How We Can Prevent Life-Threatening Falls in Elders

As a senior or a caregiver of an older parent, you have diligently prevented falls, from wearing “sensible” shoes to physical conditioning. Yet, you or your parent fell and fractured a hip. When the doctor in the emergency room asked what caused the fall, you were baffled since there were no obstructions, nor were any of the conditions associated with falling present. A mystery in desperate need of an answer.

Grim Statistics

According to the Centers for Disease Control and Prevention, more than 25 percent of adults 65 and older will fall this year, and 3.5 million will require treatment in an emergency department. If you are 65 or older, you face a 25 percent chance of having a serious fall every year. The longer you live, the more likely you’ll be the ambulance passenger.

If these numbers aren’t frightening enough, here’s one that should concern you. Falls are the leading cause of injury-related death among adults ages 65 and older, and the occurrence of serious falls is increasing.

Why Do People Fall?

The NIH’s National Institute on Aging website is a good place to start for a list of more than 20 causes of serious falls. These include the most common contributors, such as reduced muscle strength, obstructions, drug interactions, and poor eyesight.

In science, we always seek a theory that will explain multiple events. For example, to understand falling, do we need to treat each of the 20+ reasons as unique causes, or is there something that ties many or all together? We seek more effective protocols that can reverse the trend of deadly falls. In my counseling of seniors and my own experiences as someone in the earliest stage of Parkinson’s Disease (primordial), I believe there is a common theme that ties many falling events together: the disruption of automatic behaviors.

What Are Automatic Behaviors?

Most of our everyday physical behaviors are automatic. Some estimates are that it reaches 40-50 percent. These behaviors involve a connected sequence of small units that, over time, require minimal thought to execute. Walking is a great example. Most people have done it since they were infants and have repeated it millions of times.

Despite the many elements necessary to walk, few people consciously say, “I need to stand first, then raise my leg, thrust my ankle forward, place my foot back on the ground, and start the sequence again.” Yet we do this thousands of times daily without consciously instructing our bodies.

How Are Automatic Behaviors Created?

From learning experiments, we know that if you repeat a behavior a sufficient number of times, it will become automatic. A common term for this type of behavior is a habit. The number of times a behavior must be repeated to become automatic varies. According to Steph Curry’s trainer, he shoots at least 500 shots from various mid-court spots before each game. During the initial stage of my Parkinson’s diagnosis, running without scraping my shoe required more than 50,000 steps over three months.

Each time a reoccurring behavior is performed, beginning with its first repetition, the memory of the pattern is strengthened. Eventually, little conscious thought is required to execute it. Sometimes, just the initial movement is sufficient to trigger the entire sequence, much like the first note recalling a piece of music you memorized. Other examples include walking, running, and reaching for an item. As children learn to walk, their movements become more precise and flowing as the pattern is repeated. Think of successive layers of paint on a house. With each coat, the color becomes more intense, and the walking is more graceful.

We think the brain “chunks” bits of connected information like walking into patterns. For example, walking involves many parts (for example, bending the ankle, lifting the leg, thrusting the leg forward, and so on). The brain stores these elements into a pattern called “walking.”

Storing information into patterns probably makes it easier for the brain to retrieve and execute a complicated order, such as “get up and start walking.” Your brain accesses the “walking pattern” and then, through nerves, sends the electrical message to execute the entire movement. But what happens when the message to your legs is disrupted?

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The Disruption of Automatic Behaviors

The brain needs approximately 0.4 milliseconds to transmit signals to the feet and legs. That’s almost an instantaneous transmission. But what happens if the transmission is slowed and a pack of playful puppies cross your path? Instead of immediately stopping, your walking pattern may take a few extra milliseconds to stop, and like me, you might fall and tear your medial meniscus.

While recovering, I did an anecdotal survey of seniors who had recently fallen; it appeared that there was a delay in their ability to stop the patterned movement or to switch to another movement required by the environment (for example, walking at a specific pace and not realizing that you need to slow down because the crowd in front of you has stopped.

The Takeaway

Researchers should focus on understanding the underlying neurological events that affect the transmission of automatic behaviors. Practitioners should develop protocols that can compensate for neurological timing deficits. Those prone to falls or who have the burden of preventing falls in people they care for should continue to create a “safe” environment but collect data about when falls occur and share them with professionals.

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