There’s no place like home,” which is why 87 percent of adults age 65+ want to stay in their current home and community as they age. The neighborhood in which I live has many folks who’ve been here for several decades, generously sharing their wisdom and memories with the next generations. Experience tells us, however, that risk of injury from falls and difficulty with transportation are 2 challenges older adults face when wanting to remain in their homes.
Modifications such as installation of grab bars and stair railings, walk in-shower conversions, and removing some interior doors and all throw rugs can make mobility easier in traditional homes built prior to the concepts of accessibility and single-level living. There are also new, simple technologies to help keep aging adults safer in their homes.
Enhanced lighting is an important improvement to make. As we age we rely disproportionately on vision for balance; walking around in poorly lit spaces is similar to walking around with your eyes closed. It is essential to have well-lit paths in the bedroom, hallways and bathrooms at night. Plug-in, light-sensing LED night-lights illuminate dark spaces in older homes which result from limited natural or overhead lighting, and few switch controlled outlets for lamps. The new lights turn on automatically when needed, are energy efficient, and require no replacement bulbs. Their low wattage provides adequate light without disrupting normal sleep.
Unfortunately, home improvements have not eliminated falls. In June the National Council on Aging reported 1 in 4 adults over age 65 fell in 2017; 55% of those falls occurred inside the house, and 23% occurred outside but near the house. With 85% of people over age 65 now owning a cell phone, many older adults living in the community opt not to purchase a separate emergency alert system, intending instead, to use their cell phone to call for help if needed. But Murphy’s law says that the one time it’s needed will be the one time it’s left resting on the kitchen counter out of reach from the floor. Someone is rarely without their watch though, making it readily available in the event of an emergency. Gizmo-Gadget, by Verizon, is a watch with a very basic cell phone inside. It uses single touch dialing to call a limited number of contacts. The Kurio Smart Watch, and similar devices available through retailers such as Amazon and Walmart, calls select numbers by connecting to the user’s separate cell phone via bluetooth technology. We recommend testing signal range in and around the home before relying on either as a safety device.
For the 15% of older adults without a cell phone, we recommend that their traditional phone be placed within reach of the floor in the event a fall. Since almost 1/4 of falls occur just outside the home, we also recommend older adults who routinely enjoy the privacy of their own backyard keep a whistle outback to easily call for help when out of sight, but not out of earshot, of friendly neighbors.
Regardless of what call system is in place, family members often worry about older adults who live alone, especially if a few days pass without contact. Iamfine is an automated call service created by 2 sons living distant from their independent 90 year old mother to ensure routine checkins. A phone call is generated daily at a time set by the customer. If the recipient answers, alerting the system Iamfine nothing happens. The system will continue calling at predetermined intervals, and will alert the customer’s designated contacts, however, if it receives no response. More details can be found at www.iamfine.org.
Transportation to medical appointments, as well as social engagements, can be a challenge for seniors who have stopped or limited their driving. Uber and Lyft are popular options but require the user to have a SmartPhone and do not allow for prescheduled rides. GoGoGrandparent is a service which addresses both concerns. After setting up an account the user calls a toll free number to request a ride by either speaking to a real person, or once familiar with the system, using a touch tone menu. The rides, which are provided via Uber or Lyft, can be scheduled on demand or several days in advance. The service charges a per mile, per minute fee to the cost of the ride, but remains less expensive than traditional taxi rides, and requires much less wait time than Tri-met Lift or Ride Connect. There is an optional safety feature, unavailable with traditional transportation services, which alerts family members of pick up and drop off locations and times. More information can be found at www.gogograndparent.com
Most older adults want to live in their homes for as long as possible. In addition to what friendly neighbors routinely do, such as helping rake leaves or clearing sidewalks, moving trash cans and delivering an occasional meal, independence can be supported through home improvements and community services made possible by technology like those explained above.
