Finding balance and lighting the way
Many of us are grieving over recent losses, whether it's Leonard Cohen and Leon Russell, or our presidential candidate of choice. For those of us in that situation, we try to find figurative and emotional balance in our lives, to hopefully outweigh the losses with the gains.
Though we suffer emotionally, we mourn, we survive, and we persist. But it also creates empathy for our seniors, who face more literal balance concerns that may impact their lives and possibly their mortality.
The CDC says that 20% of falls in the elderly cause serious injuries. Over 800,000 of the elderly who fall every year end up hospitalized, and 300,000 of those are hip fractures. Ninety-five percent of those hip fractures are caused by falls.
Falling once doubles the chances of falling again, and falls are the leading cause of death in the elderly. Wait, what? 95% of hip fractures are caused by falls? How are the 5% of hip fractures happening?
I remember the 75-year-old lady who was confined to her bed for six weeks until her medical status stabilized and her doctor ordered therapy. I evaluated her, I got her up (surprisingly easy considering how long she was on bedrest), and on the third step she took, her hip broke.
I heard what sounded like a two-by-four snapping, felt her sinking to the floor, and supported her until we were able to get a wheelchair under her. That's a pathologic fracture, caused by the osteoporosis that exacerbated during her bedrest. Pathologic fractures happen, but they're rare.
What is seen more often are the falls related to lower body weakness, dizziness, and balance deficits. So we address the lower body weakness with progressive resistive exercise.
Even with the immobile geriatric population, it's surprising how quickly the muscles “remember” and re-strengthen. Dizziness? Benign Paroxysmal Positional Vertigo (BPPV) is the most prevalent vestibular disorder, is found mostly in middle-aged women, and is the most common cause of dizziness. It's easily treatable with certain exercises and manual therapy.
Let's talk about balance and how it impacts the falls in our elderly population. We rely on balance to maintain erect posture and prevent falling. The components of balance are: Visual, Sensorimotor, and Vestibular.
Visual: When you open your eyes in the morning on a dark room, do you need to hold on to something? When you open your eyes and the room is flooded with light, is it different? Are you more stable? Your visual cortex may be your primary balance input. Your brain automatically adjusts to the room, and creates your standing stability.
Sensorimotor: Can you feel the floor? Do you have peripheral neuropathy and the floor feels “mushy” or hot? Imagine trying to stand wearing snow boots on a pillow. Our elderly who have impaired foot sensation may lose balance and fall from the inability to feel the floor.
Vestibular: Now it gets tricky. The vestibular system acts as a “bubble level” for your brain. If the fluid in the semicircular canals in your inner ear get clogged and the fluid doesn't move properly, expect a fall. I once had a 73-year-old athlete and downhill skier who kept falling at night. I asked him to stand and close his eyes, and he began to drop like a fallen tree. Opening his eyes saved him.
Most of our patients over 80 have vestibular deficits, and that's why they fall. What do you do? You can refer to therapy for vestibular rehab. Or you can turn on the lights. Adequate lighting prevents falls, and it's that easy. There are those who can't sleep with the light on, and they may resist. But given the choice between a life-threatening fall/injury, the benefits of re-learning to sleep outweigh the alternatives. Turn on the lights.
Jean Wendland Porter, PT, CCI, is the Regional Director of Therapy Operations at Diversified Health Partners in Ohio.