John Early, MD, an Orthopedic Surgeon, Sub-specializing in Foot and Ankle Care at Texas Orthopedic Associates in Dallas talks about the struggles with balance that happen once we get older and the devices that make life for older Americans a little easier.
Interview conducted by Ivanhoe Broadcast News in April 2018.
When you see somebody like Sandy, what are you thinking? What do you want to convey to somebody like that to help them deal with the potential of falling?
Dr. Early: Well the issue is it’s a huge one. The Center for Disease Control has already put out many bulletins. Every twenty minutes somebody dies from an injury type fall. It’s a big problem in the United States for older Americans. The first thing that I want to do is access how their stability is, what are the potential problems, and how can I keep them from a significant injury. They may be coming in for a small problem but the bigger problem is if they fall and break their hip.
I remember when my Aunt fell and broke her hip it just seemed like the beginning of the end. To what degree is that true?
Dr. Early: Yes. The medical literature shows that it is a major crisis point for many people. The job of the orthopedic community is to try to get them back up as soon as possible. If they’re down for any length of time, it usually is very hard to get them independent and active again.
When you say down, do you mean when they fall or if they’re down with an injury?
Dr. Early: Well once they fall and they can’t walk, they’re down with an injury. The factor is trying to get them back out of the bed, whether its days or weeks later,
When somebody falls like for example my mom fell in the basement doing laundry. She has to go up and down stairs and she couldn’t get up. And I asked “what do you mean you couldn’t get up?” I’ve heard this so many times from older people. Can you explain why is it that when older people fall they literally cannot get up.
Dr. Early: Next time you’re out, watch some of the older Americans in a restaurant. Watch how they use their upper body to try and get in and out of a chair. Imagine trying to get up from a kneeling position or a down position without using your arms. It’s a strength and balance issue. If you’re falling in an area where you can’t grab something to help pull yourself up, you just can’t get up.
So it doesn’t surprise you?
Dr. Early: No.
It’s beginning not to surprise me either. But for the longest time I couldn’t understand why can’t you just crawl over and pull yourself up. Is the thing that they’re just not strong enough?
Dr. Early: Well some of its pain. If you injured but it’s not completely broken, you still have a fracture to a bone and the muscles won’t work. Pain inhibits muscle function so it inhibits the ability to move. That’s part of the problem. Why did they fall? It could be from just an episode where they lost consciousness or got dizzy. And that disorientation also creates a problem.
So it’s not just a stroke or something more dramatic?
Dr. Early: No. As we get older, blood pressure and heart rate play a tremendous role. Things like being startled at home, the doorbell, getting up quickly, having a pet in the house, those are enough to change the blood pressure to your brain and temporarily make you pass out.
And once you’re out there’s no strength.
Dr. Early: That’s right. Once an uncontrolled fall happens, it’s hard to do anything because you have to wake up and be close to something to be able to pull yourself up. And that’s if you haven’t injured yourself.
We talked to Sandy and she told us that she had a stroke three years ago and that’s she’s been falling quite a bit. It concerns her and her family members. So they’ve been looking for solutions. We see it on TV commercials sometimes, there’s a whole bunch of new devices. What do you think about these new devices that are designed to either communicate with the hospital, 911 or family members?
Dr. Early: It’s important that society is changing. As we get older, we want to remain independent. We don’t want to be living with family or in institutions. But independence means there are times when it’s hard to summon for help. How do you get help when there is a problem and you can’t get to the phone? So these devices are meant to be on your person at all times so they can detect things. The problem is that the vast majority of them need you to still be conscious and push a button. The idea for newer devices coming out, such as My Notify, is it will ask you if you fall on your phone. But if you cannot respond it will call the individuals that you have selected to be notified, whether it is your neighbor, your family, or your doctor. We think that that’s sort of important because it allows you to choose who’s coming in your house to find you, as opposed to a call center.
So some of these devices go to a call center, which would be like an alarm at your house or something?
Dr. Early: Essentially they’re going to call 911 and send the ambulance.
Is that good or should they get more information before they call 911?
Dr. Early: Well in many cases it’s good but not in all cases. Not everybody needs 911 from that standpoint and they can’t control where 911 takes you. People have different preferences of hospitals. Their doctors may be in different places. And they may not need that type of emergency care to get there.
Do you think that this new device has advantages over any of the other ones? Is it a new development?
Dr. Early: I think it offers many advantages. Many of the devices out there are things that you wear and are set to a call center. Many of them are also anchored within the home. They don’t necessarily go with you wherever you need to go. This device is connected to your smart phone. As long as your smart phone is with you, it can go anywhere. It also has GPS, people know where you are. If you’re in the park, in a store, somewhere in the parking lot it can notify people. And you have control of who it notifies. It’s also about prevention. It has a built application to help with therapy and balance exercises. That can be controlled by family, therapists, and doctors to help keep patients healthy enough to minimize the issues of falls.
