I tell my father all the time that "using a walker is a sign of intelligence." This approach has made something he was embarrassed about into an oft-repeated boast.
35
@Midwest Mom, You made me smile. Thank you.
3
Learning HOW to fall, might be helpful, too.
11
@Kevin
I've read some of these recommendations, but considering the fact that you can have a serious fall in a few quick seconds, I've never been able to figure out how we're supposed to implement them!
4
does the author really mean 'benadryl'? I can't find any information that this OTC medication is an 'anticholinergic' drug
1
Good Morning. I am a pharmacist. Yes, Benadryl (generic name-diphenhydramine) is an antihistamine with strong anticholinergic side-effects. It is a drug that should be used with caution in older adults because they are more likely to experience side-effects such as dizziness, dry-mouth, urinary-retention (especially men with prostrate problems), drowsiness and confusion. It is on the Beers List of drugs that are discouraged for use in the elderly.
17
@ottovon
A one-second internet search showed that Harvard Health calls benadryl an anti-cholinergic.
Incidentally, anti-cholinergics are implicated as a cause of dementia.
You can imagine how thrilled I am that I have to take it daily for an unusual, non-allergy situation.
4
Also worth adding to the list of medicines that can contribute to falls are antihistamines that cause drowsiness.
6
Two more suggestions:
1) If you have animals that roam around the house, they should have collars with bells. This way, it's easier to determine where the dog or cat is, in relation to yourself, and therefore easier to avoid tripping on them. Multiple bells if necessary to hear better.
2) When you find yourself on uneven ground, slow down and walk toe-to-heel rather than heel-to-toe. This way, you are testing the ground with your toes before planting your heel. Try it at home - it's easy and when you're on unfamiliar ground, keeps you upright and in control.
10
@ehhs toe-to-heal is indeed how people walked before the advent of the fixed sole shoe!
http://mentalfloss.com/article/505105/why-people-walked-differently-medieval-times
3
I slipped on black ice on my driveway last week, even though I saw it and told myself, go slow, careful, don't fall. Next thing I know I'm distracted looking (at the sky, the trees, nature, all the beauty around me) ... Lucky me. I'm still here. Did I learn?
Today I was in Oklahoma and saw the same black ice; windshield and mirrors crusted with crystalline water.
But today I did not let myself get distracted ... easier said than done. I've fallen through carelessness more times than I care to admit. Today was not this day. Today my mind-training took hold. A good lesson for the future.
More people need this drilled in constantly, including by their PCPs who think every visit is about some chronic disease.
18
I would reconsider the recommendation against pets.
Pets provide significant health benefits - they outweigh any risks of contributing to a fall.
And a dog would rarely cause a person to fall. Cats? Maybe.
13
Pet TOYS, not pets.
6
@Bill Wolfe. Cats-yes; I severely injured myself due to a cat dashing full speed under my feet. It’s something dogs don’t do, or my companion parrot...
3
Rather than leave lights, even LEDs, burning 24/7, install motion sensing light switches, also known as occupancy sensors. These are especially useful at the top and bottom of stairs or wherever there is a potential fall risk.
23
When putting away a garbage can in my garage I tripped on a coiled garden hose, fell and broke my arm. It happened in a few seconds and led to surgery and eight months of physical therapy. I will never have 100% arm mobility again. How quickly your life can change, so be careful.
55
I want to be like my aunt. She fell in her 90’s washing the bathroom floor. After a time on a walker she healed and went back to independent living. She lived into her 100’s. She was born in a cold water walk up in New York and worked as a school teacher, requiring remaining upright.
My fear is if I start giving up things I have no real trouble doing, I’ll lose the ability. Careful is one thing, fearful another. I do the housework, cook, we have stairs and I want to keep up with my art and craft work, some of which is physical. I want my rugs. I want to run around with my grandkids.
This article has been good to focus my thoughts. My younger sister, coming up on 72, has substituted biking for running due to knee issues. If she can, so can I.
Thank you alland thank you Ms Brody. This is a good conversation.
43
Don't forget your helmet!
2
@Karla
I was planning to get one. I need a new bike as well.
3
@nancy: really excellent points. Keep safe, use common sense -- hold onto railings -- be alert -- look out for safety hazards. But life has risks. You cannot eliminate all of them, or you end up this fearful old person living in a sterile "senior community" with no pets and never having a bit of fun.
That just existing, not living.
5
Working in an acute care hospital as an occupational therapist I'm, as it were, on the ground floor of health care's receiving end of the treatment of fall victims. One thing Ms Brody failed to mention in her otherwise outstanding article on fall prevention for the aging in place elderly individual ,that seems to be a huge contributing factor in falls for the elderly, are UTIs (urinary tract infections).
I've noted that many of us older folks are only too aware that we may have a greater tendency to develop bladder and kidney problems that affect our ability to control our bladder, but a large number of us either are not aware of the symptoms of problems with UTIs, or we try to ignore them. And one of the most serious problems that often develops with a severe UTI is disequilibrium, and even confusion that can easily (and frequently) result in a fall in your home, resulting in a severe or even life threatening injury.
My advice to many of my elderly patients and their families is that they make sure that their doctor or physician is made aware of changes in their bladder or kidney functions, like smelly or darker urine, or a greater tendency toward incontinence or more frequent (or even greater difficulties ) with your routine urination schedule. And always let your primary care giver or physician know if you are experiencing episodes of dizzyness or confusion, so that they can bring you in for more extensive testing-Including ruling out an occult UTI.
29
@Birddogi
Not really true.
The conventional wisdom is that UTIs cause everything. They don’t. And when your “provider” tells you do, find an experienced physician.
It even happens in today’s ERs. When they follow up in the office the cultures are invariably negative and the real diagnosis was missed.
The article was good. And it wasn’t hysteria. The inconvenient truth is that falls are very hard to stop and will be a leading precipitant to death for the foreseeable future. Hip fractures don’t kill people. People who are dying have a hip fracture on their way out. A healthy 60 year old falling on ice and breaking a hip has a 1 year mortality of ~2%. An 80 year old with heart failure and emphysema who falls and breaks a hip has a 1 year mortality of 100%.
14
What is your source? It seems it would depend on the severity of the congestive heart failure and emphysema, and the type of fracture as well as whether osteoporosis was present or not. The more widely quoted statistic is that following an osteoporotic hip fracture, the 1 year mortality rate is 33%.
1
@Michael Plunkett MD do you really mean by “provider” what I think you do? Experienced physicians are not always so interested or curious or helpful.
4
You gave away brand new Uggs? gee, I wish I had been your size! Uggs are soft and very comfortable. I've had them for almost 20 years and never had a single fall related to their design -- if anything, because they are soft, comfortable -- run wide -- and don't rub blisters -- I'd say they were ideal for seniors in cold climates.
6
She’s right about Uggs - I took a bad fall wearing them because they soles do catch on the ground. I do still wear them but I Need to be very aware when I do.
7
@Concerned Citizen
Uggs have no support for your foot. A tie-shoe that supports your foot has worked very well for me.
1
Buy grippy socks. Those things are a godsend and not just for yoga or barre classes!
15
I'm a self-admitted fall phobic. I moved from Miami to slippery Nova Scotia in 1980. I've since had a broken left wrist, a severely damaged right thumb, and discs damaged high and low.
So I mentioned phobic: I wear skid-proof yoga socks or sheep-skin slippers within the house as well as sturdy shoes; I religiously change into outdoor boots before taking treats to the crows.
But all it takes is once: I watched a plumber as he was replacing a hot-water tank in the basement; he thought he heard water running, but I didn't. Then he went to his car, and heard water running in the 'chem' room, a mere two rock-pathed and two low concrete walls away.
I was flat on the ground before I even knew that I had fallen. I didn't have time time to fling my arms to be broken as I had slipped on a patch of frosted grass. I also didn't crash my head onto the concrete walls which is why I can tell this tale,
9
Very helpful info but my elderly parents refused to get rid of the throw rugs that are all over the house. And they prefer to keep the house dimly lit with curtains closed so there isnt a lot of light to see when you are walking. When of the saddest things about getting old is that my parents in their 50s would have understood the reasons and modified their house. But with age comes (not always but often) a slowness of good judgement. Not a happy thing but its true.
31
Many of the causes of falls -- muscle weakness, loss of muscle mass, inflexible joints and gait impairment -- can be prevented by doing exercises that work on alignment, balance, coordination and strength. In addition to t'ai-chi, I would recommend the nationally recognized Fall Stop Move Strong (FSMS) exercise program which is a lot more fun because the exercises are more varied and done to music. In a Fall Stop Move Strong class, exercises are done standing and also on seated on chairs. . Getting up from chairs and going up stairs depend on the strength of the legs. In class many movements incorporate doing modified lunges and modified squats to build up lower body strength. Hand weights are also used to build upper body strength. The exercises are done at a moderate pace so the class is a cardio workout as well.
12
I am your age, Jane Brody, and I do appreciate this article as a reminder that I am vulnerable to falling. I have taken a couple of spills through the last few years. Mostly it's been awkward positions that I get in and lose my balance. I have also noticed that although my peripheral vision is excellent, my attention to objects that are not directly in the center of my field of view don't register as much as they used to. I have a tendency to step on the cat when I'm not focusing, which can cause a fall also. Lots of subtle changes at this age that the experts either don't know about or aren't talking about. The nuances of memory loss are interesting and troubling. Becoming elderly has been an education. Not enough research on the elderly, in my opinion. But then again, we're obsolete, so who cares? Again, thank you.
23
My mom, 86, fell last September and broke her shoulder and hip. It’s gone steadily downhill since then. Not only the physical—she went from being independent to nursing home level care—but it accelerated a mental decline as well. Lesson learned, more strength training for legs and practicing balance, balance, balance.
10
The Alexander Technique helps with balance, and should be in this article. Tightening in our necks interferes with our balance and coordination; learning how to not tighten habitually (which most people do), mitigates that.
15
@Evelyn Hess
You are right! when your muscles are tight the possibility of falling increases. Hard to do but it has all requires focus and staying in the moment.
2
I am 78, a year older than Jane, and suffer from ataxia brought on by a lifetime of profound deafness caused by the destruction of the hairs in the inner ear. These hairs are important in maintaining a sense of balance. For 75 of those years I compensated by maintaining a visual horizon. This compensation doesn't work as well as it used to. For that reason, and because I have a back condition that causes the muscles to cramp when I try to maintain balance while walking more than a city block, I use a rollator--a kind of four-wheeled walker with hand brakes and a seat. Now I can walk a mile or more comfortably while maintaining my balance, and gripping the handlebars keeps me from falling. I recommend this device highly for any elderly person. They cost between $50 and $100, depending on bells and whistles, and are easily obtainable on the Internet or at your local chain drug store.
24
@Henry Kisor: excellent advice. And I've purchased several rollators (or similar type of high end walker -- not the cheap aluminum ones you get in the hospital!) for friends and relatives at estate sales -- some were unused and still had tags on them -- for between $10 and $25 each. Every thrift store has a few walkers, so start there if you don't have a big budget.
They can restore mobility to people who are otherwise limited, and take away the fear that you will walk too far -- get exhausted or weak -- and be unable to get back. It gives you a seat when there are no benches or chairs around.
Unfortunately, quite a few seniors see them as a sign of "being old" and refuse to use one.
7
Please mention that statins cause weakness more often than recognized. My severe weakness-I could barely get up the 3 steps to my bedroom-is still being referred to as 'muscle pain' in my record. It took months to recover.
14
I took a fall once, broke a hip and received a subdural hemotoma. 100% recovery - 1 hour of aerobics a day, still working full time. Must get off pain meds ASAP 3 weeks max and keep moving to fully recover.
8
@Ken Archer
Isn’t it possible that some pain lasts more than 3 weeks?
11
Yes but exploring less potentially addictive therapies is often what's needed to avoid getting hooked on a prescription pain med...
1
Hey Jane I really loved the article you put together here. I am going to share it with my grandma cause she is very old and frail! Thank YOU!!!!!
2
One of the biggest causes of falls among older adults has been left out - alcohol.
Obviously, alcohol has tremendous effect on balance when drinking, but also after alcohol has left the body because the brain isn't healing between drinking episodes. The cerebellum - which controls balance - is actually shrinking.
Older adults are affected differently by alcohol than younger people. Their bodies cannot tolerate the toxicity as well. One drink might be equivalent to 2 or 3 in a younger person's body. If older adults are using medication, these effects and risks increase.
19
The Jan. 2, 2018 NYT had a great article about how the Dutch are addressing just this issue: how to fall or not to fall. Not only is it great instruction, it’s also a wonderful way for people to socialize and make new friends, and laugh a lot.
4
As an internist, I concur with the need to highlight fall prevention, especially the final reminder to utilize ambulatory assist devices like a cane or walker, especially in wet weather. Women over age 65 and some men should be screened for osteoporosis, and treated , if indicated, to reduce the risk of fracture from falls.
6
I think you wrote this for me. You must have been inventorying my injuries and causes the last five years.
6
Good advise. A program that should be better known to help with this issue is Bones for Life developed by Ruthy Alon, PhD a senior Feldenkrais Instructor. It addresses posture, balance, stability, flexibility and teaches the patterns of how to fall without injury. We can't control when we fall but we can encourage ways that are safe when that situation arises. Classes, Immersions and Certification programs to teach this work are all over the country and internationally. Information can be found at movementintelligence.org
6
As a retired geriatric physician and, now, being elderly myself at 91, I can agree with everything that you have written; to which only I can adds "Yes, but..." Being more limited in Instrumental ADL, my wife and I made the sensible decision to move to apartment living with provided elevator, dinner, bars by toilets and shower, no slip rugs, etc.
However (the 'but' part a/m), among our very aged population (average 87; more in the 90s than in the 70s), falls are more 'endogenous' (the conditions you describe) than 'exogenous' (such as trips and stumbles on protuberances. Alas. But we do have pullcords in all rooms to summon emergency help! Ian Lawson
17
middle ear. get that checked out. it can cause dizziness, and can worsen its effect after a fall.
9
I'm 67 and have fallen twice in the last month. The first time I forgot that a footstool was right behind me, I turned and down I went. That one wasn't too bad. Then a few days later I was sprinting to the screaming teakettle and my left leg just collapsed, so quickly I had no chance to compensate and boom! down I went. That one really hurt the left side of my body, especially my very bad back. I have no idea why my leg collapsed and do worry it will happen again.
Thanks for this article.....
10
@sophia
I’d suggest that you stop worrying and ask your doctor.
4
@sophia Really?! I'm blaming the victim here. No sprinting to the tea kettle ... or for any reason -- never! No footstool or any object in the middle of the floor -- never! You were lucky. It takes one fall to change your life. Be mindful. And as per Bob K., get your leg checked out by your doctor (sooner rather than later).
3
Beware of pets on expandable leashes that lasso and trip the unwary as well as bikes that fail to follow traffic regulations. Possibly the most dangerous, though, are the backbacks on wheels that travel low to the ground dragged by oblivious pedestrians. They are easy to miss, but pack a vicious wallop; I have seen people felled by them.
14
Excellent article. What we know vs. what's achievable. My dad is 92 and lives in a retirement building. He drags his feet and kind of walks with a small bouncy shuffle. This gives him hip pain as well as obviously being a safety concern. His balance isn't so hot either.
He used to love to walk. I got him to go to PT in his building, where they gave him easy exercises to strengthen his legs, and they had him use a walker. He could easily see how much more pleasant and comfortable it is to use the walker (the rolling kind with three wheels and a seat if you need it). We got him a walker and for a couple of weeks he used it and enjoyed the feeling of getting around. Then he stopped using it and stopped doing the leg exercises. When we went to his doctor last week, she gently encouraged him to resume the leg exercises and use the walker. He half admitted it's an "image" issue. I wanted to hit myself in the head. I told him he looks a lot spiffier zipping around the building and grounds with his wheels than shuffling around. He's 92 and upright. There still aren't that many men who can say that, even with walkers. The average age in his building is probably 80. Not too many people look like they're training for the Olympics. He's not looking for a girlfriend. He had a friend there who was using a walker and encouraged Dad to get one, but he died. Not easy.
21
Better Bones and Balance is an exercise routine developed at Oregon State University to address just this problem, focused on maintaining and improving bone strength and balance and based on scientific research. Teachers must be certified to conduct classes but if there are no classes on your area, OSU has a dvd available on the Better Bones and Balance web site.
4
I am the only one who finds "standing on one foot while brushing your teeth" at best counter-intuitive, and at worst, a great way to induce a fall?
I recall reading that the best way the elderly can prevent falls is to shower less, and certainly not daily.
6
@Bernard I also highly recommend professionally installed grab bars (never the suction cup kind). I have unoperated knees that will never be replaced due to horrible results from other surgeries. I used a walker so when I wobble I can steady. I would like another dog, but am afraid of being tripped or tangled. My best friend is six weeks into a broken foot, surg, rehab, inventing worarounds at home, etc. I am hoping to avoid. I keep thinking a big dog that would not get in my blind spots would be better. But then that requires more "walking," and the dilemma winds on.
4
@StarLawrence Sorry to hear about your knees and your friend's injury! I do think strong grab bars in the shower are a necessity.
4
@StarLawrence
The dog is worth it for the companionship. A small one with stay out of the way. A puppy could be a problem, but shelters have many great and trained dogs. People who "think" they would look good with a dog can find out they aren't really dog people. And the poor pooch goes to a shelter.
5
I find many builderfs and architercts complicit in the dangers of falls in the home. Multiple amd I mean multiple sharp right angle corners, especially in the bathroom. Countertops and sinks that are just to high, 2 to 3 inches. Making it very easy to become off balance and slip and fall when washing and cooking. And my number one issue, really POOR lighting. Why not just not have any light so the elderly can fall over all the time because they can not see. These 2 industries and their multiple suppliers have really failed in protecting the elderly and handicapped.
8
A few years ago, my 96 year old father was found on the ground next to a bench he liked to sit on at the continuing care facility where he lived in a private apartment. It was never clear whether he fell, had a stroke or fainted, but he had a bladder infection that put him in the hospital for several days and then in skilled nursing for two weeks.
However, it was clear that he now had to move to assisted living. His vascular dementia, previously minor, was advancing and he sought assurance from me every day that he was still in the facility where he had moved more than a year before.
He refused to use a cane even though it was difficult for him to stand after sitting and he had definitely fallen and injured himself previously. Eventually he had to use a walker instead, but by then he was unable to learn how to use the brakes for a walker with a seat and so had to use a box walker.
5
Reminds me it's time to reread Atul Gawande's New Yorker article in their The Way We Age series in April 2007 about foot care for the elderly being a crucial element of fall prevention. I regularly trim my mom's toenails -- she's in assisted living and they don't do that for her; she has essential tremor so can't do it herself. Trimming her toenails and fingernails is a way for me to make sure her feet aren't contributing to her gait issues. The tremor, her low BP, and her peripheral neuropathy aren't doing her any favors. The struggle is real. And for those of you who can say in these comments, "I exercise and I'm fine!" well, that's great for you, but please have some compassion for others who aren't so nimble.
59
@R A I reread this article at least once a year as well, especially the part about choking while eating.
1
I’m 73 , bike regularlyin Blkyn and go to a water aerobics class three times a week , have been going for six years with no problems but three weeks ago I slipped on the wet tile going into the pool and got a concussion. Now the neurologist says I am suffering with post concussion syndrome that could last 6 months. I’m just frustrated but trying to get back to my regular activities. I can see the fear factor now entering my life where it wasn’t before .
18
@Peggy Herron. Use flip flops whenever in the pool area. (Also, there must be rubbery slip ons one can wear in the pool as well..). I swam a lot when young and always wore them to avoid fungal infections. They are a good way to keep from slipping. Hope you get over the fear factor and simply adjust as you get back to activities.
11
Not flip flops (they can cause tripping), but swim socks work well - they are thin neoprene / elastic slippers with a rubber / grip sole. They slip on and you can wear them while swimming - they are great to avoid slipping poolside, If you are at the beach they also help you avoid slipping on wet rocks or getting cuts on the bottom of your feet due to sharp rocks / objects in the sand. There are inexpensive ones available at big box department stores (usually in the summer).
