The Best Way to Prevent Fall is Exercise

A woman is jogging outdoor.
Regular exercise is important for strong physical and mental health (Pixabay).

Having strong bones and muscles is probably the best way to prevent fall. It is never too late or too soon to start regular aerobic and strengthening exercises. Apart from improving bone and muscle strength, physical exercise is also important for ensuring good balance and brain health.

Do you follow a regular exercise programme?

New Monitoring System That Gives Early Warning If Elderly Is At Risk of Falling

Wristband that elderly wore so that their walking pattern can be tracked.
The walking patterns of the elderly were tracked by RLTS via the wristbands they wore. Credit: University of South Florida.


Technology used at BMW’s assembly line is transferred to a new monitoring system that can accurately indicate if an elderly is at increased risk of falling.

Declining cognitive function increases the risk of fall. The possible causes are medication, lack of sleep or dementia. This is a disturbing safety problem for elderly who live alone at home, or at assisted living facilities where it is not possible to have continuous individual care.

Dr William Kearns and the research team at South Florida University have developed a novel method that accurately indicates if an elderly is at increased risk of falling. Their method is based on the finding that cognitive impairment is related to the fractal dimension value (a measurement of wondering or directional deviation) in the walking pattern.

For their research, the movements of 53 residents at the Sunrise Village Assisted Living Facility in Tampa were monitored for a year. Via the wrist bands they worn, the walking patterns of the elderly were tracked by Real Time Location System (RTLS). Automated computerized reports on each resident’s fractal dimension value were generated for study.

Daily examination of each reports allowed administrators to detect increasing signs of wandering of an elderly and find out the cause — such as change of diet, medication or sleeping habits. By taking action and making adjustments in time, the elderly’s navigation could be improved and ultimately prevent an impending fall.

RTLS was created by Ubisense and is currently used by BMW’s assembly line to help the operation runs more efficiently.

RTLS is much more accurate than GPS and updates 100 times per second. It pinpoints one’s location, indoors or outdoors, within six inches. GPS is limited to the outdoors and has a one-meter resolution. RTLS is most effective for open floorplans because obstacles in the walking path may affect accuracy.

Dr Kearns is the president of the International Society for Gerontechnology and associate professor at the University of South Florida College of Behavioral and Community Sciences.

Dr Kearns believes the wristband technology will eventually be used in at-home care. He presented his findings at the International Society for Gerontechnology 11th World Conference on May 7, 2018.



“New movement monitoring system helping prevent falls in the elderly.” University of South Florida. Medical Express, May 7, 2018.


Latest Headlines Call for Better Assessment of Older People’s Medication

Polypharmacy can compromise an elderly's safety
Polypharmacy can compromise an elderly’s safety

Older people are often prescribed multiple kinds of medicines (polypharmacy). Polypharmacy 3 may cause adverse side effects such as drug interactions and other complications. The problem affects all ages, but older people are more vulnerable because they have slower metabolism and can’t excrete chemicals as efficiently as younger people.

Although opioids are sometimes necessary to treat acute pain, they can cause sedation and dizziness, and can increase the risk of falling. Besides, prolong exposure to these drugs leads to addiction.

North America is currently experiencing opioid epidemic or crisis. This is due to rapid rise of using opioid drugs for pain management in the past 20 years. Recent investigation also found that opioid prescriptions in England has nearly doubled in 10 years.

Last week, two separate research studies again cautioned drug prescription to older people.

  1. Opioid use links to fall risk and increased likelihood of death in older adults

Data analysis on 67,929 patients aged 65+, who were admitted for injury, showed that those who were using opioid were 2.4 times more likely to have a fall injury. In addition, patients whose falls were linked to opioid use were also more likely to die during their hospital stay.

The study was published in the Canadian Medical Association Journal1 on April 23. 2018.

  1. Dementia is associated with some common medicines

A research study published in the British Medical Journal 2 on April 25, 2018, found that long-term use of anticholinergic* medicines links to dementia. These medications include those for treating depression, bladder control and Parkinson’s disease. Less potent anticholinergics, such as antihistamines and travel sickness drugs, appear harmless.

This is an extensive study carried out by researchers from the University of East Anglia, UK. The medical records of 40,770 patients with dementia were compared with those of 283,933 patients without the disease; and their prescriptions over two decades were analysed.




*Anticholinergic drugs block the neurotransmitter acetylcholine in the central or peripheral nervous system. Anticholinergic drugs are used to treat many conditions: depression, gastrointestinal disorders, Parkinson’s disease, urinary incontinence, epilepsy, and allergies.

