I remember the day that Sonia Sotomayer was sworn into office, replacing Justice David Souter and being the first Hispanic justice on the Supreme Court. Yet, perhaps receiving more attention was a summer day before that in 2009. She had 6 meetings scheduled with Senate leaders (who would decide her fate). While rushing through the LaGuardia airport en route to the consultations, she stumbled and fractured her ankle. She arrived at the meetings on crutches and all the pictures (like a famous one with Senator Grasley) showed her in a big white cast.

These types of headlines caught mishaps of others as well. President George H. Bush was joined (on this list) by Senators Diane Feinstein and Mitch McConnel, all who took tough topples in their own homes resulting in broken bones, bad sprains, bruises and head injuries. During her campaign for president, Ambassador Hilary Clinton fainted, fell and sustained a concussion that was the source of much nasty political speculation.

President Biden and George W. Bush made this catalogue of falls with bike crashes while out exercising. Present Bush also took a dump on a Segway experience. Having tried a Segway tour around Washington DC myself, I have sympathy for the awkwardness compared to a bike.

As to not ignore our former presidents Trump and Obama; each took a near-fall. Obama on the stairs of Air Force One, and Trump on a West Point walkway.

So, is this a political litany? Not really. It’s just to say falls are common among all of us. Still, we aren’t helpless about spills and there are numerous (usually small) efforts we can make to avoid them. The winter may be a particularly dicey time, and a good season to consider extra precautions against such perils.

Detriments of Slips and Falls

To me, there is little doubt that the prime culprit of falls is balance. And balance might be summed up by 3 factors as shown in this simple chart: Strength, Flexibility (with good range of motion) and Confidence in our movements.

For more technical coverage of the body parts and functions involved see “Are Slips and Falls Inevitable as We Age? Maybe.” The subtitle of that article is “but what about frequency and severity?” These two aspects are definitely not as inevitable.

To summarize this by word and graphic, I’ll borrow from some of my previous text.

Anatomy of a Fall

These 3 factors equate to an anatomy of a fall: loss of strength (resulting from immobility or age-related muscle atrophy) reduced ROM (range of motion) and decreased confidence. Diminished ROM and lack of flexibility reduce strength. In turn, this reduces confidence and increases apprehension. The vicious cycle continues.

Additionally, if either weakness or reduced range of motion causes pain or reduces reaction time, the cycle of fear is increased. And confidence diminished further. Describing this in text, the circle of words makes your head spin. I think the circle as a graphic gives you the general idea.

For more confidence, you might evaluate your own body’s balance (or imbalance) by following the self-analysis of another post. See “Is Your Body Equally Balance? Test Yourself.”

Senior Survival Training 

My baker’s dozen dangers to avoid below point to a phrase I’ve used many times on Aging_with_Pizzazz, namely “avoid the landmines.” It is my number one suggestion for longevity. Low-hanging fruit for sure.

I hinted at the fact that we may not be able to totally avoid falling. Okay, true. However, there are both hazards to avoid and positive steps to take (pun intended) to promote the safest of scenarios.

In no particular order, here are a dozen situations that need just one more second of thought and caution to make all the difference in life. As we age, most of us need to take more care to dodge these problems and avoid going through a recovery period that isn’t as quick as it may have been in our years past.

Think of avoiding these landmines as your survival training.

1. Insufficient Light – anywhere. Poor lighting can trigger a detrimental duo when combined with other of these dangers.

2. Bathroom and Slick Floors. If these floors are wet it’s tricky, especially if stepping over an awkward shower curb or difficult bathtub rim. Whether the flooring is tile, hardwood or waxed, they can be slick. [So, tell me, does anyone really wax their floors anymore? Guess my question gives me away.]

3. Invisible Ice (Black ice). Black ice or other winter conditions can easily initiate slipping. See info on Yak Tracks and other walking/hiking aids at Safely Enjoying a Winter Wonderland – Senior Stabilizers.

4. Morning Rise from Bed. Often, we are not fully awake, or at least our muscles aren’t fully awake when we rise. This is a time when vision can be a bit blurry and impaired, before glasses are on, contacts are in, or eyes are focusing. Visual acuity can be even less-than-normal at this time of day. Note too, that this is a common time when Benign Paroxysmal Positional Vertigo (BPPV) strikes or when we suffer blood pressure changes shifting from lying to standing. Dizziness can cause a fall because of any of these conditions. Make it a habit to always rise slowly, especially if starting any new medications. Steady yourself momentarily on the edge of the bed (remember it is just that 1-2 more seconds of caution).

5. Yard Work. Hoses, tools and tool handles are a significant trip hazard, along with rocks and plant roots. Be on guard when gardening.

6. Uneven Ground. While this is a factor in yard work as above, it can also be a culprit anywhere in the neighborhood. People tend to be more careful when hiking than gardening, but uneven ground can be disastrous anywhere if foot placement is lazy and ankle flexibility poor. Even scooting down the driveway or to the mail box (known territory) is a frequent location for taking a tumble. When in the vicinity of uneven ground, proactively think “attack, attack, attack” with every step.

