The stretching and flexing exercises she was enjoying at a local gym weren’t difficult and left Julie Kennedy with a few pleasantly sore muscles. But it was taking a lot more concentration to keep from tipping than it had even a few years before. Was this decline in controlling her equilibrium the edge of a slippery slope that could lead to a fall and perhaps a broken hip in her later years?
Find your balance
Recently, the Canadian Institute for Health Information (CIHI) reported that 58 percent of serious injuries in people 65 and older are caused by falls (car accidents account for 31 percent). Another study revealed that 57 percent of women and 36 percent of men who die of injuries received the damage in a fall. For many of the survivors, their quality of life changes forever. They’re left with chronic pain and limited function that robs them of independence. Ominously, 40 percent of nursing home admissions can be traced to a fall. And this misery has a price. One study estimated fall-related injuries in 1994 cost Canadians $2.8 billion.
Starting Over: How to face the future after significant loss
Make Lasting Change: Your email mentor will walk with you
Balance and the brain
Fighting the pull of gravity becomes more challenging with age. The loss of balance that leads to serious, injury-producing falls can be traced to age-related changes in the brain, diminishing vision, inner ear problems, weakening of the legs and trunk and/or the declining reliability of sensory mechanisms that let the brain know where the limbs are in space.
Around age 40, the ability to sense when you’re losing your balance begins to fade, warns Brian Maki, a bioengineer and University of Toronto professor who studies balance and mobility at Toronto’s Sunnybrook and Women’s College Health Sciences Centre. Cells that measure pressure in the soles of the feet start to disappear so the brain doesn’t get a clear message of what’s underfoot. As Brian observes,
“The skin becomes less elastic, and there are more ridges and calluses. Even healthy older adults can have a profound loss of this pressure sensation yet have no idea there’s a problem.
Balance relies on so many things. You have to be able to sense where your body is and when you’re unstable. The brain has to integrate sensory information from the inner ears, from vision, from proprioceptors (sensors in muscles, tendons and joints that tell the brain where the limbs are positioned) and from pressure sensors in the soles of the feet. Once it has processed the information, the brain sends the commands to the muscles. Then the muscles have to have enough strength and there has to be enough range of motion to generate the required action, whether it’s stepping or grasping.”
Even if you’ve been an avid golfer, a fiend for tennis, loved playing hockey or zooming downhill on skis, you can’t assume you’ve retained your sense of balance.
“All of that sensory information is deteriorating as you get older because of loss of sensory cells and changes to the sensory receptors,” says Maki. “And the brain is less able to process that information because of loss of neurons in the brain. All of those parts of the picture are affected by aging.”
One foot in front of the other
Simply walking – at any age – involves subtle adjustments to remain stable while the body shifts sideways over the leg that’s contacting the ground. When someone loses balance, they instinctively try to recover by taking a step to get the body’s centre of gravity over a supporting leg. Maki’s research indicates older adults have a problem controlling side-to-side balance – crucial because a lateral fall can end in a hip fracture. Unlike younger people who recover with one step, older adults often take several steps and use their arms to grab for support. And unfortunately, their grasping reactions are slower than in younger people.
Excessive alcohol consumption and side effects from medications can lead to falls, but ongoing problems with instability should be reported to a physician. Exercising to strengthen muscles around knees and hips helps prevent falls and serious injury.
“Tai Chi focuses a lot on lower limb strength,” Say Dr. Bruce McFarlane, a physician and medical director at the Taoist Tai Chi Society’s Health Recovery Centre in Orangeville, Ont. “After age 60, we start to lose significant muscle strength, up to 30 percent. We don’t need to lose it, but in our culture, we deprive ourselves of motion. Tai Chi is a physical art. You become more aware of your body, how it’s moving. If you stumble and have to throw your arm out to regain balance, you have a much better chance of correcting as you start to fall if your shoulders, elbows and wrists can move in full range.”
Good balance keeps you mobile
Can we do anything to protect ourselves and bring our sense of balance up to par?
Happily, the answer is yes. Building strength through exercise is a good first step. You can help yourself stay safer by becoming active now – and it’s not difficult or expensive. Along with simple activities such as dance, yoga, pilates and wobble boards, Tai Chi is one of the most effective things you can do and has both physical and social benefits. Its slow, graceful movements have proven to have a profound effect in improving balance and preventing falls.
“Balance is quite fundamental to normal daily activities such as walking, shopping, doing household chores and thus maintaining independence,” acknowledges Dr. Kathryn Berg, a physiotherapist and associate director of the school of physical and occupational therapy at Montreal’s McGill University.
Berg developed a 14-point scale, now used in many parts of the world, which is designed to measure the balancing ability of frail elderly people, many with neurological disorders or recovering from strokes. She observes that balance can be maintained by exercise.
“If people include movements that help them gain control of their posture and attain a sense of awareness, they can improve their balance,” she says. “It doesn’t have to be a downward decline.”
Defining balance as “maintaining your centre of gravity under various situations,” Berg notes that such exercises as shifting weight from one limb to another, standing on one leg and changing direction – all elements of Tai Chi – allow participants to get a feel for their balance. And so does dancing, she adds. “In fact, one person I studied who was very good at standing on one leg had done Scottish dancing for a long time.”
Keep your sole sensation
Maki’s lab is developing an insole to compensate for failing sensors in the feet and it seems to work. Raised bumps around the perimeter dig into the skin slightly when the body weight shifts as balance is lost, increasing sensation. “The trick is to design it so it’s not uncomfortable,” adds Maki.
People who spend a lot of time in the athletic shoes may be setting themselves up for a fall. “You want a cushioned shoe for comfort and to avoid injury when you’re exercising,” he says, “but try and stay away from heavily cushioned walking shoes. They mask the ability to sense accurately where the pressure is on the foot.”
He recommends wearing a comfortable, yet firm insole.
Just when you need it most
Ironically, vision takes on a bigger role in maintaining balance just as it too is deteriorating. (Compare standing on one leg with eyes open and again with them closed.)
“A lot of older people have poorly corrected vision,” worries Maki. “I think bifocals and trifocals create problems in seeing obstacles. When you’re trying to grasp something for support, you have to be able to see it.”
That’s one reason fall prevention programs aimed at seniors point out the need for appropriate lighting throughout the home to clearly define changes in floor surfaces or levels and to eliminate both shadows and glare.
Clearing the home of clutter is important as well. Dr. Steven Wolf, professor of rehabilitation medicine at Emory University in Atlanta, Ga., says some elderly people have difficulty doing more than one thing at a time. They see a crumpled rug on the floor, but if their brains are engaged elsewhere, they can’t take action to avoid slipping on it.
Children of elderly parents can play a key role by checking their parents’ homes for potential hazards.
“If we keep our minds and bodies alert, then prospects for injurious falls might be diminished somewhat as we age,” adds Wolf. “If we allow ourselves to succumb to our maladies as we get older and use age as an excuse for inactivity, that’s terribly dangerous.”
Wolf’s 1996 study on the effect of Tai Chi on people 70 and older found the system had a profound effect, reducing the risk of multiple falls by nearly 48 percent.
Brian Maki notes,
“Any exercise that does those sort of movements is likely to be helpful, but Tai Chi is a nice way of doing it. It’s inexpensive, and you can do it in a group setting or on your own. It’s also relaxing. People enjoy it.”
This story reprinted with permission from 50Plus magazine.
Tags: fitness, health, Jayne MacAulay, LIFE, Men, safety, Women
Connecting Through Technology
Do you use technology to stay in touch with family and friends?
>Watch