  1. Raoul Daoust, Jean Paquet, Lynne Moore, Marcel Émond, Sophie Gosselin, Gilles Lavigne, Manon Choinière, Aline Boulanger, Jean-Marc Mac-Thiong and Jean-Marc Chauny. Recent opioid use and fall-related injury among older patients with trauma. CMAJ April 23, 2018 190 (16) E500-E506.
  2. Kathryn Richardson, Chris Fox, Ian Maidment, Nicholas Steel, Yoon K Loke, Antony Arthur, Phyo K Myint, Carlota M Grossi, Katharina Mattishent, Kathleen Bennett, Noll L Campbell, Malaz Boustani, Louise Robinson, Carol Brayne, Fiona E Matthews, George M Savva, Anticholinergic drugs and risk of dementia: case-control study. BMJ 2018;361:k1315.
  3. Duerden, M., Avery, T., & Payne, R. (2013). Polypharmacy and medicines optimization. Making it safe and sound.

How Do We Control Balance?

How do we keep balance?
How do we keep balance? (Image Pixabay)

The problem of balance had never crossed my mind until I had an attack of vertigo a few years ago. It was weird. It felt like being carried by the waves in a chopping sea. I had to hold on to the bed to prevent from being thrown off. But I knew I was lying on a stationary bed.

What is postural balance? What keeps us upright and steady?

Balance is controlled by the nervous system. When we move, stand, walk, jump, turn, etc., a very complex mechanism is in operation which we are not aware of. To keep us in balance while continuing these activities, the body has to coordinate in precision multiple sensory inputs and motor responses.

Three sensory systems take part in collecting information relating to balance:

Vision – The eyes see the surrounding objects and detect changes in space. They sense whether you or your environment is moving.

Imagine watching buildings, trees, cars and people passing by from inside a parked car; then compare this perception with what you see when driving.

Vestibular system – These sense organs are located in the inner ear. They detect equilibrium, motion and spatial orientation. Put simply, it helps to determine if your body is stationary, moving, turning or rotating.

A problem with the vestibular organs can cause vertigo—the sensation of spinning even when you are perfectly still.

Do you have experience on a swing ride at the funfair, or on a ferry crossing the sea?

Somatosensory system – Sensory receptors (proprioceptors) in the skin, muscles and joints detect the spatial position and movement of the body. The sensory input from the neck and ankles are especially important. They determine the direction of the head, the body movement relative to the supporting surface, and positions of different body parts relative to each other.

Without looking, we can tell whether the surface we are standing on is hard or soft, and stationary or moving. By the way, do you have to look at your feet when climbing stairs?

Three parts of the brain are involved in processing these sensory impulses and maintaining balance:

Anatomy of the brain
The precise coordination of nerve impulses in the brain is crucial for postural balance.

The brain stem is the posterior part of the brain that joins the spinal cord. All nerve connections between the brain and the rest of the body pass through here.

The brain stem receives sensory impulses and pass them to the cerebellum and cortex for further processing. It transmits motor impulses which control movements of the eyes, head, limbs and the rest of the body.

The cerebellum is the coordination centre. It integrates sensory impulses, controls motor activities, and enables us perform voluntary tasks such as dancing and writing. The cerebellum regulates posture, movement and balance.

Patients with damaged cerebellums have difficulty keeping their balance and maintaining proper muscle coordination.

The cerebral cortex plays a key role in memory, attention, perception, cognition, awareness, thought, language, and consciousness. We are aware of ourselves and our surrounding through the cortex. The information and experience stored in the cortex helps the body make voluntary or involuntary actions. That’s why we can maintain balance and have clear vision while moving.

Ageing problems, health conditions, and some medicines compromise balance. And poor balance is one of the main causes of fall.

Do you have any issue with your balance?

Can We Prevent or Slow Down Sarcopenia?

Regular resistance training is a sure way to prevent sarcopenia.
Regular resistance training is the sure way to prevent sarcopenia.

Is it possible to prevent or reverse muscle loss?

Yes, if you would exercise regularly and take good nutritional diet.

We know the importance of active lifestyle and exercise. And many of us already have the good habit of swimming, walking or jogging for a few times per week.  However, these aerobic exercises are great for oxygenation and blood circulation but less so for muscle building and strengthening.

To improve muscle strength and function, we must add resistance training to our exercise routines. And take a bit of time to plan a healthy diet.

