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For
elderly, a little slip can be last Baltimore
Sun, July 28, 2003 Falls: A researcher looks at why
a seemingly minor tumble can be deadly to the aging body. Here's Thurmon Lockhart's idea of a day's work: Pour soapy water on the floor. Watch a senior citizen take a tumble. Pour soapy water on the floor. Watch a senior citizen take a tumble. "It's kind of fun," he says with a chuckle. "We're very sneaky." No, Lockhart is not a sadistic sicko. In fact, he's a serious scientist at the Virginia Tech Locomotion Research Laboratory, trying to understand the mechanisms underlying a common and dangerous problem for the elderly - falling down. More than a third of older Americans fall every year, and more than 10,000 die from fall-related injuries. In 2000, more than 350,000 seniors were hospitalized after falls, mostly for broken hips. Last month, retired TV anchor David Brinkley and former Georgia Gov. Lester Maddox succumbed after falls. The month before, it was 72-year-old diet guru Robert Atkins. Among those over 65, falls are the leading cause of death from injury. "There are a lot of people dying from this, and a lot of those that don't die never recover," says Lockhart, an industrial engineer who took up the subject in 1995, when his father, a tough-as-nails Korean War combat veteran, began having balance problems. Given America's aging population, the field is growing. Lockhart is one of several dozen researchers nationwide using neurology, physics, kinesiology and sophisticated brain imaging to understand why elderly people fall and why those falls are so often deadly. But Lockhart's work is perhaps the most ingenious - or devious, depending on one's viewpoint. In his lab on Virginia Tech's Blacksburg campus, he studies "slip initiation and recovery," as he calls it. That means getting subjects to slip on a slick floor, and carefully measuring how their nerves, muscles and brains respond. To encourage his victims to move naturally, he relaxes them by playing audiotapes of Abbott and Costello routines while they walk. Below their feet is a sliding floor panel, which at the moment of truth is surreptitiously replaced by another covered with soapy water. To prevent injuries and lawsuits, Lockhart designed a harness that keeps subjects from hitting the floor. Real world falls are not so harmless, and scientists want to know why they're often lethal. Although many seniors are killed by the fall itself - particularly if they suffer head trauma - most die from related complications in the days and months afterward. In a cruel paradox of frailty, those who take the worst falls are often least equipped to recover. Especially vulnerable are the 320,000 Americans over 65 who break their hips annually. According to one study, they have a 33 percent chance of dying within a year. "They don't die from the fracture, they die from the associated problems," says Dr. Kenneth Koval, an orthopedic surgeon at the Hospital for Joint Diseases in New York. An expert on hip fractures and elderly bones, Koval says the burden of surgery and recovery often proves fatal: Anaesthesia can kill, as can infections that fragile seniors can easily contract in the hospital. Being horizontal also increases the risk, says stumble scientist Dorothy Baker of Yale University's Older Americans Independence Center. It forces the heart, lungs and kidneys to work harder and can contribute to blood clots. Often, the bedridden don't breathe deeply enough, which can contribute to pneumonia. For many seniors, regular exercise can lower the risk of falling, according to research by Baker and others. So can lowering doses of medications such as valium, which can cause dizziness. It also helps to use devices such as a shoehorn attached to a pole, which allows users to put on shoes without bending. Baker also focuses on reducing clutter that turns living space into an obstacle course. "Just at a time when you need walking paths that are wider and more direct, most people are at a point where their belongings have metastasized," she said. But these measures won't eliminate the problem. With more than 33 million elderly in the United States - a number that will almost double in the next 30 years - researchers say the number of senior falls will undoubtedly rise. So they're looking at the underlying mechanisms of "unintentionally coming to land," as a fall is known in the trade. Over the past eight years, Lockhart has learned a lot from his contraption. For example, young people actually tend to slip more than their elders because they take larger steps and walk faster. But the young also regain their balance more easily. "In many older people, detection lags behind," Lockhart said. Declining vision, strength and nerve sensitivity in the soles of the feet all play a part, as do changes in one's sense of balance and location in space. Lockhart also suspects that senior muscles contain fewer "fast-twitch" fibers than those of younger people, making split-second recovery more difficult. Lockhart's latest experiments involve sending mild shocks to the inner ear to disrupt balance. He is also working on a sort of pedestrian air bag - a device that would inflate before impact, protecting the hips of those who fall. The challenge, he says, is programming the device to recognize the difference between intentional movement and a tumble. Protective hip pads for the wobbly are already available, but they're bulky, and few seniors wear them. "My clothes are tight enough now," joked 84-year-old Gert Becker, a retired bookkeeper who broke four bones in January in a fall on an icy sidewalk near her Essex home. She has the pads but doesn't use them. Other slip-and-fall researchers are focusing on brain abnormalities. Neurologist Les Wolfson at the University of Connecticut has found that in some seniors who fall, the connection between the sensory and motor brain regions has degraded. As a result, he suspects, the brain is less able to mount an effective reaction to a stumble. Stephanie Studenski, a University of Pittsburgh geriatrician, believes that the brains of many unsteady seniors have subtle circulatory problems. Others might have a condition resembling Parkinson's disease - a cortical ailment that affects balance and movement. "In terms of falling, the brain is the part that's not yet well understood," Studenski says. Baker has yet another suspect - increasingly sedentary lives that are often the result of a fear of falling. "When an older person cuts back, the risk of falling increases, because they become more deconditioned," she says. Becker admits that she fears falling again: "I'm a little tense with everything I do." But she seems in no danger of becoming a prisoner of her fears. True, she has quit bowling, but she still goes out almost every day to the American Legion, the VFW post or the Moose Club. She even helps her husband, Ed, with yard work, picking up branches when he trims their holly tree. "I can't let my husband do everything," she said. "I don't like letting the grass grow under my feet. I have to keep moving." Copyright
© 2002 Global Action on Aging
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