Maggie McKay (Host): As we evolve, or let's just say it, age, it's a good idea to prevent falls if we can and strengthen our balance ability. The good news is it's never too late to get moving.

As we'll discuss with Falls Prevention Specialist and Geriatric Care Manager, Linda Cantrill. Welcome to Stoughton Health Talk, a podcast from Stoughton Health. I'm your host, Maggie McKay. Thank you so much for being here today, Linda.

Linda Cantrill: Well, thank you for inviting me, Maggie.

Host: So let's start with, how do falls affect individuals?

Linda Cantrill: Wow, that's a really good question. I would say falls affect individuals in so many ways; socially, economically, physically, it's devastating. It's limiting. So when somebody falls, for example, their fear of falling kicks in immediately. And so the next time they even just go out walking, they walk completely different.

Like I can tell when somebody's fallen just by how they walk and what happens is then everything around them, they start looking down more. So, you have a center of gravity, here's your head, here's your center of gravity. When their head goes down, they're already on their way down, from my experience. So, it's really important to look at why they fell and what happened, what they did, in order to prevent it in the future.

But I've seen people never, ever go home again, ever. And many die. I mean, on average, three people die from a fall related injury over the age of 65. And we have 10,000 people turning 65 every day. It's really, really a big deal.

Host: That is devastating. From your vantage point and with your expertise, what do you see as the impact of falls in general?

Linda Cantrill: Well, I think it's a national epidemic. I think the impact, gosh, I don't even know where to begin. It's so multifactorial, multidisciplinary, multi. What I've seen mostly I think with falls in my experience is a lot of people don't want to come to terms with the fact that they have a balance issue. In fact, I often don't say fall prevention. I say balance work because people really don't want to deal with the issue of aging and falling.

And so what happens is they end up falling, they end up in the ER. There's huge healthcare expenses, unnecessarily. The person, if they do go home; financially, they probably have to get help, which many can't afford. They have to rearrange their whole house, their whole life, pretty much. If they fall and they, let's say, broke their elbow or something, they might be able to go home with the right care and somebody being there for them.

But they really have to have somebody there for them, you know, and a lot of people don't have that. So we try really hard, even through the Falls Free Coalition, to really try to change the impact it's having on older adults. And Falls Free Coalition is doing so many amazing things to work towards educating older adults in falls.

And then we have a lot of programs now and classes that are evidence based. And so, to me, the impact, it's devastating. My own experience is like you lose your independence, bottom line. You lose some of your free will to do what you love to do, what you want to do.

Host: Definitely sounds like a chain reaction and not a good one. We often hear that falls are not a fact of life. Do you agree? And if so, why?

Linda Cantrill: I do agree that falls are not a fact of life. And the reason I believe that, is a lot of research has been done on this topic that show if people are active and moving and dealing with these issues as they're aging, physical issues in particular, or maybe it's neuropathy. Maybe it's some hearing issues.

If they deal with this stuff and get the help they need, they're probably not going to fall because they're going to learn skills on how to prevent their falls from happening. Which, but my experience is they got to be willing to look at what's going on in their lives and be able to admit that something's going on here and I don't feel safe.

And I have worked with World War II vets who are like, I'm fine. You know, but the minute I do assessments on them, like a balance assessment, then they're like, Oh, yeah. Okay, then. This is a different game. Now, I believe you. Now, I see it in myself. And then things can change.

Host: How do you think our local community can help with this epidemic? Because you mentioned it yourself, it is an epidemic.

Linda Cantrill: You know, it's funny, our local community, one of the things I see a lot are very dangerous sidewalks. I know this is not like, the physical part, but so many sidewalks are turned up or, people are tripping a lot. And where I came from, I was in a coalition in California where we literally, would go in neighborhoods and take pictures and send them to the city council.

And sometimes it made a big change. So I think advocacy is so important for this. So my experience is we need people to advocate for these folks, for all of us, to not fall and not pretend like it's no big deal. And the classes that people offer; my belief is all my classes that I teach are evidence based.

So I believe that it's not just standing on one leg. My experience is can I keep my balance while I'm moving? That's really the key. You know oh I tripped, you know, can I get out of a chair. All that stuff is an impact and everyone could help with that. Families, physicians, social workers, neighbors, all of us could help each other with the awareness.

