Monday, March 23, 2009

Preventing Falls - I

6/12/08: Earlier this year my wife and I were at a Lydian Quartet concert at Shlosberg Auditorium at Brandeis. We have seats in the second row, center, which is a fabulous vantage point for us to watch the cellist. (We have learned to appreciate the others very much as well.) From the second row it is a long way back to the lobby, so we wait until many of the people sort themselves out, and then we start our trek up the stairs. Something was a little different this time: I wore my bifocals so that I could watch the players through the top part and the program through the bottom part. I should have taken them off for the intermission, but I did not. On the way up the steps slightly cramped with people I started around a cluster of people, and half-missed a step. I heard the audience gasp as I went down. Perhaps because it was a fall up the stairs, it was really a minor fall with not more than a hint of bodily distress, but a note to all of us that these things can happen anywhere, anytime, with outcomes that can be much more serious.

Not surprisingly, falls have become increasingly interesting to me. This interest has even more to do with our older circle of friends. Some are still playing tennis with us into their eighties. One is ninety-nine and clearly frail, but still driving her car in to town. Others have experienced their first serious falls and live in fear of the next fall. This has led to our considerable concern about how to prevent falls, and how to minimize the damage if and when a fall occurs.

Yesterday I visited the Fall Prevention class offered by the Weston Council for the Aging. The instructor, Leslie Worris had earned her MPH at Harvard after studying such disciplines as physical therapy at Boston University and yoga with yoga instructors. She knew her stuff, which was good, because I entered the room very skeptical about the classes I had seen, in which elderly people sit in a circle of chairs and perform light exercise. Yes, this was light exercise, but it was serious in the exertion level and serious in what it sought to accomplish. It was also adapted to the present level of each of the participants. Thus for example, I used a 5-lb weight in each hand for some of the exercises, while most others used a 1-lb or 2-lb weight.

Leslie emphasized that fall prevention is a program that involves every aspect of life. What I would say is that it involves continuing to live life fully, not shutting down, and continuing with the activity program that one has hopefully already established much earlier in ones lifetime. It involves exercise, stretching, attitude, having fun, diet, and many other things. I am going to see if I can share more details about this through involving Leslie in this forum.

What did I learn from the hour with the class? Many things. Dominant in my mind was seeing people making progress in their own terms as they pushed their bodies to perform the exercises. The woman next to me was able to lift her leg repetitively forward a few inches while standing on the other leg and holding on to the top of a chair. After several exercises, she laughed “I’m going to feel this tomorrow.” So the issue was not permanent physical restriction of her joints and body motions, but rather the strength and flexibility of her muscles. Leslie emphasized the importance of building a strong base in the abdominal and torso area, explaining that this area is the root of motions that keep one upright. As I have been mindfully watching my own motion over the past months, I have also noted that I trip quite a bit, and I fall when I am moving too fast for the circumstance. So it is partly a matter of tempo, and I can live safely at a faster tempo only if I am able to adjust quickly and effectively. This requires mental alertness, physical strength and suppleness. One take-home from the class was that just being elderly is no longer an excuse to not continue exercising our bodies. In doing this exercise gently and with awareness, we also become more aware of our bodies, how they function, and importantly, how they stay upright.

The basic idea is that falls result from many different causes. Again, the details can wait for a subsequent post, and for what the rest of you share. A major area of influence over falls is the adequate strength of the muscles used to stay upright, the suppleness of those muscles, and the awareness required to use those muscles to keep us in “good standing.” Thus, balancing exercises are important, and general physical and mental fitness is also important. I am reminded of the Harvard study with nonagenarians working out on Nautilus machines to develop muscle mass, particularly in the legs. The outcome was that the nonagenarians were more ambulatory than their children.

This is a deep and extensive subject area, about which much more can be shared, even about the experience of one fall prevention class. I look forward to people sharing their insights and experiences.

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