The fall season is a good thing because the cooler temperatures makes it easier for people to be active. Falling down is not a good thing. There is growing information about falls in the general population, as well as with people living with MS or other conditions, that put them at risk.
In the general population, a third of adults more than 40 years old have some form of vestibular dysfunction (problems with balance) but are not aware of it. They are three times more likely to fall than those without balance problems. People who are symptomatic (dizzy) are 12 times more likely to fall according to a recent study at Johns Hopkins School of Medicine in Baltimore.
Vestibular dysfunction includes dizziness and equilibrium problems. It can also be tied to vision problems, proprioception (not being sure of where body limbs are because of sensory loss and other neurologic deficits), musculoskeletal problems, and other neurologic dysfunction. Medication side effects can contribute to dizziness and equilibrium problems. Making unsafe choices and/or asking muscles to perform that are no longer strong enough to stabilize you can contribute to dizziness as well.
The risk of falling is great in people living with MS. But this does include all of the issues noted above. MS symptoms that increase risk of falling include vertigo, coordination problems, weakness, sensory loss, vision deficits, hearing deficits, cognitive issues, and bladder and bowel issues. In a recent study by Peterson et al, people with MS who had osteoporosis were more likely to fall and be injured. In addition, they found a relationship between fear of falling and an increased risk of falling.
Many people who fall often “learn” to fall so as to not get hurt. The reality is that all falls put you at risk for injury even though you may get away with it most of the time. Recovery from injuries such as fractures may be difficult and may cause you to lose function either temporarily or permanently. When people experience a fear of falling, they often curtail activities. This not only isolates them, but also leads to increased deconditioning.
For people who experience a fear of falling, compensatory strategies may help such as mobility aids, modifying the home and teaching energy conservation strategies. Utilization of rehabilitation strategies might include programs to increase strength and balance. They can also include strategies to improve attention span and problem solving skills to help a person realize the difference between what they want to do and what they are capable of doing.
For people who are at risk of falling due to MS symptoms, rehabilitation measures will be helpful. Some physical therapists specialize in vestibular training which can be useful for some patients. Physical therapists can evaluate other ways for you to move about and be safe such as using mobility aids and safety additions in the home as well as helping you to become stronger and more focused. Occupational therapists can visit your home to help you evaluate ways to make it safer for you. They can also help you learn to do functions in a different way to lessen your risk of falling. Occupational therapists and speech/language therapists can help you with cognitive issues to help you be more aware of your decisions and surroundings. If you have bowel and bladder urgency, assess your clothing for ease of removal, try to go to the bathroom before urgency (talk with your healthcare provider for advice about that) and evaluate your ability to easily access the toilet. You may need to learn different ways to do that.
Knowing that there may be a connection between osteoporosis and falls and knowing that people with MS have more osteoporosis than the general population and at an earlier age, working with your health care provider to evaluate for that with a DEXA scan, the most commonly used test to measure bone density, will be helpful. If you have osteoporosis, it needs to be treated. Medications that people with MS sometimes take may make them drowsy or less aware. Having a discussion with your provider about your medications may be helpful. In general, taking more than five medications will increase your risk of falls.
Exercise is a great way to improve physical conditioning and help your body to be more stable as well as be better able to catch yourself if you falter. Yoga and Tai Chi are both gentle and help with balance and make you more aware of how you are using your body.
For any of us, whether we have MS or are aging or both, there are some safeguards we need to take.
• Start with where you have fallen before and evaluate it for hazards. If you can recall exactly what you were doing, take steps to eliminate having that happen again.
• Then, in general look at the following:
- Floors and rugs
- All rooms
- Outside your home
• Visit your eye doctor
• Don’t drink alcohol
• Don’t smoke…or if you must, don’t do so while walking
• Shoes make a difference. Some flooring requires “gripping” soles while some requires smoother soles. High heels may not be realistic.
• Having a hand held phone with you is important. Some people prefer a “help line” they wear around their neck