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Exercise
Lowers the Rate of Falls Among Elderly
By Elizabeth Simpson, The Virginian-Pilot
September 6, 2005
In a research lab in Blacksburg, Thurmon Lockhart explores a health crisis growing as stealthily as a cancer.
He attaches sensors to people from head to toe; measures nerve reactions, muscle response and messages to the brain; and downloads data into computers. The problem he's delving into costs this country billions of dollars in medical care, not to mention thousands of deaths, every year.
It's not a cancer he's studying. Not Alzheimer's or heart disease. There's no walk-a-thon or relay for life paying for his research, and Lockhart isn't a doctor. He's a researcher in the field of engineering at Virginia Tech.
The often life-crippling phenomenon he studies afflicts one-third of people older than 65 in any given year:
Falling down.
Contrary to what we see in Charlie Chaplin movies, falling is no laughing matter.
It's the leading cause of accidental death for older people. Of those people 65 and older who suffer a fall, 20 to 30 percent will experience a loss in mobility, or of independence.
About 25 percent of older adults who sustain a hip fracture will die within a year, according to one study. And more than half who survive the injury will end up in nursing homes. The nationwide cost of care of the growing number of hip fractures alone is projected to reach $240 billion a year by 2040.
"It will be an epidemic in the U.S., a pandemic for the world," Lockhart said. "Right now there's no coordinated effort to attack it. There's no society for slips, trips and falls."
Mamie Etheridge, 85, does not have to be convinced of the gravity of a fall.
"It was the worst experience I have ever had in my life," the Virginia Beach woman said of a fall she suffered in April. She had gone to get a drink of water in her kitchen.
"I felt kind of strange, " she said. "I was going to take a step back."
She tried to, but it felt like her left leg wasn't there. She fell on the floor and discovered she couldn't move. She could see her telephone above her, sitting on a small table atop a lace doily. She tugged on the doily to pull the phone to the floor to call 911.
Ten minutes later, she was on her way to Sentara Virginia Beach General Hospital with a broken leg.
After four days in the hospital and five weeks at a rehabilitation center, Etheridge knew she still wasn't ready to go home. So she signed up to stay for several months at the Sentara Village of Virginia Beach assisted-living facility.
Etheridge admits her fall put fear in her.
"It threw a shadow over me," she said.
Beverly J. Bobo, administrator at Sentara Village, said people often move there because of falls, sometimes at the behest of their children. Many, such as Etheridge, think they will return to their homes. And while some do, many do not.
Fred Meyett, 90, is one of those who did not. He lives at the Brighton Gardens of Virginia Beach assisted-living facility and is still puzzled by his life-changing fall last November.
"I have asked myself many times, 'How did it happen? Why did I fall?'" he said.
He lived alone in a third-floor apartment in Baltimore, the city where he spent most of his life. On his way home from a store one day, he crossed the street and put his left foot up on the curb. His right foot never made it there.
"I tried to pull myself up, and it didn't work."
A passer-by called an ambulance to take him to the hospital, where staff sifted through his identification cards to figure out who he was. He had broken his pelvis and his right shoulder.
His children decided it was time for him to move to Virginia Beach, where one of his sons lives. He still walks, but not as much as he used to. He confines himself to the
Brighton Gardens' grounds.
"If I fall here," he said, "they'll at least know who I am."
The fear of falling can be as debilitating as a fall itself, according to a study by the Saint Louis University School of Medicine in Missouri published earlier this year. Researchers surveyed nearly 1,000 people 49 to 65, one-third of whom had experienced a fall within the past two years.
Of those interviewed, 13 percent were so afraid of falling they cut back on their activity.
As a result, they tended to be worse off socially, emotionally and physically than adults with no fear of falling. The less active people are, the less muscle mass they have, which makes them more prone to falling.
Becky Riordan, a physical therapist at Sentara Healthcare's Balance and Mobility Program in Virginia Beach, treats that fear like a malady itself, trying to erase it by teaching people ways to improve their balance.
Her message is that people can do things to prevent falling - such as strengthening muscles around the ankles and knees. That, in turn, can keep them active, one of the most important defenses against further deterioration.
"People think as you age, you're supposed to fall, and you're not," she said.
One day in July, Jack Klinefelter, 80, of Norfolk was her client. He had tripped a few times during the past year and also noticed he wasn't walking as straight as he used to. If he was mowing the lawn or pushing a shopping cart, he was fine. But if he was just walking, he tended to drift.
Three elements are critical to good balance, Riordan said: vision, hearing and the strength of your muscles and bones. Age can erode all three. Riordan helps people improve whatever areas they can.
