8/29/17: PREVENTING FALLS: Build Your Muscles, Maintain Your Balance


It’s probably not news to you that older people have a higher risk of falling than younger people, and, that when they do fall, the damage can be catastrophic, even fatal.

According to the U.S. Centers for Disease Control and Prevention, one in three adults age 65 and older—about 13 million people—falls each year in the United States. After age 80, writes Dr. Adam Darowski, author of the patient- and advocate-friendly primer, “Falls: The Facts,” the fall rate is one in two.

Of the 13 million, reports the CDC, 20 to 30 percent suffer “moderate to severe injuries that make it hard for them to get around or live independently, and increase their risk of early death.”

Although hip, back, and other non-head injuries sustained in a fall can be life-threatening—often because of risks presented during the post-surgical recovery period—the most frightening of all injuries is a brain trauma that results in either severe cognitive damage or death. Elders with fall-related head injuries often don’t make it back.

A major reason for this increased fall risk is sarcopenia, which is the decrease in muscle mass and muscle strength that occurs naturally as we age. Sarcopenia reflects atrophic changes primarily in skeletal muscles, but these changes also occur in skin, bone, liver, kidney, and spleen. Muscle-mass loss incident to aging is greater in the lower body than in the upper body, and in the extremities, generally.

Skeletal muscles are muscles attached to your bones and are striated, meaning their fibers are streaked. Think of your biceps and triceps, quadriceps and glutes. In contrast, smooth muscles are found in the walls of your internal organs, such as your bladder, and in your blood vessels, and are not streaked.

Generally speaking, when muscle quantity declines—when you lose lean muscle mass as you age—muscle quality deteriorates. Functionally speaking, this means weakness. Weak, deficient muscles contribute significantly to your fall risk. To prevent injury to your joints and to help you to maintain flexibility and balance—all of which will protect you from falling—you have to build and strengthen your muscles.

Muscles and Balance    

Dr. Darowski categorizes falls as follows:

  • Accidents, trips, and slips
  • Falls due to an illness that causes weakness or unsteadiness
  • Falls due to an innate tendency to fall
  • Falls due to faintness (or dizziness) or loss of consciousness

He attributes the causes of these falls to what he calls intrinsic factors, which have to do with the status of the person who fell (hampered, e.g., by a bad knee, muscle weakness, poor grip, cognitive impairment, or visual deficits), and extrinsic factors, which usually exist in the environment (a slippery floor, loose rugs, or poor lighting).

Typically, extrinsic and intrinsic factors combine to create a fall.

To assess an older person’s risk of falling for purposes of prevention, you really need to probe his or her intrinsic factors. One of the most important such factors is balance, which affects gait or walking style and is related to muscle quality. According to Darowski, the balance systems of elders are “less sensitive, less rapid, less accurate, and weaker.” Sarcopenia has a lot to do with this.

As the fall-facts expert explains, balance control has to do with your ability to recognize your body’s position in space and to restore your body to a balanced position when it becomes unbalanced, for example, after a stumble. This control involves both conscious decisions to move and subconsciously made movements.

Being “in balance,” Darowski writes, means your body’s center of gravity is kept within an area above the feet known as the base of support. Your brain knows where the body’s “vertical” lies and where the body is in space at any time because of sensations it receives from your nerves. When these sensations deteriorate, as they do with age or illness, you lose your balance.

Proprioception is your unconscious perception of your body’s movement and spatial orientation. Proprioception arises and depends on your body’s nerves carrying sensory information to your brain, specifically, to the cerebellum, which, in lay terms, is the center of movement and coordination.

Besides nerves associated with your inner ear and your eyes, “balance” nerves come from all of your muscles, joints, and tendons and tell you where you are in space. Those in the soles of your feet, for example, tell your brain whether you are on firm or shaky ground. Nerves that tell you about skin sensations assist your balance nerves.

Weak, damaged, or painful muscles and joints (think arthritis), which commonly beset aging bodies, affect the brain’s ability to process sensory information. If the nerves that transmit impulses to the muscles are damaged, there will be some impairment of balance and an increased likelihood of falling.

Balance also may be threatened by a variety of other factors, including:

  • Inner-ear (e.g., vertigo) or visual impairment
  • Disease (notably, Parkinson’s disease)
  • Infection
  • Alcohol intake
  • Certain medications (e.g., psychotropics, such as drugs for depression) as well as multiple medications (polypharmacy)
  • Frailty
  • Anxiety
  • Depression
  • Confusion
  • Simple lack of concentration

Clinical research clearly shows that a use-it-or-lose-it muscle strategy can reduce and even reverse sarcopenia, particularly when the “use it” consists of weight training or another exercise of a resistance nature. Even frail 90-year-old nursing home residents can build and rebuild muscle mass and improve their functioning with strength training.

That same resident can improve his or her balance. Balance training, which you can do on your own or with a physical therapist, involves strengthening the muscles that keep you upright, such as those in your legs and in your “core.” The core muscles are those in your torso that control and support your spine. They are often referred to imprecisely as the “abdominals.”

Many people do tai chi or yoga for balance. But even simple exercises such as standing still and raising one leg for five or more seconds (without toppling over), in front, behind, or to the side of you, or standing up from a chair and sitting down without using your hands help. When you strengthen your muscles and improve your balance, you reduce your risk of a fall. Don’t let your muscles go. Use them.

In my next blog, I’m going to step out of the medical world and tell you about an exciting book project in which I’ve been engaged. It’s an unusual memoir-biography that I edited and am publishing in September. But first, I’m going to end this summer by taking a Labor Day weekend rest. Happy holiday to you all.

Ann, 8/29/17

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