​Every second of every day, an older adult (age 65+) suffers a fall in the U.S.—making falls the leading cause of injury and deaths from injuries in this age group. One out of four older adults will fall each year in the United States, making falls a public health concern, particularly among the aging population.(*1) Avoiding unintended falls is a crucial part of a Senior’s ability to stay independent and continue a quality of life worth living.  Falls are not a natural part of aging but it takes a little work to avoid these falls.  Did you know that 40% of all nursing home and Continuing Care Retirement Community (CCRC) admissions are due to an unintended fall.(*2) 
So, how can you or a loved one avoid an unintended fall? Over my 20+ year career, I have seen many different methods and programs come and go among physical therapists, personal trainers and motivated loved ones trying to help someone they care dearly about to keep them safe and independent.  Avoiding falls really comes down to these three key elements to prevent unintended falls.  So, what are they?

1. Vestibular System (Your eyes and ears)
2. Leg Strength
3. Neuromuscular Efficiency (How the brain/spine communicates with the muscular system, mechanoreceptors and proprioceptors.)

First, let’s start with the vestibular system.  What is it, how does it impact our balance?  If you or someone you know has had the bad luck and/or misfortune of experiencing vertigo, you can understand exactly how important our inner ear can be to our balance.  Loop-shaped canals in your inner ear contain fluid and fine, hairlike sensors that help you keep your balance. At the base of the canals are the utricle and saccule, each containing a patch of sensory hair cells. Within these cells are tiny particles (otoconia) that help monitor the position of your head in relation to gravity and linear motion, such as going up and down in an elevator or moving forward and backward in a car.*(3)  Our eyes also help us maintain our balance by allowing us to see where we are going. 
​
If you talk to any pilot, they will tell you that there are two types of flying.  Pilots will use their eyes are clear sunny days to help them see where they are going (visual flying) but at night, pilots rely on their instruments to guide them through flights and ensuring safe takeoffs and landings (instrumentation flying).  There is a “common” nerve that runs from our ears to our brain and it serves as the super highway if data and information that our brains must process so that we maintain balance and can orient ourselves in our surroundings.  Our eyes have their own “common” nerve that delivers data from our sight to the brain and serves the same purpose as the common nerve from the ears.
An interesting phenomenon occurs, known as motion sickness, when our brain receives conflicting information from these common nerves.  For example, if you’ve been in a boat during a storm or when the waves are particularly rough, your ears are sending signals to your brain that relay the motion of your body as you rock back and forth, up and down.  Meanwhile, your eyes are fixated on the horizon and sending signals that relay to the brain that you are fairly stable and not much going.  All the while, your being tossed around the boat due to the wave activity.  The brain is receiving mixed signals and this often times results in motion sickness.

Leg strength is what I consider a Life Indicator.  A recent study published by the British Journal of Sports Medicine found that if you cannot stand on one foot for 10 seconds or longer, your life expectancy is 10 years or less.*(4) Also, leg strength is imperative to our ability to keep our hearts healthy!  If you have weak legs and cannot stand or walk for longer than a few minutes, how are you going to do cardiovascular exercise?  As we age, polypharmacy becomes common and the side effects from taking numerous medications simultaneously that include constipation.  I know this is not the most glamorous topic, but it should be known that the more you move and walk, the more blood circulates throughout the body, including the digestive system.  And I’m sure if you’re reading this and are over the age of 60, you understand the impacts of gravity and how it pulls things down… and out!  I think you know where I’m going to I’ll leave it at that.

Neuromuscular efficiency is just a fancy way of saying, “how well does your brain and spine communicate with your muscular system”.  As we age, our bodies and brains go through a lot of changes.  In the brain, our synapses move further apart resulting in slower reaction times in our everyday lives.  The good news, the brain is malleable and exercise, along with puzzles and word search games can keep our brains in tip-top shape.  However, neurological disorders such as Alzheimer’s and Parkinson’s can have devastating effects on our brains ability to communicate with the rest of the body.
When you combine these three components in an assessment or evaluation of a patient or client, you get a pretty clear picture of their (or your) future and quality of life that can be expected.  In terms of balance, these components are a great predictor of falls. 

