Fall Prevention After 60: How to Stay on Your Feet and Out of the Hospital
Fall prevention isn’t just for the “super old.” In fact, according to my guest, Dr. Leslie, every person over the age of 60 should be thinking about how to maintain their balance and avoid fall-related injuries. As someone who has had her share of falls, I couldn’t agree more! Join us as we discuss the importance of fall prevention after 60.
My guest today is Dr. Leslie Kernisan. Leslie is a medical doctor who specilizes in geriatrics. On her website she has got an amazing selection of resources and information about how to deal with the ageing process and the medical issues that you might have. Welcome to the show Leslie.
Thank you for inviting me.
I’m really glad that you are here today. Our community mostly includes women over 60, and one of the biggest issues that we face is balance and the potential for falling. We all know that this is a cause of a lot of illness and hospitalization. So, please help us to understand what the issues are around improving our balance in our 60s.
For women in their 60s, one of the first things to figure out is whether you are a high risk or not. One of the most important signs that somebody is a high risk is if they have already fallen, especially more than once.
Falling once doubles your chances of falling again. Usually, it happens to people in their 70s and 80s, but it does happen to some people in their 60s, too. Falling can lead to devastating injuries. We know that a lot of older people fall, but many don’t even mention it, and their doctor doesn’t mention it to anyone. They feel embarrassed and don’t want to feel old.
If you haven’t had any falls, or if you haven’t been feeling unsteady, then the prevention basics include exercises that maintain your leg strength and your balance. Things like Yoga and Thai Chi are really good and help a lot.
If, however, you have had a fall, then it’s really important to take a few steps more. Falling, even only once, means that you are at risk. In that case, my advice goes along with what the Centers of Disease Control or other public health institutions would recommend.
The first thing, and it’s really important, is to get your medication reviewed. Also, make sure you are doing the right kind of exercise that will maintain—or even build up—your leg strength and your balance. Having your vision checked and working on making your home safer are also recommended.
In my practice, I often focus on two of these because I feel that people don’t do quite enough of them. The first one is having your medications reviewed, and the second is getting your strength and walking balance evaluated. Then the next step would be starting to really focus on a structured exercise program.
To be honest, I’ve had two falls. The first time I fell I was in Paris. I tripped on the cobblestones and broke my tooth. It was not a nice experience. But do you see how I place the blame on the cobblestones? Us women tend to do that.
The second time it happened I was in Scotland. I was walking along the pavement when I tripped and fell. I didn’t fall quite so badly, but it was a memorable experience because I immediately got up and started brushing my arm like nothing was wrong.
An ambulance went by just then. They stopped, and I stood up and went, “I’m okay, no problem.” But my arm was killing me. My hand was swollen, but I was not going to admit that I was in pain. And so, the ambulance just went their way.
What I wanted to illustrate is that you’re right—we don’t admit that we have a potential balance problem. So, tell us how to be careful with medications.
The usual advice is to go and talk to your doctor about medications, but doctors are often very busy. They may not even be entirely aware of which medications are associated with falls. They may not really make an effort to help you identify the risk in your medications and reconsider them unless you ask.
This has been an issue, and the Center for Disease Control in the United States created an initiative called Study. It distributes cheat sheets for health providers which make identification of medications easier. The wonderful thing is that all the information is available online, and people can see it for themselves.
Based on that, the medications to look out for are those that affect your brain and blood pressure. The ones that affect the brain are mostly sedatives, which people take for sleeping aid. They don’t realize, however, that even though they may feel okay the next day, their balance is affected.
Maybe they would sleep well during the night, but they will suffer the next day.
Exactly. There are special tests for this kind of research. Balance is tested on a special surface, and the physician will see that it has decreased. We also know that older people who take sedatives have a higher fall risk.
There is another class of medications that’s called anti-cholinergics which also tend to make people drowsy and give them dry mouth. Anti-depressants, surprisingly enough, are also associated with increase of a fall risk. Unfortunately, a lot of women are taking anti-depressants.
So, the doctor is supposed to help you review your medications, and identify all the ones that could be associated with increased fall risk. Then he should either stop the medication if possible, switch to a safer alternative or reduce to a lower dose.
In many cases, stopping or reducing is possible if you find a non-drug way to manage the problem. Insomnia, for instance, could be managed instead of a sedative with a program to help you relearn how to fall asleep. That’s sometimes called Cognitive Behavioral Therapy. On my website I have a list of medications to avoid.
That’s really helpful.
I always encourage people beyond saying, “Oh, I would ask my doctor about my medicine.” They should carefully look through the list and ask themselves if they are taking any of the indicated medications.
A good example is blood pressure medication. Some people are probably taking a little bit more than they need, and so their blood pressure might drop when they stand. So you see, sometimes dialing back the dose a little bit could make a difference in balance.
These are all things that your doctor can help you with. However, there is no guarantee they will help you unless you go and ask insistently. If you do your homework—compare your medications to the list—and then go see your doctor, you can actually accomplish a favorable outcome.
