March 1, 2010
Jay Luxenberg, MD
Injuries are the sixth leading cause of death in those over the age of 75 years. The majority of these deaths are related to falls. It is estimated that a third of all people over 65 fall each year. This risk increases with age and is particularly high in women. The risk of falling is highest in the institutionalized elderly, in spite of their theoretically sheltered living situation. Most studies suggest that nursing home residents fall on average twice each year.
Accidents happen. No advice will ever let you completely avoid accidents, but what is very clear is that many accidents are preventable. If you want to live a long life, full of physical and mental vigor, you will benefit from following advice,
Accidents And Falls
Hip fracture is one of the most serious common results of falling. Hip fracture is associated with a frighteningly high loss of life, and a relatively high frequency of permanent loss of ability to walk without help. An equally important consequence of falling is the fear that it produces, resulting in diminished self-confidence and often a dramatic loss of get-up-and-go. Frequent falls may lead to the loss of independence.
In general, the effects of aging in otherwise healthy individuals lead to impairment of homeostatic mechanisms. Homeostasis is bounce-back ability -- think of one of those punching bags, where you can push it way over, but it bounces right back. With aging, you just can't push it as far without its tipping over and falling. The biologic changes of aging must be taken into account to understand why older peop1e fall, and why the increased risk of injury after a fall occurs.
Sensory and nervous system functions are the biologic changes that most predispose to accidents. In particular, poor balance, weak muscles and bones, and poor vision and hearing all can be trouble makers. By following the simple advice in this chapter, you can minimize the toll age will take, and decrease your chance of a major accident.
By the age of 80, only 15% have 20/20 vision. Cataracts, glaucoma and degenerative diseases of the eye all contribute to the high frequency of poor vision. Even if you are lucky enough to avoid any eye disease, there are some inevitable changes with healthy aging. Your pupil, the window that lets light into the eye, decreases in size with age. There is a clouding and yellowing of the lens that focuses light in our eyes; this means older people tend to have worse vision under fluorescent light, which is rich in the blue frequencies. Together, these changes mean that there is a 75% decrease in light reaching the back of the eye in an older person compared to a younger person under identical illumination. Doesn't it make sense that for safety's sake, we need to provide extra light for older people. Because of the changes mentioned above, older people are extra sensitive to glare. The best lighting for safety and accident prevention is bright but indirect light.
Hearing also decreases with aging. This is particularly true for the high frequency sounds that contain the information in speech -- the consonants and combination sounds like sh, th, etc. It is easy to see how hearing impairment can increase your risk of accidents, because sound often warns of an oncoming car, falling object or other impending accident. Hearing is one area where prevention can really do wonders. Unfortunately, the same frequencies impaired by age are the ones that are destroyed by exposure to noise. Noise exposure at work or play can lead to permanent hearing damage that becomes evident only as we age. Think about that the next time you hear music blaring from a car waiting next to you at a red light, or see someone oblivious as their personal stereo blasts through a set of headphones. Good hearing hygiene includes wearing hearing protection while exposed to noise, so that if your workplace or hobby involves noise exposure, get some professional advice as to adequate protection. You will surely appreciate that when you get older.
The quickness of your reflexes and strength of your muscles are more important than the strength of your bones in avoiding fractures once you are over age 75. A variety of factors contribute to your risk of injury. Older people that become too thin have inadequate tissue padding to protect against injury when they fall. Thin bones are more likely to break with a fall, and the stooping of posture with age is also due to thin bones. The stooped posture throws off your sense of balance, making you more likely to fall. Although some slowing of reflexes is normal with age, alcohol and tobacco both contribute to extra slowness. Medications can contribute to impaired balance -- be sure and discuss this with your, doctor if any medication makes you dizzy or wobbly.
How can you accident-proof your environment? Start with adequate lighting. As mentioned above, we need more light to see well the older we get. At any age, it is foolish to walk around in dimly lit rooms where any misplaced object can lead to a fall. Avoid having any exposed rug edges, fringes, electrical cords, etc. If you are at all unsteady on your feet, consider having sturdy rails installed in the bathtub and next to the toilet. Take a careful look at your furniture could rearranging it or adding padding to sharp edges lessen your chance of injury with a fall? Such simple measures can help prevent major accidents.
Another key element for avoiding accidents is wise use of alcohol. If you chose to drink alcohol, never drive or operate machinery if intoxicated. The majority of single car accidents involve alcohol or drug abuse, Young people have a very dangerous tendency to ignore their own mortality. If your choice of sport is water or snow skiing, wind-surfing, hang-gliding, or other potentially dangerous activity, never mix alcohol with participation in your sport. A healthy respect for your health when you are young will help insure a healthy old age.
Another key accident source is driving. A major factor in minimizing your risk of driving accidents is to drive at moderate speed. Excess speed is a factor in most traffic accidents. Avoid driving when you are tired, never drive when intoxicated, and break up long trips so that you can be as fresh as possible at the wheel. By remembering the large number of complete numskulls you meet on a daily basis, and realizing that most of them drive, you will learn to always drive defensively. Teenagers are an important target for safe driving education, as they are at dramatically increased risk of having an accident. Students Against Drunk Driving (SADD) has developed a program addressing peer pressure and personal responsibility for young drivers. Older drivers have a different set of problems. Age takes its toll on our driving abilities. The same slowing of our reflexes and sensory impairment that increases our risks of falls also increases our risks of accidents while driving. Knowing when to limit our driving is one of life's difficult tasks. In many communities, driving reeducation courses are available to help older drivers learn to compensate for some of the age-related changes.
Living a long time is not enough -- you want to be strong and capable of caring for yourself and doing the fun things in life. By avoiding broken bones and twisted ankles, you improve your chance of such a healthy long life. As we have discussed, accidents do happen, but by preparing yourself, and compensating for some of the changes of age, you can minimize your chances of having a serious fall or accidents. A safe home and workplace, well lit and accident-proofed, and the avoidance of excess alcohol will help you reach your goal.
Reprinted by permission