4
Cardiologists, family doctors, and others who prescribe blood pressure medication should have a chat with orthopedists about the risks and benefits of keeping blood pressure levels so low for older adults. Benefits to lower blood pressures should be weighed against the risks of potential falls from lightheadedness as the result of blood pressure that a cardiologist might say is ideal.
8
"Never walk around in socks or stockings"
Seems to contradict other things I have read where it was recommended to wear non-slip socks around the house as it is better in terms of working all the feet muscles that contribute to stability.
9
@Matthew. They sell skid-free slip on socks on Amazon
https://www.amazon.com/Hospital-Resistant-Slipper-Unisex-Gripper/dp/B06W58VHWL
My biggest concern is whizzing cats. They've managed to trip me twice. Then they stand around looking puzzled at mommy who is lying on the floor groaning.
11
Thanks...that made me laugh out loud.
1
Thank you for this article. I do balance exercises and I believe they have saved me on. what seemed, my way down. more than once.
2
These are all wonderful, practical things to do. It misses however, the most important thing someone can do: balance training and weight training.
Balance training will work on strengthening muscles that most often contribute to falls: weak ankle, knee and core muscles. Weight training in general will build bone density and help reduce the risk of damage to older bones in the event of a fall.
18
Not falls per se, but another element of senior safety. Transition to lever-type doorknobs, particularly in bathrooms and on exits. Seniors can get confused in the event of an emergency and arthritic hands can have trouble gripping and turning doorknobs. I had visions of my mother stuck trying to get out in the event of a fire. (Make sure your smoke alarms can be heard by a senior, some come with flashing lights.) I simply checked the brand of her doorknobs and bought a lever set by the same manufacturer: the one set was sufficient to swap out the internal knobs of 2 doors with no rekeying necessary.
13
Paint a bright contrasting stripe on the edge of the bottom step. It is easy to miss that last step down.
20
@Gertrude Memorize the number of steps. Recite the count as you traverse the steps.
3
@Jay Good idea but I'm easily distracted and would likely either forget to count or lose track of the number.
1
Want to add I am member of Silver Sneakers for seniors and printed out an article they wrote called Is There a Proper Way To Fall. Article dated Jan. 15, 2019, written by Alisa Hrustic. I hope seniors know that Silver Sneakers is available free if you have that in your medical insurance plan. My Blue Cross/Blue Shield plan provides for it.
A reader mentioned a book Better Balance for Life and see I can get on Amazon; it's not at my library. Author Carol Clements and Jon LaPook; it's a ten week plan. No connection to any of them but want to find out more on this subject for my sake.
10
Another simple thing to remember: never look one way and walk in another.
23
@Joyce McKinney That is a good tip. I count as I creep around with my walker, it prevents me from glancing over to see if the trash has been taken off the patio or some other diversion that can in a split second...well, you know.
4
@Joyce McKinney good one! I see people do this every day. Not just walking either, they do it driving too!
3
This is a shocking statistic, but I shouldn't be surprised. In my extended family, we have lost two relatives to this exact injury. The greatest danger, of course, is for people who live alone and may not be able to call for help. This happened to my mother-in-law; she laid on the floor an entire day before someone found her.
I have two artificial knees and am extremely cautious about where and how I walk, especially outdoors in the snow and ice. But, I am determined to maintain my dog-walking schedule. I follow all of the advice given here, but still think my 2-story home may not be suitable the older I get. The idea of leaving my home is shattering.
It is a sad fact of life that as we age we fall apart in so many ways. What cruel irony that an actual fall (not cancer, heart disease, diabetes, etc) poses such a significant threat to our lives.
23
@kim murray,
I know what you mean by "The idea of leaving my home is shattering." I had to do just that when my husband passed away a bit ago. However I have found that once you get over the separation trauma of leaving a familiar place with memories that you find it wasn't as bad as you made it out to be.
No stairs in my new apartment, no walks to clear in winter, much easier to keep the place clean and in order.
We didn't fear the unknown when we were younger, moving was a thing we did when we needed to, so don't let it stop you from living life.
3
My father memorized the number of steps on the stairs and counted them aloud when going downstairs to avoid missing one of them.
32
standing on one foot is the best & shows quick results. in a week youll go from 5 secs to 10 or 20!
11
Thank you for some terrific advice! As an avid, 50-something hiker and run/walker, I depend on strength-training and yoga exercises to help me maintain balance and prevent falls. After a friend fell and broke her wrist because her shoe came untied, I also started double-tying my shoes.
6
I fell on Dec. 30, 2018; was being dropped off by a volunteer and she moved her car while I was still holding on to side of car. Didn't break anything but put me back a couple of weeks in what I could do and sure did not help. Shortly after fall I went to my podiatrist and told him story and he said my left big toe was fine and he wiggled it to show me. It was very painful after the fall. Put frozen package of peaches on it after fall which helped.
This month switched podiatrists and he told me toe in question was sprained. Had to stop balance classes as first class made toe hurt in middle of night. Foot had turned from straight to about 2:00 o'clock position for several minutes. New foot doctor said to hold off on balance class for a couple of weeks which I am.
But the balance class has helped.
I found I have to be careful when stepping back as it seems to be where it's easier to fall. Don't have throw rugs. You really have to go slower and watch where you are going all the time; outside and at home. I always take cane to bathroom at night and use cane at home when needed. Keep a flashlight next to bed. Keep another one in office also as light sometimes poor. Also need to be aware of other people near you if they will unknowingly move toward you and possibly cause balance loss.
Walkers are very helpful. Use mine to go to library as can put books in grocery bag and put bag on walker seat as books heavy. Take it out to mail box to pick up mail.
11
@Joan S. My mom (91) fell while carrying a tray of dishes to the kitchen and fractured her kneecap; she needed to be in rehab for 6 weeks.
We got a tray to put on top of her indoor walker (amazon, among other places, has them) so she can put things on top and use it to walk around her home.
6
I find while walking that concentrating on stepping in heal-to-toe order reduces the risk of tripping on irregular sidewalks and other minor obstructions.
11
From years of cycling and also walking I have learned that I am far safer from falling when I am not rushing. Slow down! (True as well of course when driving)
21
You can also practice falling so that, in the event that you do fall, you are less likely to be injured. AARP has an excellent article https://www.aarp.org/health/conditions-treatments/info-2017/how-to-fall-safely.html
3
I bought what are called touch lamps for the bedrooms. You touch the lamp and it lights up. Mine have three different settings re brightness. Nice for reading in bed, but even better for brightly illuminating the room for the inevitable stroll to the bathroom at 4:00 a.m. Much better and safer than a night light. Guests appreciate not having to bumble around in the dark trying to find the light switch.
3
I love my night lights! We have multiple motion-activated night lights all over the house. I can get out of bed, go out into the hall, through the living room to the kitchen, lights automatically coming on in front of me.
I used to use 7 watt tungsten bulb night lights, but have recently switched to the GE brand motion-activated UltraBrite (4O lumens) LED model that's very motion sensitive, and quite bright. In some outlets I place two of them. They're available at places like Target and Walmart, and no doubt, Amazon.
I also use some made by Sunbeam - that aren't as bright - but you can set them to different colors (I like amber). The advantage to this one is that you can set it to be motion-activated or a steady light (both settings only light up when it's dark or the light is quite low). These, I got at Costco, and come in a package of three.
1
Excellent article. Would like to share a "find" in the category of throw rugs. I replaced all of our bathroom rugs and bath mats with Gorilla Grip rugs (Amazon). They live up to their name !! The backing is firm enough that it doesn't slide or buckle on the floor. And they are washable, and come in a variety of colors and sizes.
9
Over time – as the auto-focus got more stiff and creaky – took to having four sets of glasses:
• 5 ft-infinity
• 3 ft-10 ft
• 2 ft-4 ft
• 1 ft-2 ft
Tried every blend of progressives or multifocals – just never stopped being distractions at the edges, with head movement...
So long as both eyes working, will depend on that 3D image, vs purposing each eye...When depth cues are remembered or intuited, that’s when a short memory lapse might go bad...
I get the cheapest optical-quality prescription glasses – buy 2-3 pairs for each focal distance...For longest-distance ones, photochromic lenses highly recommended...
More than stylistic consistency, prefer identical frames so switching from one pair to another doesn’t change the frame of view...Just get them in different (muted but distinguishable) colors....Bendable frames are the most forgiving, when sat on or rolled on...
While shopping, the 1-2 ft ones turn out to be the most useful 2nd pair – print on so many labels is so small, being able to focus at the highest “zoom” level is a plus...
On the lighting front, replaced everything with LEDs several years ago...Beyond energy savings:
• Their color spectrum doesn’t change when they dim – so replacing a 75 watt incandescent with a 15 watt LED – then dimming to about 3-5 watts, provides very effective night-lighting
• With that, our kitchen areas and halls all have this sort of night-lighting
• Can also be done in sleep areas, set low enough so not to awaken
8
Oddly, alcohol is not mentioned as a risk factor for falls.
28
Last evening I fell on a DC sidewalk. One second of not paying attention and down I went. The first time this happened, I had a severe leg break. In between, I have fallen on DC sidewalks several time. DC ;s sidewalks are more treacherous than any loose rug in my house. It is hard to be vigilant every single moment but that is what it takes.
9
When eyes are closed in the shower, touch the wall to keep your balance. Take off bi- or tri-focals when descending stairs. Use bannisters. Put a non-skid mat in the bathtub.
9
Walking sticks and tai chi. Walking sticks and looking where I am going let me still walk as much as I want. Tai chi makes me aware of my current strengths and weaknesses regarding balance, agility, flexibility and mental and moral state.
4
Excellent article with suggestions for becoming more stable and mindful about limiting common hazards.
Falling can be a life changing event at any age. The references to social isolation, limiting once beloved activities, and cascading physical limitations are, sadly, 100% correct.
When one crosses over from the nimble to the ambulatory or otherwise limiting because of injury sustained in a fall, they are immediately transported (sometime literally) to the unhappy parallel alternative universe of those unable to function normally, and in need of extensive and miserable and expensive medical treatments and interventions.
4
And: avoid hazardous activities! At 84, I’m contemplating getting another horse, six months after I lost “Xena.” Or, as an alternative, riding my mountain bike, which is leaning against the wall a few feet from my stationary, exercise bike—and on which I’ve already had six falls. Dopey? Absolutely.
“Do not go gentle into that good night. Old age should burn and rave at close of day.” (Dylan Thomas)
Yesterday I was admiring a tricycle, but it turned out to be electric and had to be ridden in the auto lanes.
8
I live in the city of New York...If you don't want to make a habit of falling don't live here. Despite efforts by the city to keep sidewalks in relatively good shape, they are a jungle of uneven and broken concrete, deep holes, loose brick and debris. There are a multitude of construction sites detouring walkers into the streets with darkening scaffolding every third building often requiring the skills of an advanced rock climber. Builders and developers are the priority in NY and that's just how it is. There are bike lanes and riders who don't stop for traffic lights while you cross with the right of way. I was recently almost knocked down by one when I had a green light, was in the crosswalk and this rider was barreling straight into me while talking on his cell phone!! Only my quick actions to avoid him stopped the collision as he rode off. Then there are the very reliable potholed streets. Careful not to fall in. A city meant for walking is somehow not meant for walkers and should be exposed as such. You might not be old. You might be in great shape. Traveling the streets of NY is a particular hazard to your health. If you wish to avoid broken bones, take taxis.
15
@S Simon NYC is a big place. I find most of the streets in Manhattan at least are level and well maintained.
A lot of experts say a big city is probably one of the best places to live when retired due to elevators, mass transit/car services allowing elders to get rid of their car, conveniences of shopping, healthcare, etc.
4
@S Simon
This is completely correct and very true
The NYC sidewalks are in terrible condition throughout the 5 boroughs and bicycle riding on them is the normal in many places
The home owners in outer city areas are responsible for their portion of these sidewalks but only repair them after some kind of disaster or lawsuit
It’s safer in a jungle than the city streets filled with every imaginable and non imaginable obstruction!
9
@S Simon On my way to Philip Roth's Birthday celebration (how many years ago?) I was walking on 9th Avenue next to the Port /authority. I took the kind of fall where you are propelled forward with no chance of stopping yourself. I ended up at Bellevue Emergency and needed stitches on my upper lip. Discovered I had featured ribs and had black and blues all over. I went back to look at the road the next tie I was i the City and saw how uneven it actually was and still is. I have had bad falls in my live, but no permanent damage so far. I a afraid of falling, however.
2
It's been said: "Talking to ones self is the first sign of 'insanity'." At 89, whether during the day or that late night/very early trip to the bathroom, that's exactly what I do. I remind myself of any obstacles in my way and turns I must take. I rise slowly, grab onto my 'stroller on wheels', take a good breath or two, and then proceed slowly and cautiously to my destination. I learned my lesson with a fall I took, injuring my right leg with a broken bone in my foot. I am grateful for being 'old', but I remain 'mindful' of the many things that have allowed me to continue to celebrate the birthdays that have brought me to my 'old age'.
20
@betty sher Talking to myself guarantees me an intelligent audience. The rest of your advice is just fine.
5
This is an excellent article. Every point is a good one.
11
Although I am not in this age range quite yet, I have tripped and fallen numerous times--the first time at just over fifty, quite in shape, over a piece of badly broken pavement (open fracture of a foot). My first broken bone ever--but since then I have broken numerous toes by ramming them into things, fallen on a slipper floor and broken my fibula, and two and a half years ago, tripped in my shoes on an NYC sidewalk and went down so hard I had a stable pelvic fracture on right hip.
Ugh. I was extremely lucky and recovered completely but I have been evaluated for osteoporis and was diagnosed with osteopenia, am doing weight bearing exercises etc. I am indeed on one of the problematic meds but am not getting off them anytime soon. I think Ms. Brody's advice is so excellent--especially on footwear (slippers; though I do miss being barefoot and sometimes cheat a little); and evaluating footwear! Love what she said about UGGS--because if the front of the sole protrudes it is a huge tripping hazard. And what you think is comfortable and low risk could be high risk depending. I had to give up the Vince slip on sneakers that I got the pelvic fracture in because the sole is just so thick I'm not safe in them, despite the fact that they are the walking shoe of choice for many.
5
@Gail C
You might have yourself evaluated for a parathyroid adenoma. It causes osteopenia which you are other wise rather young for.
There is a reliable surgical repair. Afterwards one feels great and the bone demineralization starts to improve.
It is a long term disease which starts to damage other organ systems over time. But the first sign in bone loss in post menopausal women.
Balance exercises help. Exercises such as with a bosu ball can improve one's ability to balance. Practicing with eyes closed enhances the workout since much of our sense of balance relies on vision.
8
We have always had dogs, and yes, I have tripped over them in my younger days. But after our last Border Collie died and then several years of being pet free, we adopted a shelter puppy. By then we were both in our seventies. It became clear after two months with a rapidly growing, strong puppy, that neither of us was up for the care that dog needed. We went to training, but after being pulled down flat for the third time we had to give him back to the rescue group. Fortunately, the puppy did find his forever home, and our home now needs to be forever pet free.
14
@Margo I work for a foster dog org; what might be suitable for you is an older dog (ie. 8 years +). The ones that we see are usually very laid back and calm, and likes to sleep and take slow walks. The people there can keep an eye out for a dog with your requirements; plus the older dogs are usually tougher for them to adopt out so they will be glad for your interest.
12
@kj The paradox is that a pet (dog or cat) can be beneficial to mental health, while posing a threat to physical. Both of my parents, in their 90s, tripped over their beloved cat, which precipitated their declines and death.
4
@Margo. As an ICU/Trauma NS I can't even count the large number of patients I've cared for who were tripped or knocked down by a much loved dog, cat, horse, etc. The worst falls seem to be down basement or porch stairs. You need to be much more attentive if you have furry loved ones. Falling up stairs is pretty dangerous too.
5
Be very mindful of sidewalks. I try and walk 8,000 steps a day but my walking got put on hold when out walking I didn’t see the raised sidewalk on a very busy street. I went down so hard I fractured both elbows, broke my left wrist, and bruised my chest, stomach, both hands and knees were bruised.
When I could I called the city and they repaired the sidewalk. So you not only have to be careful at home but every place you walk.
I guess my question would be, how in the world does Tai Chi help you when you go down so fast all I could do was
get my arms in front of me so I didn’t hit my face. Will be checking this out with someone locally and if it helps, I’m on board.
The doctor is amazed (and I am too)I have completely healed up in 3 months and am back walking every day at age 72 and enjoy our winter weather so much in Phoenix.
5
Physical therapy should be recommended and supported by the medical professions. I have gotten prescriptions that helped me get stronger and kept me sticking with the program. I found that I tended to stop when the sessions were over, and physical therapists have corroborated how common that is. Wish I had more will power, but I don't.
15
I am an orthopedist an orthopedist who specializes in osteoporosis diagnosis and treatment.
It is not the fall that kills the patient but the resultant fractures that occur. These are usually fragility fractures and a significant number of these may be prevented by diagnosis and treatment of osteoporosis.
A significant part of our mission is to also help patient's avoid falls particularly though secondary to balance issues. Physical therapy and muscle strengthening are part of the treatment regime when necessary.
Women over 65 without fractures and those were postmenopausal with fractures should be evaluated for osteoporosis. Men. over 75 without fractures and over 60 with fractures should also be evaluated and treated
. Well I agree that prevent in the falls is important treating the underlying disease process needs to be emphasized as well.
12
Writer states he’s always wearing shoes. I say it’s important to be barefoot sometimes. Take the time to strengthen your feet - toes and arches. I do my leg workouts barefoot and focus on my entire leg/hip, including my feet. I also do Aikido which also helps strengthen your feet and helps you fall properly. Wearing shoes all the time limits your foot movement and desensitizes your feet, robbing you of balance and sensitivity.
39
Excellent article and advice in comments as well. I would add (1) no flip flops after age 30 (we in southern California wear them year round and way into old age) - they make you very trippable, and (2) don't carry large items that take two hands when you are walking (particularly in flip flops). The combination caused a trip, fall, and broken kneecap last year. Had I not been carrying something large (light, but large) with two hands, I would have at least reached out and broken the fall and spread out the impact. Knee took all.
5
@Carol
Flip flops, swinging gate, a 6 inch step down and a large bag of fertilizer which took 2 hands. Suddenly it was turn, turn, swirl, fall hard.
Afterward I could trace the dynamics but prior to I had no inkling. I did get hurt but fell onto the grass instead of straight onto the sidewalk so that was good. But I have now learned the flip flop lesson.
Falling is a skill that can be learned and practiced, just like walking. Aikido schools teach falling first, and they welcome anyone who wishes to reduce the risk of injury from the failure to harmonize with gravity.
15
A trick I use: I walk with my legs a bit farther apart than usual. Especially helpful when rising, groggily, in the middle of night, or in the morning.
16
Leading cause of death among older adults. Ok. What’s the definition of “older adult” in this report?
4
@E. anyone older that you are, so it changes!
8
Minimizing risk is significant. But the things you can do to accomplish that, are expensive and out of reach.
Older people in this culture are not only expendable, but we live on less money. Sometimes, far less money.
Renters do not get to tear up the carpeting and replace it. If you are living in poverty, like I am, you might be living in places where high-crime is common, food deserts are pervasive, drug dealing is on the sidewalk, mass transit unavailable, and keeping a light on all night uses electricity for which specific budgets down to the penny are necessarily employed.
Installing assistive things to hold -- like handrails -- in places like the shower is not only high-end, but exactly how do you do that in an SRO and the bathroom is used by everyone on your floor and is down the hall.
We do not exist as far as those who are fortunate fail to notice how we actually live. The French call it réalité.
Once again, what we get from the New York Times is aimed at the upper middle class, and the rest of us are the throwaways to whom not even a second-thought is given as to our class conscious invisibility.
We exist.
We die earlier than the wealthy. We commonly kill ourselves. Whether or not to be here is something we struggle with every day.
Falling is the beginning of the end.
We fall a lot. Then, it's the nursing home. I would rather be dead than go to one. Death is far, far more acceptable than an existence where every time you turn around, it is a threat.
