We all fall down. But while a tumble for a toddler is a learning experience, and a stumble for an adult is usually just embarrassing, for older people it can be a serious, even fatal, incident.
In 2010, 13 million Americans reported being injured in a fall, often caused by simple trips on the sidewalk or on the stairs at home. For the over 65s, the figures are worse: One in three in this age group falls every year, resulting in some 250,000 hip fractures and more than 25,000 deaths, usually from traumatic brain injuries. The health care cost of treating these falls is estimated to be $34 billion a year.
But if falling is such a common hazard, especially for older people, does that mean falls are inevitable? Is there nothing we can do about it – like improving our sense of balance?
Part of the challenge is that balancing is trickier than you think. Most of us are lucky enough that we rarely have to think consciously about it. But try standing on one leg for 30 seconds, the way you might have to if a police officer suspected you’d been drinking and driving. Then close your eyes, and see how much harder it gets. That’s part of a sideline balance test if you’re a football or hockey player and a trainer or doctor wants to assess whether you’ve suffered a concussion.
Simply staying upright is, in some ways, a full-body exercise. You have fluid-filled “organs of balance” in your inner ear that monitor the position and rotation of your head; and there are sensors known as proprioceptors in muscles and tendons throughout your body that detect subtle stretches and deformations. Your feet alone contain 11 small stretch-sensing muscles: No matter how many calf raises you do in the gym, your balance won’t be stable unless your brain is attuned to the signals from these sensors. Even wearing socks interferes with this subtle feedback and worsens your balance.
Walking is trickier still, since each step is essentially a controlled fall. Last year, researchers from Ohio State University showed that they could predict with accuracy where a walker’s foot would land by looking only at the trajectory of the upper body during the previous stride. What seems like a simple act, in other words, is actually a complex and near-instantaneous calculation that enables you to place your foot in exactly the right spot to prevent a face plant.
The current approach to this challenge is to add an additional box to check off: balance training. United States health guidelines already suggest balance training for older adults at risk of falls, and European countries like Austria, Ireland and Denmark recommend it for all older adults.
A step in the right direction, you might say, but it still presents balance as an isolated practice. The evidence is that a more integrated approach has greater benefits.
For an older adult who wants to continue living independently, it’s clear that the ability to rise from a chair and walk across the room, which requires the coordination of muscle strength, balance and aerobic activity, is more important than any individual element of fitness. And it’s not just a physical challenge. One key warning that you’re at higher risk of falling is if you tend to stop walking when you talk — a sign that the cognitive demands of staying on your feet are overloading your brain.
A striking feature of the balance and coordination exercises is that they sound a lot like games. Whether you’re dancing or playing tennis, the unpredictability of your partner’s actions means that no two workouts are the same. Perhaps the enjoyment we get from a good game isn’t just a nice bonus: It’s an indicator that we’re fully engaged, mind and body, in the activity. You could call that achieving good balance.
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Ohio State University research is mentioned to show
- the trajectory of walker’s foot
- complexity of people’s walking
- accuracy during the stride
- actions to prevent a fall
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