From the surgical end of this story: once someone falls, how they fall carries its own risk, apart from bone density. In a Boston case-control study of community-dwelling fallers aged 65 and over (Greenspan and colleagues, JAMA, 1994), the direction of the fall was an independent risk factor for hip fracture, with an adjusted odds ratio of 5.7, and that estimate did not change when bone density was added to or removed from the model. The potential energy of the fall and a lower body mass index also counted. The authors suggested reducing fall severity, for example through muscle strength, as an additional strategy, which fits your case for keeping the strength work next to the balance work.
Hi Laurentiu. That sounds fascinating. Given the speed at which a fall occurs, what are the practical suggestions someone might make use of either in the moment or in preparation that might reduce their fracture risk?
Ben, most of it has to be in place before the fall, since there is very little time to react once it starts. Your balance work lowers the number of falls; the other options act on the landing. On your question to KB, whether ordinary people can learn to fall: in a small Nijmegen pilot (Groen, Osteoporos Int 2010), 25 healthy older adults given five sessions of martial arts fall training reduced hip impact force by 8% in sideways falls from a kneeling position, without a control group. The trochanteric padding Greenspan's group mentioned is what hip protectors are: probably a small benefit in nursing homes (Cochrane 2014, RR 0.82), little or no effect in people living at home, and poor long-term adherence.
That’s interesting. So it sounds as though prevention has the biggest part to play at the moment. I lost my mum a few months after a hip fracture, so I’d love to see better ways to avoid falls and reduce their impact.
I’m not sure that falls and fall prevention get the attention they deserve in the community.
About 15 years ago I briefly met an elderly woman who was a former gymnast and she wrote a book about how to prevent falls AND as she said "to fall properly so you don't injure yourself." I don't remember the book title but I think it's a great strategy to address both fall prevention and falling in a way that prevents serious injuries. She also made the point that "You don't need to be an olympic gymnast to fall in a way that prevents you from injuring yourself.
Hi Tom. KB’s From the Petri Dish made a similar point earlier, and pointed me to a BBC article discussing how judo principles were being used to teach older adults how to fall more safely [https://www.bbc.com/news/articles/cll44qnmgneo]. This is a great idea, and worth exploring more.
Thanks for that link Ben. It's very smart to have judo coaches teaching these skills to seniors to minimize the risks of fall injuries. Maybe in 10 years from now I'll need that training!
Your articles are always spot on. Thank you for writing this. I stand on one leg while brushing my teeth. has become a practice now. Also, while cooking, I try to stand on one leg. You know what's even better- the tree pose in yoga? One leg on the side of the other knee. (advanced practitioner reach for the groin) Stretch both arms over your head and press your palms together. Hold it as long as you can and switch. As you stretch your arms over your head, pull your torso up as well. https://www.yogajournal.com/poses/tree-pose-2/
Thanks, Gita. You know, I’ve never tried yoga. I can see how the tree pose is better than just standing on one leg. Maybe I’ll give it a try while waiting for the kettle. I can get to mid-thigh, but it’s not very elegant!
This is essential reading Ben. Falls are a major cause of death especially for seniors . I see this every day. Balance tests should be checked at annual physical, like blood pressure.
Thanks, Corneliu. Before researching and writing this, I’d never thought of asking patients to stand on one leg as part of the routine examination. Perhaps we should.
try this as a google ai query: (entering the query will also yield the links to research and discussion)
Lutein and zeaxanthin, the macular carotenoids, may improve visual motor reaction time. This can reduce fall risks.
-------
excerpts from the query result:
Lutein and zeaxanthin boost visual processing speed and visual motor reaction times by roughly 10%, which supports better balance, spatial coordination, and potentially lower fall risks.
How It Works
• Macular Pigment: Lutein and zeaxanthin accumulate densely in the human retina (forming the macular pigment) and are also selectively taken up into motor and visual areas of the central nervous system.
• Neural Efficiency: These carotenoids are thought to enhance gap-junction communication between neurons in the visual cortex, speeding up how quickly the brain and eyes coordinate a physical response.