66
@Tim Barrus
Tim, you're so right, and I am sorry for your circumstances.
14
@Tim Barrus
Tim, you're so right, and I am sorry for your circumstances.
There must be some community resources that you can tap for help. I'm thinking that it's probably illegal to not have grab bars in your shared bathroom. Call your Ombudsperson or an Elder Law attorney.
15
@Tim Barrus I agree. Home modifications cost dollars and are hard to impossible if your rent or have housing insecurities. Medicaid programs often do providence access to physical therapy to prevent falls. Many senior centers offer Matter of Balance or Tai Chi for free to the community. Consider calling you departments of health or department of elderly affairs.
- Emergency doc who studies falls
6
All excellent advice, eg I dress as much as possible standing, but let us recall that we all die and this is a natural and necessary phenomenon. Don't make death the enemy! If we don't die in a fall, something else will surely get us. Let us work on strength and balance and do the spiritual work that mortality requires so that we can meet death graciously when it comes.
43
@Jane Borish My, you are philosophical, Jane. Yes, we all die--but I am in no hurry. And I might not be gracious about it.
8
Don’t climb trees with your grandson when 60+. When you falll, the road to recovery is long.
17
Add railings to your home.
There are fittings for lamps that make them switch on when you enter a room.
Anticoagulants will cause significant bleeds from even a small gash due to a fall.
7
Also - watch out for banana peels !
4
First broken bone ever, at age 71. Took my eyes off the ice for half a second,. Boom.
7
@kw, nurse
Had one fall on ice this winter so I got a pair of micro spikes I
These slip iOn boots and improve traction.
3
I am in a Tai Chi class and highly recommend it, But, as the article suggests, if you trip over something in the dark the odds of Tai Chi helping you go way down.
4
One consequence of global warming is weakening of the polar jet stream, leading, at our latitudes, to alternating periods of bitter cold and thawing warmth. This results in sidewalks covered in glare ice, something we've experienced four times in the last month in Rochester, NY. I walk my dog at least 3 times a day and with the glare ice conditions, the best solution is to get spikes (like Yaktrax) to slip over your boots to provide traction.
15
Based upon the statement of a person dies every 19 minutes from a fall....that equates to 27,740 individuals....50,000 are are dying annually from an opioid overdose....and the "wall" serves what purpose and costs how much??
16
I don’t want to be a walking ad for Apple but I bought the new Apple Watch precisely because of its “fall detection “ ability. I worried that I would be one more “old woman who fell down stairs, broke a hip and lay there for days before being found,” a horrible scenario that has happened to several people I know. I’ve taken a few tumbles ( once while roller skating, not a good idea, I know). And sure enough, watch asked if I was okay or if it should notify someone. I clicked “ I fell but I am okay” and went on. Watch also detects heart irregularities, though I have not needed that. At least, not yet. I wear the watch in the shower ( it’s waterproof) and at night. Great sense of comfort, in addition to following the excellent advice here and in Jane Brody’s article— including yoga balance posture like Tree Pose and Warrior.
35
Often overlooked: stretch and limber up a bit before heading out. Stiff joints and cold muscles don't respond fully or quickly to commands sent by the brain to stabilize the body in motion.
28
I am approaching 80. I am mindful of falls. But not mindful enough. How many close calls? Just this week, in the beautiful Mexico City, I was not mindful enough. I was not paying attention to the absolutely horrible condition of The potholed sidewalks upturned by tree roots. My head should have been scanning every single step, but it was not. I needed my iPhone gps to find my way around. Then it happened. My partner watched as I stumbled. Watched as she thought I might actually right myself, and I really tried, using whatever nimbleness I might have once had. But I went down anyway. Did not hit my head. Did not break any bones. Scraped only my elbow.
23
I just hit 70. A few pointers I have learned (along with pointers I learned from this column).
1-Keep the area at least dimly lit from the bed to bathroom at night. You don't have to have a lite in the bedroom but the room next to it. Have places, get use to places to steady yourself with your hands like door frames, towels racks etc.
2-When walking outside, look more down and ahead of you then staring at the sky. Also if there is any uneven pavement, curb etc. coming up going much, much slower.
3-When in a position where balance may be compromised, hold out your arms like a high wire guy using a pool to help with balance.
8
Don't rely on towel racks to hold you up! They are held in place by 4 small screws. If you grab a towel rack while falling it will pull from the wall and go down with you.
11
@Mary Ann-thank you for your reply, as the old saying goes Mary Ann, any port in a storm.
I don't recommend always yanking on a towel rack, just to help you with balance and only grab if you are falling.
4
Excellent catalog of causes of falls. Medications, I believe, are the most problematic since you can't alter their sensory affect: gait, balance, body cues, dizziness, etc. A dilemma of the "pill cure" being worse than the malady.
One thing I learned after multiple falls at curbs or crossing streets with imperfections is to learn HOW TO FALL. As my fall begins, I prepare to hit the ground with outstretched hands and as soon as I make contact with the ground, I ROLL to avoid the brunt of the fall at the point of contact.
Another tip. Don't be 100% absorbed in deep thought. If you're moving, think FALL, and WATCH YOUR STEP. Save your day-dreaming for a park bench or sofa.
18
Slight musical paradigm shift. Ismael Reed; Conjure. Learn How to Fall. YouTube. The song is called Skydiving.
2
Be mindful the most recent blood pressure acceptable guidelines have been lowered. This recent study contradicted previous acceptable B/P reading for seniors, and estimated some 12 million more Americans need be prescribed a B/P med, or a cocktail of 3 . Point being, B/P drugs obviously drive down B/P. B/P drugs are major contributors to causing balance problems when rising from a sitting position, and even cause dizziness. Result, major cause of falls. Training ones self to rise slowly, takes practice and good memory. Once folks are on B/P meds, history shows dosages are rarely reduced.Readings by a hurried doctor in an exam room environment are normally elevated . Remind your P/A or Physician to take several readings. Monitor at home as well.
15
I have been using a cane from time to time to increase my visibility to cars and especially bikes who like to travel at high speeds around corners near the Brooklyn Bridge.
9
You can also get canes with a spiked tip for help navigating on ice (think snow tires) or soft ground.
I had knee replacement surgery last year, which turned out to be a blessing in disguise. In addition to all the usual benefits, the changes I made to my household in preparation for my return from hospital -- a step stool to get into the bathtub, moving all furniture out of the paths to the doorways, and many others -- are now permanent additions.
5
Old age doesn't come alone, my dear, is a phrase I am grudgingly accepting - but it beats the alternative - so make adjustments and concessions.
18
@R. Anderson
Dear Lord, allow me to get old and wrinkled!
4
Until my MIL died “from complications following a fall”, I never knew what that actually meant. In her case (she was 93), she fractured her hip while trying to get up with her walker in the middle of the night, but because of dementia and frailty, they did not do a full replacement but instead placed a rod into her leg. She never recovered from the trauma of anesthesia and pain of surgery and was in terror and agony (I can’t use the much stronger word I want to) for days before hospice was recommended. Watching her suffer was one of the worst things I’ve seen in my life. The thought was that she wouldn’t have the strength or the mental capacity to go through a grueling 8-week rehab regime and so giving her some comfort became the main focus. She had a detailed living will and DNR, which made the decision to allow her to die in comfort at least somewhat easier for the family. The hospice facility was absolutely amazing.
27
@Frau Greta During a recent prep for surgery I had the hospital put a DNR bracelet on my wrist. Told them "I either walk out or go out in a box". The anesthesiologist then told me I would have a better chance of coming through if she did not use a trach tube which frequently requires some form of resuscitation. So I had an injection to knock me out. Never heard this before. I "walked" out after I woke up.
6
Important advice. Standing on one foot for 30 seconds is an excellent way to improve balance, which in turn lowers the risk not only of falls, but of car accidents for those over 65.
23
I bought a pocket flashlight, actually several, and they are velcro-adhered by the side of every door in the house. I also installed some in the bed-pocket organizers and by the toilet paper dispenser in all the bathrooms. The pets have their room to sleep in (actually my home office) and when we lived in a place where we could not close them off, they had their cages to sleep in.
Why go to all of this trouble? My husband and I married later in life. Both of us lived on our own for about 20. He leaves books, shoes, clothing, bottles of water everywhere and anywhere. He has never in his life step on a lego at night. I Have. I've also stepped on a thumb tack at night while running into a 9 year olds child's room to assuage their nightmare.
Now I am glad I began that habit early on.
11
@Susannah Allanic
Great tips. As you age your night vision suffers.
3
Tai chi. Tai chi. Tai chi! My tai chi teacher is 83 and still teaching both tai chi and yoga to large groups of seniors in U3A classes. These men and women don't fall over.
Of course, making the home as safe as possible is important, but the mindful awareness developed in tai chi, as well as the physical discipline itself, is invaluable.
And to learn it, daily practice is necessary...so, daily movement and exercise. And, Jane Brody, as you pointed out in a previous article, it is excellent (in spite of its gentleness) for building strength, loss of which is a leading cause of falls.
All of which you have noted in this article...I just wanted to reinforce it.
22
Core conditioning and pilates to strengthen the abdominals are necessary for healthy aging and to prevent falls.
10
Great article!
My poor wife had to put up with my objection of seeing an
orthopedic doctor. Your talking to a someone who was taking
over the counter pain killers.
Luckily I had both hips replaced over a period of 24 months,
religiously did my physical training and continue to work on
flexibility.
I now sleep without pain, walk 4 plus miles a day and watch my weight.
10
For me, hip surgery happened when pain in hip and leg overcame fear of surgery.
very happy with outcome one year later !
5
@John
So true!
2
I had cataract surgery last year, and am having a heck of a time finding the right corrective lenses. The progressives were distorted at the edges. Going downstairs was problematic, and I've taken a tumble.
I didn't have these issues with my progressives before the surgery. Maybe the new ones weren't made correctly.
The Ophthalmologist recommends bifocals, but the Optician disagrees.
Any advice?
@Peg Research aneseikonia to make sure one image isn’t larger than the other. There are very few ophthalmologists or optometrists who will calculate a special lens for that. One is at Ohio State, another at the former College of the Pacific. This is caused by an excess of inflammation in the body or not enough anti-inflammatory meds. The faster a patient is treated, the more likely the disturbing condition can be (mostly) corrected. Doctors can overlook or deny various post-cataract conditions,
3
Peg,
Instead of glasses with bifocal lenses, I wear monovision contact lenses with a lens for reading in one eye and a lens for distance in the other. I don’t notice any loss of depth perception even though there is quite a difference between the two lenses (3.5 vs 1.75). I’m wondering if you might be able to do the same with glasses. Ask your Optomatrist. It might work for you. Here’s a link about monovision:
https://www.contactlenses.org/monovision.htm
Anna
2
@Peg
Progressive lenses have distortion around the edges. Maybe now you can see it.
When they first came out, I tried them, couldn’t stand them and returned them for bifocals. Recently I took an offer for cheap sunglasses, deciding to give them another try. I hate the distortion. The glasses are ok for driving when I look straight ahead, but no way would I wear them around when I have things to do that involve real visual distinction. Stuff moves around the edges.
Short answer. Try bifoculs. Or trifocals like I have. That being said I’ll have cataract surgery soon. I may change my mind
1
I am 89 and have fallen 5 times in the past 10 years requiring skin grafts on legs, many many visits for wound care and always because I forget that my head is 50 and my body is a slow 80 plus. I am so angry with myself because I am always thinking about the next thing and not concentrating on this thing. Luckily I have not broken bones; but I am beginning to accept I am an old lady and must go slowly and carefully - I use my cane all the time now and now NO beautiful throw rugs anywhere on my floors; so I ask my young friends although I look 60 I am almost 90 so bear that with me please.
23
@lillie. Insurance will cover physical therapy which is more helpful than you’d guess. If you’re truly housebound, the therapist is paid to come to you.
4
I recently turned 70 and now have to deal with the incurable and slow progressive Parkinsons Disease diagnosed 3 years ago. One of it's dangers is loss of balance and therefore falls.
I am pleasantly surprised and happy that my medicare advantage healthcare company sent me a letter which stated upon my request they will send someone to my home to look for areas that may cause falls and other tips to protect me from falling. I have been lucky a few times plus live alone.
Needless to say I have set up a day and time for such a visit.
Would suggest others with fall risks or their caregivers to check with their healthcare insurance companies if they too have such an important program of assistance and knowledge -- and take advantage of same -- it is free.
10
I’m 85 and have bad knees—if I stumble, my recovery chances are nil. Outdoors, when hiking, I always carry a walking stick, a device far superior to a cane or hiking (ski) poles for keeping you upright. But what I really want to make known, is that I also wear a helmet. Mine is a light snowboarding helmet and twice it has prevented serious injury to my head. I’m not likely to fall in my home, but if I were, I would wear a knit woolen crew cap. It’s not the same as a helmet but can still provide a valuable cushioning for your head, perhaps enough to prevent a bad gash or even a fracture.
43
Postural instability in folks over 65 is often due to B-12 deficiency which can affect the higher centers and the distal nervous system. Evaluation for B-12 insufficiency should be done if there is postural instability, alternatively, a pharmacologic dose may be given daily by mouth (500 micrograms ). Since falls with striking the head can lead to serious intracranial bleeding if platelets do not work, prophylactic aspirin … so called minidisk…is not advisable in an age group where falls are more common. TaiChi and other physical exercises can't do much if the central nervous system is diseased due to vitamin deficiency.
12
Thank you so much for this. Though not all readers have cars almost all of us ride in them, so here are a few fall-related ideas for getting in and out of cars. Get into or out of the car using two hands to steady you. Holding parcels, bags, etc. while entering or exiting can cause you to lose balance. And of course always watch for traffic, bikes, etc.
9
Take particular care on staircases to ensure your foot is firmly and completely on each step before moving onto it. I've almost fallen several times from moving onto a step with only the front part of my foot. And slow down!
And: don't wear clogs, or other footgear with inflexible soles, on stairs.
And: be very careful with multivision glasses. Bifocals and trifocals can confuse you when using stairs!
19
@Ariel Burns having torn a rotator cuff by missing a stair and putting al my weight on my shoulder as I fell, I also count the steps as I go up and down.
3
A separate challenge, of course, is how to navigate older loved ones in your life who face a fall risk. In my case it's my parents. They live in a condo filled with gorgeous rugs, glass/metal accent tables, and ceramic lamps, beautiful and loved collections accumulated over their lifetime. Every time I visit them I wince as I watch them maneuver around these items. I can't insist that they purge their treasures, even as I dread the day I get the call that one of them contributed to a medical emergency.
14
I try to remember not to run on the stairs and to act like an old lady, but I hate that. I did fall this year and hurt my foot. There was a scar on the bone where I broke it from an identical fall ten years ago. Everyone was yelling at me, the ortho guy, the GP, my spouse and kids. I think I’m not debilitated like a person 20 years older, in her 90’s I in my 70’s and have time yet. Just impulsive. I’m holding the bannister like a good old lady.m
My six year old grandkids have learned to ride bikes and I would love to get one and ride with them. My son is saying no. I don’t know how that will work out. I was playing with the kids, them sliding on cardboard on the ice a couple of weeks ago and went down. It was nothing, but I got admonished. Dunno. Hate to give up fun.
15
@nancy Maybe a tricycle? I believe they make nice big ones. Some with big baskets for carrying cargo. Could be fun for park excursions!
6
@nancy Find an althetic trainer who shares your goal and get to it. We have more capacity to stay active and continue having fun than conventional wisdom allows. Use it or lose it say I. Good luck!
4
@Lynn
I’m fine. I had physical therapy a while ago to build up strength in my back(disc issues. ) They didn’t see anything else.
I’m in an outdoor painting group and carry my Julian plein air easel and oil painting supplies up the path and down the road with people 30 years younger. No little cart: dragging thru dirt is harder than just carrying.
And I wash fleeces to spin on my spinnning wheel. I have to ask the old guy to help hauling water now. Don’t want another flare up.
When I can’t I’ll stop but for now, I’m going on. No tricycle either. Too low. I want to be me, if I can.
4
I have taken a lot from this article. I attest: having had bad balance during chemo, my confidence fell a great deal. I suggest that if you need PT you get someone who appreciates the emotional as well as the physical. No shaming or asking you to do what you're not ready for but sane pushing where he/she sees your capabilities.
Another thing is I've found exercising for strength has greatly helped my balance.
They say women in their 70's can be quite cool. I'm at 72 and thank you profusely for making this stuff okay to talk about and okay to prevent--when possible.
15
I use a small light bar that is activated by movement on my bedside stand. That way it is easy to see items without having to find my flashlight. And it’s portable.
8
Only 57 now but a regular indoor climber. As such we fall all the time. Many older than myself at the gym. I have no proof that falling regulary but on fall designed floors seems to make me stronger and better balance comes w the climbing. Some kind of limited falling classes could be designed to mimic the effects of climbing falls. Let’s say 10cm ‘falls’ and up . Seems to me it wouldn’t be a good idea.. along w the ‘learn how to fall’ info mentioned earlier.
10
The Carol Clements book Ms. Brody recommends, "Balance for Life: Banish the Fear of Falling with Simple Activities Added to Your Everyday Routine," is truly EXCELLENT! I found it not long after it was published in 2018 and started working its simple mini-exercises into my daily life.
By Xmas, it was on my gift list for every person I knew over 50. (But quite a few friends and family under 50 would benefit from it as well.)
20
I have experienced two bad falls. Both times my fall would have been minor if I had not grabbed at something in an attempt to steady myself. Once I reached for a table which slid across the floor, taking the door molding with it. The second time I reached for the ironing board which promptly collapsed causing me to face plant on the bedroom floor causing bruising and carpet burns. When you feel yourself out of balance, concentrate on falling correctly. More than likely it is too late to prevent the fall.
38
Thank you for this article on one of the big dangers that faces everyone as we age. Caring for my parent's during the last three years of their lives, I learned that many elderly die slowly, one fall at a time. My parent's were both in their early 90's when the first fall occurred. PT and OT got them back on their feet with the aid of a walker. The challenge was continuing the exercise routine provided in therapy to their maintain strength and coordination. Subsequent falls resulted in their physical decline and eventual death.
Now at 68, I am committed to learn from their experience by engaging in excercise that strengthens my core and remaining active as long as physically possible.
18
All my falls have occurred outside. Probably my worst fall was when I was walking alone on an uneven sidewalk at night, with very poor lighting. I was going from a parking lot into a motel when this happened.
I would like to implore all businesses to invest in good lighting outside, both to protect their patrons from falls and also from assaults.
32
We plug in light sensing night lights when we travel. 220volts (bought in Berlin) for outside US and other non-10 volt countries, 110 volts here.
11
I never thought of myself as elderly (I'm 71) until three months ago when I suffered a serious fall that resulted in a broken left shoulder, fracture of my left elbow, and a broken right thumb. My 3-year-old granddaughter took off running down the front stairs and I panicked because I thought she might go into the street. I ran down the stairs, neglecting to hold the railing, lost my balance and went head first down 5 concrete steps.
I wound up having three surgical procedures to replace my shoulder, stabilize my elbow, and pin my thumb. I am still having both PT and OT and probably will have to continue with therapy for several more months.
I spent a lot of time feeling sorry for myself but gradually I came to realize how lucky I am. First of all my granddaughter did not go into the street, I bet she wouldn't have even if I had not chased her! The accident was my fault, I simply panicked. However, I did instinctively protect my head with my left arm (I don't know how my right thumb got involved!). The head of my humerous was shattered. It was replaced with titanium and I have several titanium plates in my elbow. If my head had hit the pavement without my shoulder in between, I would have had a serious head injury, maybe even died at the scene.
So, now I am super cautious on the stairs and I plan to participate in an exercise and strenthining program so I will never fall again and I plan to continue babysitting once I have regained use of my left arm!