My advice: 

1. Walking is a great to build and maintain leg strength.  One of my favorite exercises to increase leg strength is to have my clients sit down in slow motion.  You want to ultimately avoid the “plop”.  Make sure that prior to sitting, your legs are chair-leg width apart and take four seconds to descend.  By the time you countdown backwards and reach “1”, your butt should be gently hitting the seat of the chair or sofa.
2. It has been widely researched and studies have been done on the benefits of doing crossroad puzzles, word searches, puzzles, Mahjong and other games that force you to think and use your brain.  The impacts of doing these mind games and challenges will ensure that you are operating at your maximum mental capacity.
3. Get your eyes and ears checked at least once a year.

 
Chris R. Williams
President (Emeritus Health)
Author of Balance University
 
Website:
https://www.emeritushealthfitness.com/

1. CDC - (https://www.cdc.gov/injury/features/older-adult-falls/index.html)
2. National Floor Safety Institute (CDC) - (https://nfsi.org/nfsi-research/quick-facts/)
3. Mayo Clinic - (https://www.mayoclinic.org/diseases-conditions/dizziness/multimedia/inner-ear-and-balance/img-20006286)
4. BMJ - (https://www.bmj.com/company/newsroom/inability-to-stand-on-one-leg-for-10-seconds-in-mid-to-later-life-linked-to-near-doubling-in-risk-of-death/)

Throughout my 20+ career, I have heard it all!  Well, I think I have heard it all when comes to excuses and why folks are not exercising or trying to improve their balance.  The excuses range from “I don’t have time” to “it hurts when I move,” however, there are some differences to consider between an excuse and an obstacle.  For example, “not having time” to exercise or work on one’s balance would align more as an excuse, whereas someone with neuropathy would be considered an obstacle that one must overcome.

Excuses come in many shapes and sizes for people.  I have found success motivating people by focusing on the short term “wins” in their routines.  For example, balance is something that comes easy for some but for a lot of Seniors, balance can be particularly challenging and frustrating.  A favorite method of mine is to find a balance position or movement that one can do efficiently, then have them work on that position or movement for several weeks in a row.  As the days pass, the individual will become more familiar and more comfortable in that position or movement, and they will quickly begin to see themselves improve.  The faster people can begin to see results, the fewer excuses they will make!  What are some common excuses (*1):

1. I’m tired
2. I just don’t have time
3. I’ve got sore body parts
4. I’m too fatigued
5. I don’t want to risk injury
6. I don’t want to over-train
7. I’m thinking about replacing the treadmill for walks at the mall
8. I don’t want to sweat or get out of breath
9. I need to lose weight first
10. I tried working out, it didn’t work
11. It takes too long to see results

Most of us can relate, and can honestly say that we’ve used at least one or a combination of these excuses!
               
​Obstacles can be a bit trickier because they can impact one’s ability to move or balance.  Obstacles include challenges like neuropathy, polio, the results of a stroke and neurological disorders.  Obstacles seriously impact one’s ability to improve their strength and balance but does NOT make it impossible.  How should you handle one or more obstacles?  Well, it depends on what you’re dealing with and challenges they present.  I take these on a case-by-case basis when I’m working one-on-one with clients.  In many cases, you have to be creative and think out of the box but I want to offer my experience, knowledge and suggestions to anyone reading this blog and struggling to find ways to overcome their obstacles.  Common obstacles include:

1. The affects of Polio on flexibility and movement
2. The affects of a stroke
3. Neuropathy
4. Parkinson’s disease
5. Alzheimer’s disease
6. Meniere’s disease
7. Amputations
8. Drop foot
9. Vestibular disorders

If you have a loved one or a patient or spouse that is having a bit of trouble improving their balance, identify if they are facing an excuse or an obstacle and you should be able to find a path forward that will produce results!
 