Whether on unlevel or level ground, if you’ve been told you are walking ‘funny’ or know your gait has changed, you might check it out. Consult with your chiropractor, physical therapist or other health care provider.

7. Walking the Dog. Yes, uneven ground could be a problem here too, but the separate category has to do with pet owners tripping over the leash or the dog itself. Fido gets excited. Even if unintentional, he can trip you up. You want to play with your pet on the floor only when planned.

8. Rugs and Carpeting. Particularly throw rugs, or cumbersome door mats that move unexpectedly are tip hazards. Additionally, watch for worn carpeting with small holes or raised upholstery tacks (ouch). When crossing the perimeter of an area rug think “march, march, march” as in lifting your legs (slightly less aggressive than “attack-attack-attack” above).

9. Stairways. Stair danger is amplified (ascending or descending) if carrying anything. One of my own rules is if you can’t hold onto the banister, try to balance yourself with the elbow along the wall. Some therapists suggest not carrying anything if you can’t hold onto the rail. I guess that’s safer for sure. Yet, it doesn’t seem that practical, especially for those of us who live with stairs.

10. High Heels. Basically, I hope no one reading this blog wears high heels (which I call high hells). Proper shoe fit, including size and comfortable insole, is vital. Shoes with traction are another plus, unless you are out dancing.

11. Biking. All of us need helmets, but if you are over 50 and riding without one, maybe you’re a budding Evel Knievel. (Remember, he’s dead.) New electric bikes take work getting accustomed to since starts and stops are not like my first Huffy, or my husband’s Schwin. If you are eyeing an electric bike purchase, consider a ‘step thru’ model. Again, this is easier to balance. Personally, I think more bikes should have step-through options. And one final word about biking – “recumbents.” Recumbent bikes are wonderful, function better biomechanically and are a dream on the spine or for those with back problems. Two-wheel recumbents are at least closer to the ground, and trikes (3 wheels) are amazingly easier to balance than all bikes. I have an electric, but love my recumbent.

12. Blur of Reading Glasses. Not all seniors wear glasses. Some are able to function with reading glasses only, or wear contacts augmented by reading glasses. So, what is the falling risk? Shifting from sitting posture to standing can already be an issue, but with the addition of reading glasses you can experience a blur in vision or disorientation as you stand. A simple solution is to always raise the reading glasses to the top of your head before standing. The added advantage is that you rarely lose your glasses – unless you forget they’re on your head.

13. Rushing Unduly especially around Cars. Elders used to tell us “haste makes waste.” I might augment that to include haste can lead to a bad dive; that in itself can add to much waste (medical bills, time, health). I imagine that Justice Sotomayor would agree.

While this point about haste could be made for any location about falls, let’s zoom in on crossing the street. You may have read that the Governors Highway and Safey Assoc. found that the rate of pedestrian deaths has increased significantly – reaching a 40-year high last year.

The leading reasons are not the fault of the walkers, but instead distracted drivers, and larger vehicles causing more damage. Other reports include impaired drivers, recklessness, impatient drivers, bad weather, road construction, multi-lane changes and cars making left-hand turns, due to difficulty or laziness negotiating the intersection. [Okay, so unless you have an auto driving car, it’s the driver and not the car making that turn.]

Suggestions for Avoiding these serious problems of #13

• Take care, walk with caution (so don’t rush).
• Use designated crosswalks.
• Do not assume at any time that drivers are paying attention.
• Think of any moving vehicle as an incoming missile targeting you.
• Don’t wear dark clothes at night without light or reflectors.
• Don’t walk in the street. Despite arguments I have with people about not jay-walking, the winning argument is that there is a greater risk of getting hit.

Even if one survives these types of falls (whether rush and fall, or hit and fall), all are life changing. We know it; we just have to remember it before it becomes a dramatic scene.

FINAL THOUGHT

Leaders are sometimes figures to admire, other times not. But when it comes to slips and falls, none of us want to use them as a role model. Not to mention that many of us don’t have their health care insurance. Thus, it’s good for us to do everything in our power to keep ourselves healthy and vital.

When someone asks, “have a good trip?” we want them to be sincerely inquiring about our vacation time and not making a middle-school joke about a recent slip-up. We might not get the same (embarrassing or sympathetic) news coverage as celebs when we take a stumble, but it can certainly interfere with our quality aging goals.

Within the next couple months, in another post, I’ll address starting our own Balance Training. Quick and easy, when added to our dozen landmines to avoid, it can help us all stay up on our feet.

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References

CDC program STEADI, standing for Stopping Elderly Accidents, Death and Injuries. (More for providers and treatment options) STEADI – Older Adult Fall Prevention | CDC

CDC STEADI: Evaluation Guide for Older Adult Clinical Fall Prevention Programs cdc_78041_DS1.pdf or Resource Algorithm for Fall Risk Screening, Assessment, and Intervention (cdc.gov)

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Graphics title picture: Supreme Court Justice Sonia Sotomayor. Photo in public domain
Balance funnel: drb

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