Maggie McKay (Host): Try as we might, sometimes as careful as we are, we just fall and it's scary to lose control. Today, physical therapist, Susan Frikken, is going to discuss ballroom basics for balance and making falls less scary and more fun.

Welcome to Stoughton Health Talk, a podcast from Stoughton Health. I'm your host, Maggie McKay. Thank you so much for being here today, Susan.

Susan Frikken, PT: Thank you, Maggie. It is a pleasure. I've been waiting for a while to be able to talk to you.

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

Susan Frikken, PT: Falls are one of the biggest causes of injury in the United States of all ages of people. However, they affect people over 50, over 65, what we consider older adults or seniors, quite a lot more frequently, and there are many reasons for that. But how do they affect us or for the people who sustain the falls, they often create an injury that keeps us in the medical system for a long period of time, costs quite a lot of money. And many people, up to one-third, often do not return to independent living.

Host: Wow. And so, now we know about the individuals, what about in a broader sense, from your vantage point and your expertise, how do falls impact people in general, like, you know, their circle and beyond?

Susan Frikken, PT: Right. So, falls impact us as a community Well, again, I had mentioned the monetary cost, if we're speaking just kind of in a numeric way. It is one of the biggest reasons for healthcare spending across the country and in the state of Wisconsin as well. It keeps our healthcare systems very busy attending to the fallout, no pun intended, but the symptoms and the outcomes of a fall, broken bones, head injuries. So, these are sort of using a lot of the resources that we do have. And also our family and our friends end up becoming caregivers, perhaps for somebody who's become dependent. And it's got many other burdens, I guess we would say, on society. But really, the loss of independence is really, I think, one of the things that comes up over and over. And that means we're dependent on other people.

Host: And Susan, how do you approach fall prevention?

Susan Frikken, PT: It's interesting, the phrase fall prevention. I and others in the community here in Dane County, Wisconsin, but also across the country and in North America, we are starting to look at things and talk about them a little differently because words matter. Fall prevention makes us feel like, "Well, if I have a fall, I have failed something."

And we're starting to talk about it in the phrase falls resiliency, perhaps, or some other phrases, meaning if we lose our balance and if we do maybe land on the ground or on something else, how well do we recover? Can we change that outcome of not returning to independence? Can we fall and still get up and be mostly okay and heal and get back to society and not be dependent on everybody?

I start dealing with falls prevention by changing the feeling around it, the fear around it. One thing that I do as a physical therapist is I evaluate people. There are many reasons people fall. It can be cognitive. It could be behavioral. Maybe we are one of those people who rush and we don't pay attention. It could be vision, it could be heart-related, it could be so many things. It could be mechanical. And I get to help people figure that out, which is great. And then, we can focus on that.

And another way that I do is with community programs, which also, we've talked about isolation a little bit with becoming dependent. One really exciting thing that I get to do is I get to bring people together to work with falls prevention, falls resilience, improving balance, improving mobility by doing really fun things like ballroom dance. Also, I do parkour with seniors and a couple of other things. Even with the people in my private practice, we tend to try to do things that are fun instead of boring things.

Host: You've answered this a little bit, but maybe you could expand on it. You mentioned fear. And as we said in the beginning, a fall can be scary, of course. So, how do you encourage someone who has had a fall to try to find that joyful movement that you speak of to help improve balance? Like you mentioned, ballroom dance.

Susan Frikken, PT: It's really important because it's scary. And once somebody has fear, they stop moving because it's scary. And that just makes things worse because the less we move, the weaker we get, the more likely we are to fall, so it has that spiraling effect. It's helpful to have somebody be successful in a safe environment. So, having supervision, doing a fun movement.

Let's say if I'm in the office with somebody and doing movement with them, I'll be close and I will hold on to them so that they feel very successful in their movement. And they think, "Oh, wait, I can still do this." And it's incremental and small. But if we're in a group setting, if we're doing dancing or parkour, what we do is we start small again, but what it's about is we often have volunteers. I recruit student volunteers for my Ballroom Basics Program so that these therapy students or health students can learn while they're with people and they can actually help those people feel safer by having somebody around, new eyes, new ears. So, in a safe environment, pushing people just a little bit so that they can experience confidence and building on that little by little.

