Falls are a leading cause of bone breaks, brain injuries for U.S. seniors | Hacker News Reader

Falls are a leading cause of bone breaks, brain injuries for U.S. seniors

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60 pointsbookofjoe56 comments

One underappreciated aspect of falls is the cognitive dimension. A huge number of falls happen at night when someone wakes up, often to go to the bathroom. If you have poor balance and you're not very strong, it takes planning and being careful to not fall. In the middle of the night when it's dark and someone is groggy, they're at their most dangerous. Older people with dementia are in an even worse position with respect to planning and safety awareness. When you put it all together, it's a recipe for an accident, and often this happens in the bathroom where there are a lot of hard surfaces that can do a lot of damage in a fall.

A relative of mine has done some work in this area and worked in a number of assisted living facilities, and this is an incredibly common scenario. I bet there's a bunch of tech and/or therapy that could help in some of these dimensions that would help. Just for example, one common scenario is that someone wakes up in the middle of the night and doesn't want to turn on the light because they don't want to wake up their partner. Often if their partner has told them explicitly (sometimes after a previous fall) to just turn on the light, they won't do it. Just making that automatic and not a choice might make a difference.

There’s already a lot of common sense things people can do: night lights, padded floor mats by the bed, handrails by the stairs, not leaving stuff on the ground where you might trip over it. I think I’d do that stuff before some sort of smart lighting system.

Seems like what's really needed is a bathroom floor material that's both soft and easy to clean.

Maybe something along the lines of wrestling mats, which could be put in the shower and hosed down from time to time?

You'd have to walk a line between making it soft enough to help with falls and making it so mooshy that it becomes a source of instability in its own right. Still, we should be able to do better than hard ceramic tile, no matter how much easier it is to clean.

It's not just the floor though.

Hitting your head on furniture/fixtures on your way down is enough to do you in. Ask Bob Saget...

LVT is a fair bit softer than tile and waterproof. Still a firm floor, so not quite into wrestling mat territory.

I am always worried for elderly people I know. It seems like a fall is inevitable - we all fall, trip, stumble, at some point, and they have worse balance and less muscle to compenstate - and they are so fragile.

How do other people deal with it? I know the basics for a fall-resistant home: no stairs, walk-in shower, handholds at toilet and shower (with a chair in the shower), hazard-free walkways.

Surround them with four year olds.

https://en.wikipedia.org/wiki/Old_People%27s_Home_for_4_Year...

(Possibly Geolocked to Australia) trailer: https://www.youtube.com/watch?v=13_rJVvxx_g

I spend time with my 89 year father helping him split wood (5 tonnes every few months), shovel manure (overfilling a double axle trailer), delivering MealsOnWheels to less able seniors, track maintainance (he caretakes 15 km of a 1,000 km walking track).

It's kind of exhausting keeping up.

That said he built a fall resistent home 30 years ago that's all single level with wide verandah patio on a sloped block where every level has ramped access for wheelbarrows, wheelie bins, and eventually wheelchairs.

Best advice? Get active and stay active.

> How do other people deal with it.

A couple decades ago it was more common to see elders wearing canes. It was actually an simple, ancient invention that made a lot of sense. But I think there's years since the last time I saw somebody with one. Our society became youth obsessed, and now people are ashamed to look old. Perhaps making canes become fashionable again would help.

I haven’t been to the U.S. for quite a while so I don’t know how common canes are there, but here in Japan it’s not unusual to see people using them. Just today, I remember noticing three people walking with canes when I was out doing errands; there were probably more, but I wasn’t paying attention. Japan’s population is aging rapidly, which helps to reduce any stigma there might have been about using a cane.

I don’t need a cane yet myself, but when I do there will be many to choose from:

http://tsueya.com/

Make them lift weights and stretch, probably the simplest, cheapest, easiest, best bang for your buck investment you can do in your entire lifetime. It's doesn't even take much, even stagnation is better than rotting away

The day you can't tie your shoes alone it's game over

This guy started at 89!

https://barbend.com/john-claassen-235-pound-raw-deadlift-92-...

several ways. There are definitely better types of flooring that are far more forgiving such as thick carpets versus a cement basement or something. A good medication review and ensure they are not taking meds they don't need or getting on meds they need timely such as antibiotics. Regular engagement from health care workers, I work as a home care aide and visit seniors daily and we ask them each day if they had any falls. Increased falls can indicate other health issues and the possibility to treat them. On that same line we can teach them better ways to do things and support them in tasks they may struggle with. Regular exercise helps as it encourages muscle building and that works hand in hand with balance and muscle control. But at the end of the day people are going to fall and that is okay. We have to let people live life and sometimes that means they are living at risk. There has been invented an airbag system for fall risk patients. It is worn as a vest and if you fall it deploys an air bag system that protects your hips, head and neck. https://www.youtube.com/shorts/azTnlWGSy5U

Thank you. I'm going to start asking (politely).

I remembering seeing a product at CES years ago which was sort of like an air bag for walking. You would wear it on your hip like a fanny pack, and if you fell, it would expand into a large cushion.

I have a feeling this was never released, since I haven't heard about it since. I wonder why. It seemed like a really smart idea.

(By "seeing", I mean I saw a video from The Verge, CNET, or some other news organization covering CES. I've never been to CES in person.)