Host: And like you say, the person themselves has to come to grips with it and have to be open to getting that help. So what are a few simple recommendations you'd give to someone struggling with their balance or who's afraid of falling?

Linda Cantrill: I think that the first thing I would say is what, you know, what's going on? What makes you think that? Has something happened? Have you noticed something? And then from there, it's like, well, have you talked to anybody? Have you talked to your doctor? Have you looked at your medications? Have you had your hearing checked? Have you had your vision checked? And first off if they say no and that right on that level then I'm like, okay well, we need to get some other things done first because your falls could be all kinds of different things. You know, I have a student in my class here in Wisconsin where she has a vestibular ocular situation going on she never heard about when she leans forward, she falls over. Just started happening.

And so I recommended she go see an eye doctor and the eye doctor said, you need to see ear doctor. And now she's seeing a specialist. And I have two people with this right now. And what I've learned is that that can be addressed. It can be helped. And a lot of us with just balance training, vestibular training, you know, ocular vestibular.

And I worked at a Balance Disorders Institute in Los Angeles, where that's the kind of stuff we worked with and the success was really good.

Host: I agree because once I had to go to one of those balance places because I had vertigo and it's just the slightest tweaks helped and I never had it again. And I was skeptical, I will say, but it was all about balance and inner ear and so what are the top three elements of a balance assessment, Linda?

Linda Cantrill: I would say strength, sensory perception. So strength would be getting out of a chair, for example, or like, can I lift anything? And then we would have, sensory perception, proprioception, any sensory systems, you know, figuring out like, close your eyes. Can you stand with your feet close together?

So I reduce their base of support. Their eyes are closed. So we took away a lot of different sensory systems and we then would see, can you stay still or are you falling or do you have to open your eyes? Because that means something's going on. So then from there we would do something like put something under their feet so I took the feeling away of their feet.

Now can you feel your center of gravity? Do you know where you are in space again? And, oftentimes they don't. Many times they can't stand on that piece of foam. And then watching them walk, you know, again, inner ear stuff, right? We watch them walk, turning their head. So balance assessments in general are very multifactorial and there's assessments that are called the tug, which is one of them. It depends on the level of the person, where they're at when they show up for us. So some of them are like 14 different movements and assessments, things they have to do.

Some of them are five. It really depends on the situation with the person, but all of them will revolve around strength, mobility, cognition, and sensory perception.

Host: Linda, in your opinion, what are the top three or four exercises you'd recommend for someone starting out to improve their balance?

Linda Cantrill: Well, I'll give you couple simple ones people can do at home. One is a sit to stand. So it's sitting in a chair and standing back up, but I always say not rocking to get up, like sit down and stand up. Which is much harder if you got some momentum going. If you have to start out that way, that's fine.

But in the long run, you'd want to be able to do this without a lot of momentum. You'd also want to make sure that you can do them safely. Over time you would not use your hands to push off the chair, for example. Another really awesome one is to do push ups in your kitchen off your counter. Because again, we're going to strengthen those arms, so if you do fall, you have the ability to get back up again.

And then another one is weight shifting. Just weight shift side to side, front and back. Put your feet wide, shifting side to side. Put them in like a semi tandem like you know, front and back. Just getting that whole shifting going on, because when you walk, you shift. You know, we don't just step, we shift our weight first.

So I do a lot of weight shifting in my classes, and center of gravity work. And then I think, walking is always good and standing on one leg. But I always say balance is not about doing it standing still. As I said earlier, it's about being able to move.

Host: Well, Linda, you have given us so much to think about and shared so much useful information. Thank you for your time and sharing your expertise. We really appreciate it.

Linda Cantrill: Well, thank you. I really appreciate you, Maggie, for putting this on.

Host: Thank you. Again, that's Linda Cantrill, and if you would like more information on preventing falls, please visit safecommunity.net/fallsprevention. If you're interested in exploring a wider range of health related podcasts, check out the Stoughton Health podcast library at stoughtonhealth.com.

Thank you for listening. I'm Maggie McKay. This is Stoughton Health Talk, a podcast from Stoughton Health.