What is resistance training?

Resistance or strength training put your muscles to work by using hand-held weights, weight machines, resistance bands, resistance balls and even your own body. Pilates and yoga classes are two examples of strength-training workouts that use your own body weight to strengthen bones and muscles.

The Center for Disease Control and Prevention (CDC) recommends older adults to take part in muscle-strengthening activities for at least twice a week. You should exercise all the major muscle groups — the legs, arms, chest, shoulders, back, and abdomen. Ideally, you should work with a trainer who can guide you through a strength training program which is effective and safe.

If you like gardening, digging and shoveling are great for muscle strength too. Even mundane chores such as carrying shopping, vacuuming, and mopping floors, can be creatively included in your keep fit programme.

The 2014 International Sarcopenia Initiative2 carried out a review of published studies from January 2000 to May 2013. The aim was to find out the effects of exercise on muscle mass, strength and performance for people aged 60 and above. The conclusion was very positive that resistance training can improve muscle strength and function. However, its effect on building muscle mass was less consistent.

Exercise programme which combines aerobic, resistance and balance training is ideal for health and fall prevention.
Exercise programme which combines aerobic, resistance and balance training is ideal for health and fall prevention.

Resistance training can help both young and old people to increase muscle strength. Studies had been done to compare the muscle strengthening effects of two age groups which were given the same training programme. It was found that the strength gained by people between 70 and 80 years old was the same as that gained by those 20 to 30 years old. So, you are never too old to start working on your muscle.

Some health providers suggest exercise programme which combines aerobic, resistance, flexibility and/or balance training for overall health benefits and preventing fall.

What happens to a muscle undergoing resistance training?

When you start resistance training, the neural activity which stimulates muscle contraction increases. As you continue to practice, very soon you will notice an increase in muscle strength.

But muscle growth is due to a different mechanism. If you lift a heavier weight than what the muscle is normally used to, it will disrupt the cell structures of the muscle fibres. The body responds by sending out signals which activate a series of biological events to repair the damage. Protein synthesis in the muscle cell will produce more contractile proteins which cause the myofibrils to increase in size or numbers. The final result is thicker individual muscle fibre, and stronger muscle contraction.

Protein synthesis in the muscle is regulated by several substances including testosterone, growth hormones, and insulin-like growth factors. This helps explain why older people and women are unlikely to grow big muscles despite training. But their muscle strength will improve.

The response of muscle to the overload stress of resistance exercise begins immediately after each session. However, it may take several weeks or months before we see the result.

Why a balanced diet with high protein is important?

Resistance training alone is not enough to improve muscle strength. We need a good diet with adequate calories and rest. A well balanced diet should contain proteins, fats, carbohydrates, minerals and vitamins.

A healthy diet should include proteins, fats, carbohydrates, vitamins and minerals.
A healthy diet should include proteins, fats, carbohydrates, vitamins and minerals.

Muscle fibres are made of proteins. In health, proteins structures undergo a constant process of breaking down and rebuilding. Much like constructing different objects with Lego bricks, our body can build complex protein structures from 21 kinds of building bricks – the amino acids.

Our body is able to make most of these amino acids if conditions are satisfied. But there are 9 essential amino acids* which can only be obtained from food. That’s why we have to eat proper diet to make sure that the pool of amino acids, especially the essential amino acids, is regularly replenished.

Leucine is an essential amino acid which plays an important role in muscle protein synthesis. And HMB**, the metabolite of leucine, has been shown effective at preserving lean mass from breakdown. However, results of comparative studies are often conflicting. So, although Leucine and HMB supplements seem to have effects on muscle mass and function, further clinical trials are needed to confirm their efficacy for older people2.

How much proteins do we need?

Healthy adults are advised to take about 0.8 gram of protein per kilogram of their body weight each day. So, for a person weighs 70 kg, he or she should consume around 56 grams of proteins per day. Bear in mind though this is the minimal amount to prevent protein deficiency. For people such as athletes who train regularly and hard, their protein needs will be much higher.

But older people need higher levels of dietary proteins according to research published in the Journal of the American College of Nutrition3. It is because as we get older, we are less efficient at processing proteins and need to consume more to build the same amount of muscle.

Therefore, you should aim to get 1.0 to 1.2 g per kilogram of your body weight of proteins per day. And more if you are showing signs of muscle loss. Your doctor, or a dietician or nutritionist will give you good advice if you are not sure.

