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