Jessie VanSwearingen, a University of Pittsburgh associate professor of physical therapy, has focused on older adults’ mobility and falls prevention issues for the past 20 years as part of her research interests.
Aging Edge sought out Ms. VanSwearingen, 61, for an Expert Q&A due to a recent Centers for Disease Control and Prevention report indicating that both the number and rate of fatal falls among adults 65 and older have been steadily increasing. The CDC says about one of every four older adults falls in a year. In 2016 those resulted in 29,668 deaths, and the mortality rate attached to such falls has been increasing about 3 percent annually.
The following interview with Ms. VanSwearingen has been edited for brevity and clarity.
Aging Edge: What’s the simplest way of explaining why older people fall with such frequency, when they didn’t do so earlier in adulthood?
VanSwearingen: Many systems in the body contribute to walking and staying on your feet, and there are age-associated decline with all of those. The combination of those declines tends to be a recipe for losing the ability to stay upright.
Aging Edge: Which aspects of decline matter most in this?
VanSwearingen: The change is less in people who stay active and healthy, but in general people lose strength and most of the senses decline some. Your vision gets worse, your hearing gets less clear, the automatic responses that help keep you on your feet slow down.
Aging Edge: Are people aware of the changes, and so should become more cautious?
VanSwearingen: Actually, fear of falling is a huge risk factor for falls. When I’m 55, I’m not worried about falling, but when I’m 70, maybe my son or daughter says, “Hey, hope you don’t fall, Mom.” Now the pressure on you goes up. People start thinking about walking more and staying on their feet.
Aging Edge: That’s somehow a bad thing, if people worry about their safety?
VanSwearingen: Normally, walking should be automatic. You reach an adult level of walking between ages 7 and 10, and then you don’t think about how you’re going to walk. You just think about going over there, and your brain sets off what it needs to, and you do it. As soon as you start thinking about it instead, you’re interrupting the program. You’re no longer an expert at doing it, because you’re thinking about doing it.
Aging Edge: And somehow that leads to a lot of older people not just falling, but dying from falls?
VanSwearingen: That’s the biggest concern, and the rate climbs the most in people over age 80 or 85. At that age, we’re keeping more people alive than ever before, but they also have more frailty. So there’s a question about their ability to withstand a fall and the major stress that may place on them. The ability to recover is much more difficult the older you get.
Aging Edge: So what are the right steps people can take to avoid falling in the first place?
VanSwearingen: The most effective interventions are environmental changes, like picking up the throw rugs in the house before you catch your foot and fall. You may need better lighting, which means having the light go on in an area before you get to it, particularly stairwells. And put in grab bars everywhere you need to grab, especially the bathroom and kitchen, where people are usually reaching for things and turning in small spaces. And broken sidewalks, broken curbs, uneven ground — those are things that usually result in falls.
Aging Edge: What about people taking care of their body, in addition to the environment?
VanSwearingen: There’s several things they should do. They have to keep a fair amount of muscle strength, particularly in the lower extremities, the legs. The CDC has exercise recommendations for what can be done just with a hand on a countertop or chair, strengthening your ankle muscles, your calf muscles, your thigh muscles. Use the right corrective lenses for vision. Manage hypertension, because that will affect blood flow throughout the body. And have a good pair of shoes for both inside and outside, ones that don’t slide from the foot, and without a lot of heavy tread, because tread catches on things.
Aging Edge: You study people’s gait as part of this. What goes wrong with it?
VanSwearingen: After people are 65, I wouldn’t be surprised if 50 percent of them have changed their walking, and at 75, maybe upward of two-thirds or three-quarters of people. I don’t know if it’s intentional, but people start to take slower steps and are more cautious. Once you lose that automaticity about walking, you put resources into something that doesn’t normally need it, and so if you happen to trip, those resources aren’t there available to help you. You actually expend a lot of energy when you contract your muscles in a cautious way.
Aging Edge: If that caution is harmful instead of helpful, how should people build up their confidence?
VanSwearingen: Get good practice where you feel safe. A treadmill is excellent, where you can hold on to something, set the pace where you want it, get comfortable when increasing the pace. It’s a good way to get the pattern up, forcing you to take steps at the appropriate time, while you can hang on and the ground’s not uneven.
Aging Edge: What about people without easy access to a treadmill?
VanSwearingen: You can clear your living room of some objects, say I’m going to walk over there, and practice taking bigger steps doing it. You can move the chairs away from your dining room table, put your hand lightly on the table and slide your hand along as you walk around the table. You’re creating a curved path for yourself, a safe place to practice. Or you can take walks with a friend who walks well, or a younger person.
Aging Edge: And you say walking slow isn’t necessarily good, so what’s a good pace?
VanSwearingen: The usual walking speed is about 2.3 to 2.5 miles per hour, but the biggest thing is to keep the same rhythm. It’s not really about balance then, but momentum, which covers up for a lot of balance issues. If people think they’re going slower than they were, it’s worth trying to go just a little faster, increasing the length of your step. Sometimes walking to music is helpful, giving a target to your pacing.
Aging Edge: Should people be talking with their doctors about fall issues, and what should doctors be doing?
VanSwearingen: Sometimes people don’t like to admit they’ve fallen or are afraid of falling, but if they’ve fallen more than once in the past year, it should put them on a list for having a falls assessment. They might be checked for their bloodwork and that their sensory systems are OK, and if there are difficulties with their balance, they could be referred to a physical therapist for assessment. Medications are a major risk factor for falls — they all have side effects — so a lot of falls reduction programs include medication management or remanagement.
Aging Edge: And how can younger family members or caregivers help?
VanSwearingen: Probably the best thing is to look around the home and see if there are things that could precipitate a fall. Typically, an older adult might fall in conditions where a young person wouldn’t fall — maybe they don’t pick up their feet as much as they used to — so we say pick up that throw rug and get rid of it. Put the dishes in the kitchen in a counter space where it’s easy to reach them. Think about safety issues like if there are lights on the stairs, if someone has to use them in an emergency.
Through its STEADI campaign (for Stopping Elderly Accidents, Death & Injuries), the CDC offers a range of educational brochures and other advice online for falls prevention.
Gary Rotstein: email@example.com or 412-263-1255.