Proteins are available in both plants and animals: meat, poultry, fish, eggs, dairy, beans, legumes and nuts. So, you have plenty of choices to mix and match them in your meal plans. But make sure you take enough carbohydrate calories to provide your body with energy. Otherwise the proteins you eat will be used for energy instead of building muscle.

To conclude…

Sarcopenia is a major health problem associated with ageing. It has a debilitating outcome which might lead to loss of independence, institutionalization or prolonged hospitalization.

The subsequent increase in healthcare costs will be a great burden on individual family and society as the proportion of elderly increases in the population. This awful scenario could be prevented if we just take a bit of time to plan our diet and exercise.

It may be cliché, but prevention is really much better than cure.




*The 9 essential amino acids are: histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, and valine.

**HMB = β-hydroxy β-methylbutyrate



  1. Borst SE. Interventions for sarcopenia and muscle weakness in older people. Age and Ageing 2004; 33: 548–555.
  2. Cruz-Jentoft, AJ, et al. Prevalence of and interventions for sarcopenia in ageing adults: a systematic review. Report of the International Sarcopenia Initiative (EWGSOP and IWGS). Age and Ageing 2014; 43: 748–759.
  3. Chernoff, R. Protein and Older Adults. J Am Coll Nutr. 2004 Dec;23(6 Suppl):627S-630S.




How does ageing affect muscular size and strength?

Sarcopenia is a progressive loss of muscle mass and strength or function
Progressive loss of muscle mass and strength or function associated with ageing

Having problem walking long distance, up a slope, or climbing stairs?

The tired old legs are usually the first to warn that we are young no more……

If you don’t have other health problems, that feeling of low energy and decreasing physical strength is very likely due to sarcopenia.

What is sarcopenia?

Sarcopenia is a progressive loss of skeletal muscle mass and strength or function. It is associated with ageing, but can also be due to long term illness, bed rest and malnutrition.1

Our muscles begin to atrophy or shrink around age 40. It is estimated that muscle mass loss after 50 is 0.5-1% per year. That rate can accelerate to 15% every 10 years from about age 70.

The muscles shrink because there is a reduction in the number of muscle fibres and a decrease in their size. This in turn leads to poorer physical strength and functional ability.

Even top athletes, such as marathon runners and weight lifters, experience decline in performance after about 40 because of lower muscle strength.

So, what is the cause of sarcopenia?

The pathophysiology of sarcopenia is quite complex and is still not fully understood. However, the following contributing factors have been suggested.

  • Age-related hormonal changes. The decreasing levels of testosterone and insulin-like growth factor (IGF-1) affect muscle growth and muscle mass.
  • Older people’s ability to produce the proteins which make up muscle fibres has decreased.
  • Poor nutrition. Older people’s diet may not contain enough proteins, essential amino acids and important nutrients such as Vitamin D. Also, there might be problem of malabsorption due to chronic diseases.
  • Many older people lead a sedentary lifestyle and not taking enough exercise. Some of them need bed rest or hospitalization because of one or more health problems. Even healthy people suffer significant muscle wasting following a period of bed rest.

We can see that some of these causative factors are modifiable. We may be able to prevent sarcopenia or improve on its outcome by changing our lifestyle, take more exercise, improve our diet, and so on.

The diagnosis of sarcopenia

According to The European Working Group on Sarcopenia in Older People, a

The body skeletal muscles
The body skeletal muscles

diagnosis of sarcopenia is confirmed if a person has low muscle mass, plus either low muscle strength or low physical function.1

The following measurement methods and techniques have been used in both research and clinical practices to diagnose sarcopenia. Some equipment is expensive and may not be available to every situation.

Measurement of muscle mass

  • Body imaging techniques have been used for estimating muscle mass or lean body mass. They are: computed tomography (CT), magnetic resonance imaging (MRI) and Dual energy x-ray absorptiometry (DXA). CT and MRI are gold standards for estimating muscle mass in research. However, DXA is the preferred alternative method because it exposes the patient to minimal radiation.
  • Bioimpedance analysis (BIA) estimates the volume of fat and lean body mass. It is an easy and inexpensive method and is suitable for both ambulatory and bedridden patients. BIA results under standard conditions have been found to correlate well with MRI predictions.

Measurement of muscle strength

Handgrip strength measured with a handheld dynamometer is a simple and widely used measure of muscle strength. When employed with population references, it correlates well with leg strength.

Measurement of physical performance

A number of physical performance tests are available for evaluating balance, gait, strength and endurance. For example: short physical performance battery (SPPB), timed get-up-and-go (TGUG), and the stair climb power test.

