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Small tumbles can predict seniors' serious falls

/ Source: The Associated Press

Trip and fall lately? Seniors often won't mention it unless they're hurt, but new guidelines say that first tumble is a good predictor of who's at risk for another, more serious fall.

With deaths from falls increasing, the guidelines urge doctors to ask patients to 'fess up.

Better would be to prevent even that first fall. Now scientists are testing simple wrist monitors that may one day be used to predict who is most likely to topple, by tracking how stable they are with each step on any given day.

"Even the frail elderly individuals, some days they have good days and some days they have bad days," says lead researcher Thurmon Lockhart, who in his Virginia Tech laboratory literally forces volunteers to trip in the name of science to determine what makes one person fall while another stays upright.

It's a question of growing urgency, as fatal falls have spiked in the last decade. The government recorded more than 19,000 deaths from fall-caused injuries in 2005, the latest data available. Three-fourths were among people 65 and older.

Nonfatal falls trigger another half-million hospitalizations and almost 2 million emergency room visits.

Anybody can fall, especially during ice-slick winters or while playing sports. Lockhart even worked with UPS, the brown-truck delivery company, to help train their new drivers to avoid falls while hoisting packages.

But aging brings physical changes that make a fall more likely. Still, falls are something of the Rodney Dangerfield of injury prevention, so commonplace — one in three seniors falls each year — that they receive little attention until someone is seriously harmed, such as breaking a hip or suffering a brain injury.

Hence the emphasis on revealing earlier falls in guidelines published by the American Academy of Neurology last week. Someone who's fallen in the past year without a logical reason, such as a sports injury, has about a 55 percent chance of falling again — and thus may need special attention to prevent injury.

Who's most at risk?

At highest risk of falling, the guidelines found, are people with gait or balance problems, dementia, Parkinson's disease or a history of stroke, weakness or nerve disorders in legs, impaired vision or who use certain medications.

The guidelines are aimed at neurologists, but a specialist in falls says asking about earlier tumbles makes good sense for any physician.

Don't "pass it off as a natural part of the aging process, but see it as a symptom with many possible underlying causes, some of which are highly treatable," says Dr. David Riley of University Hospitals Case Medical Center in Cleveland.

But before that first fall, the specific physical changes that determine why one senior can recover from a slip while another won't are poorly understood. Enter the Virginia Tech research.

First Lockhart tripped up several dozen people, a mix of young and old. Don't worry: Safety harnesses kept fallers dangling harmlessly in the air, instead of crashing. Videotape and sensors captured each movement, to map the physiology of falling.

Younger people recovered balance better so that a slip seldom turned into a fall, although some seniors recovered, too.

Why were others fall-prone? As you age, your gait becomes more variable. Seniors tend to compensate with shorter steps. But if one step varies in speed, length or direction from the next, it wobbles the up-and-down torso motion that is a key to balance while walking, Lockhart found.

So when seniors with an unstable gait encounter an obstacle — a bump in the sidewalk or a slick floor — they're already off-kilter and thus less able to recover, he explains.

Lockhart found that it's possible to measure that gait instability with some small, cheap devices, accelerometers and gyroscopes. Now, with funding from the National Institutes of Health, he has begun experiments to see if a wireless wrist monitor containing the gadgets, made by a company called AFrame Digital Inc., can truly predict who is fall-prone.

Easy check to see if you're at risk

If that sounds complicated, there is a simple test anyone can do today to check if their leg muscles are weakening enough to worry about a fall.

It's called the "get up and go" test: Sit in a hard, straight-backed chair. Fold your arms across your chest. Try to stand. If you can't on the first try, tell a doctor so you can be checked for possible problems, says Cleveland's Riley.

For people already known to be fall-prone, specialists advise some commonsense precautions: Ask a doctor about exercises to improve balance and strength. Taper off fall-inducing medications whenever possible. Minimize slipping risks, such as by removing rugs and adding stair rails and hand-grabs in bathrooms.

But fatigue and stress can overcome any precaution, says Riley's patient, Dolly Thomas of Timberlake, Ohio. Her Parkinson's disease makes Thomas, 75, fall so often that she wears knee pads to cushion the blow. Last week, tired from caring for an ill husband, Thomas fell twice in one day.

"It just makes me so mad. I'll get up and darned if it doesn't happen again," says Thomas, who just got a scooter in hopes of falling less. "When you feel good and ... you're an independent person like I've been, it's really hard to sit and take it easy."