- by Dr. Robert C. Martin

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Recently a group of elderly (and completely sane) citizens went to the Cleveland Clinic to be tripped and fall down. Although not something those of us in medicine typically recommend people to do, this activity was carried out under the watchful eye of researchers to learn more about what makes people fall. Given the seriousness and frequency with which falls occur in older adults, falls and fall-related injuries represent a pressing national research imperative. Indeed, an objective of the federal government's Healthy People 2010 initiative is to reduce death from falls and hip fractures resulting from falls.

Hip fracture, perhaps the single most devastating outcome of a fall in older adults, occurs in nearly a third of women and almost 20 percent of men who live to age 90. It is a major cause of loss of independence in this population. Furthermore, the mortality rate of older adults after a hip fracture is up to 20 percent higher than persons of similar age, race and gender. In the United States, the estimated 30 million falls by older adults each year resulting in 300,000 hip fractures. At an average cost of $32,000 per hip fracture the total annual cost of fall-related hip fracture is a startling $9.6 billion.

Tripping is a major related factor in fall-related injuries, in particular hip fractures in older adults. Specifically, tripping may account for up to 50% of fall-related hip fractures in this growing population.

Identifying the risk factors for falls is of great importance, particularly those that are treatable. A research group at the Cleveland Clinic developed a unique approach to discovering these risk factors by defining the biomechanics of fall initiation and decent, and the age-related physiological changes that contribute to falls. Their protocol centers around a method that actually causes healthy older adults to fall-safely (essentially tripping little old ladies on purpose in the name of science). The subjects were comfortably belayed using ropes and carabiners used for rock-climbing. The rope was attached to a track on the ceiling. As the subjects walked, an obstacle suddenly springs up from the floor to trip them. Although many came close to hitting the floor none did due to the ropes.

Seventy-nine subjects, ranging in age from 65 to 86, were enrolled in the study. Fifty were women, Subjects were healthy, community-dwelling people who were thoroughly screened by a physician prior to enrollment in the study.

Results were analyzed with mathematical modeling of the complex series of events involved in the induced falls and revealed that the most significant factor in falls was not lower body strength or postural control but reaction time. Put another way the speed with which they could react to the fall and catch themselves determined if they fell.

This research led to further studies showing that older adults who participated in activities that help maintain or improve their reaction time would reduce their risk of falling particularly backwards which has the greatest likelihood of causing the most serious injuries. Many and varied activities can be used to improve reaction time including most sports such as golf, ping pong, shuffleboard and lots of others, so get out there and start increasing your reaction time.