Even if the risk of falls usually increases due to normal aging, it may be dangerous to not consider all possible causes.

Especially for females, eating too little salt while also being on high blood pressure medication can lead to a too low concentration of sodium in the blood (hyponatremia), for which some of the main symptoms are balance difficulties and muscular weakness, leading to a high risk of falls.

I had this problem with my mother, for which a couple of falls have been wrongly attributed to old age and this has determined the failure to diagnose the real cause (by not sending her to blood analysis) until it has been too late and much more severe symptoms had developed, seriously endangering her life.

The content of salt in food must be monitored carefully. Both too much and too little are dangerous (recommended daily intake: 4 to 6 grams of salt).

Too much is quite a bit less dangerous than too little. In many cases excess sodium isn't dangerous at all, there are some high blood pressure conditions and kidney issues where you have to be careful there. Most people just urinate it out without any difficulty.

The Japanese are among the longest-lived people on the planet, and eat the most salt. There are a lot of confounds there, but it's at least suggestive.

The more important takeaway is that too little salt is bad news, even for otherwise healthy/young people.

Is this really news?

Not, but it's a dire, widespread problem without an adequate solution so far. I think it deserves a lot more of attention from entrepreneurs and researchers.

There’s no money in fall prevention so it’s not going to happen

How do I know, I meet s great guy a decade ago creating “FallCall” which was supposed to be a Apple watch accelerometer based fall warning (and prediction) and it worked great and patients liked it

Medicare unfortunately wouldn’t pay for that, and so unless it’s covered, no paid health service can survive

That's a terrible take considering how much money both governments and insurance companies would save. There are a ton of studies made on injury prevention every year. I've personally participated in one study for 19 years now. Exercise is one of the best methods to prevent it and it would be a very bold claim to say there's no money in fitness.

The issue with accelerometers is that they don't prevent fall, only notify afterwards, and you get a ton of false positives. To the degree that Apple devices are becoming a real issue for health personnel.

I wish it wasn’t the case but it’s state of modern healthcare

My cousin started Bold, an at home exercise program designed to reduce the risk of falls for older adults: https://agebold.com/

No adequate solution? What about strength training?

they have airbag jackets

Hacker News guidelines don't say something has to be news!

At first I thought the title said US Senators but then realized its the same thing.

Same

I think a lot of this is because of balance issues. Many people have this type of problem and it can be corrected, or at least improved, with balance exercises. A physical therapist that knows about them can show elderly people how to do them. They're actually helpful before you get elderly, you might not even realize how off your balance is.

If you look at photos of people doing some of these exercises, their eyes are closed or they're wearing something over their eyes. This is to invoke non-visual means of balancing, which is really important.

Based on my grandmother who was always very mobile well into old age and did eventually become at risk for falls: a lot of it is not lifting your feet anymore. As the leg muscles get weaker, seniors often don't fully lift their feet off the ground when walking and this drastically increases the risk of tripping on shallow obstacles like the rim of a rug.

She was able to put on a shoe while standing on the other leg but she noticed that she had stopped properly lifting her feet while walking and this eventually led to her first bad fall after which she physically deteriorated further. She had to consciously think to lift her feet while walking rather than "shuffling".

I think the root cause for this may indeed be balance issues though as the "shuffle" feels like it would stabilize and balance issues make it harder to prevent a fall when tripping up.

I recall reading a study about how the nerves in the legs deteriorated as we got old, and how stimulating them with "noise" significantly reduced the risk of falling.

The method of stimulation was to have slightly bumpy surface under their feet, though can't recall if they used special socks or inlays or what.

IIRC the idea was to boost the stimulation when they walked to revert or counteract the deterioration of the nerves.

Interesting. Balancing exercises can strengthen your legs too, although obviously leg exercises would work better. I noticed a problem in older people who have never gone to a gym, is that they have no idea how to exercise, and no motivation to either.

I guess they really need physical therapists.

Balance issues usually are a symptom of an underlying condition.

For instance, an elderly relative of mine has had several strokes. While they have regular PT sessions, it's basically impossible for them to automate countering balancing issues. Neurological specialists and therapists essentially agreed: that relative isn't going to walk a significant distance, especially outdoors, without a walker as the risk to falling is just too high. Their home (e.g. bathroom, stairs,...) has also been adapted to prevent falls.

In that regard, minding your health at a younger age pays dividends later on as it reduces to risks of landing a condition that might lead to a nasty fall.

That can be the case, but there are also other causes.

Here's a study looking at some numbers: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10242407/

They found that in 2016 about 36.8 (± 1.0) million people had balance problems in the US.

Also, many people don't know they have these problems.

I'm fairly young and I have balance issues. If I won't address them in near future,the retirement period will look very very bleak for me.

I almost fell in the bathroom. Bought myself a fall bathroom rug the next day. The last thing I want is the embarrassment of EMTs wheeling my naked body into an ambulance.

It was a painful reminder that I'm starting to get old.

Well, if Fire Dept Chronicles on YouTube is anything to go by, your naked body wouldn't even make the top 100.

My wife works as an aid for elderly people and a fall is frequently the kick-off event for their death. Older folks often have a reduced sense of thirst and hunger, even when they're not experiencing dementia, and that can lead to lightheadedness and balance issues. Independent living is great, but not everyone who wants to live without care and supervision is capable of it.