And I'm sure you know, because you talk to a lot of wonderful people in this area, that fear is one of the greatest predictors of a fall. Even more so than, let's say, weakness of your hips or vision problems. Fear is an even greater reason that people will fall. And so, it's really important that confidence is something that we address while we're working on the other issues.

Host: Just a little aside for people who don't know, what is parkour?

Susan Frikken, PT: Aha! Parkour. Parkour is from the French and it means the way. And there was a group of young men in France and Paris in the '90s who started just sort of using their environment as a playground, and they just move throughout, go over, under, around, swinging, crawling. You know, it's sort of extreme when you think about it jumping off of buildings and things. We don't jump off of buildings but what parkour has to offer is people learn how to land well. If you're jumping off of a building, you've got to learn how to land well. And what that has to offer all of us is practice learning how to land well. And when we talk about resiliency when we land, we don't have to necessarily hurt ourselves, so we get to practice maybe tripping, and we fall, and we land on our hands against the wall, and instead of becoming rigid and maybe breaking something, we get to absorb the forces and learn how to do that like we used to when we were little. And it's in there, but we get to help people practice that. And it's fun, and it's silly, and that makes things just better.

Host: Always. I have to tell you, Susan, the worst fall I ever had was the tiniest, tiniest crack in the sidewalk. I mean, it doesn't have to be like an obvious thing that you're going to trip on, and it was the worst fall ever. But it seems like we hear about falls mostly among young children and older adults, but when should someone start becoming more aware of their balance and do something about it?

Susan Frikken, PT: Oh, all the time. A really sweet spot is, if you've always felt like you were a klutz, that's a good time. So, regardless of your age, some people are just born differently with different body connections. So some of us just need to work on it all the time. But I think, those of us who are sort of moving out of our really active phase of life, like maybe teenagers, early 20s, between then and retirement age is the best time before it becomes a problem, making sure you don't just plop down in your chair, making sure you lower yourself slowly so you stay strong and you can control your movements.

There are little everyday things you can work into life. For example, when you sit into a chair, if you're an adult, instead of just collapsing, stand up and sit down three times very quietly. If you do that every day, all day, you're going to be fine, you know. And if you do lose your balance, you're going to be strong enough to have some control of yourself. So. I would say I know what you're asking, and the answer is before it becomes a problem.

Host: Yeah. The sooner, the better.

Susan Frikken, PT: Exactly.

Host: What works well in reducing the possibility of experiencing a fall? Like, how can we be better prepared? You've mentioned a few things, but anything else we should know?

Susan Frikken, PT: Yeah. So, vision, making sure you have healthy vision and if you have issues with your vision that you get them attended to as much as possible. Our vestibular system, our inner ear, if you've got dizziness or lightheadedness on a regular basis, make sure you find out why because that increases your risk.

What we call polypharmacy or more than five medications of any kind that people take increases a risk of a fall because of interactions. Many of them affect the speed that we react. If maybe it's a sleep aid, it makes us slower to react. If it's a heart medicine, it might affect our blood pressure. So, these are some of the big ones.

The other one is your environment and your behavior. So, it could be physical, it could be the environment you're in, and it could be your choices that you make. Are you wearing safe shoes? You know, do you always trip in this pair of shoes? Well, perhaps consider how valuable those shoes are to you, you know, versus falling down. And then, you know, your environment, can you make changes to your environment that are safer?

Host: Thank you so much for sharing this practical and useful information and sharing your expertise, Susan. This has been really informative.

Susan Frikken, PT: Thank you for having me. And if I can provide any more resources, I'd be very happy to do so.

Host: Again, that's Susan Frikken. And if you'd like to find out more, please visit safercommunity.net. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library at stoughtonhealth.com for topics of interest to you.

I'm Maggie McKay. Thanks for listening to Stoughton Health Talk, a podcast from Stoughton Health.