Riordan had Klinefelter stand on a flexible, air-filled disc that forced him to use his ankles to maintain his balance.
"Good. Good. Use your visual focus," she said as he found a place on the wall to concentrate on.
She also advised an exercise that keeps his gait strong and long, because people tend to shorten their steps and slow down when they fear falling. That makes them shuffle, which puts them more at risk of a fall.
Klinefelter, who also has daily exercises Riordan sends home with him, said he can tell his ankles get a good workout.
"I'm more aware now that I have to use my ankles and keep my weight better distributed," he said. "If I concentrate on that, I will do all right."
The science behind those exercises intrigues Lockhart, an assistant professor at Virginia Tech. He already had been studying the mechanics of falls - mainly industrial-related ones - when his elderly father started to have balance problems. Lockhart decided to focus on falls among older people, which garnered him grants from the National Institutes of Health and the Centers for Disease Control and Prevention three years ago.
His study in his Locomotion Research Laboratory - which analyzed the phases of falls and why the elderly are prone to them - also drove home what America is in for as its population ages.
One of the challenges, he said, is getting the word out to people that something can be done.
Media images sometimes portray older people as powerless and pathetic, as in the "I've fallen and I can't get up!" commercials for devices that alert help after a fall. Television shows such as "Saturday Night Live" and "America's Funniest Home Videos" use falls for comic relief.
"Falls are considered laughable," Lockhart said. "Even someone who falls will get up and laugh, even though they're in massive pain."
There are many special ties that play a role in prevention, which makes it difficult to bring everyone to the table to unify marching orders.
There's the medical: building stronger bones throughout life; addressing vision and ear problems; monitoring medications that can cause dizziness; and managing diseases such as Parkinson's, diabetes and arthritis.
And the environmental: cleaning up clutter in homes, adding handrails and removing hazards such as area rugs.
Finally, there's exercise, which is becoming perhaps the most critical prevention.
A study published in the British Medical Journal in 2002 compared the effects of modifying homes, improving vision and increasing exercise. Those who had only home changes or vision improvement had no change in their fall rate. Those in the exercise-only group had an 18 percent lower fall rate than the control group. People in the group that combined all three strategies had a 33 percent lower rate.
One recent day in Norfolk, a dozen students - mostly in their 60s through 80s - slowly, gracefully, moved their arms in gentle arcs, as they shifted their weight from one well-placed foot to the other.
The ancient Chinese practice of tai chi brought them to this weekly class at Bon Secours DePaul Medical Center.
"Heels together," instructor Donald Davis said as he walked among his students, straightening a shoulder here, adjusting an elbow there. "Shift all your weight into the left leg. Now step to the right. Put all your weight in the right leg. Make sure your left leg is empty. Release whatever tightness you feel so the body is relaxed and empty."
Older people have been drawn to the classes. The slow shifting of body weight from one foot to the other has been shown to improve balance, strengthen muscles and improve flexibility.
Don't just take Davis' word for it, though. A December study in the journal Medicine & Science in Sports & Exercise found that tai chi classes taken by a group of people 70 and older were able to reduce fall rates.
The poses with ethereal names such as "White Crane Spreads its Wings" look easy, but they aren't.
"It's murder doing it slowly," said Florence Karp, 87, of Portsmouth.
Tai chi may not appeal to everyone, but fortunately there is plenty of other exercise fare. Sentara Healthcare has yoga classes for seniors. YMCAs have "body recall" classes to help older people improve strength and flexibility.
At the Senior Station in Portsmouth, Marvin Gardner regularly draws 70 to 90 people three days a week for his low-impact aerobics class.
"It's all about the tunes," said Gardner, who tries to stay away from what he calls the "E" word - exercise - and focuses instead on having fun to lively music.
"OK, let's do the washing machine," he yelled as he twisted to the rock 'n' roll classic "Tutti Frutti."
Nettie Anderson, 83, has been coming for three years, even though she uses a cane.
"It picks me up," she said. "I use my muscles more. And I like the camaraderie."
Back in the Locomotion Research Lab, Lockhart said there is still much work to be done in measuring just what kinds of exercise work best, how often, how much, how best to get people to do it, not to mention research on other preventions.
One idea that grew out of his own research are hip pads for "frequent fallers" with small air bags that deploy during a fall. There are hip protectors on the market already, but they're so bulky people don't wear them as much as they should. His invention - already patented - lies flatter, in shorts that inflate when sensors signal a fall.
As a nation, he said, we are still coming to terms with the problem of falling and all the ways of tackling it.
"In five or 10 years, it's going to be a huge problem," Lockhart said. "And it's not like there's a medicine you can take once a day to fix it."
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