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Friday, July 12, 2024
Dr. Brown: Not as nimble as we age, falls are major danger

When we were children and teenagers, we often fell. And if we had much to do with rough and tumble sports, falls were part of the game with nothing more to show for them than a few scrapes and bruises.

By the time we were adults our falling days were over, except perhaps for the odd fall skiing after which we brushed ourselves off and kept going.

Then, much later in life, falls became more common and more likely to be associated with sprains or worse. That happened to my sister in B.C. who, at 86, was an active walker and doer, but one day fell off a ladder and fractured her hip. Unfortunately, a few weeks later following hip surgery, she developed a clot in one leg and a few days later died from a sudden pulmonary embolus.

Looking back, at 86 she shouldn’t have climbed that ladder, but like many of us probably assumed that what she had been doing for years without a second thought was still OK. It wasn’t.

Sally had a history of at least one minor symptomatic stroke several years before and a CT scan had shown evidence of several other clinically silent small strokes. When she was told about them, she dismissed them, despite feeling a little off-balance from time to time.

And that’s the problem isn’t it. We’re not as nimble and sure-footed as we once were but ignore the risks.

Too often, we fall – perhaps a slip on a wet floor or ice, catching a foot on a carpet edge, tripped by the cat darting in front of us or our ankle turns when we’re walking or gardening – and when we least expect, we’re down, without the quick reflexes of our youth to check our fall or failing that, soften our landing.

The numbers are worrying. Roughly 30 per cent of those 65 or older experience one fall a year and 10 per cent have two or more falls in a year.

Some of those falls are associated with a significant sprain or worse, such as dislocation of the shoulder or fracture of the wrist, hip or ankle – or perhaps a head injury or maybe several of the above.

Falls in the elderly account for roughly 300,000 ER visits annually in Canada. That’s a lot of falls and they’re probably underreported by patients to members of their family or family doctor because, “I don’t want to make a fuss” or “I don’t want any pressure from my family to move into a long-term care facility” or “I’ll be more careful next time.”

And some of those “fallers,” without saying much to anyone, begin to curtail their activities and social lives out of fear that they might have another fall.

A higher risk of falling can be related to many factors – weakness chiefly affecting the trunk (core) and leg muscles, significant drops in blood pressure when standing up (postural hypotension), dehydration, medications (especially sedatives), impaired walking related to degenerative spine disease, movement disorders such as Parkinson’s disease, cognitive impairment of any kind, impaired vision, arrythmias of the heart such as atrial fibrillation or bradycardia and other risk factors – often in variable combinations.

All of these concerns, and others, are important risk factors for falling – some of which can be changed for the better by, for example, cutting out certain medications known to increase the risk of falls, managing postural hypotension and cardiac arrythmias, and strength-training programs to improve weakness and impaired balance.

Anyone over the age of 65 who has fallen two or more times needs to be assessed to determine which risk factors might have contributed to the falls, including checking the home environment to look for obvious risks for falls.

One simple test you might want to try at home – with someone there to keep their eye on you – is the TUG test, which stands for Timed Up and Go. This test measures the time between when you get up from a chair, walk 10 feet (three metres), cross the line, turn around and return to sit down again in the same chair. Google it to get the details.

Physiotherapists and physicians in geriatric clinics use this test to assess your speed and balance and, hence, risk for falling. Simply watching someone walk provides other useful clues to impairments the subject might not be aware of.

Falls are an important subject because of the risks of serious fall-related injuries. For that reason falls are the first subject to be addressed by the Infohealth series, which returns on May 5 at 2 p.m. using Zoom and YouTube.

June’s Infohealth session is on lumbar stenosis. No sessions are planned for July and August but Infohealth returns in the fall. McMaster medical students rejoin the program in January 2022.

Please remember to register for the sessions with the Niagara-on-the-Lake Public Library – and stay safe.

Dr. William Brown is a professor of neurology at McMaster University and co-founder of the Infohealth series at the Niagara-on-the-Lake Public Library.  



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