If you, or an important older adult in your life are struggling with mobility at home, give us a call. We specialize in keeping older adults active, independent and mobile by seeing them in the convenience of their own homes. Colleen Gilroy, PT Founder of Vitality PT NW Healthy Aging experts in Portland, Oregon www.vitalityptnw.com Together, let’s keep you on your feet.
Colleen Gilroy, PT Founder of Vitality PT NW Healthy Aging experts in Portland, Oregon www.vitalityptnw.com
Falls happen backwards for a variety of reasons, including stiff, weak ankles as mentioned in the previous post. But another reason is that older legs are out of practice stepping backwards.
Every day we walk forward, so if we start to fall in that direction, our body knows what to do: step or reach to try to catch ourselves.
But if there is a loss of balance backwards, the older adult typically has one of 2 reactions:
They freeze, immobilized briefly by indecision/anxiety/fear, and a painful Nestea plunge toward the floor follows.
Unfortunately the ground is less forgiving than water.
OR, they take a series of rapid, mini steps backwards, trying to stay ahead of their momentum, until they can’t.
Often a counter, wall, chair, or the floor is what finally stops the motion.
By practicing taking steps backwards, the body becomes familiar with the movement and is prepared to react to the same movement to prevent a fall.
Stand at the counter and practice taking a SINGLE step backwards, moving your weight onto the back foot and STOP.
Once that is smooth and easy, add leaning forward at the hips as you step back. Doing this quickly shifts weight forward, making it harder for the body to keep moving backwards toward a fall.
Video Transcript:
I’m going to show you how to safely practice stepping backwards.
Begin at a sturdy surface like the kitchen counter or a solid chair.
Have both hands on the surface.
Begin with just taking small steps backwards.
Move your weight onto the back foot as opposed to just moving your foot back. Actually step back onto it.
As this becomes more comfortable you can begin taking larger steps back.
Try to get your foot at least past the other foot.
Once that becomes comfortable, begin practicing leaning forward while you step backwards.
By doing this you’re shifting the center of gravity into the middle of your base of support, so you’re much more solid when you stop.
The whole idea is if you lose your balance backwards, to be able to take a single step, not several steps backwards.
As you get more comfortable, practice “sticking the landing.”
When we are standing and start to lean forward slightly, sensors in our ankles notice the small movement. They quickly correct the tilt by firing our calf muscle to pull us back into upright.
The same happens on the front of our shin if we tip backwards.
But the built in sensors around the ankles can’t work properly if the ankle is really rigid or if the muscles are too weak to react to balance changes.
Practicing going up on your toes and rocking back onto your heels improves the movement in your ankles while strengthening the muscles.
When you raise your heels, going up onto your toes, you should get taller. If the calf is really weak, the body will try to cheat by moving the knees forward, and not getting any taller.
Next, rock back onto your heels, lifting the front part of your foot off the ground.
Don’t worry about how high you can lift to begin with, just get your ankles moving. Go up on your toes for one minute before switching to lifting your toes off the floor.
Video Transcript:
I’m going to demonstrate how to safely practice going up on your toes and rocking back onto your heels.
Start at solid surface like the kitchen counter or a sturdy chair.
Begin with both hands on your surface and progress to just one.
When you go up onto your toes, lift your heels up off the floor growing taller.
Be careful not to go up onto your toes only by rocking
forward at the knees and not getting taller.
When you go up we want you to go up slowly and controlled.
Be on the big toes, not rolling out onto your
little toes.
Hold it there, then lower gently to the ground.
When you go back on to your heels you’re going to lift the front of your toes up off the floor.
You won’t have as much range as you do going up on your
toes, but lift your toes as high as you can.
Hold it there and lower gently back down to the floor.
Each time we step, we have to rapidly switch our weight from one side to the other while lifting the other foot. We have to do the same motion when we step onto a curb, but have to hold it a bit longer.
It requires strength and balance to stand on one leg briefly, but also coordination to time moving side to side, lifting our leg, and planting the foot.
As we age, we tend to slow down and rapid movements become more difficult. Practicing moving from one foot to another improves coordination and reaction time.
