Humpty Dumpty in Retirement

September 28, 2010

“Humpty Dumpty sat on a wall…”

Of course if you are an egg like Humpty, hanging out on the top of a wall is inherently dangerous whatever your age. As for humans, we are able to go through most of life, taking our tumbles and in many cases getting right back up, without needing “…all the King’s horses and all the King’s men…” to put us back together again or without even requiring a cast. But as we get older, falls become more dangerous.

Why is that and what can we do about it?

Older people fall more frequently than younger adults for a variety of reasons, e.g.

* Impaired vision
* Side effects of medications
* Reduced muscle strength
* Joint and muscle stiffness
* Balance issues
* Environmental factors such as home or community hazards
* Decreased feeling in the feet
* Deformity and/or pain resulting from osteoporosis and/or arthritis

While older adults don’t fall as often as infants learning to walk, about one third over the age of 65 who are living at home fall once a year or more. The frequency of falls in institutional settings is even higher. The majority of hospitalizations for people over the age of 50 result from falls.

Older adults are also more likely to break bones when they fall. This is due in large measure to increased frequency of osteoporosis.

Osteoperosis is a condition is which our bones become more porous. Bone tissue regularly goes through a process of breaking down and reforming. As we enter middle age the reforming process normally slows and our bones gradually become more porous, less strong and more susceptible to fracture.

While osteoporosis occurs naturally as part of the aging process, it tends to occur more frequently in women, lighter-skinned individuals, sentient people, smokers, people with inadequate volumes of calcium and vitamin D in their diets and those who consume significant amounts of alcohol.

Vitamin D is essential for strong bones. Our bodies need it to absorb calcium and phosphorus during our digestive processes. Calcium and phosphorus help build strong bones. We can get Vitamin D from a few foods we consume, by exposing our skin to sunlight and through supplements.

There are not a lot of outwardly visible symptoms of osteoporosis. Some people lose height or may develop a stoop or “dowager’s hump.” But one of the most common symptoms is the breaking of a bone, particularly in the spine, hip or wrist.

There are simple, non-invasive screening tests for osteoporosis and osteopenia (a condition that reflects deficient bone density but not yet at the level of osteoporosis).

So, if the risk of falling increases as we get older, as does the risk of serious injury from falling, what can we do to reduce those risks? A lot!

* Have regular eye exams and wear corrective lenses as needed. Have eye conditions such as glaucoma and cataracts treated as recommended by your physician.
* Understand the side effects of any medications you are taking and the interaction of your medications with other things you may consume. For example, some medications when combined with alcoholic beverages result in dizziness.
* Exercise on a regular basis. Weight bearing exercises that strengthen your muscles also strengthen your bones. Walking is excellent. Yoga and Tai Chi can help with flexibility and balance as well as muscle strength.
* Maintain your weight in an appropriate range.
* Consume alcohol only in moderation. If you smoke, stop.
* If you sometimes feel dizzy when you stand after sitting or lying down, make it a habit to stand up slowly and allow your mind and body a moment to adjust before setting off.
* Wear sensible shoes with non slip soles, a firm grip of your foot and low heels that provide a solid platform for your feet. If you have orthotics, use them as advised by your physician.
* In your living space, assure that there is adequate lighting; tripping hazards (throw rugs, loose carpets, extension cords, clutter etc.) are eliminated; night lights are placed in bedrooms, bathrooms and the hallways in between them; grab bars are in bathrooms; stairs have railings and nonslip treads; use cordless phones to increase mobility. (See the “Home Sweet Home” section for more information on how to safeguard your home).
* If it is prudent for you to use a walker or cane for assistance, by all means do so.
* If you are at particular risk for falling you may want to consider wearing a padded hip protector. It may not sound cool, but professional football players and top female college basketball players wear them for protection, why not you?
* Consume adequate volumes of calcium and vitamin D to maintain bone health. Most authorities recommend at least 1,200 milligrams of calcium and 600 milligrams of vitamin D. Food sources of calcium include milk, yogurt, cheese, green leafy vegetables (broccoli, kale, spinach, turnip and collard greens), peas and beans, salmon, sardines and fortified juices). Food sources of vitamin D are few and include fortified milk, salmon, tuna and sardines.

People also produce Vitamin D through exposure of the skin to sunlight. However, as we get older this process becomes less effective and therefore supplements can be helpful. If you choose to take a supplement, it may make sense to take one that combines calcium and vitamin D.

Consult with your physician. If appropriate for you, there are medications that can assist with bone reformation.

It may also be helpful to reflect might happen if you do fall. How would you get up? Is there a phone within reach of the floor if you are not able to get up? Should you carry a cell phone with emergency numbers set up on speed dial? Should you wear a device that allows you to push a button to call for help?

Finally, the fear of falling hovers over many older adults. It restrains their activities and thus makes it harder to build the strength and flexibility to avoid falling in the first place. While it is important to understand the risks of falling and to not behave like Humpty Dumpty we cannot let the fear of falling restrain us from living our lives to the fullest. As Marie Curie (1867-1934) said: “Nothing in life is to be feared. It is only to be understood.”

R. Kevin Price

© 2008-2010 R.K. Price