Website:
https://www.emeritushealthfitness.com/the-bu-blog

SOURCES: 

1. Senior Fitness 4 Life (https://seniorfitness4life.com/top-10-excuses-seniors-use-to-not-exercise/)

​Seniors suffer the most after a natural disaster and among the frail, natural disasters are often fatal.  I saw firsthand what impact Hurricane Irma had on my clients that stayed behind to endure the onslaught.  Hurricane Irma made landfall in Southwest Florida as a Category 4 and caused $50 billion in damage, making it the fifth costliest hurricane to hit the United States according to The National Hurricane Center. (*1)  The damage caused by Irma will be considered minor once officials release the estimated cost to rebuild after Hurricane Ian.  Families, homes, and businesses deal with the aftereffects of a hurricane as best as they can while not having electricity to power the AC, and in Florida, temperatures frequently rise above 90 degrees in October and November.  Along with hot temperatures, roads are blocked, stores are closed and it’s difficult to restock supplies like food and water.  Also, gasoline becomes extremely hard to find which makes filling up your car or generator becomes an almost impossible task.
That is a lot of adversity for one to overcome and especially for our Seniors.  Chronic diseases are so prevalent among the elderly that 80% have at least one chronic illness, and many elderly individuals have two or more chronic conditions. (*2)  Moreover, elders “may also suffer from mobility, cognitive, sensory, social, and economic limitations that can impede their adaptability and ability to function in disasters. (*2)  The senses of vision, hearing, smell, taste, and touch diminish with age, and loss can be intensified by chronic disease. (*2) 
Many Seniors rely on in-home health care workers and when those services are halted, medication schedules can become disrupted or halted altogether.  Those that rely on oxygen may lose the ability and access to that oxygen.  Even if a portable, battery powered machine is available, once the battery is dead it will be unable to be recharged due power outages.  Same goes for those on dialysis that need the use of machines and seek treatment multiple times every week.  With power outages and no generator, there is not a way to cool homes and/or businesses and that puts Seniors at risk for heat strokes, heat exhaustion and dehydration.  Older adults naturally have a lower volume of water in their bodies and may have conditions or take medications that increase the risk of dehydration. (*3)  This means that even minor illnesses, such as infections affecting the lungs or bladder, can result in dehydration in older adults. (*3)  After natural disasters, there will always be a trail of destruction left behind that will increase the risk for an unintended fall.  As it stands today, every 19 minutes, a Senior adult dies from a fall. (*4)  Fallen trees and other debris create fall or tripping hazards for Seniors in pathways they may frequently travel.  The situation could be made worse if the disaster were to occur at night and with no, or little lighting, a Senior may not see the trip hazard at all.  Lastly, malnutrition becomes a real concern as food prep will present more challenges.  Microwaves are easy to operate, and often used to heat meals and reheat leftovers among Seniors and their caregivers.  Mass power outages could take weeks, extreme cases could take months, to fix and bring power back online.  If Seniors are missing meals because they’re not able to properly prepare the food or the food has ruined in a warm refrigerator, malnutrition can cause a host of problems.  Seniors may experience a loss of energy, weakness and loss of stamina that are crucial to maintain when living and surviving in a disaster area.  Cognitive function decreases as well as malnutrition and dehydration set in.
If you can evacuate, that is always the best thing to do when a hurricane is bearing down on your town.  If you cannot, please consider all that I have written about here and take steps to address each one.  Battery powered fans, 30-day supply of medications, plenty of water and MRE’s (Meals Ready to Eat) are a good place to start.  Hopefully, you fortunate and will not face any natural disasters in your lifetime!
 
Chris R. Williams


Website:
www.MyBalanceUniversity.com

Sources:

1. World Vision
   1. https://www.worldvision.org/disaster-relief-news-stories/2017-hurricane-irma-facts
2. The Hill (Seniors Suffer the Most After a Natural Disaster)
   1. https://thehill.com/opinion/healthcare/351377-seniors-suffer-the-most-after-natural-disasters/
3. Mayo Clinic
   1. https://www.mayoclinic.org/diseases-conditions/dehydration/symptoms-causes/syc-20354086
4. Aging.com
   1. https://aging.com/falls-fact-sheet/

