The mother of a friend of ours, I will call her Barbara, was an active octogenarian, a widow, full of life and enthusiasm with generally good health. But she had unrecognized osteoporosis and some balance problems, the latter she largely ignored, and her muscle mass and strength had declined substantially since her retirement as a nurse. One day, Barbara was at the farmer’s market and tripped off the curb, a curb she had negotiated many times over the years. She fell. Her hip was broken. Surgery repaired it, but one thing led to another — more on that below — and she was dead within two months.
It’s a sad but all-too-familiar true story. But it does not have to be that way.
Beginning at about age 40 and often well before, our bodies begin a process of organ and functional decline of about 1% per year. Bone mineral density decline can eventually lead to osteoporosis and a higher risk of fractures; balance decline makes falls more likely; muscle decline leads to loss of strength while increasing the fracture risk further. Declining reaction time exacerbates the risk more than most people recognize.
Almost 30% of older Americans fall each year, and 38% of those who fall say it limited their activity or led to a doctor’s visit, according to the Centers for Disease Control (CDC).
For people over age 65 in the US, falls are the most frequent cause of fatal and nonfatal injuries, with 27,000 deaths and 2.8 million ER visits along with 800,000 hospitalizations. Not surprisingly, the percentage of individuals who fall rises with increasing age, as does the percentage of serious falls. Healthy individuals of any age are less likely to fall or have a significant injury than those with poor health (69 fall-related injuries per 1,000 compared to 480 per 1,000.) The CDC estimates that at least 25% of falls could be prevented by screening older adults for fall risk with gait and balance assessment, offering strength and balance exercises, managing medications known to be closely related to falls, and, in many patients, prescribing added vitamin D.
So, yes, muscle strength and mass, along with balance and reaction speed decline over time, but these can all be slowed and even improved with appropriate aerobic and resistance exercises along with balance work, augmented by a good diet. The first step is to test your likelihood of falling.
Assessing your fitness status –
Grip strength — This is done with a simple device that measures your strength. This is an interesting measure because your grip strength correlates very well with overall muscle strength. Some call it an “indispensable biomarker for older adults.” Your grip strength correlates well with not only overall muscle strength but also the risk of injury, dementia, obesity, and even your immune function, along with an increased risk for some chronic illnesses like diabetes, heart failure, and lung disease. Fundamentally, reduced grip strength predicts life expectancy and especially reduced health span.
Big toe strength — This may surprise you, but big toe strength is essential to prevent falls. Try standing in bare or stocking feet, chin back, and with arms at your sides with palms turned out. Keeping your body straight, lean forward a few inches (like Michael Jackson used to do). You will feel your toes gripping the floor. Do this regularly and feel your toe strength improve.
Sit to stand — Another simple fitness test, including strength and balance. As with grip strength, this test is a good predictor of mortality. If you cannot meet the standard, you have a 5–6 times greater likelihood of dying in the next six years. Here is the CDC’s 30-Second Chair Stand assessment. To do the test, in bare feet, sit on a chair with your arms folded across your chest and stand up using the least possible supports (like pushing on the arms of the chair), sit back down, and repeat. Do this for 30 seconds as fast as you can. For a 60-year-old male, the minimum is 14, women, 12; for a 70-year-old male, 12, women, 10; and for an 80-year-old male, the minimum is 10, women, 9. Exercise more if you cannot meet or exceed your age-based level. Of course, your results will depend not only on leg muscle strength but on health in general, the presence of chronic illnesses, and your overall fitness.
Balance on one leg — for 10 seconds. This is a great, simple test of your ability to balance. If you cannot meet the standard, take a balance class or try yoga. Balance, like muscle mass and strength, is critical to prevent falls. It declines with age, so if you do not work to maintain balance, it will soon fail you.
