Ruth Bader Ginsburg and Recovering From a Fall
Expert advice on how to prevent falls and how to recover from them
Supreme Court Justice Ruth Bader Ginsburg has been hospitalized after fracturing three ribs due to a fall in her office. But her well-known strength training regimen, shown in the recent documentary about her, may help speed the recovery for the 85-year-old. Strength training programs can help build muscle mass and improve balance.
Every 13 seconds a person over 65 requires emergency room treatment because of a fall; every 19 minutes, one of them dies from those injuries, according to the National Council on Aging (NCOA). Data released this year from the Centers for Disease Control (CDC) reveals that deaths from falling have increased from 2012 to 2016, despite over a decade of initiatives to reduce them.
Falling is Not 'Normal Aging'
What causes people to fall, and what can we do about it?
First, it’s important to understand that falling isn’t a normal part of aging. People fall at all ages of life — from spills on slippery sidewalks to chasing runaway pets — and while some of the normal processes of aging, if ignored, can make a fall more likely, it is also possible to take action to reduce the risk.
There are three stages to a fall: the inciting incident (the object that pushes your body off its base of support), the body’s reaction to that incident (either overreacting or not reacting fast enough) and when the body makes contact with the ground.
An individual’s fall risk is highly personal, and composed of both environmental (pets on the loose, uneven sidewalks) and intrinsic factors related to his or her health.
Reacting to a Fall
Many advice columns emphasize how to reduce home hazards related to falls, such as fixing loose rugs and cords, using non-slip pads in baths or showers and having night lights for bathroom visits after dark. These are important steps to take, but they only address the first stage. or inciting incident. How then, can we measure our risk of stage two — our ability to react and avoid a full-on fall?
Balance is relatively complex. A sense of balance uses inputs from various systems in the body, including eyes and ears; our sense of where our limbs are in space and input from our feet and muscles that tell us where the ground is, as well as whether it is sloping or full of obstacles. These inputs then have to be processed by the brain and the brain sends the correct messages to the right muscles to take corrective action. A weakness in any part of these systems means increased risk of falling.
How to Assess Fall Risk
Specialist balance clinics and centers can assess your fall risk, but they are not available in all communities and the cost can be high for people without health insurance or Medicare. However, there are proxy tests for balance than can indicate fall risk — usually described with subjective terms like "high" or "low" risk.
The American Geriatrics Society recommends that doctors ask all patients over 65 whether they have fallen. In practice, while trying to fit in all the other screening of a wellness appointment, this is often just a quick question, but it doesn’t have to be.
You can and should ask for a fall screening at least once a year. It usually consists of gait analysis (watching and timing as you walk), a measurement of lower limb strength (such as repeatedly sitting and standing) and a questionnaire component that includes any fall history, which lets the physician evaluate your mental state regarding falls. It is well documented that a fear of falling usually increases a person’s risk of having a fall — often because he or she limits activity, denying the body the practice it needs to remain capable of moving around.
Any balance screening only provides a snapshot in time of your balance and fall risk, which can fluctuate significantly, even for healthy people with good balance. And it can’t reveal if your balance is improving or declining. The greatest value lies in being able to track your balance on a regular basis. However, a screening by your doctor is a good first step to taking control of your fall risk.
What to Do if You Are at Risk for a Fall
If your doctor finds that you are at moderate or high risk of falling, he or she can review your medications, refer you to a physical therapist to help you address muscle weakness or stiffness and advise you how to avoid environmental hazards.
Your doctor may suggest using a cane while you improve your balance — many patients report such assistive devices give them greater confidence that allows them to keep moving and remain independent. If you will get a cane, have a physician or physical therapist fit you for it and demonstrate how to use the cane safely.
The most important takeaway is that balance reflects how your body works together to keep you upright. Some decline is age related, but the body is terrifically adaptive and other systems can compensate for a weakness in one area. Human biology also responds really well to challenge: it is perfectly possible for an 80-year-old to have the balance of a 35-year-old. If your balance is poor today, reach for help. There are so many ways to improve it. What are you waiting for?