No more falls

Philip J. Goscienski, M.D.

November 2008

Have you noticed that old people shuffle? Do you wonder why? Old people shuffle because they don't have enough strength in their legs to lift up their feet! A raised doorway threshold, a high curb or a little irregularity in a carpet are enough to cause a person to fall. And it has nothing to do with growing older.

The person who doesn't exercise loses a small amount of muscle mass every year beginning at the age of about 25. By the time he or she has reached the age of 65 it's not uncommon for the amount of muscle mass in the legs to be a lot less than the fat mass. If those muscles are not used regularly — that means daily — with moderate effort, all that fat makes it even harder to lift. No wonder more than a third of people over the age of 70 take a tumble every year. The lucky ones end up with a few bruises; for too many it's the end of the line. In 2005 more than 15,000 Americans over the age of 65 died as the result of a fall and the numbers increase every year.

Many deaths result from a head injury but sometimes a broken hip sets off a chain of events with a fatal outcome. Prolonged immobility often leads to pneumonia and to blood clots in the legs that cause serious, sometimes fatal, complications. And of course, there is always the specter of a hospital-acquired infection.

It doesn't take much to reverse this trend. Walking is a great start and it doesn't have to be a long distance or very fast. Start with 5 minutes the first day and add another five minutes every day for a week. Aim for at least 45 minutes eventually, 4 or 5 times a week. Walk briskly, but you should be able to keep a conversation going all the while.

Do resistance exercise with weights or machines at least twice a week. Heavy weights aren't necessary. You can begin by lifting and extending each leg while sitting in a chair. It won't help you to win a bodybuilding contest but it will lower the risk of falls at least a little — a little that could make a difference.

When we lose muscle mass we lose some of our ability to maintain balance. That's because unused muscle fibers not only lose the power to contract, they lose the tiny nerve endings attached to them that help us to maintain balance.

Some persons have remarkable natural balance but most of us do not. For those of us who would never even dream about walking a tightrope it's easy to improve our balance enough to make falling less likely. Practice by standing on one foot while brushing your teeth or by taking the weight off one foot while standing in line at the checkout counter. When these become too easy, consider enrolling in a tai chi class where you can improve balance and muscle tone at the same time.

The bottom line: most falls can be prevented with minimal lifestyle changes, and the earlier you start, the better.

Philip J. Goscienski, M.D. is the author of Health Secrets of the Stone Age, Better Life Publishers 2005. Contact him at