Walking (gait) speed — This simple test is walking at your usual pace for ten meters (about 33 feet) while timed. Normal walking speed is an interesting measure of multiple aging impairments. It slowly starts to decline like other body functions and does so gradually but steadily, accelerating over the age of about 70. As measured by walking speed, mobility is a unifying concept in gerontology. As we might imagine, gait speed is adversely affected by aging impairments, chronic diseases, disuse, and de-conditioning. Overall, gait speed is a marker for “biological vitality” and is sometimes designated as the “6th vital sign.” Gait speed is a potent predictor of multiple adverse outcomes. As just one example, the number of deaths per hundred person-years is markedly up for those with a slow gait speed versus those with a rapid gait speed. [See nearby chart modified from a lecture by Dr. Jack Guralnik, professor at the University of Maryland Medical School and formerly at the National Institutes of Aging.] Nursing home admissions and general well-being follow the same pattern. (Comment from Ed – Later models of Apple iPhone, actually monitor and rate your walking Gait. See details in Health App on iPhone)
Modified from Jack Guralnik, MD
Barbara was an active octogenarian but did not exercise her muscles regularly or attend to her developing balance and coordination issues. When she tripped, it took her longer to react, and her muscle strength was insufficient to “catch” her fall, so down she went. The impact was enough to break her osteoporotic hip. That was the first step in a series of consecutive events that eventually took her life. The hip was surgically repaired. She could not care for herself at home initially, so she was sent to a nursing home, hopefully for just a week or so, while she regained her ambulation. She needed to get up and about, but her muscle strength was limited, and she spent too much time not moving. Soon, she developed a blood clot in her leg, which migrated to her lungs (pulmonary embolism.) Anticoagulants were begun, but she was now increasingly tired and weak and soon developed pneumonia and died.
Preventing falls –
You don’t have to follow that same path. Prevention is quite possible. Be sure you do not have rugs that can slip. Keep your floors clear of items that you might trip over. Be watchful for where your pets are. Put grab bars in your shower and near your toilet. Do not wear shoes with slippery soles. Have night lights to find your way to and from the bathroom. Do not drink too much alcohol. All simple things but vitally important. But fall prevention involves a commitment to fitness, also.
Begin a regular exercise program. First, you need 30 minutes of aerobic exercise six days per week or the equivalent. Just brisk walking will be fine.
Second, do resistance exercises with weights or resistance bands or even body weight twice weekly, preferably more. If you do not have a gym membership, you can do a lot at home using your body for resistance with exercises such as the plank (great for strengthening your core muscles,) pushups, squats, and crunches. These do not cover all muscle groups, but it is a good start. It is harder for an older person to build muscle compared to someone younger, but build you must; you can do it. If you belong to a gym or fitness center, ask a personal trainer to show you the proper form. A good personal trainer is invaluable — money well spent.
Third, adding high-intensity interval training twice weekly is also a good idea. For example, if you are riding an exercise bike in the gym, set it for a moderate resistance level and pedal at a brisk pace for two minutes, then increase the resistance and your speed as much as possible and go for 30 seconds. You should feel the effort with some burning in your legs, and you will be breathing harder. Then, drop back to the modest level and speed for 90 seconds. Repeat eight times for a total of 20 minutes. This is great for your heart and lungs but is especially good at maintaining and even growing neurons in your brain. The grips on your bike handles might display your heart rate on the bike’s screen. Also many smart watches will display your HR.
Take a balance course. You almost certainly have reduced balancing abilities. Get tested and then follow instructions in a gym course, with home exercises, or both. It will make a world of difference.
Improve your reaction time with some cognitive exercises. Yoga and meditation help, as does using your non-dominant hand to do everyday activities — brushing your teeth, eating and drinking, and writing.
And remember that you need a healthy diet with plenty of adequate protein, including omega-3 fatty acid-laden fin fish and lots of nutrients from vegetables and fruits.
Assistive devices –
You may need a rollator, a cane, or other device. Doing so is not a marker of neglect or personal failure. Use it and avoid a fall. There is no shame in being safe. But use it properly. For example, most people lean over their rollator; instead, stand up straight. If you do the exercises suggested to rebuild your muscle strength and do the balance exercises, you will likely be able to toss the rollator away or donate to someone else.
Is it worth your time and money?
Follow these suggestions and the chance of a fall will be markedly less, and, should you fall, your ability to “catch” yourself or break your fall will be much improved. Do not become a negative statistic. You cannot prevent every fall and still “live your life,” but you can markedly reduce your chances of a serious event, one that could lead to your death or long-term disability.
You don’t need to tackle everything at once. Choose something to start, maybe a regular walk with a friend. Add other items over time. Remember, you are not alone. Every senior has lost muscle strength, reaction time, and has declining balance. Although you may instinctively want to deny a problem, it is best to accept it and do what you can to improve. There is no shame in recognizing it.
(An article from www.medium.com by Stephen Schimpff MD, MACP) June 2024