Exercise helps fight fear of falling
American Geriatric Society adds T'ai Chi to exercise list for older people who run high risk of falling.
St. Louis Post-Dispatch
ST. LOUIS — Rolf Krojanker was at The Monday Club in Webster Groves, Mo., on a Tuesday evening wearing two hearing aids and a T'ai Chi Ch'uan T-shirt.
Those two details might seem unrelated, but they're not.
The American Geriatric Society recently added T'ai Chi as a form of exercise to its list of recommendations for older people who run a high risk of falling. Checking for hearing loss has been on that list for a while now.
In its recent updates, the society recommends that physicians review medications that their elderly patients take, and reduce the use of those that increase the risk of falling, such as anti-depressants and sleeping aids. Previously, it suggested reviewing medications if a patient was taking four or more meds. The recommendations are for patients age 65 and older, which is considered geriatric, who run a high risk of falling.
According to the Centers for Disease Control and Prevention, falls are the leading cause of injury deaths among older adults in the United States, and the rate of those deaths has risen by more than 50 percent over the past decade.
In 2002, more than 12,800 people over age 65 died and 1.6 million were treated in emergency departments because of falls. In 2007, more than 18,000 people died after falls; in 2009, more than 2.2 million older people visited emergency departments for nonfatal falls.
The CDC estimates that one out of 10 falls among older people results in serious injuries that require hospitalization and that many people spend a year or more recovering in long-term care facilities. Some never go home.
Those numbers are expected to continue growing dramatically as baby boomers age.
Dr. Dulce Cruz-Oliver, assistant professor of the department of internal medicine and geriatrics at St. Louis University, said older people who have fallen in the past run a particularly high risk of falling again.
"There are many factors that contribute to the increased risk, including changes in posture and gait, medical conditions such as dementia, Parkinson's disease and stroke, poor eyesight and hearing," Cruz-Oliver said.
Your risk of falling increases when the number of these biological and environment factors increase, she said. Family doctors can determine whether you're at risk.
Cruz-Oliver said the best way to maintain a keen sense of balance is to exercise, and to start it in your 50s before you begin losing it.
"If you don't use it, you lose it," she said. "Balance is something you should continually train and use."
T'ai Chi has been proved to decrease falls in the elderly. Gait-training, physical therapy and dancing help as well, though fewer studies exist on their effectiveness.
"You need to do it one to three times a week for more than 12 weeks to really have an impact on decreasing falls," she said.
Krojanker, 88, has been taking T'ai Chi for 10 years. When asked if he's ever fallen, he said: "Well, of course. When I took Jiu Jitsu."
Mike David, one of the T'ai Chi instructors, has noticed the number of older people coming to class increase significantly during the past decade.
"Baby boomers are coming of age, so to speak, so that might have something to do with it," said David, 63, of St. Louis.
In addition to lowering blood pressure, helping with rheumatoid arthritis, increasing breath efficiency and reducing stress hormones, David said T'ai Chi employs small muscles that aren't often used but help with staying upright.
"Also you try to keep your center of attention in your core area, which is where your energy should come from," he said.
Several years ago, David recalls, a woman who had two hip replacements and was walking with a four-prong cane began taking T'ai Chi lessons with him.
"When she came in I thought, 'Oh boy.' She said she was really afraid of falling," he said. "After one month, she threw her cane away.
"A fear of falling changes not just the way you move but the way you live," he said. "Then you gain more weight by being docile and there's more stress every time you have to move and it multiplies from there."
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REDUCING RISKS FOR FALLS
Recommendations by The American Geriatric Society and The British Geriatric Society to help reduce the risk of falling.
Exercise: Take part in programs that help improve balance, gait and strength training, such as Tai Chi or physical therapy.
Environment: Make changes to reduce your fall risk factors in the home and in daily activities, such as keeping high traffic areas clear of furniture or clutter.
Vision: Undergo cataract surgery when needed, though not as an individual approach.
Fewer meds: Reduce medications, regardless of the number prescribed, particularly those that affect the brain such as sleeping medications and antidepressants. In 2001 this was only recommended for elderly people who were on at least four medications.
Blood pressure: Raise low blood pressure and manage heart rate and rhythm abnormalities. Consuming more salt and water and wearing compression stockings can raise low blood pressure. In extreme cases, doctors can prescribe fludrocortisone to control low blood pressure. Sometimes, doctors can control irregular heartbeats by altering medications.
Home safety check list from the Centers for Disease Control and Prevention
Avoid slipping: Remove rugs or use double-sided tape or a nonslip backing so to avoid slipping, or remove altogether and attach nonslip rubber treads. Put a nonslip rubber mat or self-stick strips on the floor of bath tub or shower.
Tidy up: Always keep objects off the floor and stairs.
Cords: Coil or tape cords and wires next to the wall to avoid tripping.
Too loose?: Fix loose or uneven steps. If handrails are loose, maybe it's time to install new ones. Make sure they're on both sides of the stairs and are as long as the stairs.
Lighting: Install an overhead light and light switch at the top and bottom of the stairs. Place a lamp close to the bed so that it's easy to reach. Consider using a night-light so you can see when you're walking to the bathroom in the dark. Some night lights go on automatically when it's dark.
Sightlines: Paint a contrasting color on the top edge of all steps so you can see them better.
Stepping up: If you must use a step stool, get one with a bar to hold on to. Never use a chair.
Getting up: Install grab bars inside the tub and next to the toilet if you need help getting up or out of them.
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