How does sarcopenia affect our life?

Age-related sarcopenia is recognized as a geriatric syndrome and is linked to a number of adverse health outcomes.

  • When muscle are weak, simple tasks such as getting dressed, lifting up objects, using the bathroom and walking can become difficult.
  • It can become more difficult to maintain balance.
  • The walking speed will slow, and the risk of falls and broken bones increases.
  • The older person will lose his or her ability to live independently and needs institutional care.
  • Sarcopenia is also associated with a variety of other chronic diseases and earlier death.

Studies on the prevalence of sarcopenia had inconsistent results because of different choices of definition and measuring methods. Nevertheless, the numbers are significant and alarming.

A review of past research showed that prevalence in the 60–70 years olds ranged from 5–13%. For elderly aged above 80 years, 11 to 50% of them were found to be sarcopenic1. It is a world-wide problem affecting both men and women.

But it is not all groom and doom though.  You can take steps to maintain muscle mass and strength. We shall look into that in the next post.

It is never too young or too old to look after your muscle health.




  1. Cruz-Jentoft J, Baeyens J,  Bauer J,  Boirie Y,  Cederholm T et al (2010). “Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People”. Age and Ageing, Volume 39, Issue 4, 1 July 2010, Pages 412–423


  1. “What Is Sarcopenia?” International Osteoporosis Foundation.


  1. “Sarcopenia with Aging”.


  1. “The Facts about Sarcopenia”. Aging in Motion.



Are You Taking Vitamin D Supplement?

Older adults need Vitamin D supplement
Older adults need Vitamin D supplement

You should be.

Medical experts recommend people at risk of Vitamin D deficiency to take supplement every day.

The at-risk groups include older adults, people with little exposure to sunlight, dark-skinned people, and those who are on vegan diet.

Why Older Adults Need Vitamin D Supplement?

Vitamin D is available in two natural sources: (1) it is produced by the skin after exposure to ultraviolet B (UVB), and (2) it is present in a few types of food – oily fish, egg yolk, liver, cheese, and yogurt.

Older adults are vulnerable to Vitamin D deficiency because:

  1. The skin is less efficient in producing Vitamin D as we grow older.
  2. The exposure to sunlight is inadequate.
  • Some elderly, especially those living in care homes, spend little time outdoor because of mobility problem. Because UVB cannot pass through glass, therefore sitting near the window won’t help.
  • UVB radiation is affected by seasonal variation, latitude, and the time of day. People who live in northern latitudes such as Ireland or Finland do not get much UVB in the winter months. While we are more likely to exercise outdoor in the morning or evening, UVB radiation is actually strongest around midday.
  1. They may not get sufficient Vitamin D from their diet because only a few types of food contain Vitamin D. It is particularly problematic for a vegan. A possible solution is taking Vitamin D fortified dairy, orange juices and cereals.
  2. Elderly may have problem with malabsorption, especially those with chronic liver diseases, Crohn’s Disease, and cystic fibrosis.
  3. Because melanin blocks the absorption of UV radiation, dark-skinned people are very vulnerable to Vitamin D deficiency if they are also subject to one or more of the above factors.

The Irish Longitudinal Study on Ageing (TILDA) at Trinity College Dublin found that 1 in 8 older adults in Ireland suffers Vitamin D deficiency4. And in winter, the rate goes up to 1 in 4. Even in summer when the body normally produces Vitamin D, 5% of adults were deficient.

The researchers also found that Vitamin D deficiency increased with age. For example, in people over the age of 80, 37% were deficient in winter, compared with 22% of age 50-59 years. Those who were physically inactive were also much more likely to be deficient.

Lifestyle seems to play a part too. The study also found that Vitamin D deficiency was more common in smokers (23%), people who live alone (21%) and those from a lower socio-economic background (17%).

We may assume these findings are relevant to all countries with seasonal variation in sunlight.

What are the known problems of Vitamin D deficiency?

Vitamin D produced by the skin or absorbed from food is converted by the liver to calcifediol, also known as 25(OH)D. Vitamin D deficiency is diagnosed if a person’s blood level of 25(OH)D is less than 12 mcg /ml (equivalent to 30 nmol/L).

Vitamin D is essential for maintaining normal blood levels of calcium and

Calcium with Vitamin D
Calcium with Vitamin D

phosphate. Therefore, Vitamin D deficiency leads to low bone density, resulting in osteopenia and osteoporosis. Abnormal calcium level also affects muscle contraction, nerve conduction, and general cellular function of all body cells.