• Balance & Motor Control: Studies link higher macular pigment optical density (MPOD) to better postural balance and fewer errors in high-speed visual-motor and anticipation tasks
----------------------------------------
one of the references:
A role for the macular carotenoids in visual motor response
Lisa M Renzi 1, Emily R Bovier, Billy R Hammond Jr
Methods: Balance ability (measured via the Standing Leg Test) and simple reaction time (measured via a stimulus appearing in one of four quadrants of a computer monitor) were measured in 49 subjects (mean age = 54.8 years). Fixed and variable reaction time, and coincidence anticipation ability (estimating the arrival of the stimulus at a target location moving at four velocities) were assessed in 106 younger subjects (mean age = 23 years) using a customized device. MP optical density was measured in all subjects via customized heterochromatic flicker photometry.
Results: MP optical density was significantly (P < 0.05) related to reaction time and to balance ability for the older subjects. Even for the younger group, MP optical density was significantly (P < 0.05) related to fixed and variable position reaction time, as well as coincidence anticipation errors, at high speed.
These supplements are also advertised to golfers, tennis players, baseball player etc. to improve their athletic performance, both for vision enhancements and response times in hitting at pitches.
A Dietary Strategy for Optimizing the Visual Range of Athletes
If you are fortunate, your optometrist can assess your MPOD - macular pigment optical density.
But that may be rare to find in your area.
Alternatively, s/he takes an OptiMap [fundus map] image of your retina. Ask how yellow your macula appears in the image. That will give an idea of your lutein and zeaxanthin intake.
Lutein and zeaxanthin are associated with faster neural processing. The idea that it’s linked to a lower risk of falls is plausible, but not yet proven - perhaps because it’s not been properly studied yet, and existing studies are small but suggestive.
Lutein and zeaxanthin are also important in preventing age-related macular degeneration, and most of us have a diet that’s woefully inadequate.
Caratenoid-rich foods include leafy greens, broccoli, corn, orange peppers, goji berries and avocados. You really need to pair these with fats to help get the fat soluble compounds absorbed.
It can still be tough to get enough, which is why some researchers advocate supplements.
Interestingly enough, I had a fall not too long ago but somehow my experience in Judo kicked in. It's how the energy gets dissipated by directing it. No, I am not suggesting this for older folks but a few the exercises is part of my PT for hip. No, the hip wasn't pleased by the fall but recovered by next day. I see that they are trying this in your neck of the world. https://www.bbc.com/news/articles/cll44qnmgneo
As always, you’re a fount of fascinating information! I’d never heard of this, but it makes perfect sense. What a great idea. It was clearly a reflex for you after, I’m guessing, lots of experience - in judo, not falling! I wonder if regular folks can be trained to react quickly as you did.
This is very timely. I was doing 20 squats daily and 20 sit to stands, in addition to strength training and 30 minutes of walking daily. But at 70 years old and dealing with Ehlers Danlos syndrome, RA and small fiber neuropathy from autonomic dysfunction, I knew I was a fall risk. I wear leg braces for my dislocating knees and ankles. One night in June, it was very hot, so I took the braces off early. I walked around my kitchen island and caught two of my toes on a step stool leg. I fell, hitting my head first on our wooden dining room chair and landing on my outstretched left arm. I sustained a complex shoulder fracture. I spent the entire summer healing. EDS causes proprioception issues, so that may have added to it, but it was the perfect storm. I am grateful I did not fracture my hip too. I will add more balance exercises to increase my balance. And no more braces off!
Yikes, Jan. That sounds terrible. How miserable. I’m glad you’ve healed, and I’m glad you’ll be adding in some balance exercises to reduce the risk of anything like that happening again.
