Every 20 minutes, someone older dies from fall-related complications in our nation, according to the Centers for Disease Control and Prevention (CDC). One in four older adults falls each year, with one in five causing serious injury. More than just our pride then, is likely to get hurt when we fall. With age, many changes occur that cause us to fall frequently.
Frailty is a core physiological feature underpinning falls as we get older. Though frailty is directly correlated to falls, nursing home placement and death, most clinicians are unaware of how it develops or what to do about it.
Frailty Factors
Physiological factors that contribute to frailty include:
- Sarcopenia or weakness when muscle tissue is replaced with fat tissue
- Slow walking speed
- Weak grip strength
- Skeletal changes that lead to spine curvature
- Difficulties swallowing and chewing causing an inability to take in protein-rich foods that counter frailty
- Blood pressure that drops dramatically upon rising from a sitting to standing position, causing dizziness and falls
- A reduced ability to recognize thirst, thus losing the warning signal for dehydration
- Vision changes and loss of depth perception that impair judgment when stepping off of curbs
Superimposed on top of all these frailty factors are chronic medical conditions and hospitalizations. It is said that with every day spent in the hospital bed, we lose 50% of our function from the previous day.
As well-intentioned hospital care teams force us to stay in that hospital bed, they are unwittingly contributing to increased frailty, the associated risk of falls and longer hospital stays.
Not surprisingly and consequently for most older adults, physical therapy teams often recommend hospital patients transition to short-term physical rehabilitation facilities for more intense physical recuperation rather than go directly home.
Help Yourself
Fractures comprise a third in the triad of frailty and falls. After age 50, half of all women and a quarter of all men suffer a fracture related to osteoporosis (fragility or brittleness of underlying bone).
There are clear guidelines, especially for post-menopausal women, to have a bone density (DEXA) scan every two years to screen for osteoporosis, but this is often a much-neglected preventive health care measure.
To counter the “3 Fs” of Frailty, Falls and Fragility, the best investment in our own health is mobility and its cornerstones of aerobic and weight-bearing exercises.
Regularity rather than intensity of these exercises is integral to preserving mobility and function. Exercise built into daily routines is a time-tested principle of “Blue Zone” cultures (areas of the world with the most successfully aging populations). The Sardinians, for example, live on rocky terrain and for centuries they’ve visited neighbors and friends by walking or cycling over. Similarly, Tai Chi balance exercises are a mobility-promoting gift from ancient civilizations.
In the midst of the pandemic and as winter looms, it may be challenging to exercise outdoors. Indoor exercises can range from home exercise bikes and treadmills all the way to chair yoga.
Prevent falls by installing grab bars, shower benches, walk-in showers and raised toilet seats. Have adequate lighting; remove throw rugs. Eat enough protein to get the most out of exercise and to strengthen muscles.
Emergency contingency measures such as Life Alert necklaces and bracelets are essential. Mobility holds the keys to preserving functional independence.
Dr. Ardeshir Z. Hashmi is the Endowed Chair for Geriatric Innovation and Director of the Center for Geriatric Medicine at Cleveland Clinic.
