The Meaning Of Falling

Ann Schneider has the spirit of a child--but a body succumbing to age. Her physical decline started 13 years ago, when she tripped and dislocated her hip. A hip replacement got Schneider, now "80-plus," back on her feet and, until last March, she was still out line dancing with her friends. But Schneider's joint has weakened over the years, and after several recent falls in her bathroom, she is barely able to walk. She's still lively, gets out as much as she can--even doing volunteer work--and is optimistic that her condition will improve. But another fall is her greatest nightmare. "That is the biggest fear of many older people," she says, "that fall, that big fall, that changes your life."

For millions of Americans, many of them our parents and grandparents, that big fall threatens like a fault line. Other symptoms of aging sneak up slowly: hearing dims, vision blurs, muscles weaken. But a serious tumble strikes without warning, and can shatter bones in an instant. One in three people older than 65 falls each year, and in 1998, about 9,600 seniors died from fall-related injuries. Spurred by the realization that the problem will only get worse as our aging population surges, researchers are now focusing on the reasons for falls and on better methods for preventing them. Falls are "a huge public-health issue," says Dr. Ron Adelman, co-chief of geriatrics at Cornell University's Weill Medical College. And they're far more than just a physical event. "Many older people see a fall as a very symbolic marker," says Neville Strumpf, of the University of Pennsylvania's School of Nursing, "a growing awareness of the consequences of aging."

Falls can be triggered by a host of problems: muscle weakness, poor vision, a skewed sense of balance. Diseases, including osteoporosis, arthritis, diabetes and alcoholism, can make people unstable. And then there are prescription medications, specifically antidepressants, sedatives and blood-pressure drugs, which can cause dizziness, confusion or sedation. These factors, combined with poor lighting, loose rugs, slippery tubs and icy sidewalks, can make a single step disastrous. Little research has been done on psychological causes, but they, too, may play a role. One recent study found that patients who fell and fractured their hips had experienced more major life events--an illness, the death of a family member--in the year preceding the accident than people who had not broken bones. It's possible, says the study's lead author Margaret Peterson of New York's Hospital for Special Surgery, that people get "so distracted and so upset" by traumatic events, they pay less attention to what's in front of them.

Whatever the cause of a fall, the outcome can be devastating. Ruth Stark works at Boston's Hebrew Rehabilitation Center for Aged, but she was unprepared for the day three years ago when her mother, then 82 and living alone, slipped in the shower. "That was really the beginning of the end," says Stark. Before the fall, her mom, Marianne Breuer, loved to listen to opera, play bridge and make her native Viennese pastries. But the accident shattered Breuer's self-reliance and her "interest in just about everything," says Stark. Today, Breuer is confined to a wheelchair in a nursing home. "She bruised herself pretty badly," says Stark, "but I think she bruised her psyche the most."

And the psyche is often the most difficult to heal. Carlos Guaderrama has been worrying about his mother, Josefina Guzman, 75, ever since she fell and had hip surgery last August. He especially frets about her state of mind. "She's sadder now," he says. Unable to participate in their favorite activities or visit with friends, seniors like Guzman are susceptible to loneliness, depression--and fear. That fear is not unwarranted: those who have fallen are two to three times more likely to fall again. More than the physical trauma, seniors dread the possibility that a fall could rob them of their independence. Worried that a relative will yank their car keys or, worse, herd them off to a nursing home, many elderly people keep falls a secret, even from their doctors. "We'll see a black-and-blue mark and ask, 'How did that happen?' " says Steven Wolf, at Emory University. Only then, he says, will they answer: "Well, I kind of fell." A study of Australian women over 75 makes clear how strongly the elderly value their independence: 80 percent said they'd rather be dead than suffer a hip fracture bad enough to land them in a nursing home.

Falling, the experts insist, does not have to be a natural part of aging. It "used to be considered inevitable," says Dr. Mary Tinetti, of Yale University School of Medicine. But that is beginning to change as doctors and public-health officials pay more attention to the impact of falls--and their prevention and treatment. Exercises like tai chi improve balance and ward off falls significantly. Poor vision can be treated, rugs removed and handrails installed. And a study published last week found that hip protectors, customized pads worn under clothing, can dramatically reduce the number of fractures after falls. Since fear can lead to hesitation and immobility--which, in turn, can cycle back to more tumbles--boosting confidence and encouraging small steps back toward activity may be the most critical part of rehabilitation. Marge and Sam Lamport are proof that the downward spiral can be halted. Marge, 81, tripped and broke her hip in 1998; Sam, 77, bruised himself badly on the ice last March. Walking is difficult, but they're building strength through fitness classes at their Cleveland retirement community. And they are determined to visit Marge's son in Taiwan next year. Yes, Marge admits, she's afraid of falling again. "But you can't stop living because of the fear." A powerful drumbeat for the older generation--and for the rest of us, whose own sure steps will one day falter, too.

The Meaning Of Falling | News