If and when you need to rapidly get your foot onto the ground, like during a stumble forward, you’ve practiced it and your body will know what to do.
Start by tapping the base of the cabinet for one minute. Once that is smooth and easy, move to tapping your foot onto something 3” or higher.
Video Transcript:
I’m going to show you how to safely practice alternating toe-tapping.
As always begin at a sturdy surface such as the kitchen counter or a solid chair.
You can have two hands or one depending on your comfort level.
Begin by simply tapping your toes against the base of your kitchen cabinets.
Once that becomes easy and smooth, you can place your feet on top of a solid surface.
We increase the difficulty of this by either moving to a slightly higher surface or trying to go a little bit faster.
I’m proud of you for working to improve your balance.
Welcome to Part II of our series about improving your balance: Standing with the heel of one foot touching the great toe of the other foot, also called Tandem Stance
I know outside of the Olympics no one walks on a balance beam.
But most people do walk with their feet in a nearly straight line and heels almost touching as one foot is brought forward past the other.
Walking with our feet close together, or standing that way, requires our ankles to constantly be making small adjustments to keep us centered over our feet.
Think of how much harder it is to balance on a bicycle, with wheels in a line, than a tricycle with wheels far apart.
Our bodies are designed to detect movement between body parts, and their relative position to each other. This is called proprioception. Proprioception is how our feet and ankles sense we are leaning forward, even before our eyes notice the wall is now slightly closer to our face.
Standing in Tandem Stance works on proprioception in the ankles, retraining the brain to pay attention to small movements, and react to them.
And when you train your brain to react to small changes, it knows what to do if the ankles sense you starting to lean one way or the other.
Practice standing with each foot in the back for 1 minute each.
Watch the Video below to see me perform the exercise.
Video Transcript:
I’m going to show you how to safely practice standing with one foot directly in front of the other.
As always begin with a solid surface, like the kitchen counter or a sturdy chair.
You can have both hands or just one for support.
Place one foot directly in front of the other such that the heel of the front foot is touching the big toe of the back foot.
Once in position you can decide if you want more of your weight on the back foot or on the front foot, or somewhere in between.
But no matter where your weight is distributed you’re going to feel your ankles working hard to keep you upright.
Switch feet and have the other foot in the front and keep track of which foot is easier to have in the front or the back.
As in the previous exercise most people find they aren’t even.
I’m proud of you for working to improve your balance.
Balance decreases gradually over time for a variety of reasons, including age related nerve changes, muscle weakness and simply not performing movements that challenge your balance.
Research tells us that strength, flexibility, balance and reaction time are the most readily modifiable risk factors for falling. Which means, many of the changes leading to poor balance can be delayed, slowed, or even reversed. That’s great news!
In this 5 part series I am going to demonstrate 5 quick and simple exercises you can do to improve your balance.
By performing these exercises for one minute each, every day, you have the power to improve your balance, increase your strength and stay active and independent in your own home.
Let’s get started!
Stand On One Leg
Before you say, “I can’t stand on one leg,” think about this: unless you are using a cane or walker, each time you take a step there is a moment when you are standing on one leg.
This exercise is training you to extend that moment in time so that if you are walking and are about to step on the proverbial banana peel, you can hold yourself on one leg long enough to select another spot for your foot to come down.
Stepping on and off curbs also requires standing on one leg.
So although you might not be able to stand on one leg right now, if you practice it, it will improve, and so will your balance!
Watch the video below to see how to do it safely and leave any questions you may have in the comments section below.
Video Transcript:
I’m going to show you how to safely practice standing on one leg. To begin with start at a sturdy surface like the kitchen counter or a sturdy chair that won’t move on you.
You can begin with both hands on the surface and progress to just one. Lift one foot up off the floor, being careful that your legs don’t touch or your hip doesn’t drop.
You’ll feel this in your standing hip. Practice both sides keeping track of how long you can do it on the left and the right, because most people are not the same.
I’m proud of you for wanting to improve your balance.
