Antonia Diegisser, M.Sc.
NAR-Kolleg, Heidelberg University
Interview of June 14, 2013 with Annette Franke
What exactly is the risk of falls at an older age?
It has been researched in many scientific studies, that the tendency to fall increases at an older age. We are not talking about falls that happen during extreme sports like an 80 year old driving down a mogul slope etc. but the risk of falls during every day movements. The classic example is an older person needing to go to the toilet during the night and not properly turning the light on. He has no problem with that in the first 5 years and then he falls.
What is the difference between falls of older and younger people? How can one imagine that? Do they have a similar way of falling or are there differences?
While younger people mostly fall during sports like soccer- little kids fall 20 to 30 times a day and get back up- it is much different with older people. They fall in every day situations, at the market place while shopping, or they might overlook the stairs in the theatre and fall. The place and the reason is different. Younger people and kids overestimate their strength and therefore fall. With older people the problems are more the lack of physical power, coordination and balance.
Do older people also have a different way of falling or is there a pattern of them always falling forward, backwards or to the side?
The most common fall at an older age is the fall to the side and therefore the most frequent fracture is that of the hipbone. There are a number of examinations of younger patients who put on markers and were videotaped to analyse this fall mechanism. There you could see that younger patients, when they fall on the side, are able to avoid the direct impact on the hipbone by rotating to the front and also quickly move the arms to the front. And they assume that older patients lost this rotation of the body and the fast reaction of the upper extremities.
And there is something very apparent in these sideway falls: When a younger persons sense of balance is disturbed, he will just make a sidestep and is therefore stable again. However, with older people it takes more than one sidestep or rather this typical cross step. And with these cross steps, the danger of both legs bumping into each other is higher and they practically fall over their own legs. And through the longer phase of the one leg stand, the whole stability is required much stronger.
When does age begin in your studies?
You cannot exactly tell, it depends on many factors. But our test persons were older then 55. How high the fragility is, depends on the level of physical fitness for example. Even a 80 year old patient with a strong osteoporosis who regularly walks, participates in a osteoporosis sport group, grocery shops with the bike, naturally does not have such a high risk of falling then the 80 year old that just sits in front of the TV and drinks coffee.
So lifestyle plays a big role. You just mentioned osteoporosis and that is also your research question. Where is the connection between the different levels of restrictions of the spinal column: pain of the vertebral column, vertebral statics, vertebral mobility and osteoporosis. How can you explain this connection?
We look at osteoporosis patients because they show the typical aging phenomena in a very compressed form. When you look at a osteoporosis patient, he will show three main symptoms. There is kyphosis, known as the “widows bump”, the hunch back. Then the reduced mobility of the spine in all four dimensions of rotation, lateral inclination and extension- flexing and also pain of the vertebral column due to fractures or muscular indurations. Since these 3 dimensions: vertebral column pain, vertebral static and vertebral mobility are the main symptoms of osteoporosis patients and we know that those patients fall more often, the questions arises: Is there a connection between spinal fractures and risk of falls?
Can you tell us a little something about your study? What exactly did you examine and what are the main results?
We looked at 100 osteoporosis patients and examined them with a battery of tests. Those were standard methods of testing, that examined balance, secure gait, mobility but also vertebral static and –mobility. Also vertebral column pain was monitored as well as risk factors that favour falls like decreased vision, cognition or multi-medication. So we had a lot of risk factors that we collected on a data sheet. Then we analysed the linear regression to see which of these factors really influence falls. And to no surprise, pain of the vertebral column showed the strongest influence. Someone in pain moves more careful, moves less and therefore does not have so much power and movement security as someone that has no pain. So vertebral column pain has the strongest influence on risk of falls but interestingly enough also vertebral rotation. The less vertebral rotation was, the higher was the risk of falls of the test persons. In some studies it was found that younger patients avoid falls on the hip by rotating the spine. Like the cat that jumps from a tree always lands on its paws because it turns on its own axis. And these factors of vertebral rotation and vertebral column pain are both hardly recognized in known fall prevention training. That would be an outlook for the future, that these factors are integrated in fall prevention programs.
Is there a preventive possibility to avoid these factors?
Definitely, just stay mobile in everyday life. Ride the bike, go hiking. It doesn’t always have to be a fitness studio, but easy things like working in the garden or in the house. When you stay agile and mobile, you are already doing a lot. Of course you can use real sport programs like a fitness studio. When you stand on one leg without shoes while brushing your teeth or being on the phone, it would cover the areas of balance and coordination. And also the tandem stand, where the feet stand behind each other on a line, helps in those areas. But what I found also very important is that the spine stays mobile. When you work in the garden or in the house, it would do that. But you can also use specific active movements that keep the spine mobile. For example, if you sit straight and look over your shoulder to the right and slowly to the left. If you can integrate that into your daily life, of course not just once but around 20 times in the mornings and afternoons, you do yourself and your stability a lot of good.
Maybe there are nutritional factors to consider? With osteoporosis I am thinking about calcium deficiency especially with women.
That doesn’t necessarily has anything to do with the risk of falls. But if you suffer from osteoporosis or someone in the family has osteoporosis, a calcium rich nutrition is important: cheese, milk products, green vegetables have a lot of calcium. But also important is vitamin D. But enjoy the sun in moderation without getting sunburned. Try to go outside every day.
Antonia Diegisser trained to be a physiotherapist from 1998 until 2001 and worked in a physiotherapy practice with its focus on orthopaedic, surgical and sport therapy. In 2007 she received her bachelor degree in physiotherapy at the University of Fulda and her masters degree in 2009. Since 2009 Antonia Diegisser is a scholarship holder at the NAR-Kolleg.
In her free time, Antonia Diegisser likes to hike or work in the garden. She likes cooking with friends and togetherness with her family. Her 18 month old daughter keeps her on her toes.