I noticed the types of exercises that you would prescribe to older people and that’s important. Even if things are deteriorating they still need to do as much as they can to strengthen either their core or their muscles.
Dr. Early: Absolutely. I mean life is a fight. We have to fight all the way. And yes, people get tired. It’s harder to do things but if we let gravity take its toll, that’s when we get in trouble. It’s about trying to fight it all the way, to work on balance every day. As my mother would say, the computer in your brain gets tired over time and if we have to reboot the computers on our desk, we have to reboot the one in our brain too.
Are the exercises in the app useful? Are these the kind of things that seniors should be doing?
Dr. Early: Absolutely. They’re all from the American Physical Therapy Association and other organizations that are directed towards safe core balance exercises that should be done.
What is something that people should take in to consideration as they’re getting older and they’re starting to develop issues with their balance or their coordination? What do you tell them when they haven’t had the big fall yet and something is bothering them? Do you have pep talks or encouraging things that you tell seniors?
Dr. Early: Absolutely. I see people all the time who come in with aches and pains. Sometimes it’s an overload in the foot or a weakness that’s going on. Or usually a significant other brings them in and talks about how he’s limping or she’s limping. And it can be an unrecognized thing but that’s balance. When you’re limping without noticing, that’s a balance issue. It’s a sway and that’s usually the first sign that there’s a problem. It’s no different from when you’re getting an athlete back on the field after an injury. Their coordination, their balance, their timing is off. And if they get put back on the field before they are where they need to be, it presents a problem during play. This isn’t any different.
Earlier you were talking about how life is a marathon. Why is that important as we age? I think an underlying message is we’ve got to stay physically fit the best we can.
Dr. Early: The biggest conversation I have with my patients who are retired is now you have more time to work out. And you need to do it two or three times a day. Patients come in and say they walk but they don’t work on the balance. They don’t work on single leg and all those other things on a daily basis. The issue is walking requires standing on one leg and getting up on the ball of your foot. As you lose that ability, your walk changes and you become more likely to fall.
So one of the most important things that we should work on as we get a little older is balance?
Dr. Early: I think one of the most important things to find out is a system check. If your standing balance is off, there are potential problems from your brain down to your toes that are going on and that’s an easy check to do.
That makes me think of doing tai chi.
Dr. Early: Absolutely. You’ll see it all the time for older Americans and for all Americans. Tai Chi, Yoga, those exercises that require slow, controlled motion and balance are great to minimize injury.
These are not the things that we learn when we’re younger or we even think or care about. Is the message as we get older that we have to change your routines?
Dr. Early: Well, you have to remember when you were younger you were running, playing, jumping, doing all the balance exercises at high speed without thinking about them, it was fun. As we get older, we forget how to have fun and work on balance. It’s something we’ve done but just forgotten about it.
That can lead to the conditions that can result in a fall?
Dr. Early: Absolutely. It’s just like anything that’s sedentary. If you put a car away for twenty years it doesn’t run nearly as well.
Is there anything else that you would like to say about falls or anything that we haven’t really talked about?
Dr. Early: One other thing about My Notify is that it’s like everything else. If you just do it once or twice a week you really don’t advance. It’s something that should be done every day, especially if you’re having problems and want to get better. Physical therapy is the same way. If you don’t take the instructions they give you and work on it, you don’t advance very well. The body needs that type of exercise, that type of motion, that type of training on a daily basis or it forgets it. You’ve got to remember that in order to move your knee, ankle, or foot that signal has to go from your brain and it has to know where everything is. The GPS gets lost after a while if you don’t retrain it, and it makes a wrong step. Or it doesn’t catch when you step on that acorn and that causes a fall. The inability to recognize a problem in your brain before it’s consciously recognizable.
Are the falls inevitable?
Dr. Early: Falls are inevitable, accidents happen all the time. But they become more problematic as we get older because we take it for granted that it’s going to happen rather than fight it.
Part of it is people don’t want to give in to it. That aunt that I was talking about fell and broke her hip because she picked up the groceries and started walking before waiting for help. She did what she’s always done
Dr. Early: Nobody wants to lose their independence. We’ve done well all our lives and we want to continue until our time is up. But the idea is that with independence comes responsibility. The responsibility is to maintain your conditioning, your balance and your ability as best you can. When it becomes problematic the issue is having a way to notify friends and loved ones, that there’s a potential problem. This doesn’t mean that you lose your independence, it’s a way of maintaining independence by showing that you want to be safe.
And that’s what these new devices help with?
Dr. Early: Absolutely
END OF INTERVIEW
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