From the surgical end of this story: once someone falls, how they fall carries its own risk, apart from bone density. In a Boston case-control study of community-dwelling fallers aged 65 and over (Greenspan and colleagues, JAMA, 1994), the direction of the fall was an independent risk factor for hip fracture, with an adjusted odds ratio of 5.7, and that estimate did not change when bone density was added to or removed from the model. The potential energy of the fall and a lower body mass index also counted. The authors suggested reducing fall severity, for example through muscle strength, as an additional strategy, which fits your case for keeping the strength work next to the balance work.
Hi Laurentiu. That sounds fascinating. Given the speed at which a fall occurs, what are the practical suggestions someone might make use of either in the moment or in preparation that might reduce their fracture risk?
Ben, most of it has to be in place before the fall, since there is very little time to react once it starts. Your balance work lowers the number of falls; the other options act on the landing. On your question to KB, whether ordinary people can learn to fall: in a small Nijmegen pilot (Groen, Osteoporos Int 2010), 25 healthy older adults given five sessions of martial arts fall training reduced hip impact force by 8% in sideways falls from a kneeling position, without a control group. The trochanteric padding Greenspan's group mentioned is what hip protectors are: probably a small benefit in nursing homes (Cochrane 2014, RR 0.82), little or no effect in people living at home, and poor long-term adherence.
That’s interesting. So it sounds as though prevention has the biggest part to play at the moment. I lost my mum a few months after a hip fracture, so I’d love to see better ways to avoid falls and reduce their impact.
I’m not sure that falls and fall prevention get the attention they deserve in the community.
About 15 years ago I briefly met an elderly woman who was a former gymnast and she wrote a book about how to prevent falls AND as she said "to fall properly so you don't injure yourself." I don't remember the book title but I think it's a great strategy to address both fall prevention and falling in a way that prevents serious injuries. She also made the point that "You don't need to be an olympic gymnast to fall in a way that prevents you from injuring yourself.
Hi Tom. KB’s From the Petri Dish made a similar point earlier, and pointed me to a BBC article discussing how judo principles were being used to teach older adults how to fall more safely [https://www.bbc.com/news/articles/cll44qnmgneo]. This is a great idea, and worth exploring more.
Thanks for that link Ben. It's very smart to have judo coaches teaching these skills to seniors to minimize the risks of fall injuries. Maybe in 10 years from now I'll need that training!
Your articles are always spot on. Thank you for writing this. I stand on one leg while brushing my teeth. has become a practice now. Also, while cooking, I try to stand on one leg. You know what's even better- the tree pose in yoga? One leg on the side of the other knee. (advanced practitioner reach for the groin) Stretch both arms over your head and press your palms together. Hold it as long as you can and switch. As you stretch your arms over your head, pull your torso up as well. https://www.yogajournal.com/poses/tree-pose-2/
Thanks, Gita. You know, I’ve never tried yoga. I can see how the tree pose is better than just standing on one leg. Maybe I’ll give it a try while waiting for the kettle. I can get to mid-thigh, but it’s not very elegant!
This is essential reading Ben. Falls are a major cause of death especially for seniors . I see this every day. Balance tests should be checked at annual physical, like blood pressure.
Thanks, Corneliu. Before researching and writing this, I’d never thought of asking patients to stand on one leg as part of the routine examination. Perhaps we should.
Thank you Ben . Yes we should at least ask about previous falls and what are the patient’s thoughts about his balance.
try this as a google ai query: (entering the query will also yield the links to research and discussion)
Lutein and zeaxanthin, the macular carotenoids, may improve visual motor reaction time. This can reduce fall risks.
-------
excerpts from the query result:
Lutein and zeaxanthin boost visual processing speed and visual motor reaction times by roughly 10%, which supports better balance, spatial coordination, and potentially lower fall risks.
How It Works
• Macular Pigment: Lutein and zeaxanthin accumulate densely in the human retina (forming the macular pigment) and are also selectively taken up into motor and visual areas of the central nervous system.
• Neural Efficiency: These carotenoids are thought to enhance gap-junction communication between neurons in the visual cortex, speeding up how quickly the brain and eyes coordinate a physical response.