Besides medications, exercise is the next thing you should focus on. Everybody knows exercise is good for your health, but what we need to keep in mind is that there are four types of exercise that are recommended for older adults.
There’s exercise that builds strength, endurance exercise, flexibility exercise and balance exercise. That last one specifically works on your balance, and is great for preventing falls. It’s especially important to work on things that build lower leg strength and balance.
What people don’t realize is that walking alone is not enough. On my podcast I once interviewed a physical therapist, a woman who specialized in fall prevention. She was actually given a grant by the Centre of Disease Control to help disseminate a physical therapy exercise program that has been proven to reduce falls by 35%.
What is the program called?
It’s called Otago, and I actually have a page with videos explaining and showing some of the exercises. It turns out that a lot of older people who fall, when tested show signs of low leg strength or poor balance. Testing isn’t that hard.
There are three little tests that even your doctor could perform, although a physical therapist would be better at doing them. The first one is having the person stand up from a chair, walk ten feet, and then sit back down. How long does that take them?
The second test has the person sitting in a chair that is against a wall. They are asked to cross their arms over and then stand up and sit down without touching. The therapist will also count how many times they can stand up like that in 30 seconds.
The last one is called ‘the four stage balance test.’ It involves an older person standing in four different positions without touching anything, all the while being timed how long they can stand. The first position is pretty basic—standing with their two feet next to each other.
Next, they are asked to move one foot halfway in front of the other. The third position has the feet positioned heal to toe, which is quite hard to do without holding onto anything. The last one measures balance on one foot, either way.
Those are three of the assessment tests which are also included as part of Otago. Many physical therapists can perform them. Often, when somebody is falling, if we do those assessments we find that they either have some balance difficulties or do not have enough lower leg strength.
If that’s the case, you would want to do an exercise program that is specifically designed to help you work on those issues. Otago is one of the good programs out there. If you want to do your own exercise plan it should help you work on those issues.
Make sure you get assessed first though, so that when you exercise it is for the specific problem. If you put in the work, you should be able to see improvement within a few months.
Many women say, “I don’t exercise, but I do walk a lot.” But you’re saying walking isn’t a good for falls. How do you increase your lower leg strength? There is one Yoga exercise I can think of that can sort of help with balance and that’s the tree. I think Tai Chi is another good exercise. But what else is there?
Actually, Thai Chi has a good record in fall prevention. I have a page on my website with Otago reviews that presents, with video, each of the different exercises a therapist might use. Those videos can give you an idea of the kinds of exercises that are involved in strengthening the lower leg.
However, people shouldn’t try to do that program alone. Otago is designed to be done with a physical therapist over a period of six months. It is a longer kind of program and during its course the weights are progressively increased to build that muscle strength.
Walking is wonderful. I encourage everybody to walk. But if you’ve been having falls you need to think about doing something more structured. I would encourage people to discuss it with their doctor, and ask about a physical therapy consultation to properly evaluate your balance and strength.
Of course, you can do the program that the therapist mentions, but experts recommend going through a structured program because you’d be following a proven recipe. The problem with medicine health care is that clinicians are quite autonomous, and they get to suggest whatever they want.
They are trained, and many of them are very experienced, so sometimes it works really well—but sometimes it doesn’t. When you follow a defined, structured recipe that has been shown to work well for people, you have better chances that your time and effort is going to get you what you want—in this case, more strength, more stability, fewer falls and a better foundation for a healthy life.
Actually, you have a quick checklist on your website that includes the tests older people need to perform to determine their risk for falling.
The list includes checking your bone density; practicing balance exercises like Yoga, Pilates, Thai Chi; reviewing your medications; checking your blood pressure and the medications that you are taking; staying hydrated.
I think that is really great advice if you are having problems with you balance.
Concerning the bone density test, I think the thing that everyone fears is a hip fracture or a really bad injury. We do know that most people who fracture their hip have low bone mineral density and weren’t treated for it. That treatment is part of preventing a fall injury.
People who exercise are less likely to get injured, but it is important to be screened for osteoporosis at least once if you are an older woman. If the doctor tells you your bone mineral density is really low, then you should think about medication. If it’s just a little low, then there are lifestyle ways to improve your bone density. Screening is an important factor in avoiding a bad injury.
I think that distinction is really important—falling is one thing, but breaking a bone or fracturing a bone when you fall is another thing. Get your balance right so that you don’t fall. But if you do fall, having a good bone density will get you up on your feet without a bad injury.
Yes, you will be less likely to be badly hurt and have to change your life—which is what we’re all hoping to avoid.
I feel really encouraged by your words. My two falls have taught me that I have got some work to do with balance. Practicing Yoga helps, but you have given us a lot of really good information. Thank you so much. I feel like I’m much more educated now. So, no more falls.
You are on the right track. Taking action is the way to get started. Thank you so much for inviting me.
Thank you, Leslie.
Have you had a fall? Did you get injured? Have you had your bone density and balance tested? Which do you think is your greatest weakness? Please join the conversation below!