Falls

Falls are part of our lives. Babies learn to walk with tentative steps, teetering, tottering, and falling.

The falls become less frequent as we go through young adulthood, somewhat reflecting the way life stabilizes.

Starting around midlife, the falls pick up again. I still remember my first midlife fall, literally falling flat on my face, as I was walking home shortly after dusk.

Physician friends fretted, wondering if there was some underlying medical condition that caused the fall. In retrospect, I think it was just age reminding us to be more careful, especially out in our streets, darkly or not lit at all and with uneven pavements.

In a way, I was lucky I had that midlife fall, an early warning that made me much more conscious about the risks of falling (including falling in love) in midlife.

My consciousness about falls was further enhanced because my mother had so many falls, definitely connected with her health. She was prone to transient strokes and was just, simply, quite frail, easily losing her balance.

My sister, an occupational therapist in Canada, often sends long-distance advice about falls. Age makes our feet less sensitive and so, we don’t quite feel the ground as we did when we were younger. Vision problems aggravate matters—it’s not so much a matter of near—or far-sightedness than the sense of depth, making us miscalculate the steps, especially on stairways and on uneven ground.

As my mother’s falls happened more often, I reconfigured my parents’ house, putting in ramps and railings. My being an anthropologist alerted me to the many cultural habits that endanger the elderly. One is the use of those small rugs—the type you buy from street vendors, three for a hundred the last time I asked. They’re sometimes called “basahan” because you use them to wipe your wet feet or shoes before entering the house but that wiping motion, and the material of the basahan, make it easy to slip and fall.

When COVID-19 came along, we were fooled into buying all those disinfecting mats, which were useless against the virus but, like the basahan, quite dangerous. I slipped on those mats at least three times, once in UP right before I was to deliver a commencement speech. Fortunately, like other elderly people, I’d learned how to regain lost balance from several falls.

The twisting and turning may make good choreography, but might not be enough to protect you or might even cause a hip fracture. Women with brittle bones (osteoporosis) are much more prone to hip fractures than men, but there are other risk factors, mainly those that create balancing problems, for example, Parkinson’s and low blood pressure.

Hip fractures can lead to blood clots in the legs, infections, and further loss of bone mass, which then create a vicious risk cycle for the fractures. The worst consequence of hip fractures is death.

Dementia worsens the risks of falls in general. My father died from a fall in 2018 because he had dementia, and forgot he could no longer walk. His caregiver had left the room and he got up on his own, fell, and suffered a brain hemorrhage.

Dementia isn’t just being forgetful but losing executive functions, the ability to make sense of a situation, and making a timely decision. Falls come from split-second failure with decisions, and the shock of the fall itself further aggravates a shutdown of the body’s systems.

Hazards-wise, I’d say our streets carry the highest risks for falls. It helps to use a walking cane, but our senior citizens will resist, for reasons of vanity.

Falls happen all the time indoors as well. Audit the home or office for safety aids, as well as risks, like those slippery mats. Install motion-sensitive lights that automatically come on when it senses movement; they keep away burglars as well.

Make annual physical check-ups a norm, noting conditions that increase the risks for falls.

I thought, too, about some institutions with the highest risks for falls among the elderly: hospitals, hotels … and jails. Reading about Sen. Leila de Lima in that hostage incident is so infuriating: one wonders why senior citizens—she’s 63—are incarcerated in the first place and, in her case, on trumped-up charges and farcical legal proceedings.

mtan@inquirer.com.ph