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Avoid falls with exercises to improve your balance.

Older adults are at higher risk of than younger individuals, according to the Centers for Disease Control and Prevention (CDC). Roughly a third of people over 65 fall each year, and Sara Bradley, MD, assistant professor of geriatrics and palliative medicine at Mount Sinai, notes that they can suffer serious consequences. "As well as causing pain and stress, injuries can result in loss of mobility and independence," she explains. "They're also associated with greater morbidity and mortality in the older population."

This means that reducing fall risk in older individuals is important, and both you and your doctor have a role to play in doing so. Guidelines from the American Geriatrics Society (AGS) state that fall screening and prevention should be a part of all health care for older adults. Your doctor should determine whether you are at risk of falling by asking if you're having problems with your balance or unsteadiness while walking, and if you have fallen recently or within the last 12 months. "If your doctor hasn't asked you these questions, make him or her aware of any issues," Dr. Bradley advises.

Assessing your fall risk If you have suffered a fall, you should be asked for a detailed description of the circumstances falling in which you fell, whether you were experiencing any symptoms such as dizziness when the fall occurred, and if you suffered any injuries. "Acute or chronic medical problems, such as arthritis, osteoporosis, cardiovascular disease, and conditions that can cause numbness in the feet, such as peripheral neuropathy, will be factored in," says Dr. Bradley, "as will any neurological impairments."

Medications you take also will be considered, as some may raise the risk of falls (for example, blood pressure medications, sleep medications). "As a rule, your doctor should review your medicines at every visit, and you should bring all of the medications you take, or an up-to-date list of them, to every visit," says Dr. Bradley. Doctors also are encouraged to focus on raising low blood pressure, since this is a fall risk, and managing heart rate and rhythm abnormalities. Your doctor should also take into account your visual acuity, and your footwear.

Improving your balance David Thomas, MD, professor of medicine and rehabilitation medicine at Mount Sinai, recommends that you exercise in a way that challenges the body systems connected with balance. "Being able to move in all of the planes of motion is crucial to being able to correct your posture if you lose your balance," Dr. Thomas says. "As we age, we tend to stay in one plane of motion--forwards and backwards. We stop twisting and turning as much and that means we may be less able to do it when we need to prevent ourselves from falling." T'ai chi is particularly effective for this (see our June issue); something as simple as standing on one leg for a second or two also can help (hold onto the back of a chair if you are particularly unsteady on your legs). "Walking is probably the easiest, most cost-effective, and available form of aerobic exercise," Dr. Thomas adds, "and changing pace and direction while you do it will introduce a balance element." Plan in strength exercises too, since strong muscles in your legs and hip area can aid you in adjusting your position in order to avoid a fall.

"Your doctor can refer you for physical therapy either as an outpatient or in your home to help strengthen your gait, improve balance, and prevent falls," says Dr. Bradley. She adds that environmental adaptation also should be addressed to reduce hazards such as poor lighting, loose carpets, and lack of bathroom safety equipment. The AGS guidelines also recommend cataract surgery earlier if someone is a recurrent faller--see our September issue for more information on this surgery.

RELATED ARTICLE: Easy Exercises to Boost Your Balance

Heel to toe walk Walk as though on a tightrope, positioning the heel of one foot right in front of the toes of the other foot. Walk heel, toe, heel, toe in a straight line across the floor for at least 8-10 steps, and then walk back.

Single leg "walking" Stand on your left leg. Move your right leg out in front of you in a walking motion as your left arm swings forward; then move your right leg behind you as your right arm swings forward. Repeat these movements for 20-30 seconds. Then do the same while standing on the right leg for 20-30 seconds, making sure to reverse the arm movements (move the left leg in front of you as the right arm swings forward; move the left leg back as the left arm moves forward).

Sit to stand, no hands Sit in a strong, stable chair with your feet firmly on the floor. Cross your arms or put your hands behind your head. Press down into the floor to stands, then sit down in a controlled way. Repeat 8-10 times.
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Title Annotation:Fitness
Publication:Focus on Healthy Aging
Geographic Code:1USA
Date:Nov 1, 2013
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