34
I fully agree with Gillian. The local senior center in my area has a workshop every year with a couple of PTs on how to fall (along with how to keep yourself from falling in the first place -- suggestions similar to Jane Brody's) and how to get up if one does fall. The primary lesson is, as you did, to turn as you fall so you take the brunt of a fall on your upper arm. Shortly after this workshop I tripped on an icy spot on the breezeway from my garage to my house (and, no, I was not paying attention as I had some bags in my hands while fiddling with my keys to the front door...). I had a nanosecond to realize I was going down, that there was no way to stop it. I let all the bags go (I make no stupid attempt to "save" whatever I was carrying) and twisted by body to the right as I was going down, thereby taking the blow on my upper arm, secondary on my elbow, followed by my upper leg. I was winded for several seconds, but there was no damage done. I am so grateful for having gone to that workshop! I'm assuming there are YouTube demonstrations that also show how to fall. In meantime, realize it's best to turn and roll if you can. If you can't roll, at least turn and take it on your upper arm to the extent you can.
25
Showering in bathtubs can be deadly slippery, at home or in hotels. No treatment work better than a wet terry-cloth towel used as a mat. Try it.
25
If you live in a cold area with icy conditions, you should get ice grippers (also called creepers or ice cleats) to slip over your shoes and boots when you walk outside. Up here in midcoast Maine where we've had a lot of ice this winter, they make an enormous difference. On a day like today, when my driveway is sheer ice, I can't even walk to my mailbox without them.
19
Using ski poles or a shovel to slowly move across ice also works.
6
@Mrs. Proudie
And also look out for "black ice", more correctly called clear ice as it's transparent and thus almost invisible.
I was walking with friends in August at Blackheath in the Blue Mountains (NSW) and were about to step onto a concrete pathway in a park. Looked normal at first but just one step on it revealed that it was quite slippery. It was completely covered by clear ice. Quite unexpected as footpaths elsewhere were ice free but they had been warmed by the morning sun. A nearby duck pond was ice free too.
7
Older folks need exercise and strengthening of their bodies. Getting stronger throughout their body will help mitigate the chances of sudden death by falling.
20
Hearing aids -- it is important to wear TWO. If only one, it is impossible to detect the direction of noise-danger.
14
I read all the comments to see if anyone shares my #1 worry: elderly husbands who climb a tall ladder to clean out the gutters. I showed him the article, and he laughed and replied, “See? She didn’t say to not clean out the gutters!” I hope it will only be his pride that goeth before a fall.
60
A cautionary tale for your husband: the husband of my mom’s friend did just that - climbed a ladder to clean the gutters. Fell off and died from head injury. Hire someone younger with better balance
31
Hire a handyman.
21
@Green Pen
I save my marital "threats" for just such occasions. And I had to use one to get my husband to stop climbing on the roof. We now use a lawn service to clean the gutters.
24
Excellent Analysis. Thank you.
1
Two small thoughts to contribute: buy or make some kind of attachment that you can wear to keep your cell phone handy. I’ve had two falls where I was unable to get up. Good to know about the Apple Watch, too.
Other thing is about throw rugs. At a pretty upscale home decorating store I saw a display of vinyl floor coverings and mats that were very thin, attractive, and size customizable. Nothing like old style linoleum. One brand you could google is Spicher. Myriad patterns. I’m getting ready to replace my braided (slippery, foot catching) kitche and hall rugs. You can get samples, but they’re probably not hard to find in larger areas.
4
My father, James McAllister, died November 10, 2018. He had fallen 10 days earlier in his assisted living apartment and broken his back. He died in the health care section of the assisted living buildings. He had been in good physical condition for his age —94– when he fell. He walked every day for years and only recently began using a cane. The fall took him from us.
25
@Sara Lowe, I am so sorry for your loss. My prayers are with you and your family.
This was truly a sad situation.
1
Falling on snowy Icey pavements is a huge risk for everyone, but especially dangerous for seniors. Avoid reaching out to stop a fall which commonly leads to a wrist fracture. Prepare and practice for falls at home by following some basic rules such as softening your muscles, fall to the side, etc. I tell patients to use Yaktrax, an inexpensive portable way to add small cleats to your shoes or boots that work fabulously well and bring great peace of mind and body. Love the Apple Watch fall app as well for those living alone. Marie Savard, MD
14
@Marie Savard
I bought YakTrax this year! So glad I did and wish I had bought them sooner!
4
@Marie Savard But be very careful with gear like yaktrax if you live in a city, walk, and are in and out of buildings in the course of your day. Yaktrax can be treacherous on indoor surfaces like terrazzo (Grand Central Terminal) and marble. I almost fell on my face a couple of years ago when I went from a snowy sidewalk straight into GCT without removing the stabilicers (similar to yaktrax). Generally, I find the good lug soles of a pair of hiking boots are enough (and also help keep my ankles stable). In Manhattan I find I need to take out the stabilicers only once every couple of years or so.
2
@Lim. Try stabilicers....much better than YakTrax. I have many pairs, in my car always.
1
Thanks for these excellent suggestions, but your readers should be advised of a wonderful program taught at the JCC and available on CD called Stop Fall - Move Strong - that is specifically designed to help reduce the risk of falls. My wife and I attend twice a week and love the sessions, which run an hour. It builds your strength, your stamina, improves your balance and definitely helps you guard against falling. I cannot recommend it strongly enough. And, of yes, it's fun!!
13
My wife and I are in our 70s. We have two sets of stairs in our home. We use a simple rule; take the stairs slow and keep a hand on the banister.
10
Also engage in working with a trainer to work on balance and strength. Makes a difference.
10
I have always loved Jane Brody's columns but when my 93-year-old mother with some dementia told me she was doing everything standing on one leg yesterday, I was horrified. There should have been some caveats, like: do not try this at home if you're really old and live alone.
10
@Jackie: standing on one leg is good for balance and strengthening her core. But - she must be near something she can fall against. Or even hold onto something, like a bar, at mid-body level.
4
@Nette I agree, but I don't believe that was stated in the article. Hence, my comment.
1
What about personal air bags... that inflate when you start to fall? There seem to be several such devices on the market; notcsure if they work well though.
3
Rushing has been my downfall.
71
Amen.
6
@Maura3 Was that "downfall" pun intended. Very good.
8
Bifocals - esp when you are new to their use - are definitely known to be dangerous on stairs and in settings like getting on and off a bus. But progressive lenses are not so bad.
Balance exercises and just challenging your balance as often as you can (like always standing when putting on pants and socks or running up stairs with heavy shopping bags) have possibly another benefit. Like juggling, they demand intense mental calculation and so are good for your brain. (Your arms are not so helpful for balancing because they get their "orders" too slowly.)
6
A very informative article.
Thank you.
I just crossed 70 - and I read NYT obits because they are so well written. Though I also admit that only recently, I started reading them avidly.
I also do occasionally notice deaths brought on by falls.
My maternal aunt was 93 when she fell and had her hip issues.
Not quite sure how serious.
But she lived in Mumbai and medical care especially for aged is not the best. Also, it does not help, there is a lot of money grabbing practices that go on.
I told her daughter - my cousin - don't get her operated on for a hip replacement. Keep her as comfortable as she can be - even with pain medication as long as she has some mobility.
A surgery at that age - and confined to a hospital - gets more health scares.
But her doc talked her into it.
She never left the hospital as she died of pneumonia.
I think falls are not so much fatal as often wrong treatment including invasive surgery.
15
@Neil in Texas. I previously worked in a hospital. A hip fracture is most often a VERY painful event. Almost every movement one makes in a bed requires some activation of your leg muscles just to stabilize oneself even if you are not moving the legs. It is debilitating for the elderly after surgical repair, but more so if not surgically stabilized. Please imagine the level of pain meds that would be required if one opted against surgery. One would be in a zombie-like state from the meds which would be just as debilitating. Such an outlook is bleak and pneumonia from the decreased activity and positioning on the back is a likely outcome. If you would like to decline surgery if you have a hip fracture that is fine, I would never recommend that in the vast majority of cases.
7
I had hip surgery when Pain > Fear.
One year later I wish I had done it sooner.
2
Ms. Brody, you write a wonderfully informative, very readable column, and you provide a great service to readers.
I hate to tell you, Jane, but scanning the obits is a pastime of old people.
I am going to turn 65 this year, and my balance is better than in my youth. I was never much of an athlete, but I persevered enough to become a pretty good skier. I would not recommend the sport because I have seen a couple fatalities on the slopes.
But let me tell you, all that schussing improved my native balance (knock on wood).
I am also an inveterate hiker over rough terrain with a lot of mountain rocks. As I get older, I plan to obtain one of those padded caps proposed for baseball pitchers or a light helmet for hiking or other semi-perilous activities. I am surprised that sporting goods companies do not do more marketing to seniors.
My 94 year old mother has hematological problems that have induced fainting. She fell and hit her head seven years ago, and suffered a brain hemorrhage. She was in the hospital and rehab for almost 6 months, with home nursing after that. Most of those patients expire, and I am surprised she is still with us.
Listen to Jane.
8
@Joe
I also try to avoid tripping (on anything) by picking my feet up. Really helps.
7
@Joe Consider buying trekking and hiking poles for hiking over rough terrain. They're like ski poles and are a big help for balance, especially on steep downhill pitches. I'm 79 and have been using them for years.
8
I've used a trekking pole and highly recommend them for hiking. I can go where many fear to go! Age 67 but hope to continue for a while (writing now from the big island of Hawaii).
6
Fifteen years ago I was pregnant with my daughter. I often squirmed in my sleep, trying to get comfortable, and needed to wake for more potty breaks than I care to count. One middle of the night, I was carefully rising from bed and heard a loud boom. My husband had run into our bedroom door and fell head first to the hardwood. He was used to my waking patterns and wanted to dash to the bathroom to beat me. He didn’t end up having a concussion, but has a small scar on his forehead from the fall. Best method of preventing these accidents (and simultaneously maintaining a marriage) is to NEVER compete with your wife for anything, and NEVER put yourself before an expecting mother!
52
Never leave doors half open!
6
Thank you... for making me laugh out loud. Never try to beat a pregnant woman to the bathroom, in fact, just be good to others so karma doesn’t push you over. How did that not make it into this article as a fall risk?
3
Alexander Technique can be very effective in enabling older adults to improve their balance and mobility, encouraging them to move about more with less risk, and thereby preserve and improve their mobility still longer.
8
The Egoscue Method is excellent, too! I've been doing their various sequences of exercises and stretches for 14 years, and am quite strong, upright, aligned, and well balanced for my age.
If there is only one stair rail then walk sideways going down stairs, holding the rail with both hands. Walk or crawl backwards if there is no rail, or avoid those stairs altogether.
If you live far from your neighbors, be sure to have a charged watch phone on you or a regular iphone when going outside.
And, if you are much younger than I am, take judo or Aikido lessons to learn how to fall. I have never gotten hurt falling, even when launched off a horse, thanks to all the practice I did 35 years ago in Aikido. I fall just fine; but I can't get up due to horrid knees!
14
Two words: mindful movement.
46
Also paranoia.
5
I am very surprised that no one has mentioned "learn how to fall"..... I am 75 years old and have osteoporosis. It was recently determined that I need to take infusions to help stop it and hopefully reverse it possibly. However my main point is people stiffen up as soon as they begin to lose balance and start to fall. If they were able to learn to roll and curl as they fall, they would suffer far less injuries.
Last weekend I was at a Bolshoi Ballet simul cast at a local college theater. When we came out, it was dark and we had quite a distance to walk to our car. As I started across a grassy median, my foot stumbled over an abrupt rise in the ground and I fell. I went down and literally rolled onto my side and then my back. People came running over to see if I was hurt - which I was not. I laughed and said the only thing hurt was my ego for being such a klutz. I immediately rose to my feet and did not suffer any aftermath.
For all the over 55 communities, it would really be a great benefit to teach folks how to minimize injures learning how to keep the body in motion as you fall and roll and by not stiffening up and not brace your arms to stop yourself.
173
please think again about taking the bone drugs. a personal trainer can help you increase bone density without bad side effects.
14
I think that refusing drugs for osteoporosis is a huge mistake. Using a personal trainer will not prevent or stop osteoporosis. I broke a hip 4 years ago. I took Prolia shots for 2 years, and my new doc, a geriatrician, has given me 2 infusions of Reclast. The Prolia got rid of the osteoporosis in my back and improved my other hip.. I am due for another scan this summer. I’ve had absolutely no side effects from the meds. Nor has anyone else I know, whereas a friend who had tried going the none-medicated route has seen her osteoporosis get much worse.
13
Excellent but it takes much practice for falling techniques to become automatic. I (think I) retain that ability having learned at a young age. As such, anyone over 55 should have at the least a first degree brown belt in Judo.
2
Walking around in stocking feet is bad, bad, bad. Even on carpet. Wear some good, sturdy house-shoes with good tread on them. Those cheap non-slip socks don't count, either (my parents saved every pair they ever got when at the hospital--throw the blasted, ill-fitting things away). And don't wear Uggs or Ugg knockoffs when walking in the snow or on ice--they're deadly.
13
@Anne Rockport's Darwyn Fisherman Slingback Sandals will protect you feet and keep you from slipping. Online only, not available in stores.
1
I'm 68 years old and I have multiple health issues. Two things I do yo make my life safer:
1. I never carry anything going up or down the stairs. You need to firmly grasp the banister. Let someone else do the carrying.
2. I never go outside in icy or snowy weather unless absolutely necessary. Wait until the next day or have what you need delivered to your home.
33
@george
Visited my daughter in upstate NY, where endless snow is melting, refreezing and created an ice rink out of the apartment parking lot. Her landlord in my opinion will be responsible for any injuries due to anyone falling on the ice. That being said, I chose to crawl the lot from the street past the 8 parked cars rather than risk falling. I’m 62 and not taking any chances. My pride is less valuable than my potentially broken body, right?
8
I bought Icebug boots on Amazon to prevent slipping on ice and snow. They work perfectly.
3
Dogs. Yes dogs sleeping on the bedroom floor in the dark. A nasty obstacle I've encountered a few times. Solution: A flashing dog collar. Really.
14
@Chris
They should be sleeping in the bed!
3
I think that it is quite possible that the condition precipitates the fall rather than that the fall causes the condition or injury. Why has the person fallen? Maybe the bone has broken, the heart has failed, or the brain has had a stroke.
11
I bought the new Apple watch, which has “fall detection” software. If you fall, the watch will buzz on your wrist and display “we think you fell”, and you have a chance, if capable, to say “yes” or “no”. The watch will call 911 and another emergency number you have loaded if you do not respond. The watch has many features, including heart rate monitoring, but I consider it a “must have” for seniors because of the fall detector.
30
Opioid use also contributes to falls risk. Old people are on opioids, sometimes strong ones and high doses, it is not unusual at all.
5
I’m not so sure about standing on one foot while brushing teeth. Bathrooms usually have hard surfaces. However it’s good practice to put on one’s socks while standing up, perhaps near furniture with cushions
6
Yes the last is the most important. Eliminate or reduce those things that can cause falls, and be very careful as well.
4
I was part of a study of tennis players and bone density a very long time ago. They found the player's dominant arm had 30-40% higher bone density. The constant stressing of the bone caused it to be more dense.
Now, women and bone density is more complex, but watching TV while just gently bouncing from one foot to the other (there are mini-trampolines with handholds are available now) helps both bones and cardiac stressing (this is not "cardio" but something to do with extra G force on you veins and valves, which I clearly do not fully understand, but the researcher who talked to me did).
Programs like MyBodyzBetter and Feldenkrais Workshops make dramatic changes to your balance while improving your posture. These are easily done by people with back problems in their 80s.
I memorize everything in my own home and any place I visit. I do not want to turn on lights in the middle of the night (Jane can write about light destroying chemicals in our brains needed during sleep). The only rug in my house is right next to my bed to wipe any dirt off my feet before I get in bed. I have a pair of Birkenstocks as my house slippers now because my House Slippers were too hard to get on!
I do sudoku every day, use an app for my eyes and absolutely never walk while using my iPhone. I also walk my dog 4 times a day (he is helping unblock an artery along with a no oil plant based diet). When we cannot go for a walk, he runs around in the grassy area and I dance like a hippie in the 60s.
24
This is a helpful column, and falling is something we all need to be aware of, both for our older relatives and ourselves. Both my grandmothers broke their hips, and osteoporosis runs in my family. One grandmother, then 77 years old, fell getting out of bed one summer morning. She recovered well from the surgery and rehab, although she walked with a cane for the rest of her life (another 13 years). Another grandmother slipped and fell in her apartment three months before her 90th birthday. She did not recover: the impact of the fall and the subsequent hospitalization, along with the physical problems and declining health she was already experiencing, led to her death some seven weeks later. I think age and physical condition definitely play an important factor in the recovery process following a fall. The younger and healthier you are when a fall occurs, the easier it may be to come back from it. I'm trying to do all I can now to build bone strength and I'm only in my 30s. Breaking any bone, especially a hip, is no joke. I've seen the aftermath of that on two separate occasions, and it's not easy recovery by any stretch of the imagination. Falls can alter lives, and they can, unfortunately, kill.
9
This probably isn't going to be helpful for folks thar are already old but when I was in college back in the 70's, I took judo for 2 semesters. The instructors were pretty hardcore... 2 ex Marines (Okinawa and other islands) who had learned judo in Japan while on occupation duty after the war.
I don't remember any useful judo moves that I could defend myself with these days but boy they taught me how to fall. The first thing they taught was not to throw year hand out... You learned to talk your arms in against your body and to try and to land on the upper back of one shoulder and the roll to kill your momentum. We did that dozens of time in each session until it was, indeed, instinctive.
Years later I fell down a flight of steps while on vacation (just not paying attention to where I was stepping) and, sure enough, the judo instinct was still there... I pulled my arms in against my body, tucking in my head and ended up at the bottom of the steps with only my dignity hurt. :)
61
@Engineer
There is an actual orthopedic diagnosis for hand injuries incurred in a fall: FOOSH, for "fall on outstretched hand."
8
My mother (92 years old) lives in a retirement community. She attends an exercise class, which also teaches them how to fall.
6
One can start Tai Chi over 70
6
Always great to read Jane Brody's columns.
Traffic is an issue as to falling as well, when walking in NYC and other places.
But the worst culprit, I think, are the bikes, notably those going against traffic.
Of course being alert to traffic is essential, as is watching for bikes heading in the same direction.
But bikes going against traffic are terrible, and it's very hard to watch out for them as you watch out for traffic and bikes going in the same direction.
19
my cousin was killed by a bike downtown NY when he was 70. it was really heartbreaking.
10
@Terri Sorry to hear about your loss. One really has to look out for all sorts of things in NYC. A couple of months a retired professor and his wife who had just come into town were on a subway platform near Penn Station. Some young dude running down the platform in a rush to catch a departing subway train pushed them out of his way, knocking the man down and fracturing his skull. He died a short while later. (And despite the huge amount of "anti-terrorism" surveillance going on in NYC, there was no video or anything else that would have helped identify that thoughtless young guy).
3
@Peter Lobel In NYC one has to walk defensively -- looking out for bikes, cars, defective sidewalks, really everything.
3
About ten years ago, my neurologist suggested I use a Wii Fitness game to help with my balance. I wasn't even in my 60s yet. I used it, beginning with the yoga program, per his suggestion, feeling a little foolish as I stood alone in my unfinished basement.
I ended up really enjoying it, and started using the other games provided. Now, ten years later, I have grandchildren to play with me, and they have a hard time beating some of my scores. I also gained some confidence in areas where I had traditionally been very insecure. What a smart doctor. What a fun grandmother!
53
JB is a sage of common sense, especially for the senior moment tending reader.
I identify with what she writes today, and it's at least (not exactly) humorous when it happens.
I broke pelvis avoiding stepping onto rescue
West Highland terrier.
I am not a big fan of the breed, my wife luvs
'em.
But a utilitarian terrier that is probably keeping me from being room temperature by insisting
we walk except when raining is a Wheaton-greeton.
I tell kids that pet him that he's like Little Orphan Annie's, they look at ole man kinda
dumb-founded especially when he jumps, however.
8
Falling is an ongoing issue for seniors. A few years ago my town's Council on Aging sponsored, and I participated in, a fall prevention course titled "A Matter of Balance". I highly recommend you take this course if it's taught in your area. In addition to addressing fears and building balance with simple strengthening exercises, it stressed never wearing thong slippers and taping down throw rug edges if you don't remove them.
