By Alan Koenigsberg, M.D.
Continuing with the general health theme during summer, I have recently read a number of articles in the medical journals about falls in the elderly. I fondly remember when being elderly was defined as at least 10 years older than we were at the time, but alas, that’s really no longer the case…
I remember many years ago when I was visiting my wife’s grandfather in the hospital subsequent to a fall at his home. He was a tall, elegant, robust man in his 80s and had fallen the night before while at home.
I asked the nurses if I could review his medical chart with his permission and I noted that he was on three different blood pressure medicines. His blood pressure was around 120/80, which is normal for a 30-year-old but low for an 80-year-old. I asked the treating internist to taper and discontinue at least two of the three medications.
What I have noticed over the years of practice is that “normal” blood pressure has not been adjusted for advanced age. As we age, most people undergo what we call “hardening of the arteries.” This means that more pressure is needed for the blood to get through narrow and hardened arteries.
Given that the brain sits on top of our body and uses about 30% of the body’s oxygen, it stands to reason that we need a lot of blood and oxygen to reach that area. When an older person — say, someone in their 80s — has lower blood pressure, they are prone to falls, due to lack of oxygen as well as low blood pressure.
Add to that the intense heat of summer, with its accompanying sweating; it makes older people at high risk of falling.
There are many excellent website sources. I recommend the Mayo Clinic and the CDC website, each of which has a dedicated section concerning falls.
Here is some information from those sites:
• Check for loose area rugs, and either tack them down or remove them.
• Remove extraneous electric extension cords on the floors.
• Install grab bars in the shower.
• Install handrails and lights on stairs.
• Exercise your lower body…strengthen legs.
• Do daily stretches, especially lower back and legs.
• Improve balance with various exercises.
• Discuss with physician and concerns about balance and falling.
• Be vigilant about staying hydrated, especially during the intense summer heat.
• Wear supportive shoes.
• Immediately clean spills.
• Ensure adequate lighting in all areas.
We all know that prevention is much better than treatment. All falls may not be preventable, but many are. As older adults, we are more prone to hip fractures, pneumonia and other complications if we fall and hurt ourselves.
We need to do our best to keep moving, strengthen our legs, maintain our balance, monitor our medications and continue to learn. We can often remain mobile and active if we take the proper precautions and actions to achieve long-term activities.
Alan Koenigsberg, M.D., is a practicing psychiatrist and clinical professor of psychiatry at UTSW Medical School in Dallas. He can be reached at firstname.lastname@example.org.