How often do you hear the word Osteoporosis?  The older we get, it's likely we'll hear that word in more and more of our conservations with our peers.  So, what exactly is Osteoporosis?  Osteoporosis is a disease that weakens bones to the point where they break easily - most often, bones in the hip, backbone (spine) and wrist.(*1)  Osteoporosis is called the "silent disease" because you may not notice any changes until a bone breaks.(*1)

If you could take a look at the bones of someone who is has been diagnosed with Osteoporosis, they would look very different from someone with healthy bones.  A close look at the inside of bone shows something like a honeycomb.  When you have osteoporosis, the spaces in this honeycomb grow larger, and the bone that forms the honeycomb gets smaller.  The outer shell of your bones also gets thinner.  All of those makes your bones weaker.(*1)
You can compare the structure strength of a building to the structure strength of our bodies.  What is the construction company used sub-par or a lesser quality steel to build the building.  Along with compromised steal, the materials used to frame out all the office spaces on each floor are of lesser quality and weaker as compared to competitors.  This is only to make an analogy.  Code restrictions and inspections keep the construction of our building and homes to the highest quality.  Think of your body the same way you would think about the structural integrity of this building.  You would live in it?  When you have been diagnosed with Osteoporosis, this is type of structural integrity being provided by your body.
What are some risk factors for Osteoporosis?(*1)

1. Do you have a family history of broken bones or Osteoporosis
2. Have broken a bone after age 50
3. Had surgery to remove their ovaries before their periods stopped (Hysterectomies)
4. Had early menopause
5. Have a history of smoking
6. Used certain medications, including medicines for arthritis and asthma and some cancer drugs

So, how does Osteoporosis increase our fall risk or exacerbate injuries from unintended falls when they do occur?  Research was conducted with 558 women over an 18-month period.  The mean age of this group of women was 74.8 years.  What researchers determined was that fall risks and Osteoporosis increased with age.  Specifically, femoral neck (FN) Osteoporosis led to an increase in risks for an unintended fall.  The younger group of women in this study showed 37% and the women towards the oldest group showed a 63% increased chance for an unintended fall.  That is significant!  In fact, researchers in Australia found that the cost of poor bone health attributed to $2.75 billion and 64% of this cost was directly associated with treating and managing fractures.(*3)  Did you know that one-third of hip fractures occur in men?(*3)
At this point, the question should be about how we can prevent Osteoporosis.  The answer is simple and easy.  Load bearing exercises.  FYI… There are only two non-load bearing exercises that exist.  And what are they?  Swimming and riding your bike.  I want to be noticeably clear that I support both types of exercise so if these are exercises that you partake, please continue but consider adding some squats or leg extensions while watching TV.
At the end of the day, Osteoporosis is a disease that can be prevented.  Moreover, if you have been diagnosed with a low T-score (2.5 or lower), you can increase the density of your bones by performing load bearing exercises.  Balance University provides those exercises for you in our BU book/guide.  We will take you step-by-step using pictures to illustrate the movements that will help reverse the effects of Osteoporosis.  To go along with the book, every exercise in the book has a video in our video library to ensure you or a loved one have the tools you need to succeed!  Our goals are to keep people strong, mobile and independent.
 
Chris R. Williams


Webpage:
www.MyBalanceUniversity.com

​
Sources:

1. National Institute on Aging
   1. https://www.nia.nih.gov/health/osteoporosis
2. National Library of Medicine
   1. https://pubmed.ncbi.nlm.nih.gov/15545286/
3. National Institute of Health
   1. https://newsinhealth.nih.gov/2015/01/osteoporosis-aging

Does Dehydration Increase A Senior's Chance For An Unintended Fall?
There are many factors that can lead to a Senior experiencing an unintended fall, however, dehydration may be one of the more dangerous factors due to its impact on so many other systems in the body.  Falls can be devastating and around 50% of falls have psychological consequences too.(*1)  Dehydration may be more common in the Senior population than you realize.  In fact, dehydration affects 20%-30% of older adults.(*7)  It has a greater negative outcome in this population than in younger adults and increases mortality, morbidity and disability.(*7)  