I didn't do either. I tripped and went flying. I was lucky I didn't break my neck. Fortunately, I was just shocked and slightly bruised.
Learning how to fall is important also. Don't put your arms or hands out to break your fall. Keep them at your sides. This will help prevent a broken arm and wrist. Also, whenever possible, protect your head.
Thank you, Jane Brody, for writing about such an important topic.
16
Former paratrooper here. In 40 years of combined active duty, an unusual federal civil servant career, and a highly active lifestyle, I have broken more bones than the average adult, but none from a fall -- and I am a world-class klutz.
Oh, btw, I'm a 66-year old woman.
14
I have a fractured humerus from a fall two days ago when I tripped on an uneven rough patch crossing the street. I am aware that being an older female makes me more prone to falling. I have been to lots of great PT for balance and a foot/gait issue. The article is good but you failed to mention why older people take the medications you mentioned- sleep difficulty. I have huge issues with insomnia and have for many years that resolves with medication. Now, because of my age and new policies, even though I never abused and never needed an increased dosage, I no longer can get benzos. OTC brands and medical marijuana, to me, are no safer in high doses than any kind of prescription medication that works, and each individual is different. Now, I am often tired and way off my game making me much more vulnerable to falling. A major impact on balance is how well rested you are.
16
@Jane Flack I am your twin. Same. I worry about lack of sleep, because I know that there is important neurological work being done in our brain during our sleep. I have some benzos, too, rarely use them. And when I do, I do wonder if they make any difference. I think they do. There was an entire talk at the senior center on marijuana, which is legal in Washington state. Most seniors say it helps them most with arthritic pain, which I also have in shoulders, knees and wrists. Sleeplessness, and how to manage it, is my greatest risk factor...way more significant that the rest of my colorful health history.
5
@shirley I finally decided to make an appointment with a sleep dr. We must not be the only ones because the soonest was April 30. I need something more than blah-blah-blah, the same old suggestions. I have arthritis, too, and medical marijuana is legal in DC so I was very optimistic when I tried it. Unfortunately, it’s only a small help for sleep or arthritis and certainly not an inexpensive alternative.
2
Love your column Ms Brody. Move to a one-story house if possible! Both my husband and I fell on or down our stairs in previous two-story homes.
11
Fell breaking my femur and lay on floor for 12 hours until I could reach my cell (crawling with broken leg). My Comcast regular phone was worthless due to an “outage”. Spent over three months in hospitals regular and rehab. Developed massive DVT despite the heparin. Six months from fall waiting for DVT to resolve so I can get off anticoagulants. A fall for me could be fatal or an emboli from DVT could kill me with pulmonary emboli. Before this I was a healthy independent person. Don’t Fall!
22
I might add keeping any extra weight off. Being slim helps one's range of motion in countless ways. I constantly see Baby Boomers who are about 30 lbs overweight. Imagine yourself climbing stairs, navigating uneven terrain -- or anything else -- carrying a 30 lb. sack of potatoes!
18
@Sarah Carroll
On the other hand, if you do fall, the extra padding on your hips can save them from damage! Interesting that when you do your bone density assessment, your risk goes up the less you weigh.
15
@Sarah Carroll
Sarah, Not sure your advice is medically supportable. At best, it is too simplistic. I’m not slim but do Pilates which is excellent for range of motion, balance, and much more. Also can ride 50 mile bike rides. I can out perform many folks my age that weigh more than me. Suggest you get more familiar with medical literature that documents there are many more criteria in considering being a healthy individual than your denigrating comment about “sack of potatoes.”
6
Dear Jane,
You forgot something important as a cause of falls! Alcohol! A friend, aged 63, has had 3 major falls in the past year. After every test under the sun to determine a cause of what she describes as vertigo we think its her heavy drinking. Even if there is an underlying cause, too much drinking causes unsteadiness in even the fittest. And there is nothing about getting older that ensures that alcohol abuse diminishes.
18
Your article refers to "slippers". I like clogs with a big textured footbed. My current pair are Merrell brand. They are made to be shoes but I keep them for indoor use. They are easy to put on for a midnight trek to the bathroom. If I visit someone who discourages wearing shoes inside, I bring my clogs in my bag and change inside. The ones I have are washable.
5
Be careful with those Merrills, especially on carpets. Don't shuffle when you walk while wearing them. They can easily catch because of the rubber soles.
3
Fear of falling makes me aware that I's a wobbly old man. I am pushing 85, if I make it. Over the past 5 years I have fallen in my apartment many times.
The problem is that I can no longer get up by myself. Most of my falls have been in the kitchen, one in the living room. I always have a cell phone and can call the super for help. When I am alone with my wife not present and if the super is not available I have a real problem.
My solution is that outside the kitchen door on the dining room wall I installed a vertical 24" grab bar and a 30" horizontal grab bar, I installed 2 grab bars in the stall shower and bought a good seat for the shower.
Never the less when I fall I must drag myself to the dining room, kick off my shoes and and press my feet on the baseboard, reach for the horizontal bar, using the vertical one to reach it if necessary and pull myself into a standing position. If my wife is present she will slip a chair behind me and I sit. I and then rise from a sitting position. I never walk without shoes.
What is new is that the last few falls were outside the home one while shopping in a supermarket my knees decided that they would not hold me. My wife was with me and I fell again before I got home and each time while holding on to a rollator, Which I now use to go from room to room. Physiotherapy begins again in April.
My biggest fear is falling half way across Northern Blvd and the light changes. My advice is when you feel tired or wobbly sit
14
Yoga, with its emphasis on balance and flexibility , is also very helpful for fall- prevention .
11
Please recommend a specific mat for the bathtub. I live in a rental with a small tub, so while it must definitely be non-slip, it also cannot leave behind marks when removed. Finding the perfect mat has been impossible; just reading reviews proves I’m not alone.
2
@Charlotte
I've been buying all different makes of tub mats. It never occurred to me that there might be a perfect mat. I check the size, which is listed on the label, so it isn't too big and check to see that there are suction cups. Most important, I rinse and remove the mat after each use. Sometimes I wash it with my bath towels to be sure it's totally clean. I throw it away and buy new when it doesn't come clean or gets hard or brittle.
8
@Helen
I’d appreciate it if you would share some names of the ones you’ve found that really work. (If any are available on Amazon that would be a big help. While I like to support stores, mobility issues do not allow me to carry too much.) I do everything you mentioned, rinsing and drying, but still find my current one slides, especially if I decide to bathe instead of shower. Thank you so much!
1
Someone commented on using a wet bath mat on the shower/tub floor. Sounds like a good solution.
Not to be overly cynical, but sometimes the "complications from a fall" include the horrors of then being in a hospital, where 24/7 bright lights, ringing bells, staff shortages, and insurance-checkbox-oriented patient "care" that demands that you rate your pain on a scale of one to ten a dozen times a day are worse than the actual fall itself. People can sometimes recover from falls, given time and rest and peace. At least, they sometimes did before the advent of health care for profit, rather than for patient care.
67
Absolutely. And let's not forget the almost certain chance of contracting c-diff infection, which can be deadly in the elderly.
11
My grandmother fell and spent the remainder of her life in a wheelchair. My mother fell, broke her hip and arm and died post surgery at the rehab center. I am trying to do weights to strengthen my muscles in addition to treadmill and stay active. It used to be about calories and losing weight. Now it's more about strength and balance.
63
My grandfather had a saying that you die from a fall or from something "inside," which in Greek rhymes.
Pushing 65, I have already outlived a maternal aunt, a paternal aunt, and three first cousins. My father died at 70, Mom at 75.
If I fall at 75 or 80 and die, I'll be doing okay.
(Just hope I get to Mom's age. I'm not sure about the odds, though.)
6
@Deborah
A dear friend, at only 68 (my current age), fell and broke her hip in an intermediate-care pavilion to which she'd been discharged after a hospital stay to improve her oxygenation. She was a brittle Type 2 diabetic, had COPD, and was petite and severely osteoporotic--despite having taken boxing classes and done personal fitness training till her lungs began to fail her. She could not have the hip surgically repaired. She spent the next year in first a nursing facility and then physiotherapy in upscale assisted living, before moving from her townhouse to a ranch house and using first a rollator and then a wheelchair. Shortly after her 70th birthday, her COPD (worsened by "de-conditioning" from inability to exercise due to the hip fracture) landed her in the hospital, where she eventually developed irreversible sepsis.
I will do whatever it takes to avoid that!!!
10
Instead of leaving lights on all night, I recommend motion detector night lights - available through Amazon. I got them for my 90+ year old mother - they allow the room to be dark, save energy, and come on the minute someone moves. I have the pathway to the bathroom lined with them.
72
Great advice (lighting, footwear, obstacles) for us all. It is SO important to work on strength, particularly legs and core. This does not need to be strenuous, but consistent and challenging. Pilates, swimming, weights, cycling and yoga are all accessible to most of us and increase strength and body awareness. As a yoga instructor (age 67) I don't know any yoga studio that would refuse a client who cannot pay and many offer "donation" classes. Most communities have gyms that are almost free for seniors. I find exercising in a class or group highly motivating and the social aspect is also important. Our biggest challenge is to slow down, pay attention and let go of our ego involvement. Acceptance of a cane, walker or even a wheelchair on occasion should make us feel smart and in control, not "less than". Let's all choose to age wisely and safely. Thank you again!
30
I’m 68. I started falling ten or fifteen years ago. The falls were often benign, although one caused a concussion. My optometrist told me my cataracts weren’t bad enough for surgery, so I found a good ophthalmologist. I had cataract surgery on both eyes during summer, and haven’t fallen once since. Besides the problem of having poor vision, I really think my progressive lenses produced significant distortion that added to my instability. So if your eye doctor doesn’t want to address what you think is having dangerous consequences, get another opinion! We won’t even talk about night driving....
57
As Samuel Johnson , the celebrated British lexicographer,once observed in sheer circumlocution,falling is just changing one’s verticality to horizontality.But,its consequences are nonetheless deleterious in stripping one of his/her life. Silken soft floorings, absence of handrails while changing positions,jerky and demonstrative movements to conform to some impromptu situations ,and last but not the least ,the inroads of age into our awareness or alacrity of response could be at the heart of a sudden and disastrous fall,which signifies the arrival of senility.That a seemingly innocuous slip could usher into a
sorrowful exit at a time of our least concurrence is the crux of the potential of shock implicit in such fall.Unsteady gait imparted with age or sedatives could be another contributory cause.All in all,wisdom resides in eakefulness at all depleting junctures so that one need not feel remorse over a past
3
And if you live in New York CIty, walk defensively, the same way you drive defensively. Even when light is green & you are in crosswalk doesn't mean some fool in a car rushing to get on the 59th st bridge isn't going to run you over while making a turn.
When walking down a street with narrow sidewalks beware Uber drivers in a rush to get out of their cars to assist waiting "clients." In past couple of months I have twice been hit on my right side, while walking down Lexington Av., by Uber drivers who open driver side doors without looking.
Just today I let my guard down while exiting a Starbucks on Lex. Starbucks doors are heavy & when I am carrying a lot I usually lean to open door with one side of my body. Today, just as I started to lean on it some dude on his phone came rushing up & yanked the door open from the outside at the same time he stuck one of his feet in my path.So the force of his pull had already propelled me forward & when I tripped on his foot I went flying forward, unable to stop, & ended up sprawled face down on the sidewalk. The force of it scraped skin off my elbow even though I was wearing two shirts & a lined winter parka. For a bit I was worried I had done something to my right wrist but that pain has subsided now -- thank goodness, barely 18 mos ago I had an open fracture of the right thumb. But mostly just bruises & scrapes this time. For a brief instant I let my guard down & this is what happened - always be mindful of your surroundings.
23
@ellienyc I hope he apologized and helped you up!
7
@ellienycYou are right...I live in Washington, DC. You can never let your guard down! That really goes for all ages esp. the clueless wearing headphones.
8
@ellienyc
People who look at their phones (and those who wear earbuds, listening at high volume) while walking are menaces--not only to themselves but to the rest of us, whether we're on foot or behind the wheel. How hard is it to stop on the sidewalk or duck into a doorway when texting or talking on the phone?
8
As a pharmacist, I highly recommend having all medications (both prescribed and OTC) to be reviewed. Older people often see multiple prescribers and they do not assess what happens with combinations that can impact blood pressure, increase sedation, and cause fatigue. Many drugs cause falls and increase bleeding risks which can contribute to mortality. Ask a pharmacist to help review medications and if you have Medicare or supplemental insurance there are ways to get preventive healthcare (e.g. medication management services by phone).
My insurance pays for Silver Sneakers classes that provide excellent guidance for maintaining your health and strength. We even have people who are in their 90s and one who is 100. I give talks on why nutrition, exercise, sleep, hormone balance and minimizing drugs (deprescribing) must happen for prevention of chronic diseases and conditions. Also vitamin D deficiency contributes to lower calcium levels that results in osteoporosis and broken bones plus can cause multiple health conditions. Many people need vitamin D3 daily supplements to achieve blood levels of 40-80 ng/ml which helps with whole body health.
Older people need to be proactive with their healthcare, avoid polypharmacy, and reduce substance use (e.g. alcohol, tobacco, benzodiazepines, gabapentin/pregabalin, opioids, cannabis). Ask a pharmacist to help review your medications and they can make recommendations for avoiding adverse effects and drug-drug interactions.
11
@Martie
If any of your doctors is affiliated with a healthcare system that offers an online patient portal, be sure to sign up for it. All such portals have a page where you can list all your meds--Rx & OTC--and supplements. If you have a smartphone, it probably has a Health app--list all your meds there too. At every doctor's appt., your meds list will come up on the monitor screen for you and your provider to review (and if necessary, revise) together. Try, if possible, to fill all your prescriptions at a single pharmacy (or at least one in a single nationwide chain). If you must fill any prescriptions elsewhere, provide the pharmacist there with your complete and current meds list (and make sure the pharmacist at your main drugstore knows about those other prescriptions).
And there is no dishonor in wearing a fall-detection monitor, whether a pendant connected to a monitoring service or included in an Apple Watch Series 4. (Wear the latter, if you own one, as much as you can, even in bed--charge it at chairside, which takes less than an hour to get to 100%--and put it back on when you stand up).
5
Thanks, Martie, for this thorough and timely pharmacist advice. As a physician who have always cared for seniors, I know all too well the hazards of polypharmacy and how hesitant doctors are to deprescribe a medication once someone else starts it. Benzos and Z-drugs for sleep as well as OTC anticholinergics such as Benadryl in common sleep aids is a huge hidden senior problem leading to falls. I write a blog devoted to empowering seniors to take action. Simplify medications and take only those that are safe and truly matter. Marie Savard, MD
3
Thank you much. Unfortunately, so true. I broke my foot in a fall, tore meniscus in another one, and my husband is recovering from a week in hospital caused by bp medication-induced fall. Both of us led athletic outdoor lives until last year, and now we mince along like the old people we are, determined not to become paralyzed or killed by a fall. And gone are sailing alone on the ocean, bicycling 10 miles a day, climbing trees to prune limbs, driving a low-slung sports car difficult to get out of. Darn it!
39
@Anne Russell, wondering why you must give those things you loved to do up? If you were active before you should not let this get to you. P.T. and O.T. can help you take your life back. I know, I did!
Please don't give up completely.
1
The roll of alcohol is conspicuously absent from the list of risk factors.
17
I know this is not popular these days as it is considered a miraculous substance by most, but the article did not mention marihuana as a possible trigger for falls, young or old.
4
Uneven sidewalks are my biggest concern. Looking down instead of up takes determination when the sky is blue!
28
@CAR I find that is also true in NYC. Sidewalks are poorly constructed by day laborers who know nothing about what they are doing. Or they are old and crumbling and the property owner responsible for them does nothing. The city may issue a citation but doesn't follow up. I have had a couple of my most serious falls right on the corner of 44th and 2nd in Manhattan on a faulty sidewalk owned by the government of Nigeria, which built the high-rise building adjacent to the sidewalk, making them responsible for the sidewalk. But they don't maintain it, they don't shovel it when it snows, and they deny they have responsibility for it when I go into their building to speak to them. The city issues citations but there's nothing they can do as Nigeria has diplomatic immunity. I live near the UN and some of my worst neighbors are foreign governments.
It's true. You have to look both up and down at al times.
17
How about watching/eliminating alcohol consumption??
3
@M Wein Many people don't drink or drink very little. I drink practically nothing and certainly hadn't drunk anything when I had an accident 18 mos ago and slipped, fell into a door, and ended up with an open, bleeding fracture of my thumb. I got into a cab and took myself to the ER at the NYU Langone Medical Center. Though I am an articulate former lawyer who clearly described what had happened, I found myself undergoing intense grilling by a team of smarty pants residents who had apparently had been trained to YELL questions on drinking at old people they seemed convinced must be in denial about their SECRET ALCOHOLISM. They didn't seem to want to believe this wasn't all caused by drunkenness.
38
@M Wein
May I gently suggest that assuming that people are usually falling because of alcohol use is a way of comforting yourself that it won't happen to you? The scary fact is that people fall, and are usually not to blame. Take our precautions, enjoy life, realize that bad things can still happen and extend compassion rather than blame.
3
my partner's uncle was a fine healthy sophisticated man in his seventies and was learning classical guitar and interested in life in retirement
until - he slipped and fell on his hard-tiled shiny floor and fractured his hip - I have read a virtual death sentence for old people - and it was for him too
the next time I saw him he held my hand and cried - he was in so much pain just sitting still - it was horribly sad - his life savagely cut down by something as simple as a slip'n'fall
he died soon after.
since then whenever I see or read people's comments about how they hate carpets and prefer tiled floors, I just think to myself 'I'm keeping wall-to-wall carpet' as I've never slipped and fallen - on carpet.
my partner has - twice - twisted her ankle on a city street pavement crack - the first time wearing thick sole shoes - she doesn't wear those anymore - the second time actually broke a foot bone - her eyesight is not so great so I encourage her to wear lace-up shoes, avoid thick soles that could twist the foot on a crack, and watch where she walks.
in other news, I stand on each leg for 30 seconds each morning while heating the jug for my coffee - I do shoulder lift exercises while standing on each leg.
15
At age 80, I use a flashlight when I get up at night: a big help. But throw out my antique oriental "throw rugs", I don't think so. Haven't tripped over them yet.
4
@Molly K.
Get rubber-mesh undermats (even shelf liner) for the throw rugs; and use velcro tape at the rugs' edges (hook portion on the rug bottoms, loop portion on the floor). Even if you live in a rental, you can remove the tape without damaging the floor or leaving a residue.
4
@Molly K. I had never tripped over my lovely area rugs for years. And then I did. I fractured my shoulder. Incredibly painful for months. Strong meds for painful physical therapy. For weeks, I would cry because sleep was torture.
2
Improve your reaction time by improving hand-eye coordination, by juggling two balls, bouncing a ball on a tennis racquet, playing jacks. My falls have been pet related, so teach your dogs to get out of the way (lotsa luck trying that with cats).
11
Install motion detectors to light your way to the bathroom and on all stairs.
2
Make it a habit to hold the banister on stairs and have and hold a grab bar getting in and out of the shower. Once you start to fall it is usually too late to grab the support...it has to be an all the time habit. AND be very careful about tripping over pets. Teach your dog to stay out from under your feet and LOOK where you are stepping in case the dog is asleep. If you have (as I do) a black dog who likes to sleep on the dark carpet in the hall, keep a small light on there so you will see him. And if you do fall, LOOSEN your body instead of tensing and the fall will do much less damage. I learned to do that in my many years of tai chi training and it has saved me many times.
6
@Catherine Enderton
If you have a strong and sturdily-installed shower curtain rod, throw your towel over it before you leave the tub. Hold on to it with one hand (and use the other to hold a grab bar if there is one) as you carefully exit. There are also removable grab handles that can be clamped securely to the edge of the tub.
1
But what if I fall in the bathroom while I'm standing on one foot and brushing my teeth?
17
@CGM Lol. Be prepared to steady yourself with the hand that isn't brushing your teeth?
