“Please help me, I’m falling . . . “

San Miguel is a beautiful place to explore on foot, and we walk everywhere we go. The architecture, the views, the bougainvillea, jacaranda and other plants and trees in full bloom at this time of year all offer a rich and colourful feast for the eyes.

In sharp competition for a walker’s attention, however, are the streets and sidewalks themselves. It is often difficult to know whether to have eyes up to drink in the surroundings or eyes down, on the lookout for unmarked holes and uneven cobblestones.

Mexicans, of course, are skilled at navigating what we northerners think of as the pitfalls of walking in SMA. Mexican women, in particular, manage to walk on cobblestoned streets and around giant holes in the sidewalks while wearing breathtakingly high heels, with seeming comfort and ease.

Those of us who visit here wear decidedly sensible footwear and develop what I think of as the SMA stroll: legs slightly apart to maintain balance on the uneven surfaces beneath our feet, moving forward with a cautiously rolling gait to reduce the likelihood of tripping or twisting an ankle, heads bobbing up and down to keep track of what’s under our feet while also looking at our surroundings.

Fortunately, cars in this town with no stop signs or traffic lights always stop for pedestrians, so we don’t have that to worry about.

Frequent fallers

Of course, falls are not just a concern in San Miguel. Especially as we age, we become more prone to trips and falls.

According to the Canadian Institute for Health Information, in 2017, falls resulted in 1,800 visits per day to emergency rooms across the country and cost the health care system more than $2 billion a year.

For those of us who are older, a publication by the Public Health Agency of Canada (PHAC), Seniors’ Falls in Canada, provides a grim list of statistics. Here are just a few: 20 to 30 percent of people over 65 years old fall each year; falls are the leading cause of injury-related hospitalization for older people and are the direct cause of 95% of hip fractures.

Those falls can have serious psychological as well as physical consequences, with many older people developing a loss of autonomy and greater isolation as well as depression and fear of falling, which creates a vicious cycle of greater isolation, increased depression, more falls, and on it goes.

Close to home

In mid-December, my almost 91-year-old father fell and broke his hip. He, like 50% of older people who fall, did so at home: standing up from a chair, he toppled over and – boom – his hip was broken. He doesn’t remember whether he caught his foot on something, if it just gave out from under him or if he had a dizzy spell.

He spent three weeks in a critical care hospital, even though he was medically ready to be discharged much sooner than that, as he waited for a bed in a rehab facility to become available.

After seven weeks in rehab, he has just gone home to his wife in the retirement community where they have lived for several years. He will be using a walker, as he was before the fall, and should be able to resume his life much as it was. Nonetheless, we have no doubt that he will be less confident, which may restrict his activities to some extent.

He is one of the lucky ones. He has a wife and lives in a retirement community, so he is less likely to become isolated than if he lived alone. For many people of my dad’s age, a broken hip would have meant a move to a long-term care facility, with less mobility and chronic ill health a result. For 20%, that hip fracture would have led to death within a few months of the fall.

Fear of falling

According to PHAC, risk factors – which we need to understand to prevent falling – can be divided into four categories:

1. Biological or intrinsic: physical and cognitive issues we deal with
2. Behavioural: reliance on assistive devices, alcohol consumption, footwear, medication and fear of falling
3. Social and economic: the more isolated and the poorer we are, the more likely we are to fall
4. Environmental: the design of our surroundings, including furniture, and the weather

Interestingly, 61% of people who fall when they are walking are not walking on snowy or icy surfaces; but that may be because the fear of falling that many older people have keeps them indoors in inclement weather.

There are ways to reduce the likelihood of having a bad fall. Improving balance, wearing sensible (or, as a friend’s daughter likes to say “old lady”) footwear, increasing agility, balance, flexibility and upper body strength and walking regularly all help.

In Toronto, older people can attend a 12-week falls prevention course at the Toronto Rehabilitation Institute to learn about the importance of exercise, how to get up from a fall, stair safety, healthy eating and how to overcome the fear of falling.

Another innovative program, this one in the Niagara Region, pairs a paramedic and an occupational therapist for responses to 911 calls from people over 65 who have fallen. While the paramedic deals with any urgent medical issues, the OT assesses the person’s environment and works with them to reduce risks in their physical space.

Let’s face it: there is nothing appealing about falling as we get older. It behooves all of us of a certain age to consider the possibility of falling and put preventative measures in place where we can.

Off to tai chi to improve my balance and flexibility!