What, exactly, is dehydration and how does this happen?  Dehydration occurs when you use or lose more fluid that you take in, and your body doesn’t have enough water and other fluids to carry out its normal functions.(*6)  As we age, there are many changes that occur to the body and the way we process and metabolize water changes a bit too.  Older adults are at great risk for dehydration because of several normal aging changes that occur throughout our lifespan.  As we age, we feel less thirsty because of apoptosis of the hypothalamus, the thirst center location.  Apoptosis of neurons in the pituitary result in decreased antidiuretic hormone production.  The aging kidney is less responsive to antidiuretic hormone and less able to concentrate urine with increasing age.  Our body water content also decreases from 70% at birth to 40% in older women and 45% in older men, leading to decreased fluid water reserve.  In addition, many older adults limit their fluid intake in an attempt to prevent urinary and fecal incontinence.(*4)  In my experience, I have had Seniors tell me that they just don’t think about drinking water or they do not feel thirsty.  Also, on a few occasions, I’ve been told that some just do not like the taste or want to drink water.

So, how does this increase the potential for falls in the Senior population?  Older adults naturally have a lower volume of water in their bodies, and may have conditions or take medications that increase the risk of dehydration.(*6)  According to a study from University of Wisconsin, out of 30,634 patients that had been admitted into the hospital for some other reason, 37.9% were dehydrated, 11.4% had a fall during follow-up and 11.7% died during the follow-up period.  They concluded that there was positive association of dehydration with falls alone!(*4)  Dehydration impacts the muscular system and nervous system in a huge way.  In my practice, I hear from many of my Senior clients say that they have trouble sleeping due to leg cramps and drowsiness is a collateral impact and can lead to a fall.  Also, cognitive ability slows when one is dehydrated. 

What are symptoms of dehydration in older adults?(*6)

• Extreme thirst
• Less frequent urination
• Dark-colored urine
• Fatigue
• Dizziness
• Confusion

When should you see or contact a doctor?(*6)

• If you have had diarrhea for 24 hours or more
• Are irritable or disoriented and much sleepier or less active than usual
• Can’t keep fluids down
• Has bloody or black stool

Let’s get to some answers… I’ve written about all the problems and issues dehydration can cause.  So, how can we avoid dehydration?  The daily amount of water a Senior should drink depends on body weight, age, medication use and fitness and activity levels.  In general, a good rule is to divide your weight in half to calculate daily water intake by ounces.(*5)  A good rule of thumb that most follow is that if one feels thirsty, that is the first stage of dehydration.  So, drink up!!

The takeaway, dehydration is easily preventable.  I’ve seen caregivers and adult children lay out bottles of water just like one would do for a pill schedule.  Determine how much water should be drank, then construct a schedule that is conducive to reaching that goal.  If you’re caring for a Senior, or you are a Senior, that needs a little flair to their water, there are many flavoring additive products out there that can change the flavor of water and make it more palatable. 
Falls are not a necessary part of aging but it does take a bit of effort to avoid an unintended fall!
 
Chris R. Williams

For more information:
https://www.emeritushealthfitness.com/
​

Sources:

1. SafeAtLast (20+ Fall Statistics That Will Make You More Careful Today)
   1. https://safeatlast.co/blog/fall-statistics/
2. Great Senior Living (Dehydration in Elderly People:  Risks, Warning Signs and Prevention Tips)
   1. https://www.greatseniorliving.com/articles/dehydration-in-elderly
3. Nutrition and Healthy Aging
   1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5734130/
4. PubMed.gov (Association Between Dehydration and Falls)
   1. https://pubmed.ncbi.nlm.nih.gov/32542217/
5. The Daily Meal (We Asked 10 Nutritionists How Much Water Should We Really Drink)
   1. https://www.thedailymeal.com/healthy-eating/we-asked-10-nutritionists-how-much-water-you-should-actually-drink-0
6. Mayo Clinic (Dehydration in Seniors and Falls)
   1. https://www.mayoclinic.org/diseases-conditions/dehydration/symptoms-causes/syc-20354086
7. Mayo Clinic (Dehydration in the Older Adult)
   1. https://www.mayoclinic.org/diseases-conditions/dehydration/symptoms-causes/syc-20354086