Stumbling and Tumbling

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Age UK and the NHS have declared  this “National Falls Awareness Week”. This may seem unnecessary advertising for Catholics and similar, who already keep too strict a tally of soul-lapses, but for old bodies it is a timely nudge. Even among fit free-range elderly the probability of a fall is 35% for over 65’s, and 45% for over 75’s rising to 50% in institutional care. Odds are worse for women than men. For older people falls are the most common reasons for visits to hospital emergency departments and their consequences significantly shorten and  impoverish lives.

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We take for granted the triumph of bio-engineering our species achieved to keep balanced on two multi-jointed moving props. We need to know how our legs and bodies are located in space, by how much our joints are bent and whether, and by how much our muscles are tensed or relaxed. Losses of skin-pressure-receptors on the soles of our feet make us less sensitive to small changes in pressure caused by slights shifts of balance. Degradation of balance organs, mounted next to our inner ears, also makes our judgments of the vertical less accurate, our feel for accelerations and decellerations coarser, loses information about forward and backward acceleration and of changes in body positions when climbing and descending slopes and stairs. This vestibular information supplements vision, particularly peripheral vision that monitors the peripheral flow of the streaming world as we move forward or backward. Age losses of peripheral vision make this less reliable.  Some textbooks genially comment that because seasickness is caused by the  mismatch between the information that we get from our vestibular organs of balance and from our eyes, loss of vestibular information eliminates these discrepancies and frees the elderly from  seasickness. I only wish my personal experience bore this out.

A key problem is that it becomes hard to recover from trips and stumbles. Not just because we lose leg-muscle strength and our limbs may collapse as we try to use them to prop ourselves but more importantly because we take much longer to notice that we have lost balance and can be well into a fall before we begin to try to correct it. Sensing danger, we are slow to make a rapid forward step to counteract a stumble and sluggish and awkward in initiating other movements to recover balance.1

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It is not surprising that the changes in our brains, nervous systems, sense-organs and muscles that make it harder to balance are also signals of general ill-being. A large sample of elderly in Sweden, Denmark and Finland were assessed when they were all aged 75 and again when they reached 80 2 . Those who had died before they reached 80 had, when they were earlier tested at 75, lower balance scores than those who survived. Even very simple tests of balance are predictors of levels of general health and so of risk of earlier death and loss of mental abilities.

The relationship between risk of falls and cognitive losses is interesting because it highlights an unexpected point that walking, as effortless and unconscious as it may seem, does take up substantial amounts of our mental capacity.  Sal Connolly found this while collecting data for a PhD thesis in Manchester. In what she called her “Gerry Ford Experiment”  after an alleged remark by Lyndon Johnson that his successor, Gerry Ford, “couldn’t walk and chew gum at the same time”. This was the LBJ famous for many brutal comments such as “If you have them by the balls their hearts and minds will surely follow”. LBJ does not deserve recognition for an early insight in understanding a relationship between  cognition and movement because his actual pungent comment was that the unfortunate Ford “Could not fart and chew gum at the same time”. (I mention this only for sake of historical accuracy. Please do not think too long about it).

Sal gave older people easy tasks such as simple mental arithmetic while they were guided through a short, easy safe indoor path. Doing an additional task caused many of them to go walk more slowly and some to trip and stumble. She found that  those whose walking was most affected by these additional mental tasks had previously suffered, and recovered from strokes which had, by the time she tested them, affected their gait  only very slightly or not at all. They had no problem unless they were distracted by simple mental tasks.  Excellent studies at the Berlin Max Planck Developmental Psychology headed by Ulman Lindenberger and colleagues 3,4  have since confirmed and extended Sal’s results by showing that not only recovered stroke patients but also healthy elderly people have difficulties in combining mental tasks with walking.

Fortunately there are many things that we elderly can do to rehabilitate ourselves and keep spry. For example an article in the Journal of the Academy of Nurse Practitioners reports the experience of elderly patients who were enrolled in a 9 week course in Jazz Dance 5 . Within three weeks of joining, and throughout the rest of the course, volunteers experienced significant improvements in balance and stability, cognitive ability and also more positive mood. Studies of elderly Chinese show that Tai-Chi preserves their balance and flexibility. An especially heroic experiment also found that regular Tai-Chi practice allows even older practitioners to preserve their balance in spite of disorienting stimulation of their vestibular systems 6 . So let’s hear it for National Falls Awareness Week! Time to make rehabilitative resolutions. Line Dancing! Yoga! Pilates! Tai Chi! Determined Long Walks!

 

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  1. van Dieen, J.H., Pijnapples, M., Bobbert, M.F. (2005). Age –related intrinsic limitations in preventing a trip and in regaining balance after a trip. Safety Science, 43, 437-453.
  2. Heikkinen, E.P., Gause-Nilsson, I., & Schroll, M. (2002). Postural balance in elderly people: changes over a five-year follow-up and its predictive value for survival. Aging and Clinical and Experimental Research, 14, 37-46.
  3. Lindenberger, U., Marsiske, M., Baltes, P.B. (2000) Memorizing while walking: Increase in dual-task costs from young adulthood to old age.
  4. Lindenberger, Ulman; Marsiske, Michael; Baltes, Paul B.     Psychology and Aging,  15  417-436.
  5. Allpert, P.T., Miller, S.K., Wallman, H., Havey, R. et al.  (2009). The effect of modified jazz dance on balance, cognition, and mood in older adults. Journal of the Academy of Nurse Practitioners, 21, 108-115.
  6. Tsang, W.W. and Hui-Chan, C.W. (2006).  Standing balance after vestibular stimulation in Tai Chi-practicing and nonpracticing healthy older adults. Archives of Physical Medicine and Rehabilitation.  87, 546-553.

 

 

About Gray Rabbitt

Grumpy gerontologist
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