Planning for Catastrophe

Last week, we lost the peerless poet, songwriter, novelist, and performer Leonard Cohen. Aged 82, Cohen was battling cancer and looking frail, but it turns out the proximate cause of his death may have been a fall.

May have been. Cohen may have fallen as a result of a preterminal event like a cerebral hemorrhage or stroke....or his fall may have triggered the terminal event. We will probably never know. And as noted, Cohen was already in a fight for his life.

But, as related in this excellent article by Dr. Jeremy Faust over at Slate, it does underscore the catastrophic impact of falls and their effect on morbidity and mortality.

Falls are both a cause and effect of frailty in the elderly. Frailty and weakness are invariably associated with osteopenia (decreased bone mass) and poor balance. Poor balance and weakness lead to falls. Falls, if not immediately lethal, lead to fractures, sprains, strains, and even head injury.

These injuries usually lead to protracted convalescence and immobility...which potentiates weakness, frailty, osteopenia, and poor balance.

Which leads to more falls.

And so on.

This is a lethal pattern, a common variation of the Sick Aging Phenotype of which I often speak. Fortunately, this vicious cycle can be broken. There are two approaches. One is far more powerful than the other, but both are indicated for the frail older adult, and both should be implemented simultaneously.

The first approach is to address environmental factors that make falls more likely. These are discussed in Faust's article, and much of the emphasis is on safer flooring and removing trip hazards like certain types of rugs, baby toys, and poorly-placed furnishing. As Faust notes, appropriate lighting is essential

I include in this category the selection of appropriate footwear. Older, frail adults at risk for falls should generally not wear sneakers or shoes with rubber-soled toes. These tend to catch, especially while walking over certain smooth floor surfaced, and precipitate trip-and-fall disasters.

You can find an excellent resource on fall-proofing the home here, but please ignore the picture of the guy doing the stupid chair exercise.

One more thing about the fall-proof home. For some reason, when people feel dizzy, like they might fall or pass out, they have an irresistible urge to go the bathroom, which is the single worst room in the house for fainting or falling down. Every emergency physician has seen this a thousand times. Patient felt dizzy, so he got up from his chair or his bed, and went to the room with all the hard porcelain surfaces, counter tops, slick floor, corners and fixtures...so he could pass out there.

Please. Don't do that.

The second approach is the more powerful. It's important to make your environment more fall-proof, but it's far more effective and important to make you more fall-proof. Dr. Faust's fine article touches on this, but he doesn't really get to the meat of the matter: People are more likely to trip and fall and wreck their lives when they have poor strength, poor balance, and poor body composition.

So we can make people more fall-proof by improving their strength, balance, and body composition.

You'll never guess how I think we might accomplish that.

Yes. Strength training with barbells will make you less likely to fall and break your hip and die. Or fall and crack your skull and die. Or fall and break both your wrists and find out who really loves you because you can't wipe your own ass for the next 12 weeks.

Strength training with barbells makes you...well, stronger. And strength improves power, and strength and power enable us to move more efficiently, gracefully, precisely, and confidently. Strength and power allow us to "catch ourselves," to recover faster and better from a transient challenge to our balance, avoid the fall, and get on with our life.

Strength training with barbells is performed standing up, moving the barbell on our back or in our hands over the middle of the foot as part of a normal human movement pattern, and not falling down while we do it. So barbells train proprioception and balance.

Finally, strength training improves body composition. It makes bones thicker, tendons and ligaments stiffer, joints tougher, and muscles more massive. So if you do trip, or even fall, you aren't as easy to break. And even if you do break something, you'll bounce back faster and get back to life sooner without a descent into greater frailty, because you are strong.

Strong people are harder to break.

Turns out they're harder to trip, too.

We miss you already, Leonard. You will shine your light through that crack in everything for a long time to come. Peace.