2
Use micro-spikes on your boots to navigate icy/snowy sidewalks and driveways. Change into regular boots in the garage before driving.
11
@Cameron Also take them off if you go into any building in New York City with marble or terrazzo or other slippery flooring. If you don't you may very well end up on the floor. I have Stabilicers and they aren't worth the effort of constantly having to take them off and put them back on in a big city.
3
@Cameron. Can't recommend the type with little studs in them too much. They are easy to slip on/off with most shoes or boots if you get the right size. T
However, they will destroy most indoor floors so you must be willing to take on/off. I leave them on the floor in front of the driver's seat so I can easily use them. For icy climate these are essential.
4
Good suggestions.
My wife (68) and I (71) are conscious of maintaining our coordination abilities as well as our cardiovascular and physical strength (for which we cycle, backpack hike, swim, and do pushups). Consequently, we purchased a ping pong table and use it regularly. It is great for eye-hand coordination and balance. We also enjoy ballroom dancing, which is great for balance and coordination.
Our philosophy is use it or lose it--an old saying that is true, but not trite. We both have serious arthritis, with both of us having pieces of titanium in us plus about two feet of screws. I also have a bovine heart valve and a big piece of plastic tubing in my heart. One just has to get up every day and MOVE in order to hold back the inevitable ravages of time. But it works! At the moment we are writing this, we are in our pickup camper, in the middle of the Arizona desert, preparing for a 6 mile hike carrying 20 pound backpacks. I am less than 5 months out of open heart surgery. Neither of us are athletic monsters, both won't step foot in a gym, but both are committed to finding enjoyable ways of moving our bodies 2 hours a day.
We are convinced that this type of commitment gives our bodies the best chance for maybe a longer life, but assuredly for a more pleasant one.
28
THANK YOU, THANK YOU for this important reminder! I gave up false pride this past week and got out a cane from two years ago when I had knee replacement. In three months I will be 73, the first official batch of "Baby Boomers". Alas, pesky osteo-arthritis, genetic gift from my maternal line, is increasingly making life a bit uncomfortable.
NOT walking is a cardiac harm, and that's what I had started doing, becoming more and more sedentary. What I want for my birthday is a lovely carved walking stick, brass handle and all! From now on it's the best walking shoes, from England of course, and my cane/walking stick. I want to someday hold my great grandchildren, see a grand daughter graduate Medical School, a grandson travel to China on business !
I want to go to England in 2020, and WALK as much as possible, be a tourist climbing onto the famous sight seeing buses. And while I'm at it, I'll let my long, blond hair go white !
Dear Boomers, Let us embrace our fourth quarter of Life !
14
@LKL Agree with you all the way. I had to give up running temporarily and do much less jarring walking. Midwest winter with deep snow and ice slowed that down, too. I found a number of indoor walking videos that allowed me to work at my own pace, indoors in my pajamas and gym shoes. Love them. Lifesavers.
5
@Johnnie
SO important in the Midwest to learn to "walk like a penguin" with your side by side shuffle and weight leaning to the front! I worked in senior living in Milwaukee for 8 years, and we put this advice in our newsletter every year, and I repeat it to myself every time I have to go out on icy roads and sidewalks.
5
@Marlene Heller
I had to learn the "penguin walk" my first winter in Chicago (the infamous "blizzard of '79") when I was only 27. On uneven terrain or icy sidewalks I use a hiking cane (Leki Wanderfreund, from REI) with a tungsten carbide tip covered by a removable--and therefore pocketable--rubber cap. It was made for hiking in snow; and in a fall, using its handle for the "ice-axe belay" maneuver to arrest your downhill sliding and help yourself back up on to your feet.
4
An excellent column, Ms. Brody. I particularly appreciated your comments about slippers and the potential some of them have for contributing to falls.
For several years I wore a comfortable pair of moccasin-style slippers. However, on two occasions I nearly fell on my stairs when the side of one of the slippers turned under my foot.
After the second near-fall, I took a close look at the slippers and determined what the root cause of the problem was: The body of the slipper was "U" shaped and, over time, the leather had weakened causing the side of the slipper to twist under the weight of my foot when I put it down.
As much as I liked the comfort of these "broken-in" slippers, I discarded them and purchased another pair of moccasins with hard rubber soles and leather uppers. The added support of the hard soles prevents my feet from sliding to the right or left. (I disposed of the slippers in the trash, not wanting someone else to find them and decide to wear them to their detriment.)
I would recommend that anyone who wears slippers examine them carefully to ensure that their slippers have good lateral support.
5
I hate wearing shoes or even slippers indoors. I have a wide variety of socks with grippers on the bottom, something like the ones used in hospitals. They give me a much greater sense of “floor feel”.
Strengthening exercise is vitaly important as we age. I’ve been lifting weights for over forty years, but recently added squats on a Smith machine. Hiking up hills helps too.
2
I'm 67. I play competitive basketball three times a week, often with much younger players, and recently added weight and balance training another day. I've been to probably eight national tournaments with my team placing first, second, and third in the over 60 division (full court), but I didn’t start playing until I was 47. In February last year, I cracked one and broke one rib in a game. In August, I broke two more falling unhindered onto the edge of a bench. Both times it took 14 weeks to heal completely, but the last time I played in a national tournament after seven weeks and was the high scorer. When I climb stairs, I run up them two at a time for exercise. I still climb trees and trim branches with a hand saw. I have various aches and pains from previous broken bones, injuries, and surgeries, but I don't let them get in my way. I hope I never get old.
As another comment said, exercise, exercise, exercise! We don't all have to become old and feeble, especially not prematurely. Exercise both your body and your mind, and hopefully we can all live long, fulfilling lives.
6
I didn't feel old at all when I was 67. Unfortunately, it will probably hit you sometime in your 70's. Exercise helps, but most of us have to adapt to the ravages of time.
10
@Susan Optimism helps. I'll be 84 in a couple of days and I am not ready to call myself "old" yet. I still walk faster than anyone on the city streets here.
8
I am 67 and am partially paralyzed on my right side from a scuba diving injury 17 years ago. I walk with a cane (even inside my apartment) and have had multiple hip and spine surgeries over the years. I have always been athletic, and am frustrated by my limitations now, although I exercise 3 times a week at my gym. I recently had a bad fall in the hallway of my building. I tripped over my neighbor's welcome mat and went flying, landing face down. I sprained both wrists, bruised a couple of ribs, sprained my knee and fractured my right foot. It's been a month, and I am still healing. This fall has made me feel much more vulnerable, and I realize that I have to focus more and not take my body for granted.
13
If you watch a football game, you see the players fall constantly. Sure, they are in MUCH better shape than the rest of us. But they also know how to fall and practice it. Thus my concept of wanting to teach people how to fall. Not sure it’s a realistic concept.......
4
Excellent stuff with helpful comments. Would like to see less MD blame for prescriptions (often literally demanded) often needed for medical problems. The many suggestions here should be heeded. And remember, fellow seniors, from dust we came and to dust we shall return...despite cosmetic surgeons.
8
Excellent suggestions, particularly the lighting comments. We recently installed a motion activated LED nightlight in the hallway between our bedroom and bathroom. It has been very useful for us and guests.
3
I am 66, in decent health (no persistent issues), slightly overweight (BMI 31). I fell 5 years ago, which led to a rotator cuff tear. That is now completely fixed. I am not interested in another rotator cuff issue. That has led to a slight issue - you become a little more tentative and that sometimes can make you more fall-prone.
8
In our late sixties, my wife and I were recently on a trip to Macchu Picchu . In addition to the thin air, we were aware of the challenges presented by the many irregular steps to be negotiated. Walking down steps required extra mindfulness as there was frequently nothing to grasp for stability.
9
As an occupational therapist I would like to say this is an excellent article! One thing to add- use a cane or walker if necessary. There are so many great options available. Find one you love and don't feel self conscious it.
16
@ACEmiOT
Sporting goods and outdoor recreation stores--especially REI--carry trekking poles and canes designed for trail hiking on plain pavement and snow & ice. The latter are available with compasses embedded in and LED lights mounted on the handles--great for night walking to illuminate icy patches ahead. You can even buy the light separately and duct-tape it to the cane.
3
I am 69, normal weight and exercise regularly. I have sustained multiple fall related fractures and tears in past 15 years. I attribute my falling to foot conditions. Born with flat feet, I've worn orthotics of every shape and material since I began walking. My feet are the epicenter of my falling. I've be treated by multiple orthopedists and podiatrists and the balance issues, mitigated somewhat by surgery and appliances don't solve the problem of a flawed foundation - flat feet.
15
I have always found my flat feet helpful managing jetty and breakwater boulders and Acadia National Park clambering. More surface, see.
Also for picking up chthonic vibes in oak groves. LOL.
2
After a bad hiking fall, hiking with poles, yak-trax in the snow, and barre classes are my strategies to enjoy life and lessen chances of falling.
5
@cmc
Trekking poles are a godsend. YakTrax are good, but I find they last at most a season. I bought MICROspikes three years ago. Because the bottoms are stainless steel chain with spikes, they’re holding up well.
2
@GiGi. YakTrax are good in snow but bad on ice. The tiny metal studs are much better on ice. And poles are great when hiking.
1
Well done Jane. I am a 73.5 year old gym rat who tries to follow most of your Rx. The gym is the most relaxing venue in my retirement. The stretching and tai chi ease the stress of life and age. The weight machines remove much angst. Finally the recumbent bike and treadmill allow me not to get bored but to read many wonderful ebooks. Thanks again for your thorough article. Hope it motivates lots of seniors.
23
@Curiouser
I wish gyms had the recumbent ellipticals found in physical therapy centers. Easier on the back & knees than recumbent bikes and standing ellipticals. Unfortunately, they are pricey and too large for home use.
5
Grip strength is a good indicator of health as we age. And, if you can hold onto something with a strong grip, that may break your fall and avoid injury. Grip strength.
22
@David N. Stonehill, Attorney Yep, gone is my grip, courtesy of arthritis. Can't open a new jar of jam, constantly dropping items.
7
@Anne Russell
Occuptional therapy can work wonders for hand & grip problems. In a couple of "shoe-malfunction" falls, I broke my scaphoid (palm) bone and tore my TFCC (wrist cartilage), the latter requiring both debridement and an ulnar shortening osteotomy due to a congenitally too-long ulna "gnawing" at the TFCC. Six weeks of twice-weekly OT gave me back not just my grip strength but the ability to painlessly and cleanly fret my guitar and dulcimer fingerboards. Look into it--never too late!
5
@David N. Stonehill, Attorney: good point, but I think also practice and training in HOW to fall....it is an actual skill you can learn.
And you can improve balance and posture, to gain core strength for stability -- that helps tremendous. A lot of older seniors tend to creep along, shuffling their feet and hunched over....that does nothing to help with stability or strength.
2
Some more ideas .My mom till age 88 has personal trainer come to house 3X week working on balance and leg strengthening. She still does this with a P.T. now.
She wears sleep socks at night that are like hospital socks that grip so no slipping..She has a walker next to her bed she can use it at night PRN .. She doesn't need a walker but this makes her safe especially as she takes some meds at bedtime.
I also fight with her doctors to keep her off meds, seems like at every check up they want to give her more meds.
Getting rid of throw mats in the bathroom has been impossible so I just buy ones with good grip and replace often.
She's now 96 , still walking on her own , goes to P.T, still has strong legs and good balance.
40
I am 79. Tripped and fell over the years. Broke all hands and ankles. Last one, fractured my right knee. I have done well thanks to my surgeon but I saw a cane advertised on television and
I bought it. Its a Hurricane cane. Do I need it? Not really, do I use it? Yes, I love the darn thing with its three pronged feet. It steadies me on the stairs, getting up in the middle of the night and wherever I feel like taking it. I feed a colony of feral cats, and last week the cane accompanied me over the ice and snow to feed them. It comes it pretty colors. Husband says I should have two. One for upstairs one for downstairs.
8
@Luz Damron
Actually, you should have three of these canes: one for upstairs, one for downstairs, and one to go outside, so you will not track dirt into the living room
(I got mine when I had to, because my knee was hurting so much. Now I use the outdoor one to go to the mailbox; even after the snow is gone, it reminds me to look for these tiny patches of leftover ice that can maim you.)
13
@Fran
Keep another Hurry-Cane in your car, too. Never know when you (or a passenger) might need it.
3
Why in heaven's name do some physicians allow older adults to take Lunesta / Ambien for long periods of time? In my estimation these were a factor in my 88 year old mother's fall that led to a broken hip. She got up to use the toilet, was disoriented, and fell. Those drugs do a number on cognition upon awakening. You would think they would stop prescribing Lunesta after her fall and hip replacement, but no. She is still on this noxious stuff. She had multiple risk factors prior to her fracture (prior falls, blood thinning and blood pressure lowering meds, refusal to wear hearing aids). Her primary care and other docs don't look at her as a whole person. Polypharmacy goes unchecked. Medical ageism, too.
Thank you, Ms. Brody, for drawing attention to falls.
66
Lunesta and other Z-drugs for sleep such as Ambien are only recommended for two weeks at most. After that the risk of harm is twice as great as any benefit. For seniors they are NEVER a safe idea. Your mother needs hers slowly tapered with the help of her physician. Yes, some withdrawal may occur and rebound poor sleep, but in the end her brain and body/hips will thank you for it. Find a physician to help if her primary won’t step up. Too many physicians hesitate to deprescribe these drugs thinking they don’t want to rock the boat so to speak. Marie Savard, MD
11
@Pika Consider changing doctors: a D.O. instead of M.D. Osteopaths are more likely to b e whole-life-oriented.
4
@Pika My 87 year old aunt, totally unsure on her feet, is a sleeping pill addict. She gets up to pee several times a night and is zonked and has fallen as a result. I have asked the Dr. to stop prescribing and she always talks him back into it.
2
Boots. Loose boots have been the culprit of my recent falls. I already gave one pair away after having fallen in them twice. And just last month I slipped on an uneven sidewalk wearing a pair of boots that were slightly loose since I was wearing tights instead of socks. Luckily my down coat and gloved hand prevented any injury.
4
@Bonnie Geller-Geld: look for laced snow boots or zipper ones -- not the "step into" kinds, which must be loose to be easy to get on.
Also, you may be wearing the wrong size. If you don't wear heavy socks, you may be in a boot that is 1-2 sizes too large for you.
3
When I'm going down the stairs, both reading glasses and bifocal glasses alter my visual perception of the steps to an almost dizzying degree. In this case, slightly blurry vision is preferable to altered depth perception. I now remove my glasses when navigating stairs and suggest others do the same.
14
@Some old lady
Put a second handrail in your stairs. That is one of the best things I ever did. With two rails, holding one in each hand, your chances of falling are considerably reduced. On a good day, you can even run up and down instead of walking (first, of course, make sure your shoes fit and are safe).
7
@Fran: that's a good idea -- and pretty inexpensive -- you can get a handrail at any Home Depot or Lowe's type of stores.
Also people need to learn to TAKE OFF the reading glasses if you get up from reading, and go elsewhere. They will really blur your distance vision!
8
The best defence against falling is to keep your body strong with activities which improve ballance. I don't know why ballroom dancing is not promoted more for this. Studies have been done which show that ballroom dance improves ballance and also is fun. It also engages you mentally as you learn and also you need to constantly adjust to your partners. Take some lessons from a good studio, such as Arthur Murray. I have been doing this since I turned 80 four years ago. I had previously fallen several times and I have not fallen since I began dancing.
23
This is another useful and interesting article. I have been lucky enough to take “Fall Stop Move Strong” program at Manhattan JCC. It saved me from a fall when I was pushed from behind because I was not walking fast enough. I really learned from that almost fall that activities of class were really beneficial. They are spreading the word thru offering training in their program.
You can also take balance training as a senior with specially trained PT.
Anything that can prevent a fall can save a life.
7
@Susananne
There is also a dvd of program on their website!
3
If you have a balance disorder, you can not walk across a room without some type of assistance. If you can walk across a room without assistance, you don't have a balance disorder.
Standing on one foot or doing Tai Chi is not going to make normal balance better.
Falls are caused by tripping and falling. Brody has good advice for making your home safer and your awareness better.
But tripping still occurs and your best defense is muscular strength of the spine, hips, and legs. The more weight you can lift and the further you bend your joints while lifting the weight will give you the best protection against the injuries that follow falls.
11
Another excellent article by Jane. I would suggest one other option - hiking poles. I lead hikes of varying difficulty and distance and always bring extra poles so people can try them out. Poles improve balance, posture, breathing, upper body strength while reducing falls. On a recent “easy” hike, a woman and her 80 year old mother participated. I convinced them both to try hiking poles and both loved the security the poles provided. The older woman told me she would not have made it through the hike without them (I agreed but didn’t tell her that). For those who are thinking poles are fine for hiking but “I don’t hike”, I would suggest you try them on you daily walk in your neighborhood or in the mall. You’ll be pleasantly surprised at the difference poles can make.
If you are interested in trying poles, there are many tutorials on YouTube to help with fit and form. To get the most out of them, please look at a video to learn how to correctly use the poles.
16
@Toni Vallee
People get those poles twisted up and fall, I strongly suggest a cane or use one pole otherwise they are dangerous.They also break.
1
@Chelsea
Both my cane and my trekking poles are lightweight metal and spring-loaded for shock absorption; they also have tungsten-carbide tips for snow & ice, covered by removable (and pocketable) rubber caps.
@Chelsea I agree! A cane is much safer than either one or two trekking poles. Two is the worst. And if using one pole,I think a cane is still better.
1
Taking the long view, it's probably an improvement that people are dying from falls - which are preventable - and not complications of childbirth, tooth abscesses, or childhood diseases. You know, the way the majority of humans have died for most of human history.
I cringe at the notion that if one prepares well enough, one's body ought to be immortal. It leads to a failure to confront our limited lifespan. As an ICU nurse, how many times have I seen the seventy-something children of a nonagenarian say, "Do everything possible! She's so young! It's too soon!"
37
@Susan, RN
The goal should not be to live forever; it should be to live as long as possible without medical help. Unfortunately, doctors are trained to find "conditions" and treat them rather than to try and make sure that patients don't need them.
23
@Susan, RN
Not to worry, mortality rates for humans are 100%.
7
In NYC one of the major risks is delivery people riding their bicycles on the sidewalks. They come, silently, from behind and pass within centimeters of pedestrians, terrifying those of us who are the recipients of these close calls and increasing our fall risk.
And, in spite of numerous calls to the police, city council representatives and 311, nothing is done and it's getting worse.
Maybe we can sue the city when we fall because of a bicycle illegally ridden on the sidewalk?
49
You’re not going to be able to hold the city liable for that, in my opinion. But it would be nice if people spoke up about the problem, so that the police could be instructed to actually give tickets to sidewalk bikers. Enforcement is the key. Here in San Francisco, sidewalk bicycling is tolerated on Market Street, where are the sidewalks are extra wide, but you don’t see much of it elsewhere.
12
@BA
Nope, you can't sue. Most municipalities (and states) have rigid exceptions to "sovereign immunity" statutes: you have a very short limitations window between the incident and the deadline for reporting it, and then between notifying the city and filing your claim in a designated forum (usually outside the actual court system). And in order for the city to be liable, the accident must have been caused by a physical/structural defect of which the city had notice AND the legal responsibility to have either prevented or repaired. Failure to enforce a statute (i.e., to punish a violator) is not such a "defect" and therefore not actionable.
(I used to be an asst. IL A.G. in the Court of Claims Div.--which "court" was an arm of the IL Sec'y of State dept. I had a friend who held a similar position with the city's Corporation Counsel. Claimants rarely prevailed).
2
I can’t sleep with night lights. Just turn on a light next to the bed before you get up. It gives much better lighting anyway.
9
@Rich
Most "mesh" whole-home wi-fi network repeaters also double as night lights.
My mother is a healthy 90. I lived with her for years as her falls became more frequent, both inside & outside, likely the result of hip replacements & inner-ear problems. My sister kept bringing mom decorative throw rugs which I made her take back or threw away when mom left the house.