Vitamin D deficiency is known to be associated with muscle weakness. This problem is common among elderly who are housebound. The muscle weakness is manifested by a feeling of heaviness in the legs, tiring easily, and difficulty in climbing stairs and rising from a chair6.

Recent studies also link Vitamin D deficiency with heart disease, kidney disease, brain health, diabetes, Alzheimer’s disease and cancer. However, the results from these studies are still inconclusive, so further investigation is required.

Once these associations are confirmed, we could implement appropriate health policy to deal with high incidences of Vitamin D deficiency in the older adult population. Vitamin D deficiency can be treated easily with supplementation and food fortification.

What is the recommended dosage of Vitamin D?

Because there are still a lot of unknown factors surrounding Vitamin D and its effects on body tissues, medical experts have not agreed on the optimal level of Vitamin D for health benefits. The decision is also made difficult by regional, seasonal, lifestyle, genetic, and diet differences.

Suggestions from leading authorities are:

  • The US Institute of Medicine recommends 800 IU/day for adult above 70 years.
  • The American Geriatrics Society (AGS) recommends older adults to take 1000 IU/day to help prevent fractures.
  • The Public Health England (PHE) advises adults and children over the age of one to take a daily supplement containing 10mcg* of Vitamin D, particularly during autumn and winter.
Multivitamin containing Vitamin D
Multivitamin containing Vitamin D

Most doctors think a daily dose of 800-1000 IU of Vitamin D will benefit the general health of ageing adults. This dosage is highly unlikely to cause harm, unless there is other medical reason against it. You should consult your doctor or pharmacist if you have any doubt.

If you are taking multivitamin or calcium supplement, please check whether Vitamin D is already included in the supplement, and how much. Again, it is prudent to check with your pharmacist if you are not sure.

To treat people with very low Vitamin D level, especially if they are at high risk of fall, doctors can prescribe higher dosage. Of course, that has to be monitored carefully and reduced as soon as the high dosage is not required.

Excessive intake of Vitamin D may cause Vitamin D Toxicity which is harmful to health. For example, taking large doses of Vitamin D over a long period could weaken your bones.

Vitamin D exists in two forms: Vitamin D3 (cholecalciferol) and Vitamin D2 (ergocalciferol). Most supplements contain D3. Studies suggest that D3 increases the blood level of 25(OH)D a little better than D2.

Both Vitamin D2 and D3, whether produced naturally by the skin, or absorbed from food, or taken as supplements, have to be activated by the liver and kidneys before becoming useful. People with liver or kidney disease may need to get a special type of supplement from their doctors.




*The amount of Vitamin D contained in supplements is either expressed in international units (IU) or microgram (1µg).  One microgram (1µg) is equal to 40 IU of Vitamin D.



  1. National Institutes of Health Office of Dietary Supplements. Vitamin D – fact sheet for health professionals.
  1. Vitamin D Deficiency and Related Disorders.
  1. Kernisan, Leslie. Vitamin D: The Healthy Aging Dose (Plus Answers to 7 FAQs).
  1. One in eight older adults in Ireland are deficient in vitamin D.
  1. Getting Enough Vitamin D in Later Life.
  1. Janssen, H., Samson, M., Verhaar, H. Vitamin D deficiency, muscle function, and falls in elderly people. The American Journal of Clinical Nutrition, Volume 75, Issue 4, 1 April 2002, Pages 611–615.

Unsafe Footwear Impairs Balance and Increases the Risk of Fall

Safe shoes fit securely and has non-slippery soles
Safe shoes fit securely and has non-slippery soles

Elderly who fell and injured themselves often were found wearing inappropriate shoes.

In “The Guideline for the Prevention of Falls in Older Persons”, both American Geriatric Society and British Geriatric Society have pointed out inappropriate footwear as a major cause of concern.

Whether indoor or outdoor, unsafe footwear can cause loss of balance and bad gait. The risk of falls is especially high for elderly whose muscular strength and balance are already impaired.

What kind of footwear increase the risk of falls?

Evidences collected by researchers show that falls were often associated with the following kinds of shoes:

  • Loose, worn or backless slippers. These are one of the most common causes of older people falling.

