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Why Falling is a Plague

Why Falling is a Plague

July 15, 2020

Let’s talk about falling. As a toddler, it’s simply a part of life as one learns to use their legs for their intended purpose. As a kid, you might suffer a scraped knee while running around the playground with friends or if you fall off a bike. Oftentimes the most exciting plays in sports, such as baseball, volleyball, and soccer, involve an intentional dive to the ground. As an adult, falling becomes less frequent, but who hasn’t slipped on the ice or a freshly mopped floor? These instances rarely lead to serious injury, but even a broken arm will heal with time and some pain medication. Even the recent story of my sixty-year-old father falling into a leaf pile with a 30-pound leaf blower on his back was more amusing than concerning.

So why are falls a plague? Because they are impacting us more and more every year, there is no cure, and they are deadly. There was a time when falls affected almost no one, simply because humans did not typically live long enough for them to rear their ugly head. In this way, they are similar to heart disease and diabetes: modern medicine and food production has helped us live through so many other ailments that we are succumbing to new issues. For us to beat falls, we need to better understand why they happen and why they are dangerous.

Falls become more frequent as we age for several reasons. We lose balance as we lose strength in our muscles. We lose valuable reaction time. Our eyesight deteriorates, and thus we are more likely to miss something on the floor. Chronic diseases cause us to limp or walk with a less-than-ideal gait. Complex medications can cause us to be disoriented. While there are ways to mitigate all these risks, falls are undoubtedly a part of aging in our modern world.

Falls also become more dangerous. First, the falls themselves become less controlled. Despite the fact that younger people fall all the time, they usually have the coordination, muscle strength, and response-time to turn a fall into a controlled fall where damage is minimized. When I slipped on an icy patch in my driveway a few years ago, I was able to put my arm out and use my triceps to minimize the impact to my hip. Had my arm not been quick enough or strong enough, more force would have been delivered to my hip.

Second, more damage is done as a result of impact. Bones becoming more brittle as we age, and the same fall that ended with a bruise when you are 60 might lead to a broken bone when you are 70. Blood thinners are a common medication to reduce the risk of cardiac issues, but they prevent clotting and lead to more severe external and internal bleeding.

Third, uncontrolled falls have a greater chance of resulting in traumatic brain injuries from head impact. TBIs can be fatal themselves, but even when minor they can lead to decreased quality of life and be a complicating factor.

Fourth, our immune systems become more susceptible to infections as we age. Infections are common after an extremely invasive surgery, such as a hip replacement or repair. Of course, open wounds are also of concern. But infections can happen simply by being in a hospital, skilled nursing center, or even by spending too long in bed. When mobility is reduced post-fall, people can easily develop urinary tract infections by holding their bladder and not consuming sufficient fluids.

Fifth, many people do not receive immediate help when they suffer a fall. Social isolation is a well-documented issue among older adults, and this lack of regular human interaction can have huge consequences when it matters most. Even for people with vibrant social lives, they are not with their friends, families, or spouses all the time. Obviously, a call to 911 through a cell phone or emergency response pendant is ideal after a fall, but all too often these devices are forgotten or simply not worn regularly around the house. As a result, a study (1) found that the average response time to a fall is 4.5 hours, but those found deceased had been on the floor about 18 hours before found. If the fall was not fatal, the wait for help may be.

Lastly, many people lose their independence after a traumatic fall, which can lead to accelerated cognitive decline and the loss of will to live. One need only read Atul Gawande’s Being Mortal to understand the story of Alice, who’s loss of independence in a nursing home led to her passing away. The psychology is complex and not fully understood, but the idea that people need to make decisions for themselves and have hope of a better tomorrow is not new. Unfortunately, many of our modern methods for keeping people safe also impede their autonomy and independence.

If falls were a disease, there would be an emergency World Health Organization task force aimed at stopping this plague. While the problem of falls cannot be solved with a vaccine, there are a number of treatments intended to limit risk (using a walker is one of them). When we better understand the issues around falls, we can design solutions to limit the impact of this plague on our lives, and the lives of our loved ones.

 

Written by Peter Chamberlain, WalkWise Founder and CEO.

 

 

 

https://www.nejm.org/doi/pdf/10.1056/NEJM199606273342606?articleTools=true 

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