by Dr. Vimal Mahendra Telang (PT)
We commonly hear in our discussion with friends and relatives about somebody fracturing their upper limb bones, hip bones, a head injury etc. after falling in the toilet at night, from the bed, after slipping on a slippery/wet surface, down the staircase, tripping over an obstacle, fall while standing up or sitting down from a chair etc. The stories about disability due to a fall, the treatment,
hospitalisations, home care etc are heart breaking.
As per W.H.O., falls are the 2nd leading cause of mortality worldwide. 40% of all injury deaths are because of falls with, women falling more than men. The prevalence of falls in India, above the age of 60 years is reported to range from 14%–53%. Fall can be a cause of many disorders as well as an effect of many conditions. Hence Fall prevention needs to be addressed.
The human body is a master piece of engineering which is links together 206 bones forming 360 joints. Besides, the heavier portions of our head and trunk are placed upon a narrow base of support of our two feet, similar to an inverted cone, making it an inherently unstable framework.
The innumerable joints in our body are held together or stabilized with the help of ligaments and muscles. Ligaments are short stiff bands that help hold the bones and joints together. Muscle is like the cables providing support to the main structure of the bridge. The human body is not just a static structure but a very dynamic one performing innumerable activities viz. standing, reaching, walking, running, sports, dancing etc. requiring high amount of coordination, mobility and stability. Each activity performed is planned and monitored by our brain based on feedback received from our sensors that are in our ears, the eyes, and our skin, joints and muscles.
The sensor in our ears “the semicircular canals” gives us the information of the position/orientation of our body with respect to the earth (“Gravity”), that is whether the human body is am horizontal/ vertical/ tilted/upside down etc. Our Skin, Joint &, Muscles inform us about the support surface, whether the floor is slippery, sandy, uneven etc. They help us judge the position of body parts to each other without looking at our body parts i.e., whether the knee is bent, the foot is turned in /out, the toes inside the footwear are curled or straight, the finger position while picking up an object etc. It is the major information on which the body relies during movements. With Vision, we see objects, its type, size, shape, its position with respect to other objects, its velocity of movement etc. This information coupled with our past experience guides us whether we should bypass, a puddle of water, go over a stone, wait till a speeding care passes by etc.
The body through gradual development, practice along with past experience learns to stabilize the body parts in advance of the activity intended or situations faced to prevent a fall., But sometimes, even the best of machines experiences an error or a hang or a complete breakdown due to internal or external factors and the human body is no exception to it.
The balance of the human body is challenged by the following factors:
1) Internal forces generated while performing activities such as when we reach out to take a book from the top shelf, the shoulders, the legs and our trunk need to be stabilized while our hand reaches out so that a fall is prevented.
2) External forces such as
a) a push /pull in crowded places,
b) sudden breaks applied while travelling in public transport,
c) ground surface e.g. slippery floor, uneven surface, loose carpets, floor mats, toys/ objects lying on the floor, pets etc.,
d) Furniture: low-seating, low beds, chairs without arm rests etc.
e) poor lighting at night,
f) inappropriate footwear,
g) crossing roads, heavy traffic
h) a sudden loud sound etc.
However, when faced with unanticipated external forces as mentioned above, the human body tries to prevent a fall by various patterns of muscle activity and movement depending on the direction, speed and force of the external force. e.g., just a foot movement or stepping forward/backward, reaching out to hold on to a support when travelling standing in a moving bus.
However, as the body ages, the quick reflex actions and the agility to prevent a fall is gradually reduced. This leads to a fall for trivial reasons leading to the fear of falls. Family members out of concern prevent them from going outdoors alone. “Fear of falls” is a common reason among the elderly remaining indoors, curtailing his/her outdoor activities, socializing, leading to depression, anxiety thus affecting his/her Quality of life.
So can falls be prevented?
The Good News is Yes!!!
Here is the list “To Do” guidelines to prevent a fall.
Exercises are therapeutic. They help maintain and improve the strength of the muscles to stabilize the joints and move them. Practicing a healthy lifestyle, addressing the changeable factors in the environment, good balanced diet is a panacea for healthy ageing and prevention of falls.
Senior citizens are a very big resource to guide the younger generation. They deserve to be active and productive. The handy tips given in the table alongside can go a long way in preventing a fall. Infact it would make the elderly to love the FALL-Fabulous Age to Live and Love.
What can you change?
- Remove loose mats on the floor
- Use non slip mats outside and at entrance of toilets
- Avoid clutter on floor.
- Install grab bars in toilets.
- Keep Flooring Dry.
- Use Night light in room, passages and toilets.
- Take a bath sitting on a high stool.
- Storage facility to be kept within reach.
- Avoid using low beds, seating, chairs without arm rests
The author Dr. Vimal Mahendra Telang (MSc. PT, P.G.C.R) is a Consultant Physiotherapist with 43 years of experience. She is the former Head of the Department of Physiotherapy at All India Institute of Physical Medicine and Rehabilitation, Mumbai. Her speciality area is Neuro-Physiotherapy and Community Physiotherapy. She has guided numerous post graduate research theses.
At present, she heads the PhysioCare Centre, the physiotherapy rehabilitation unit of GSBS Medical Trust.
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