    Open-backed slippers and slip-on shoes are not safe for elderly
    Backless slippers and slip-on shoes are not safe for elderly
  • Poorly fitting shoes. To accommodate painful feet, some elderly like to wear soft and/or overly long and wide shoes.
  • Slip-on shoes, such as sling backs or flip flops and shoes without fasteners.
  • Shoes with poor grip or worn soles can cause you to slip especially on wet surfaces.
  • Shoes with minimal contact with the ground, such as high heels, can make your foot unstable and can cause your ankle to turn.

Wear Proper Shoes to Prevent Falls

People of all ages should understand the importance of wearing well-fitting shoes, and wear suitable shoes for a particular activity. One of the main causes of foot problems such as bunions and corns is badly-fitting shoes.

Apparently, three out of four people over the age of 65 wear shoes that are too small. Perhaps it is because we did not realise our feet actually get bigger as we age. Besides, the feet and ankles may become swollen because of chronic medical conditions.

It is often a combination of foot problems and inappropriate footwear that increases the risk of falling.

What are the characteristics of safe shoes?

  • It should fit well and neither too loose or too tight on the feet. Some people may need footwear specially made to accommodate and protect swollen feet and ankles.
  • It has a high back or collar to support the ankle.
  • The sole is firm and not too thick for better sensation of foot position.
  • The sole is slip resistant with tread for good grip.
  • A low square heel which is not more than an inch to improve stability.
  • Adjustable fastener – laces or buckles or Velcro – on the front so that it won’t slip off easily.

Indoor footwear

As mentioned earlier, elderly should avoid loose, backless slippers. It is recommended that older people wear close-backed, well-fitted, slip-resistant slippers or house shoes indoors. A house-shoe offers the comfort of a slipper, but with the stable support of a shoe.

A wide opening makes it easier to get your foot in and out of the slipper which is important if you have swollen feet. But make sure it can be strapped down securely so that it won’t slip off easily.

Do not walk bare-footed or in socks or stockings.

For some cultures and in hot climate, folks may prefer to walk bare-footed at home. However, it has been shown that a proper pair of shoes provide more grip than bare feet and enhance walking stability. Shoes also protect the feet from mechanical injuries.

Get help

Podiatrists, also called chiropodists in UK and Ireland, are foot care specialists. Ask your doctor to refer you to one if you have pain or any other foot problems.

Your podiatrist can help you choose suitable shoes and orthotic inserts if you need them.

Diabetes sufferers will benefit from seam-free footwear made to avoid rubbing, which can lead to ulcers that are difficult to heal. In UK, specially fitted footwear can be purchased free of VAT if the wearer has a chronic medical condition such as diabetes. You should be able to get further information about this from a podiatrist as well.



Further Reading:

Menant J, Steele J, Menz H, Munro B, Lord S (2008). Optimizing Footwear for Older People at Risk of Falls. Journal of Rehabilitation Research & Development, 45(8), pp. 1167–1182.


Hip protecting airbags

Hip’Air - a hip protector by Helite
Hip’Air – a hip protector by Helite

At the Consumer Electronics Show (CES) on 7 January, French company Helite launched Hip’Air, a safety product for the elderly.

Hip’Air is designed to prevent hip fractures. It is a wearable belt with a sensor and two airbags. Within 80 milliseconds of detecting the wearer is about to fall, the airbags on either side of the hip will inflate. Therefore, it has the potential of protecting the wearer of pain and danger associated with hip fracture.

The manufacturer claims that the air bags could absorbs 90 per cent of the impact of a fall, and it is nine times better at absorbing impact force than traditional protection pads.

The belt weighs around 2lbs and attaches with a simple click. The arrows on the belt show you the correct way to wear the belt.

The hip protector when deployed

Airbags prevent hip fracture when deployed (diagram from Helite’s website)

The device will be available for orders in March across Europe and in the US in September. It will sell in the US for around $800. Please note that each time the airbags are deployed, a gas canister will need to be replaced for $50.

Most people I have talked to thought the price is prohibitive. However, when you consider the human cost and financial cost of hip fracture, the use of the device may be justified for those elderly who are very vulnerable to falls.

Would I get one for myself? May be – if I participate in dangerous activities or sport. But I don’t think it is something I would wear to go about my daily life. It is probably too bulky to wear under clothes.


You can find out more from:

Plantar Fasciitis and Helpful Remedies

A friend phoned and said doctor told her she has plantar fasciitis in her right foot. “The pain is killing me,” she said. “Could be the walking.”

She has recently taken up walking exercise and strength training, and has been very enthusiastic about it.

So, what is plantar fasciitis?

Plantar fasciitis is a foot problem that results in pain and stiffness in the bottom of the foot, usually in the heel. The pain is most unbearable when you climb stairs or standing still.