Mom was greatly helped by regular visits from a physical therapist. I learned she didn't lift her feet well as she got older, she tended to trudge and the therapist worked with her with daily exercises meant to get her to lift her feet higher. I think many falls were averted because of that.
Last year she moved into assisted living & quit physical therapy. She insisted on moving large heavy recumbent bike into her new bedroom, which I said was a bad idea. I was overruled. Two months later, she stumbled one night & landed on the bike. When attendants found her crumpled up they thought she's had a heart attack. Nope. The hospital found a concussion, broken nose & broken ribs - terrible injuries for someone 89.
She's recovered well - better than I'd thought she would. The only real difference I see now 6 months later is that - maybe because of the concussion or trauma - her memory is worse. She was sharp before. She still is but doesn't always recall recent events.
My recommendation is: hire a physical therapist & work with them on issues making you vulnerable to falling. Joyce is now seeing my mother again - I think working with her is why my mother is alive.
Thank you Joyce!
126
@fast/furious: a lot of good points here. Many seniors past a certain age -- with bad knees and hips -- start "shuffling". It is so classically aligned with getting old, that walking that way is how an actor would portray an old person! but it is a recipe for falling. They also hunch over -- sometimes, especially in women, this is osteoporosis and "dowager's hump" -- which means they are not looking around, able to spot obstacles but just blunder into things.
Many forego exercise or physical therapy due to cost, or they just don't want to have to do it. And once they DO have a bad fall....they often get overly fearful of another, and restrict all physical activities. Then they get WEAKER and this leads to more falls. It is a vicious circle.
Your mom's memory may simple be going with age, or early stage dementia. However, even in those cases...regular exercise and PT are beneficial and can greatly reduce falls.
12
I’ve heard quite a few people say they try to avoid gripping the ramps of stairways (outside the home) and escalators for fear of germs, when surely it is safer to carry a bottle of hand sanitizer to use after touching ramps than risk a dangerous fall.
27
@Susan
Anything wrong with wearing gloves?
9
@Susan Thank you for mentioning this, Susan. My mother does this everywhere and it drives me crazy! She knows better; her shoulder will never be the same since she broke it in three places a year ago, in a fall. Railings and bannisters have been my best friends since a spectacular fall I took twenty years ago, down a long flight of stairs in a London tube station. The railing was just out of my reach the whole way. Luckily I didn't take anyone out with me, which could have killed them. Please, everybody, use the railing, without trying to carry so much that you can't grip it well. Use the cane or the walker if you need it, and take your time. You can clean your hands when you're off the escalator; people in a hurry can go ahead of you. Please, please, take the small precautions. Save yourself the pain.
11
@Susan: OR they can wear a good pair of gloves -- leather or with "grips" -- keep your hands clean and yet you can hold onto rails and handles.
As you say, normal handwashing would remove any germs.
7
I'm 82,. In 2008 I had a stroke. In 2015 I had a "heart attack". Years of research and advice from a Tucson Medical Center Cardiologist made me realize that my stroke, heart problem and falling were because the medication to lower my blood pressure meant that blood was not getting to my heart or my brain fast enough. So I stopped taking my BP medication in 2015 and I no longer have a tendency to faint or fall since my blood pressure is working the way it should. This whole blood pressure subject needs to be researched.
201
@Jim Dwyer: absolutely yes! in my early 50s, I was put on BP meds, and they lowered my BP to an astonishing 90/52. My doctors LOVED that -- it can't get low enough for them! but it made me lightheaded and dizzy. One day, I got dizzy and fell forwards, hitting my head on the dishwasher! leaving a big round dent (still there!). I passed out, but got up....only to faint, fall backwards and hitting the back of my head on the edge of the kitchen stove. A double concussion!
Shortly thereafter, I quit the BP meds.
34
@Jim Dwyer
I agree. The new AMA bp recommendations are far too low for older people (120/60). My daughter who is a doctor and my family doctor both say we should be happy with under 140/90. CMA has not adopted the AMA recommendations.
Jane please investigate this issue!
51
I agree to a certain degree. Two common medical problems of the elderly are diabetes and hypertension, and treatment plans have goals. While tight control of blood sugars in a 20 year old is important, is it wise in someone after age 70? The risk of a fall from hypoglycemia is greater than end organ complications at that point. Same is true for BP control. Ask the nurse to take your BP both sitting and standing. BP may look good after you have been sitting, but drop precipitously upon rising. Also keep in mind that many cardiac medications (beta blockers, ACE inhibitors, diuretics, nitrates) also lower BP. Some of these used for protection from cardiac events may have to be reduced or eliminated if patients drop their BP...especially if they are also on aspirin or blood thinners that may increase the risk for a brain bleed.
6
Many of the suggestions are for actions I've already thought of and take, but there are some others that I hadn't thought of. Not mentioned, but something that has helped me avoid falls is not to hurry when doing something, not to take "shortcuts" trying to get something done more quickly. When carrying tools or other things from the basement to the ground floor- often with both hands full - I used to close the doors behind me with my elbow or by pulling it with one foot. No more, and I leave the lights on, and then return to close the doors and turn off the lights. And in the process I get a little more exercise! Ladders are really dangerous! If I must use one I place it where there is the possibility to hold on to something firm and solid. Even better is to get my son to do the ladder climbing!
18
@J K Griffin
Gorilla Grip 2 and 3 stepladders that come with a railing attached and wide steps may be helpful, cost between $20 and $30 from a hardware store like Ace or Home Depot.
3
Scary - I am 62 and looking forward to a 30 km cross country ski trip this weekend, to finish up the season before my biking season starts in full swing. Falls are inevitable on the loipe, part of the fun of trying to keep up with men 1/3 of my age. Maybe the constant switch from left to right on skating skis helps me stay balanced for the rest of my life.
I never thought that I was old, however!
10
Enjoy yourself. I'm 62 and an avid skier and biker as well. But suddenly my shoulder is unexpectedly giving out. and neither of these things plus yoga and swimming are possible at least for now. I'm still trying to figure out a diagnosis, but the reality of my life changing over night is starring me in the face. So.....moral of the story....have so much fun with your healthy body while it lasts. @Sally
20
@Pam Ward
Have you tried just ignoring your shoulder, just sort of giving it a rest. That's my favorite tactic; it usually works: the elbow stops hurting, the knee begins; at least there is some variety.
13
@Pam Ward, I used to swim 1+ miles a day but had to give it up three years ago when I developed “frozen shoulder.” For the first year or so, I even had to stop using the drive-in window at the bank.
I have tried acupuncture, injections, and physical therapy, but nothing has worked as well as switching to switching to hill-walking with trekking poles.
5
I'm 68 and took two nasty spills last spring, courtesy of "shoe malfunctions:" too-big backless clogs lined with fabric the same texture as my stairway carpet caused a fall that tore my wrist cartilage (NEVER break a fall with an outstretched hand): and too-sticky gum-soled loafers, a careless hurried gait, and a terrazzo floor resulted in a "catching-foot" fall that caused a broken hand and exacerbation of the cartilage tear, resulting in ulnar-shortening surgery. Well-fitting shoes and a deliberate heel-toe-gait are essential.
Physical therapy is a must--for balance and proprieception training, as well as leg muscle strength and flexibility. No dishonor in using a cane on uneven terrain (I use a hiking cane with an ice-axe-shaped handle so it doesn't look geriatric) and tungsten-carbide-tipped hiking or X-C ski poles in snow, especially if deep or concealing ice.
And Jane, there is nothing wrong with UGGSs provided they fit snugly (they run a half-size large and should be worn w/o socks), have well-cleated soles for winter streets, and you mind your gait. Always look down AND ahead. (And ditch those heels, platforms & high wedges). I also wear orthopedic sandals or slippers at home--or if it's cold, those socks with rubber grippers they give you at hospitals. The socks in airline amenity kits are useless.
14
@Sandy
There aren't many versions of UGG shoes that work for me. In fact, I haven't found any that are perfect. A laced up sneaker is by far the best footwear for me.
4
@CAR
Everyone's feet are different. If you can't wear UGGs because they are too loose or unsupportive (I actually use shearling-covered orthotics in mine), wear whatever makes you walk most naturally and confidently.
3
And if you live in New York CIty, walk defensively, the same way you drive defensively. Even when light is green & you are in crosswalk doesn't mean some fool in a car rushing to get on the 59th st bridge isn't going to run you over while making a turn.
When walking down a street with narrow sidewalks beware Uber drivers in a rush to get out of their cars to assist waiting clients. In past couple of months I have twice been hit on my right side, while walking down Lexington Av., by Uber drivers who open driver side doors without looking.
Just today I let my guard down while exiting a Starbucks on Lex. Starbucks doors are heavy & when I am carrying a lot I usually lean to open door with one side of my body. Today, just as I started to lean on it some dude on his phone came rushing up & yanked the door open from the outside at the same time he stuck one of his feet in my path.So the force of his pull had already propelled me forward & when I tripped on his foot I went flying forward, unable to stop, & ended up sprawled face down on the sidewalk. The force of it scraped skin off my elbow even though I was wearing two shirts & a lined winter parka. For a bit I was worried I had done something to my right wrist but that pain has subsided now -- thank goodness, barely 18 mos ago I had an open fracture of the right thumb. But mostly just bruises & scrapes this time. For a brief instant I let my guard down & this is what happened - always be mindful of your surroundings.
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@ellienyc-Another reason to stay out of Starbucks-
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@ellienyc I hope your saboteur noticed and stopped to assist! Take care out there.
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@Jeanne DePasquale Perez: Besides the fact that it has the worst coffee around? Yeah, two good reasons.
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While personal responsibility is vital, it's also long past time for the medical profession to pay more serious attention to falls. Tossing off pain and injury as just something to be expected in seniors is not helpful. More attention should be given to research and best practices in this area, and physical therapy and rehabilitation should be available to seniors, even those on Medicare.
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@Cloudy What drives me crazy is when an older person is run over by a car while crossing the street (often in a crosswalk and with a green light) and is described on TV as "the elderly victim," as if it's to be expected that there is something about "elderly" people that causes them to go wandering around in the paths of cars. I never hear anyone described as "the middle-aged victim."
Medicare pays very little for PT and many physical therapists are reluctant to take on older patients for too long.
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@Cloudy Physical Therapy certainly IS available to Medicare recipients! Just ask your
doctor/orthopedic surgeon for a referral!
Here in Stockton and Manteca, hey, Modesto too! we have several excellent choices and you in San Francisco should have even more!
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@Cloudy There was a cap on the amount of PT a Medicare patient could receive before needing the doctor to re-confirm the treatment as medically necessary. That cap was eliminated in 2019. I attend Pilates classes at a local PT facility, nearly all the patients I see there are over 65. Elderly patients are physical therapists' bread and butter unless they specialize in sports injuries.
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Really great column. The throw rugs are a big cause of falls. I got my Mom using two hiking sticks for her walks. She walks faster and her posture improved.
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About night lights, which can disturb sleep. I have motion activated ones in the bathroom and on the stair landing. Stays dark for sleep, but when someone gets up we have light
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@Merckx
Buy a sleep mask at the Dollar Store or wear a light weight knit cap pulled down over your eyes. This will increase moisture in your eyes and block out the light. Adding some moisturizing eye drops before sleep will also help keep the lids closed and cut down on light sensitivity.
We don't teach people when they are young, how to fall. I learned as a teen in skating, how to fall to protect myself. That aside, there is something to be said for the proverb that Pride Goeth Before the Fall. That was what got my mother who was in her 90s. She was too proud to use a cane at 93 and therefore suffered more falls because she refused to do anything to help her balance.
Pride continues to come before the fall. If you are unsteady on your feet, there is no shame in using an assistive device. Because the broken bone or hospitalization from a bad fall is going to do more harm if you are in your 80s or 90s. (Take it from the child who had to watch and nurse the parent though it.)
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I am by no means elderly but I was born with a medical condition that affects my ability to walk. I've fallen thousands of times but ow in my 20s I can't bounce right back. I've started using a really good, ultra lightweight wheelchair for longer distances (large stores) and a trekking pole for when I want to walk out and about. I need to be better about using something at home but work in progress. I know people don't like to use assistive devices but take it from someone who is still "young"-your pride isn't worth pain and serious injury. I wish I had used the wheelchair years ago, I can get around much easier with it than I can walking and exhausting myself. Avoiding the fatigue of walking around large stores reduces my falls at home when I am walking.
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@JJ
Even if I can easily carry my purchases in a hand-basket slung over my arm or just cradled in my arms, I always use a shopping cart instead in stores--it's a "walker" that helps me stay upright.
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We built our retirement house with one story -- no stairs from the garage to the house and no stairs inside the house. We've been in the house for seven months and love it.
We've been doing yoga of various intensity five days a week for the past 18 years for balance, flexibility, strength, and a clearer mind. We pay more attention to watching where we step. I know we could still have a fall.
I like all of the other recommendations in the article, except for small pets. I think the advantages of having a pet as a companion out weight the disadvantages.
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@J the A reference to pet toys left on the floor or furniture as a fall risk, not removal of pets.
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@J the J This very morning I had my first reservation about "small pets" as a cat we've adopted wanted to rub against my leg . I was
walking and had not there been a doorway to reach for, a fall might have happened.
However.....
BIG dogs are quite dangerous for anyone with unsteady balance, my daughter's huge German Shepherd has such a big tail it nearly knocks me over and does knock over objects !
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That's what happened to my dad- died from complications of a fall at age 90. He walked a lot, but balance and strength were lacking. He tripped over my niece who as sprawled on the floor- he was stepping over her to get to the couch instead of walking around.
Took a few days to go; he was on blood thinners and basically bled to death, slowly. Wasn't pretty. He was ready to go though, and refused medical treatment, which would have left him bed-ridden. My social worker sister was able to get him into hospice quickly, and he was mostly comfortable.
I am active, and do balance and strength exercises. Just have to watch the clutter and the cat. I have fallen on my rear while hiking- feet slip out from under me on the downhills. Just bruises so far. I take my time, take more breaks, eat and drink.
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I'm a 67 year old figure skater. I fall all the time. When I see a new doctor when I get the 'old lady question' "Do you fall" I tell them "Yes, but it's nothing you need to worry about."
A lot of this is just training. I do one legged squats for sit spins, I do balance exercises on one foot on a stability disk while moving a dumbell from hand to hand to shift the center of gravity, I maintain flexibility for spirals, I skate regularly on blades less than a quarter inch wide while doing turns, footwork, spins, and stamina work. I'll be surprised if a fall kills me.
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@Glenda,
Me,too! But falling on a double sal means you slide on to your tush if you're on the ice. I tore a meniscus practicing them on the floor and foot planted, body kept turning.
Still: had arthroscopic surgery and was right back out there after month. I think it's a great sport for the middle-aged because our falls usually are harmless slides. Great for our balance in general, too.
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@Glenda As a former competitive swimmer in my seventies, I'm just plain envious!
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@Glenda For most people, 60's are the same as middle aged. You are not old yet.
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Terrific piece. Needs wide dissemination.
Include aspirin in the discussion, as low doses are being taken by many for prophylaxis of cardio-vascular events.
Problems can be serious when the head and skull are banged, even not when not appearing to be serious injuries, and aspirin or other blood thinners are in our systems.
Hemorrhage in and around the brain often occurs, a closed box, sometimes slowly and delayed, other times acutely, and both can be life threatening or fatal.
Same for other fractures- hips, pelvis, where bleeding often is then far more severe when on blood thinners.
Need emergent medical evaluation if on such drugs and head trauma or related occurs.
Emergency Medicine/trauma center M.D.
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People on blood thinners are at a much greater risk. Recently, two people I know, a friend and a
my realtor, both on Warfarin, fell. They sustained head injuries and bled out in minutes. Tragic and needless deaths.
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I discovered the “Classical Stretch” program by Miranda Esmonde-White on PBS and bought season 12 (30 different focused sessions each 23 minutes long). Her techniques promote mobility through flexibility. She incorporates tai chi and graceful ballet type moves for all muscles, bones and joints. Ms Esmonde-White is almost 70 years young. Her instructions are within reach of most folks of all ages, are researched, make sense, easy to incorporate daily and make us safe to age fantastically. If there was ever a confidence builder and a fall prevention program, this is it.
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@Ann S.
I use her "Classical Stretch: Aging Backwards." My favorite 30 minute workouts are Body Shape, Weight Loss and Pain Relief.
Previously a ballet dancer, she also uses some isometric exercises with bits of tai chi. I've been using it for around eight years. Her stretching movements are excellent and my balance, which was never particularly good, has greatly improved. My husband was diagnosed with a "frozen shoulder" and told that he would have to live with it. He began to join me while I exercised, after a few months of Miranda, he has full movement and no pain in that troublesome shoulder (stretching!). I like it because there is no hopping around while making me feel great.
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I am your age and my old friends and I sign off our conversations with, "don't fall!"
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@Bev
When I took a spill and tore my TFCC (wrist cartilage), my primary care doc told me "11th Commandment: thou shalt not fall. 12th Commandment: if thou shalt fall, thou shalt not break thy fall with thine outstretched hand."
NOW they tell me! Wish the ice-skating instructor I had as a preteen hadn't advised me to "fall forward to protect the spine." I ended up spraining both wrists at my first lesson, thinking that was a small price to pay.
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Wow! I thought it was only me Who scanned the obituaries every day to see not only who died, but HOW too! Jane Brody does it as well! Now I don't feel like a ghoul!
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@Tom-Check out Roz Chast's reading the obituary cartoons- "older than me-younger than me- just my age"
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I took an 8 class course, " Balance Training & Fall Prevention " last November with a wonderful PT who was presenting a special NYS approved course, aimed at re-educating yourself on how to keep moving, safely. It covered the the areas mentioned in Ms Brody's article. The leader encouraged participants to draw on their own experiences to come up with strategies for keeping safe but active. Some of the group had some very serious challenges because of past injuries or certain diseases, but I believe everyone walked away with some new ideas.
One I have yet to implement. If you have any balance issues at all, hire someone to climb up on ladders to replace lights in treacherous locations - as in stairwells. Or maybe add a wall light on a cord at a height you can reach to substitute for a ceiling light. It's often the little stuff that will get you.
And she - we - did talk about overcoming feelings of self consciousness or embarrassment. Knowing that I had so much company dealing with the same things helped me get over it fast.
I have a headlight for night /dusk walking - it straps around the head so my hands are free - free to hold that walking stick! The other has to hold the dog's leash)
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@cheryl
I bought a belt/leash combo online so I can walk my dog with both hands free.
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Nutrition tends to deteriorate as well.
If you do a DEXA bone test, ask for the bone size measurement.
We face a lot of challenges. If you're a smoker, then as osteoporosis sets in, heavy metals are released into your bloodstream.
Folks don't go outside as much.
Given all the fantasies about a good diet, the best thing is a comp blood chemistry. Then you can see what your diet is missing. Since 60% of the American diet is processed food and since nutrient levels in food have declined significantly (USDA), it is likely many folks are deficient.
Bones are metaphorically stiff muscles.... they are a living protein-mineral-fat matrix that adapts to load. And your bones make important cells.
Osteopenia can be reversed with adequate protein (Heaney) as one example. But bones need 20 nutrients (Brown).
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Therefore, disuse atrophy applies to both bones and muscles. Use it or lose it.
Read the NASA bone research..... it is the most comprehensive body of work around
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I had my first geriatric fall at age 82 -- last year -- and it was an unexpected extension cord -- moved from a sensible location, and forgotten -- that got me. Luckily, another no-no -- momentarily clutter -- provided a cushioning effect that prevented worse injury. but that's the kind of inappropriate luck one should not count on. I am still an active community videographer, so I have a camouflaged walking stick in then guise of a functional monopod that I can use for supporting camcorders and cameras, but I mostly use it for supporting this recorder. Also, black ice is a real killer device -- decades ago, a small patch brought me down horribly fast while I was -- ironically -- on my way to a funeral parlor . . .
Fear of falling can be paralyzing. Awareness of the risk can keep us from that fall. On the way to a recording session a few weeks ago, an ice storm caused the first battle between my brain and my autonomous system that I can recall. My body refused to continued down some icy stairs despite my mental commands to move ahead. My legs simply refused to do anything but go back. Weird, but I am still unbroken, today, because of that. Prevention beats correction, every time. Thank you for reminding us of that.
