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Why do the elderly fall?

The answer will save lives, Virginia Tech researcher believes

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Tips from Thurmon Lockhart for preventing falls around the house

  • Wet surfaces may not appear dangerous until you step on them-and then it's too late. Heed these tips to stay safe.
  • Minimize changes in walking surfaces, and use slip-resistant coverings such as rough tile and carpet with short, dense pile.
  • Create color contrasts between walls and floors; lighter-colored floor surfaces are preferable.
  • Increase lighting and reduce the contrasts in lighted areas.
  • Install wall-mounted light fixtures, accessible while standing on the floor.
  • Install more outlets to minimize the use of extension cords.
  • Relocate switches so that the homeowner doesn't have to walk through darkened areas.
  • Kitchen and Bathroom:

  • Securely install grab-bars in tub/shower and near toilet at height and angle best suited for homeowner's needs; tubs/showers typically require two bars positioned for support when entering and exiting.
  • Install slip-resistant tile.
    " Increase door width to 30 inches for homeowners with wheelchairs or walkers.
  • Clean up grease, water and other liquids immediately. Don't wax floors.
  • Avoid climbing and reaching to high cabinets or shelves, or use a sturdy step stool with handrails.
  • Always keep a night-light on in your bathroom.
  • Use bathroom rugs with nonskid backing.
  • Vary the colors in your bathroom. Having a white tub, white toilet and white walls can be a safety hazard. If everything is one color, add bright decals or even red tape so older adults can see the edges.
  • Be sure shower stalls have code standard shatterproof glass.
  • Stairways:

  • To reduce injuries on stairs and steps, consider these modifications:
  • Install handrails on both sides of the stairs and extend them one foot beyond the last step at both top and bottom; position top of the railing at elbow height of the homeowner.
  • Use handrails that allow the homeowner to use a "powergrip" -- to encircle their thumb and fingers around it -- and allow hand clearance between the handrail and the wall.
  • Use a different color contrast to mark the first and last step.
  • Limit stair rise to seven inches; make tread at least 11 inches.
  • Use incline risers with 15-degree angles.
  • Remove thick (3/8 inch or thicker) carpets and underpads on treads.
  • Make sure stair height and tread widths are adequate, and each step is identical in size.
  • Install a second handrail if the stairs are wide enough.
  • Install light switches at the top and bottom of stairs.
  • Be sure carpeting is tightly woven and installed so it doesn't move or slide.
  •  

    Falls are the leading cause of accidental deaths among people over the age of 75 and the second leading cause for those aged 45 to 75, according to the National Safety Council. Although the consequences of falling are well known, the relationship between aging and falling is still a mystery.

    Working in his Locomotion Research Laboratory at Virginia Tech, Thurmon Lockhart is determined to solve this mystery. "Fifty percent of people over 75 will either die or be forced to enter institutional care because of falls," he said. "What I want to find out is why these falls happen."

    Lockhart, an assistant professor of industrial and systems engineering with a research background in biomechanics and human motor control, also wants to learn how to help prevent falls.

    "About one-third of the elderly living at home fall each year and one in forty of them are hospitalized," he noted. "Of those admitted to the hospital, only about 50 percent will be alive one year later. And the economic projections are that $20 to $50 billion will be spent in the U.S. by 2020 on the medical costs resulting from hip fractures alone."

    Funded by a grant from the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH), Lockhart is suiting up young and old volunteers in a harness and a network of sensors that test musculoskeletal and neuromuscular changes and biomechanical responses during slips and recoveries.

    As a test subject walks back and forth along an experimental platform in Lockhart's lab, the sensors monitor muscle and joint activities in the feet, ankles, legs, hips and arms. At a randomly chosen moment in the test, a student assistant stealthily pours a slippery solution of liquid detergent and water behind the subject. On the way back, the subject slips and goes through the motions of recovery (an actual fall is prevented by the harness).

    All the data from the monitoring sensors is fed into a computer model, providing information to the researchers about the subject's gait while walking and the body motions involved during slipping and recovery. Lockhart and his students are running tests on a group of 60 volunteers divided into three age groups -- 18 to 35, 40 to 55 and over 65.

    There's more to Lockhart's study than investigating the mechanics of walking, slipping and recovering, however.

    "Another important factor is understanding the intrinsic changes to gait and balance brought about by aging," he said. For example, as people age their walking gait tends to change. "We may take slower and shorter steps, making a higher velocity contact impact with our heels -- which in turn seems to make slipping more likely. Why does this happen?"

    Also as we age, Lockhart noted, sensory factors such as vision, inner ear and touch sensitivity decline. "These changes make us less able to detect that we're slipping until it's too late."

    Lockhart's tests also include strength measurements taken while subjects are recovering from slips. Understanding the mechanics of recovery could help the researchers learn how to prevent slips from becoming falls.

    In addition to the first three phases of this CDC/NIH-sponsored project -- learning the mechanics of slipping and falling; determining the gait, visual and sensory, environmental, strength and perceptual factors behind the mechanics; and modeling the muscle, joint and bone involvement -- Lockhart plans a fourth phase.

    "I want to develop intervention strategies," said Lockhart, who also is affiliated with Virginia Tech's Center for Gerontology. "For example, after our modeling helps us understand the mechanics of falling, we might be able to develop special shoes, strength training routines or environmental and flooring designs that will help prevent falls among the elderly."

    Lockhart and Stefan Duma, an assistant professor of mechanical engineering, already have a provisional patent on a hip pad they created that can reduce impact injuries from falls. Based on air bag technology, a sensor device triggers deployment of the "HIP-bag" when the wearer takes a fall.

    Lockhart and a student researcher are conducting another study of falling among the elderly who live in nursing homes. By investigating data collected at Warm Hearth Village, an assisted living facility in Blacksburg, the researchers hope to devise a model for predicting the risks of falling for individual residents.

    "We need to understand more about the mechanics involved in being older," said Lockhart, who became especially interested in the subject a few years ago when his elderly father fell and broke his ankle. "It's important that we not simply accept the folklore about aging and injuries if we can learn how to prevent those injuries."

     

    For more information about this research, contact Thurmon Lockhart at 540-231-9088 or lockhart@vt.edu.

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