Plantar fascia is the ligament joining the heel to the toes
Plantar fascia is the ligament joining the heel to the toes

What causes plantar fasciitis?

Despite advance medical science, the cause of plantar fasciitis is not very clear.

The plantar fascia is the ligament that connects the heel to the front of the foot (runs under the arch of your feet). It supports the arch of your foot and helps you walk.

In plantar fasciitis, the ligament is damaged by tiny tears and breakdown of collagen. It is the result of repetitive injury of excessive straining. The damage is most significant where the plantar fascia joins the bones, especially the heel bone.

Some known risk factors include standing, walking, running over long period, especially on hard surfaces. Flat feet, high arch, inward rolling of the foot, a tight Achilles tendon or calf muscles, pregnancy and obesity have also been blamed.

Wearing shoes with poor sole and arch support when you do training can also result in plantar fasciitis.

Although heel spur, a small bony calcification on the heel bone, is found in up to 50% of those with plantar fasciitis, it is not the cause of heel pain.

Who are likely to suffer?

Plantar fasciitis is a common cause of heel pain. One in ten people are affected at some point of their life, especially people between 40–60 years of age.

The condition tends to happen to people whose occupations or sports put a lot of stress and strain on their feet. They include: teachers, shop assistants, catering staff, factory workers, ballet dancers, soldiers, athletes, long distance runners etc. It seems more common in women.

What are plantar fasciitis symptoms?

Plantar fasciitis causes pain to the heel or arch
Plantar fasciitis causes pain to the heel or arch

Typical symptom of plantar fasciitis is sharp heel pain. It usually affects just one foot but may happen to both feet. The pain is most acute in the first few steps after getting out of bed, or after sitting down for some time. The pain may ease off when you continue walking. Symptoms of numbness, tingling, swelling, burning, or radiating pain have been reported but they are rare.

Although heel pain is the most common complaint, we may have pain in the ball of the foot and along the arch too. It hurts most when climbing stairs or standing for a long time.

Common plantar fasciitis treatments

If you have foot pain, please go to see your doctor or a podiatrist to get a proper diagnosis. It is important to differentiate plantar fasciitis from other foot complaints such as arthritis or stress fracture.

In most cases, plantar fasciitis will improve with rest and conservative treatment. There isn’t a best treatment applicable to everybody. You may find relief from a combination of remedies. And it may take several months for the symptoms to clear.

To start with, rest and stay off your feet if possible. You should stop or reduce the activity which brought on the problem. In the acute stage, apply cold compress to the sore area for 15 to 20 minutes, three or four times a day may help to reduce pain and swelling.

Stretching the plantar fascia and Achilles tendons is a recommended treatment for plantar fasciitis. You can get help from a physical therapist for this. He or she can also teach you plantar fasciitis exercises to strengthen your calf muscles, to stabilize your walk and lessen the workload on your plantar fascia.

You can wear a night splint to stretch the Achilles tendon and plantar fascia. This can help prevent pain and stiffness in the morning.

Inappropriate footwear is often the culprit of foot problems. You must wear shoes that have good arch support and heel cushioning.

Orthotic or shoe insert for arch support may be helpful. It is designed to alleviate the pain, and reduce the strain on the ligament to prevent further damage. If the pain is specifically in the heel, a gel heel cradle can be worn to cushion and support the heel.

A boot cast can be worn to immobilize the foot and reduce strain, thus allow the plantar fascia to heal. You can take the boot cast off when you need to, for example, to take a shower.

Nonsteroidal anti-inflammatory drugs, such as ibuprofen or naproxen, may help to relieve the pain. You should ask for medical advice if there is any worry about allergies or contraindications.

If the problem has not improved after trying all the above for several months, your doctor may recommend other options:

  • steroid injection
  • platelet-rich plasma injection
  • extracorporeal shockwave therapy
  • Tenex procedure

Surgery is the last option when all else failed to stop pain. But it must weigh against the unwanted side effects of weakening the arch of the foot.


If you ignore the condition and not getting treatment or rest, further strain can rupture the plantar fascia. Typical signs and symptoms of plantar fascia rupture include a clicking or snapping sound, significant local swelling, and acute pain in the sole of the foot.

You can develop chronic plantar fasciitis from recurring acute attacks. This can change the way you walk and cause injury to your legs, knees, hips, and back.

Therefore, it is wise to stay with some of the preventative remedies even when all the symptoms have cleared.

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