• Balance & Motor Control: Studies link higher macular pigment optical density (MPOD) to better postural balance and fewer errors in high-speed visual-motor and anticipation tasks
----------------------------------------
one of the references:
A role for the macular carotenoids in visual motor response
Lisa M Renzi 1, Emily R Bovier, Billy R Hammond Jr
Neurosci. 2013 Nov;16(6):262-8. doi: 10.1179/1476830513Y.0000000054. PMID: 24148268
[an excerpt]
Methods: Balance ability (measured via the Standing Leg Test) and simple reaction time (measured via a stimulus appearing in one of four quadrants of a computer monitor) were measured in 49 subjects (mean age = 54.8 years). Fixed and variable reaction time, and coincidence anticipation ability (estimating the arrival of the stimulus at a target location moving at four velocities) were assessed in 106 younger subjects (mean age = 23 years) using a customized device. MP optical density was measured in all subjects via customized heterochromatic flicker photometry.
Results: MP optical density was significantly (P < 0.05) related to reaction time and to balance ability for the older subjects. Even for the younger group, MP optical density was significantly (P < 0.05) related to fixed and variable position reaction time, as well as coincidence anticipation errors, at high speed.
-------------------------------------------------------
These supplements are also advertised to golfers, tennis players, baseball player etc. to improve their athletic performance, both for vision enhancements and response times in hitting at pitches.
A Dietary Strategy for Optimizing the Visual Range of Athletes
https://www.golfdigest.com/story/golf-nutrition-foods-to-improve-eyesight-reading-putts
----
If you are fortunate, your optometrist can assess your MPOD - macular pigment optical density.
But that may be rare to find in your area.
Alternatively, s/he takes an OptiMap [fundus map] image of your retina. Ask how yellow your macula appears in the image. That will give an idea of your lutein and zeaxanthin intake.
Hi Cathy. This is a great point.
Lutein and zeaxanthin are associated with faster neural processing. The idea that it’s linked to a lower risk of falls is plausible, but not yet proven - perhaps because it’s not been properly studied yet, and existing studies are small but suggestive.
Lutein and zeaxanthin are also important in preventing age-related macular degeneration, and most of us have a diet that’s woefully inadequate.
Caratenoid-rich foods include leafy greens, broccoli, corn, orange peppers, goji berries and avocados. You really need to pair these with fats to help get the fat soluble compounds absorbed.
It can still be tough to get enough, which is why some researchers advocate supplements.
Interestingly enough, I had a fall not too long ago but somehow my experience in Judo kicked in. It's how the energy gets dissipated by directing it. No, I am not suggesting this for older folks but a few the exercises is part of my PT for hip. No, the hip wasn't pleased by the fall but recovered by next day. I see that they are trying this in your neck of the world. https://www.bbc.com/news/articles/cll44qnmgneo
As always, you’re a fount of fascinating information! I’d never heard of this, but it makes perfect sense. What a great idea. It was clearly a reflex for you after, I’m guessing, lots of experience - in judo, not falling! I wonder if regular folks can be trained to react quickly as you did.
This is very timely. I was doing 20 squats daily and 20 sit to stands, in addition to strength training and 30 minutes of walking daily. But at 70 years old and dealing with Ehlers Danlos syndrome, RA and small fiber neuropathy from autonomic dysfunction, I knew I was a fall risk. I wear leg braces for my dislocating knees and ankles. One night in June, it was very hot, so I took the braces off early. I walked around my kitchen island and caught two of my toes on a step stool leg. I fell, hitting my head first on our wooden dining room chair and landing on my outstretched left arm. I sustained a complex shoulder fracture. I spent the entire summer healing. EDS causes proprioception issues, so that may have added to it, but it was the perfect storm. I am grateful I did not fracture my hip too. I will add more balance exercises to increase my balance. And no more braces off!
Yikes, Jan. That sounds terrible. How miserable. I’m glad you’ve healed, and I’m glad you’ll be adding in some balance exercises to reduce the risk of anything like that happening again.