The older we get, the less we want to make like Humpty Dumpty

The Woolwich Observer - - COMMENT - STEVE KANNON

“I’VE FALLEN AND I can’t get up.”

From cheesy com­mer­cial (first aired in 1989 by a com­pany called LifeCall) to fod­der for co­me­di­ans and pop-cul­ture ref­er­ence (i.e. “I’ve fallen and I can’t reach my beer”), the phrase has at its root a very real is­sue for older adults.

Falls are the lead­ing cause of death and hos­pi­tal­iza­tion in Canada for se­niors, with some 20 to 30 per cent suf­fer­ing a fall each year, ac­cord­ing to the Pub­lic Health Agency of Canada.

That real­ity fu­els re­search by Univer­sity of Water­loo ki­ne­si­ol­ogy pro­fes­sor Michael Bar­nett-Cowan. In a new study, he found that it takes se­niors twice as long to re­al­ize they’re fall­ing by com­par­i­son to younger adults – it’s a matter of mil­lisec­onds, but it can make a big dif­fer­ence.

Younger adults per­ceive that they’re fall­ing quicker than do older adults – 44 mil­lisec­onds ver­sus 88.

“That doesn’t seem like much time, but by that time, you’ve ba­si­cally al­ready fallen,” says Bar­nett-Cowan of the longer time­frame.

To mea­sure fall per­cep­tion, re­searchers pre­sented study par­tic­i­pants with a sound at dif­fer­ent times rel­a­tive to a su­per­vised fall. They found that young adults re­quired the fall to hap­pen about 44 mil­lisec­onds be­fore the sound in or­der for both cues to be per­ceived as oc­cur­ring si­mul­ta­ne­ously. But adults over 60 years old re­quired fall on­set to oc­cur about 88 mil­lisec­onds be­fore the sound.

“This lag means that by the time older adults re­al­ize they are fall­ing, it’s of­ten too late for them to con­sciously do any­thing about it. Given that falls are of­ten the cat­a­lyst for a tran­si­tion to long-term care, th­ese find­ings high­light both the im­por­tance of ad­e­quate as­sess­ment for older adults and the need to ex­pe­dite new pre­ven­tion tech­nol­ogy.”

As a rule, he says, peo­ple don’t have a good rec­ol­lec­tion of a fall – one in­stant they’re up­right, then next they’re on the ground won­der­ing what the heck hap­pened. His re­search aims to de­ter­mine how the brain in­ter­prets in­for­ma­tion about fall­ing and falls.

Sta­tis­ti­cally, older peo­ple are more likely to fall, mak­ing the re­search more press­ing to an ag­ing so­ci­ety. Along with the im­pact of hos­pi­tal­iza­tion and even death, falls come with a price tag es­ti­mated at $6 bil­lion a year. Se­niors who are hos­pi­tal­ized for a fall re­main in hospi­tal an av­er­age of nine days longer than those hos­pi­tal­ized for any other cause.

Ac­cord­ing to the On­tario In­jury Pre­ven­tion Re­search Cen­tre, the prov­ince sees some 100,000 emer­gency room vis­its by se­niors (65plus) each year, re­sult­ing in 20,000 hospi­tal ad­mis­sions and $1 bil­lion in di­rect costs. Some 2,000 die as a re­sult of falls in any given year. The most com­mon type of fall in­jury in­volves slips and trips, falls on stairs and falls from fur­ni­ture.

Fall pre­ven­tion is a key com­po­nent in deal­ing with the health care of an ag­ing pop­u­la­tion, along with the associated ris­ing costs.

“Falls are costly. And as we’re re­minded with win­ter’s com­ing, there’s def­i­nitely a need to deal with this,” Bar­nett-Cowan notes.

While his new take on re­search into falls is still in the early stages, Bar­nett-Cowan sees this kind of test­ing be­ing used to help pre­dict which older adults are more like to have a prob­lem. Fu­ture re­search may in­cor­po­rate peo­ple who have a his­tory of falls as a way of de­ter­min­ing the use­ful­ness of fall per­cep­tion as a tool.

To fur­ther his re­search, he’ll be look­ing to col­lab­o­rate with oth­ers, such as doc­tors who deal first­hand with th­ese is­sues.

“Is this po­ten­tially an early de­tec­tion tool to iden­tify the peo­ple be­fore the fall even hap­pens?” he posits.

Find­ing those answers is where fur­ther re­search comes into play.

Fall pre­ven­tion has been a strat­egy for years, par­tic­u­larly cen­tered on im­prov­ing the re­flexes and sense of bal­ance in older adults. There’s also the is­sue of bone health, as falls and bro­ken bones are a com­mon pair – the cliché-like bro­ken hip, for in­stance.

As well as iden­ti­fy­ing at-risk in­di­vid­u­als, the re­search could lead to wear­able fall pre­ven­tion tech­nol­ogy or per­haps even phar­ma­ceu­ti­cal ap­proaches to en­hanc­ing the brain’s abil­ity to cope with fall­ing.

“Fall­ing threat­ens one’s sur­vival,” says Bar­nett-Cowan. “When the ner­vous sys­tem’s abil­ity to de­tect a fall and com­pen­sate with pro­tec­tive re­flexes di­min­ishes, the risk of in­jury or death in­creases sig­nif­i­cantly.”

The con­cept of wear­able tech­nol­ogy – an ex­ten­sion, one would think, of the kinds of so-called smart cloth­ing al­ready touted – would have to be mind­ful of some se­niors’ aver­sion to out­ward signs of ag­ing and de­pen­dence on, say, canes and walk­ers.

I’m pretty sure my im­age of one day wan­der­ing around out­fit­ted in one of those gi­ant sumo wrestling suits or maybe hockey gear to pro­tect my­self from a fall isn’t what re­searchers have in mind, though maybe some knight’s ar­mour would be cooler. There are some real con­cerns, as Bar­nett-Cowan notes there are so­cial is­sues such as pride in­volved in some older adults choos­ing not to use sup­port such as canes and walk­ers.

There’s also a qual­ity of life is­sue in the mix, as some peo­ple who know they have bal­ance is­sues could be choos­ing to stay home rather than be seen us­ing as­sis­tance out in the world.

“We want to em­power peo­ple with as much in­for­ma­tion as pos­si­ble,” he notes.

To come up with the kind of in­for­ma­tion that will be use­ful in our ag­ing so­ci­ety, he and his col­leagues will be look­ing at older adult brains for cues and clues.

In the mean­time, Novem­ber is fall pre­ven­tion month, with an ar­ray of health care prac­ti­tion­ers warn­ing about the dan­gers of falls, rec­om­mend­ing ways to lessen the risk and

tips for im­prov­ing over­all health and bal­ance, the key to re­duc­ing the num­ber of falls.

Given that we’re liv­ing longer, there are a num­ber of age-re­lated health is­sues that are be­com­ing more preva­lent. And none of us is get­ting any younger – if it’s not an is­sue for you to­day, it will be even­tu­ally.

“It’s one more ex­cuse to get back the gym,” laughs Bar­nett-Cowan.

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