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@Kevin Murphy: I got through last winter without one fall....and then, on a near-spring day I stepped out on my back deck and whoosh! down I went. I grabbed the door handle which helped, but oh, it really jarred my back. Now I always do a 'test' step and really look before I step out. It's hard to see true black ice.
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This extensive list of good-to-great ideas to prevent falls has one significant limitation:
The people most at risk for falls are unlikely to be able to independently implement most of these strategies.
The incidence of falls goes up as people age and develop multiple or more severe problems. But once mild cognitive decline occurs, the ability to perform the higher-order judgement and pre-planning required to implement these ideas will be gone.
What does this mean? A person will not be aware that they need better visibility, or remember to slide on shoes when awakening. They will not remember catching their shoe on a throw rug last week, or mention to their doctor that since taking the new medication they are a bit dizzy.
As an Aging-In-Place Specialist, my recommendations are to use universal design and adaptive design well before you have multiple risk factors for falls. If your parent is beyond assessing and acting on their fall risks, then take action with their input. Altering the home environment isn't totally dependent on memory, judgement, or good communication with a medical provider.
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Another thing that makes falls so lethal for the elderly is that many of them take anti-coagulants like warfarin, Pradaxa, Eliquis, etc. which can increase the risk of bleeds in head injuries. "Blood-thinners" have done a great job of reducing strokes in a-fib patients, but if they fall, be sure to get medical advice ASAP.
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Strength training. Strength training. Strength training. The simplest way to reduce the chance of falling, and btw, to improve your quality of life for as long as possible into a ripe old age, is to do some very basic weight lifting. Four or five exercises, one set, once a week, 15 minutes, is really all you need.
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@mrfreddy - You're right. Pump that iron!
Leg strength is required to use a toilet. Get those squats in daily - the bonus? Your tush will look cuter.
Upper body strength - biceps, triceps, and shoulders - can help you catch yourself. If you don't have weights or a gym membership, start with cans of soup and graduate to larger cans of tomatoes.
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Couldn’t agree more. Being weak is very dangerous.
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@mrfreddy BINGO! My personal trainer has worked with me for several years and keeps my core strong by strength training, especially weight lifting. Strength training stabilizes my core and even if I start to fall I am able to right myself to prevent it. Of course, I'm also blessed with quality foods and good genes and take zero prescription medications.
My mother suffered quite a few dangerous falls until I got her geriatrician to prescribe physical therapy. It worked like a charm. The PTs worked on her balance and gait etc. At age 89, she was able to get in and out of my low-to-the ground car better than me! I wish I had suggested it sooner.
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Why don’t you do your mom a favor and buy a small SUV she can get in or out of without difficulty. I have had sports cars all my life but now I have a small SUV. That is why you see so many being driven by us 82 year olds.
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@Rich
What small SUV do you have?
Some SUVs are hard to get into.
Thanks!
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@Rich
Very good suggestion. I have weak legs to to nerve injury in back. I caved and bout a Mazda CX-5. So much easier now to get in and out!
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Crocs seem to be non-slip on dry surfaces.
Get grandchildren to put away their toys when they are done with them for the day.
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@Howard Fischer Crocs are terrible on wet surfaces though, and don't provide any stability, if you should slightly turn your ankle etc.
I slipped on our back deck that had been rained on the first day I wore my crocs. I thought they would be good for going out in the yard.
I threw them away.
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@Jean
I agree, Crocs are terrible. Slippery on any damp surfaces, slide around on your feet, no support.
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Judo can teach you how to (break a) fall.
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@Ed
Absolutely agree. In over 40 years of doing martial arts, falling is the only thing that I ever used in real life. I am not that old yet, and the falls were usually stupid things I did on a bicycle. But I like to think that falling as I get older will also be easier for me with my experience in martial arts.
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@Ed You are correct, sir. I tell people in my beginning Aikido class that if they get attacked regularly, they need to examine their lives. What's real is ice, shoelaces, broken sidewalks. There is a self defense aspect to Aikido and Judo (both of which emphasize Ukemi, safe falls) but the bigger threat is having the ground come up to smite them.
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A close friend, a very fit 62 year old, took a bad tumble. The next day he seemed fine. One week later he was dead. If he hadn’t died, it would have been life in a nursing home.
Bad fall? Immediately go to the doctor. Don’t wait. Don’t be like my friend.
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I'm glad you mentioned cell phones--that is, look where you're going rather than at your phone. Recently, after a 10 mile hike in the mountains, I was relaxing and reading email on my phone. As I wandered, looking at my phone, I fell and almost hit my head on a fire hydrant. Oh dear, could have been a big problem.
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I hate walking on ice! 4 winters ago, I slipped on a patch of ice -- hidden beneath a light layer of new fallen snow! And I broke my right wrist.
now I use YakTrax for walking on icy surfaces; they are a non-slip device that go over the bottom of my boots, sort of like rubbers. I keep a pair of YakTrax on one pair of boots all winter long. If I have to walk inside, I change into indoor shoes. My motto is: Better Safe Than Sorry.
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@Dr. J I bought a pair of them after our huge ice storm in 1999. Shortly thereafter, I realized two things.
1. We very rarely get the kind of weather that would require their use.
2. On those occasions we do, I'm not going outside anyway.
They are nice to have around in the event of an emergency, though.
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@Dr. J Please know that wearing wet Yak Trax on a terrazzo floor is awful slippery as you come indoors. Also the spirals if worn inside out have edges that can catch on loop carpet. Otherwise I have good results from Yak Trax.
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@Dr. J
There is a form of ice cleats with little points instead of the coils, and they work much better on ice. Sometimes the coils seem to slip instead of grab.
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I'm on the cold, snowy, icy side of Washington State, in a town that is all hills, and keep cleats and a cross-country ski pole in the car.
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@Diane
sounds like Pullman! I remember those hills well! I took the bus and stayed home, plus good snow boots.
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@patricia
Funny: the same thought crossed my mind just before I opened your comment.
You would be surprised to know how many people never heard about "cramp-ons" for snow and ice!
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The angle of vision in progressive lenses as you lower your head to descend stairs / steps or to step down a kerb is completely wrong. I have heard of a few older people who have taken falls while negotiating their way downstairs or across uneven surfaces while wearing progressive lenses.
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@JJ
I put of getting bifocals for years because I worried about falls. I won't touch progressive lenses.
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@JJ
Progressives are for me, deadly. can't play golf with them either!
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At 82 I have never had a problem with progressives. Without them I would spend half my waking hours looking for my other pair of glasses.
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Beware of tripping over pets.
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@jahnay
Indeed. I'm in week nine of recovery from a broken femur when my options were to fall into the wood stove, squash the small dog, or take the hit myself. Since then I've learned of several friends who have had a similar experience. While I'm glad I didn't squash the dog, I wonder if he'll ever understand my sacrifice. BTW, I trained regularly to avoid this scenario and it did make my rehabilitation easier. Not easy -- easier. Work that core, people.
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I've fallen three times in my adult life. All three instances involved a "wait, hold my beer" scenario that almost dictated I go to ground and should have been obvious well before I set out to be an idiot. Fortunately, excepting one fall involving a lovely dislocated finger, the only injury suffered was to my ego.
Last year, though, I found I had to be very careful. I had worn the same pair of Sperry Topsiders going on 15 years and they had reached the end of their functional lifespan. So I purchased an identical pair. When I put them on it was like I had slathered pine tar and epoxy on the soles. Until I broke them in, I had to learn how to walk again.
I would put my foot down walking on a smooth, hard surface and it was like I got stuck. I suppose that is exactly the feature one would want when walking on a boat deck during a storm, but it got in the way of traversing the aisles in a grocery store. When stepping into the car, they would grab the floor mat and push it well up under the dashboard.
After a week, I was able to stop concentrating on "step, plant, lift, step plant, lift" and was able to walk normally again. But during that time, I was sincerely concerned that I was going to fall when the shoe planted and inertia kept the rest of me moving.
Great shoes, but unless you are a seafarer, you should probably use sandpaper on them first.
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@Steve Crisp It sounds like you had gotten into the habit of shuffling your feet.
Having to lift them is probably a good thing.
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Also, there's a wrong and wrong way to walk.
To spouse who gets toes caught on any handy pebble and trips, I say, "Heel-toe, heel-toe, heel-toe . . . ."
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55 years ago, I broke my leg in a bad parachute landing. While waiting in the emergency room, chatting with others there, I discovered that most of the ER visitors that Sunday afternoon had tripped on throw rugs and fallen, injuring themselves.
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I live in a Sr residential home with an Independent (IL), Assisted (AL), and Memory Care living sections. Falls occur almost daily with a check by medical personnel arriving by ambulance mandatory. Living here has made me mindful to keep up daily exercise, other good health habits, and caution. Even with that, falls are a threat even to the spry, fit Seniors here.
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After age fifty, opt for knee-high pets that are easily visible. Large rambunctious dogs are obviously dangerous; I know of one middle-aged, small woman who was yanked off her feet by her bolting retriever--hit her head on a curb, and died.
All this being said, a pet is an antidote to loneliness; just choose the right one.
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I agree to get pets that are easily visible. I tripped over our black spaniel mix more than once. After he died (of a heart attack, not because I fell on him) the next dog is so light she looks almost white. Also paid for 2 weeks of professional training to decrease the pup’s urge to jump up and to bolt on walks. Money well spent.
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I use a balance board (got it when I did physical therapy, they are inexpensive). 5-10 minutes a day while watching TV has helped me avoid falls a few times when sidewalks or curbs were not well marked. Also, good for core muscles.
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I use a walker which is otherwise parked near the bed for nighttime bathroom navigation.
Do not use a cane on slippery surfaces, it is very dangerous because it is more likely to slip than to provide support.
I reinforce the necessity of tai chi and/or yoga, it's fun too.
Go slowly and be very alert, don't live by your previous standards for movement, allow more time for everything.
Be aware that even small alcohol intake can be hazardous.
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@RG A cane or pair of walking sticks can improve balance. Source:
https://canadasafetycouncil.org/safety-tips-for-winter-walking/
A cane or walking pole can help you prevent a major fall by allowing you to interrupt or catch the fall before it gets out of control.
Practice using your poles or walking sticks in warm weather, and do not use poles with hard, sharp tips to walk on tile or ceramic surfaces.
For midnight trips to the bathroom, a walker can help, as you mentioned. Or use a bedpan.
Instead of getting out of bed rapidly and immediately starting to walk, take time to sit up and wake up . (When you first wake up, your awareness and sense of balance may be temporarily diminished, and your reaction time may be longer.)
Avoid slippery surfaces, but if necessary, slow down, stay loose, shorten your gait, and plan your steps. And running in the rain or sleet can be especially dangerous.
5
Yoga over Tai Chi, because you need to get down on the floor and back up. The loss of the ability to get up off the floor begins as early as 50 and by 70, it is gone for a many. Exercise by getting up and down from the floor and chairs, practice good upright posture, and feel where your body is and how it is moving. Personally, I will continue to walk barefoot in my home because it makes me pay attention to my gait, my balance, and my movement. I also wear barefoot style shoes outside. I am only 60, but my 87 year old mother can still sit on the floor and get up and continues to walk barefoot in her home. I think those two habits have everything to do with her avoidance of falls.
Socks, however, are slippery and to be avoided. Barefoot or sure-footed rubber soled slippers in the winter for me. Also, an uncluttered house without excess furniture in the walking routes - and sane floor coverings (enough with the ceramic tile, Florida retirees!).
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@Anne: After 3 knee surgeries, getting down onto the floor or back up from the floor is a non-starter. And that was in my 40's!
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@Anne I can't agree more. Only I am the old mother and have been taught a lot by my movement-aware daughter.
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@L: I've had both knees replaced. I can get up from the floor but someone had to teach me how. A physical therapist did it.
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Diseases, such as Parkinson's can cause feet to "freeze" while walking, so people must learn to wait for a few seconds until this resolves rather than continue trying to walk. Also, do your best to support bone health before any potential falls by having a bone density scan and consulting with a specialist on any needed action. My mother -- who had both Parkinson's and osteoporosis -- had 3 fall-related broken hips. On at least one occasion her doctor said the broken bone caused the fall not vice versa.
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I enjoyed this article, however, I already knew that falling was a major health hazard. I learned this from Judge Judy...she stated that a physician friend of hers told her that he could tell her how to live to be 100 years old in two words...."don't fall"...I'm a bit older than Judge Judy but am careful not to fall. I did fall down the staircase a year ago (carpeted) and escaped without injury....good bones also help.
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And, if yours are anything like mine, consider if you really need pets.
I'd never give my two cats up, but sometimes I do think they are trying to murder me by getting under my feet, or spreading around things to fall over at night.
Keeps me on my toes!
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@Chris By keeping you on your toes, and therefore more nimble, your cats are actually helping you, aren't they? Mine do the same and I'm grateful. They also teach to be mindful, stay balanced and remember to stretch!
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I really want and need my two cats... They get me up and running in the morning and although sometimes under foot they are not the reason I fell in 2014...it was a rainy day, uneven sidewalk going into the grocery store and my shoe, a running shoe with great tread caught on the uneven wet sidewalk. I am tremendously fortunate that two nurses were coming into the market just then because I literally fell on my face hit my forehead and got quite a facial cut and a banged up knee with lots of blood running down my face. They covered me for shock, called the ambulance and calmed me about my injuries. I am so grateful for them. But doctors at the emergency room besides taking great care of me immediately referred me to physical therapy and a class on balance... No falls since. I had been hurrying in to buy cat food and litter!!!
2
Put a very noisy bell on your pet's collar, so you'll be more cognizant of his/her whereabouts !
3
My mother (82) had her 3rd fall in September. The 2nd fall was very bad, broken arm, broken facial bones and traumatic brain injury but she came back from that fall, somewhat diminished. Then, 15 months later, she had another fall and hit her head again, no broken bones. But this brain injury was worse, she can’t walk and is suffering from confusion. Had to move in to memory care. Please be careful of falls! Work on your balance. Don’t walk dogs when you are not steady yourself! Thank you Jane Brody for this column.
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Practice standing on one foot WITHOUT a toothbrush in your mouth or while holding dishes! Take a minute to stand on a rug ad do it while just watching or listening to something, or even nothing.
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@Stuart yes and increasing the amount of time one can stand on one foot with eyes closed is great. Do no th sides.
The movie, Roma, had a great exercise: Yoga’s Standing Tree Pose with eyes-shut. It looks easy but the actor held it or seemed to for quite a few minutes! At least 2 or 3. Wow!
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All balancing poses in yoga are useful, even if you feel your muscles quivering after a few seconds. Keep practicing. You're strengthening those smaller muscles in your ankles and feet allowing you to regain your balance if you stumble and prevent you from tipping completely over to the floor or ground.
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Not just pet toys, but pets themselves - especially small, quiet animals like cats or small dogs - can pose a tripping hazard. Be aware of where your pets are before setting off across a room, or turning suddenly from a kitchen counter.
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@LEW absolutely, my 96 year old mother took a terrible fall when she tripped over the dog’s leash.
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@LEW
And always make sure your cat has not chosen to sleep on one of the stair steps (mine often do) which unless the cat is light colored, and if the stair covering is dark, can make them practically invisible. Another reason stair lighting is so vital.
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@LEW
My grandmother was in a nursing home that had many ladies who had fallen when their cat slipped through their legs as they walked. Many cats do this to their owners, young or old.
22
An older person in my family was trying to help her spouse, who was struggling to walk with a walker. The effort proved too much for her: she fell, broke her hip and now walks with a walker. We need to think twice before offering physical assistance the way we may have in the past.
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I could make a whole wing of my hospital just for older folks who hurried to the bathroom during the night and fell. Please, if you do just one thing, clear the path to the bathroom! Or better yet, use a bedside commode or urinal at night. Rushing to avoid dripping a few drops of urine are just not worth the debilitating after-effects of falling.
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@Nurse Kathy
When I was a home care OTR, the first thing people wanted gone was the bedside commode. It was an unwelcome symbol of their aging and infirmity. Some men would be willing to use a urinal, but not all of them. Again, the device said "You are OLD" and that was more powerful than the recommendation to be safe rather than sorry.
And keeping a light on to see the path to the potty would ruin their already poor sleep quality.
It is a lot harder to get people to accept vulnerability and act to prevent problems than it seems, even after a medical crisis that requires in-home therapy.
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@Nurse Kathy: my elderly aunt suffered from this, and also rejected a commode. She had several falls until I figured out she would benefit from sleeping in Depends. They now make attractive styles of adult diapers in pastels with designs, so less offensive.
She was rushing to the toilet, in a foggy state of half asleep, out of fear that a leaky bladder would soil herself, her bedding or the room (necessitating a difficult clean up!). The Depends ended that problem.
It also helps to have a wet-proof mattress pad -- the flannelized rubber kind -- it's not "crinkly" or hot -- the kind they put on a baby crib mattress (only bigger).
Without that "fear", she was able to slow down and get up carefully, without risk of soiling herself.
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@Concerned Citizen
A good piece of advice I once learned from an emergency room nurse: When you get up to go to the bathroom in the middle of the night, take a moment to just sit before actually rising. This has been excellent advice: I never just bound out of bed anymore.
25
I have a friend that slipped on ice and fell and hurt her arm or elbow. I often slip on ice in the winter but I don't fall. I credit a fairly regular yoga practice. as I age, I realize I will have to do some yoga everyday to stay mobile and healthy.
31
@JA I find that wearing ice cleats over my boots or shoes when outdoors in the winter makes all the difference. A fall on the ice can be truly devastating, and the cleats just take a moment to put on.
13
@Ailurophile,
just ordered some :)
3
There are probably classes on balance someplace near you. If you're over 65, take one. If there aren't any classes nearby, google balance exercises. I learned one from my granddaughter, watching her tightrope on the railroad tracks, and I make a point of doing that sort of thing a few times a week.
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@Blonde Guy Just pay attention to the train schedules.
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@Osama And get a vision and hearing checkup, too.
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@Blonde Guy6
After a fall in which I broke my wrist I took a fall class at the local hospital. All the tips became second nature, plus from that time I take calcium supplements. No more broken bones.
3
It is well known in my field (family nurse practitioner) that falls are a major concern for the elderly. Thank you for highlighting this issue. Folks might find it useful to search their health insurance - many offer reduced rates for senior yoga, floor pilates, etc - all of which increase flexibility. Plus the group classes have the added benefit of social interaction.
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@Suzanne Yes, Silver Sneakers is a great free program for those who have Medicare Advantage, and maybe other supplements as well. I have been going to a chair yoga class 2x/week for 2 years and feel so much more flexible and less achy. The instructor is terrific! https://www.silversneakers.com/ to determine eligibility.
2
Thanks for this useful article. As I age, I can see and feel my balance getting worse, but I didn't realize one of my meds might be part of the reason. Can't stop the med, though! But back to the gym. Ugh.
32
I did not see alcohol use mentioned as contributing to falls. Alone, or in combination with prescribed or OTC drugs, alcohol can be problematic.
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@VPS
Absolutely : a friend broke her femur: She'd been at home, drinking wine with friends, and walking in socks across her slippery wood floors. You don't have to get drunk or tipsy; we tend to react more to alcohol as we age, in addition to possible using some sort of medications.
26
@VPS
I am 80 and recently severely strained my knee trying to prevent a fall. While I avoided hitting the ground my knee was in such pain that the next day I had my wife drive me to an urgent care center.
The visit and x-rays were covered 90% by Medicare, and the subsequent physical therapy prescribed by the doctor is 100% covered by Medicare.
After 3 weeks of PT the knee pain is almost gone, my balance and leg strength have improved and I use a cane only as a precaution when walking outdoors or on uneven surfaces. Based on current progress I should be able to get back to walking normally in a few more weeks.
Two take-always: 1) If you are of a certain age Medicare will pay for physical therapy if needed (requires a doctor referral) and 2) it’s never too late to work on improving your strength and balance through physical therapy, yoga or a regimen of exercises from sources familiar with the needs and issues of seniors.
1