Photo: Nathalie van der Velde.
Nathalie Van der Velde recommends that everyone, regardless of age, start thinking about fall risk.
Somewhere along the line, medical appointments suddenly featured a new opening question: “Have you had any falls?” It took me by surprise. But now that I’ve seen what can happen to people who fall, I understand.
At the Washington Post, Gretchen Reynolds interviews Nathalie van der Velde, a leading expert on aging about why staying staying active is key for preventing falls at any age.
“A single fall can define how we’ll age,” says Reynolds, “representing a key ‘inflection point in later life,’ according to a study of 2,454 men and women ages 65 or older, published this month in the Journal of the American Medical Directors Association.
“About 20 percent of the people in the study experienced a first fall within two years of joining the study. For many, that fall’s effects lingered for months or years, nearly tripling their chances of needing ongoing care, either at home or in a facility, and making future falls more likely to cause fractures and lead to emergency room visits.
“That inaugural fall often initiated a persistent downward ‘domino effect’ on older people’s health. …
“Which is why Nathalie van der Velde, one of the study’s authors, is so intent on lessening the impacts — literal and figurative — of falls among older people. A professor of geriatric medicine and falls prevention at the Amsterdam University Medical Center in the Netherlands, she studies and works with older people at risk of falling. …
“I caught up with van der Velde to talk about how older people can make their homes safer, when to do a medication audit, at what age fall risks rise — spoiler: decades before 65 — and why, having turned 51 this year, she stands on one foot while brushing her teeth and avoids bifocals outside. …
Gretchen Reynolds
“Do you advise [your parents] about fall prevention?
Nathalie van der Velde
“[Yes.] Some years ago, my mother had problems with dizziness and even losing consciousness and falling. Her cardiologist was giving her medication and was really, really happy with her low blood pressure. But what happened was that sometimes, especially at night, it was so low when she got up that she would fall or faint. … It took some time and discussion with the cardiologist to find the right doses and types of medications for my mom, but in the end, we did. And that really changed everything. …
Reynolds
“Are there lessons in that experience for the rest of us?
Van der Velde
“For sure. One is that, at least once a year for an older person, there should be a medication assessment review. Maybe the physician can look at alternatives or different dosages. Another is to be honest. … People often won’t say anything because they’re afraid they’ll be put in a care home. …
Reynolds
“When should most of us start thinking about our fall risk?
Van der Velde
“Probably now. … By the age of 50, we know the risk of falling starts to go up, especially for those who are sedentary or taking many medications.
“For a healthy young person without any disabilities, it takes a major disturbance to trip and fall and land hard. But in older people, much smaller disturbances end in falls and injuries. Medications make them dizzy or arthritis makes their mobility worse or they’re wearing inappropriate footwear or they have poor vision. A fall in an older person could also be a symptom of an underlying condition, such as cardiovascular disease, which should be evaluated. …
“Don’t have unnecessary hazards. The Centers for Disease Control and Prevention has checklists online for what to do around the house. Use nonslip footwear. Check the lighting. Drink enough fluids. Avoid alcohol. Don’t stand up too quickly. Get your vision corrected if needed. Cataracts influence fall risk. But be careful with bifocals. If you wear them outside and need to climb stairs or step onto or off a curb, you usually look through the reading part of the lenses and don’t have good depth perception. We know people who use regular glasses outside instead of bifocals fall less.
“Mobility is the most important treatable fall risk factor, and exercise is the best way to stay mobile. Work on your strength, work on your balance, and keep a good general level of fitness. Go for walks. …
Reynolds
“How can the rest of us exercise to prevent falls? What do you do? …
Van der Velde
“Before, I mostly did strength exercises, like push-ups, but now I also do balance training in my morning routine. There are many ways to incorporate balance training into your day. Stand on one leg when you’re brushing your teeth. I do that. It’s a good one. Also practice getting up from the floor. Which is hard, by the way. …
Reynolds
“What about wearables? I have a smartwatch that can alert someone if I fall. Is that a good idea?
Van der Velde
“Absolutely. If you’re alone and fall, that’s a way to get help. But we also know that after a first fall, especially with an injury, some people get really fearful about another, which can limit their social activities. … A wearable can be a way to feel more secure about going out and doing things. It’s also a way for carers to be less frightened. Because if I can give one piece of advice to carers, it’s don’t stop your loved one from moving about and doing things. The worst thing you can do is get them in that circle of inactivity, losing muscle strength, losing balance. … Whatever your age, the key to avoiding falls is to stay active.”
More at the Post, here.
