(This article first appeared in the September 2011 issue of Active Aging.)
I had a personal reason to attend an evening presentation at the Newton Medical Center recently on the subject of “Good Balance and Falling Prevention.”
Here it is: Last December, I did a face-plant on the asphalt driveway outside of Dillard’s at Wichita’s Towne East Square. I have no excuses. It was mid-afternoon, no rain, no ice, no curb, no high heels. One moment I was walking, talking with a friend, and the next moment was aware that I was falling. I was fortunate, in that all I got was a skinned knee and elbow and my head felt as if it had been bounced on the pavement event though it hadn’t.
This unexpected fall was embarrassing at best, and created a lot of nagging questions in my mind. Why? Will this happen again? When?
I am certainly not alone. Emergency rooms across the country treated 2.2 million non-fatal falls in 2009. One in three persons above the age of 65 fall each year (I’m 68) and in 2007, 81 percent of fall deaths were among persons 65 and older.
Unless you have been physically challenged in some way, most people — myself included — pretty much take standing up for granted. Prior to the “Good Balance” presentation, I did not realize that human balance is maintained using complex input from three systems: Visual, proprioceptive and vestibular.
The presentation on “Good Balance and Falling Prevention” was given by Bonnie Tandoc, Ph.D., APRN; Valentin T. Tandoc, M.D.; and Phillip A. Harris, M.D., FACS, FARS. The Tandocs gave a beautiful competitive ballroom dance demonstration and led discussion on the importance of dance as it related to balance and fall prevention.
Dr. Harris, whose primary expertise is in one of the vestibular portions of the balance equation, gave a more detailed presentation with supporting visuals. He specializes in the ear and inner ear, and how well they work to get signals out to other areas of the body.
Dr. Harris explains that the ear is essential to balance. The inner ear has a complex make-up of fluid responsible to positional change, pressure and noise. In addition, it contains small stone-like weights that allow the body to know movement in space up or down (vertical) and forward or backward (horizontal). The ear coordinates with the opposite side, the eye, the spine, and the central control centers to tell our body where in space we are, where we are headed, and what type of reaction our body needs to complete our task of remaining in the position desired.
What causes falls?
Dr. Harris says that in general, falls occur because:
- Information is not being synthesized by the brain
- Information is not getting from external balance input of neck and ear to the brain (vestibular)
- There is a visual input deficit
- There is a proprioceptive input deficit (muscles, tendons, joints that tell us where we are in space)
- Medication (some can make you sleepy or dizzy)
- Lack of planning (such as hazards in the home)
- Pride (do not be too confident that it couldn’t happen to you!)
Diagnosis
Dr. Harris strongly urges people to be interested in their own health. For common balance problems, he says that 80 percent of the diagnosis is a patient presenting a clear history of issues, timeframes, aggravating factors, associated symptoms such as ear fullness, neck pain, loss of hearing and a recognition as to whether it is caused by vertigo. Write down the what, when and how of a dizziness or fall incident and then think about it, he advises. Sudden loss of hearing is a red flag, and may even foretell a stroke in another area of the body.
Prevention
- Exercise regularly to improve core strength, coordination and balance
- Have all your medicines reviewed by your doctor or pharmacist
- Have your eyes and ears checked once a year
- Make sure you are taking adequate calcium and Vitamin D
- Get a screening for osteoporosis
- Make your home safer
Dr. Harris’ best advice for people who have had balance compromised by medications, chemotherapy, trauma or other issues, is, “Never give up. Position vertigo is very treatable. Other issues that are not reversible still are treatable. See your doctor and physical therapist for help.”
What am I going to do about the nagging concerns that I have? A Tai Chi class has always been on my bucket list — although finding the time is problematic right now. I am fortunate to have my own horse, and although I haven’t been riding much in the heat of the summer, I plan to get back in the saddle soon.
Balance and coordination is of utmost importance in riding horseback. Yes, there is risk attached, but as an almost 90-year-old American woman who last heard was still leading pack trains in Iran told her doctor, “I am not too old to ride. I’m too old to fall off!’
Trust me, I’ll second that.
Writer: Joan Stibal Carter, advertising manager at Active Aging