BetterConduct

The prevalence of falls in the elderly is worldwide. HealthDirect, an Australian government funded agency that provides medical information, cites three reasons why the elderly are more likely to fall:

1. Chronic health conditions such as dementia, heart disease, and/or low blood pressure which can cause dizziness

2. Impairments, such as poor vision or muscle weakness, and

3. Illnesses that can affect balance. (What causes falls? (n.d) HealthDirect.  Retrieved from https://www.healthdirect.gov.au/what-causes-falls on July 6, 2018.)

 

If other senses in the elderly decrease in proportion to age and as a result of medical conditions, wouldn’t it be safe to assume that the kinesthetic sense would also be affected?  Normal aging conditions cause loss of body muscle mass, changes to vision, decreased visual tracking, and reduced hair cells and number of vestibular nerve fibers in the ear (Fernandez et al, 2015). It is no wonder that falls occur more often in the elderly.  What is this little discussed sense?

 

Mosby’s Medical Dictionary, 9th edition (2009) defines the kinesthetic sense as “an ability to be aware of muscular movement and position.  By providing information through receptors about muscles, tendons, joints, and other body parts, the kinesthetic sense helps control and coordinate activities such as walking and talking”.  (Kinesthetic sense.  In MedicalDictionary.com.  Retrieved July 6, 2018.)  I remember learning in my education courses that some students—and typically the hard-to-reach ones—learned best performing a task or going through the movements associated with an endeavor.  These particular students benefited from tracing spelling words in sand trays or having their arms physically moved to imitate motions they were asked to copy.  They learned best by doing. It turns out there may be a parallel with the elderly and learning new skills or maintaining movement and previous abilities. We call this kinesthetic learning. 

 

What changes in the body’s interpretation of balance as one ages?

The Medlexicon Dictionary defines proprioception as

“a sense of perception, usually at a subconscious level, of the movements and position

of the body and especially its limbs, independent of vision; this sense is gained primarily from input from sensory nerve terminals in muscles and tendons…and the fibrous capsule of joints….”  (Proprioception.  In Medilexicon.com.  Retrieved on July 6, 2018 from tps://www.medilexicon.com/.) 

Muscle mass decreases with age due to many factors, including limited exercise and lack of hydration to the muscles themselves. Proprioception is linked to balance issues in the elderly.  Perhaps the input of information from muscles and joints is distorted in some way as we age, and this incomplete data is translated into movements that are less precise or controlled.  The elderly must adjust and adapt to changes in sensory input, body structure, and physical movement.  No wonder maintaining balance is an issue.  

 

If falls are inevitable or highly likely, why not teach someone how to fall in a way that minimizes injury?  And, since many elderly individuals fear falling, wouldn’t learning how to fall help reduce this anxiety?  Most research concerning falls targets balance maintenance.  Stephen Robinovich, a professor in the School of Engineering Science and the Dept of Biomedical Physiology and Kinesiology at Simon Frasier University in Canada, states this maintenance relates to “how we perform activities such as standing, walking and transferring without losing balance.”  Transfer means changing from one position to another, which involves shifting weight.  Most falls occur when weight is shifted incorrectly during standing or missteps during walking, not from slips or trips.  Fear of falling can put you at risk because you may walk abnormally and change your gait.  Change in walking results in shifting weight differently as you move.  The elderly are more prone to these incorrect shifts during transference because “they have illnesses that affect their cognition, coordination, agility, and strength,” according to Fay Horak, a professor of neurology at Oregon Health & Science University. (Steinberg, 2017).  They also have changes to kinesthetic and proprioceptive feedback. 

 

Scientists agree that if you are falling, first protect your head.  Hal Needham, a stuntman who became only the second such artist ever to receive an Oscar in 2012, suggests a few strategies to help prevent injury when falling.  First, buckle your knees.  Needham says this decreases the height of your body which reduces your impact when hitting the ground.  Second, he recommends throwing an arm across your chest.  Do this even if you are falling backward. Third, Needham says to rotate your body in the direction of the arm you wrapped around your chest.  He says you will come down on your backside if you rotate far enough.  Try to roll into a ball while falling.  Of course, a stuntman prepares for a fall and practices techniques, which eliminates the element of surprise and spontaneity of an unplanned tumble. (From How to fall down without getting hurt (Sept 1, 2013) Bottomline, Inc.  Retrieved from https://bottomlineinc.com/life/personal-safety/how-to-fall-down-without-getting-hurt on April 13, 2023. 

 

Neurology Now magazine published a checklist for preventing falls in its Dec 2014/January 2015 issue.  It included clearing areas of debris and clutter, securing floor coverings, and recommendations for lighting.  It would be worth the time to review this list (Stephens, 2015).  

 

Sources:

Fernández, L., Breinbauer, H. A., & Delano, P. H. (2015). Vertigo and Dizziness in the Elderly. Frontiers in Neurology, 6, 144. http://doi.org/10.3389/fneur.2015.00144.

 

Steinberg N. A better way to fall. The Week, 2017; September 8, 2017: 36-37.

 

Stephens S.  Staying safe and grounded:  Tips to prevent falls at home and around town.  Neurology Now, 2015; Dec/Jan:65-67.