Fall Avoidance ..

[chenrezig]

Okay, so I don't think all of us are likely to be windowcleaning skyscrapers but there is some useful advice here for avoiding falls at home ..

http://www.dailymail.co.uk/health/artic ... death.html

falls can happen anywhere at any time to anyone.

Spectacular falls from great heights outdoors like the plunge of the Moreno brothers are extremely rare.

The most dangerous spots for falls are not rooftops or cliffs, but the low-level, interior settings of everyday life: shower stalls, supermarket aisles and stairways.

Despite illusions otherwise, we have become an overwhelmingly indoor species: Americans spend less than 7 per cent of the day outside but 87 per cent inside buildings (the other 6 per cent is spent sitting in cars and other vehicles).

Any fall, even a tumble out of bed, can change life profoundly, taking someone from robust health to grave disability in less than one second.

Falling can cause bone fractures and, occasionally, injuries to internal organs, the brain and spinal cord.

'Anybody can fall,' says Elliot J Roth, medical director of the patient recovery unit at the Shirley Ryan AbilityLab in Chicago.

'And most of the traumatic brain injury patients and spinal cord injury patients we see had no previous disability.

'We can think of falls as having three stages: initiation, descent and impact,' says Stephen Robinovitch, a professor in the School of Engineering Science and the Department of Biomedical Physiology and Kinesiology at Simon Fraser University in British Columbia, Canada.

'Most research in the area of falls relates to 'balance maintenance' – how we perform activities such as standing, walking and transferring without losing balance.'

By 'transferring', he means changing from one state to another: from walking to stopping, from lying in a bed to standing, or from standing to sitting in a chair.

'We have found that falls among older adults in long-term care are just as likely to occur during standing and transferring as during walking,' says Robinovitch, who installed cameras in a pair of Canadian nursing homes and closely analysed 227 falls over three years.

Only 3 per cent were due to slips and 21 per cent due to trips, compared to 41 per cent caused by incorrect weight shifting – excessive sway during standing, or missteps during walking.

For instance, an elderly woman with a walker turns her upper body and it moves forward while her feet remain planted. She topples over, due to 'freezing', a common symptom of Parkinson's, experienced regularly by about half of those with the disease.

In general, elderly people are particularly prone to falls because they are more likely to have illnesses that affect their cognition, coordination, agility and strength.

'Almost anything that goes wrong with your brain or your muscles or joints is going to affect your balance,' says Fay Horak, professor of neurology at Oregon Health & Science University.

Fall injuries are the leading cause of death in people over 60, says Horak.

People who fall suffer the expected physical injuries, but accidental falling also carries a heavy psychological burden that can make recovery more difficult and can, counter-intuitively, set the stage for future falls.

Children begin to walk, with help, at about a year old.

By 14 months they are typically walking unaided.

Those first baby steps are guided by three key bodily systems.

First, proprioception – input from the nerves in the muscles, a sense of where limbs are relative to each other and what they're doing.

People whose limbs are numb have difficulty walking even if their musculature is completely functional.

The second sense is vision, not just to see where you are going, but to help process information from your other senses.

'Most people who walk into a dark room will sway more than if they can see – about 20 percent more,' says Horak, an expert in how neurological disorders affect balance and gait.

Every year, about 30 per cent of those 65 and older living in senior residences have a fall, and when they get older than 80, that number rises to 50 percent.

A third of those falls lead to injury, according to the CDC, with 5 percent resulting in serious injury.

It gets expensive.

In 2012, the average hospitalisation cost after a fall was $34,000.

How you prepare for the possibility of falling, what you do when falling, what you hit after falling – all determine whether and how severely you are hurt.

And what condition you are in is key.

A Yale School of Medicine study of 750 over-70s, published in the Journal of the American Medical Association in 2013, found that the more serious a disability you have beforehand, the more likely you will be severely hurt by a fall.

Even what you eat is a factor: a study of 6,000 elderly French people in 2015 found a connection between poor nutrition, falling and being hurt in falls.

And third is your vestibular system, canals of fluid in the inner ear that work in a way not very different from a carpenter's spirit level.

The system takes measurements in three dimensions, and your body uses the data to orient itself.

With these various systems doing their jobs, you can step forward and begin to walk, a feat that performance artist Laurie Anderson once described in a song with succinct scientific accuracy: 'You're walking, and you don't always realise it/But you're always falling/With each step, you fall forward slightly/And then catch yourself from falling/Over and over.'

Or don't catch yourself.

We fall when the smooth, almost automatic process of walking goes awry.

Perhaps it is something as crude as your step being blocked by an obstacle: you trip, over a prankster's outstretched foot perhaps.

Or the traction of your foot against the floor is lost because of a slippery substance – the classic banana peel of silent movie fame, what researchers call 'perturbation'.

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