Why Does Fall Risk Increase with Age?

It’s no secret that balance tends to decline with age. We all take it for granted until we start noticing our balance isn’t as sharp as it used to be. You may notice that you are swaying a bit more while standing and walking, or feeling weaker or less steady. We all want it, but what is balance? We need to understand what it is in order to restore what was lost, safely, effectively and efficiently.  In science-speak, balance is the ability to maintain the body’s center of mass over its base of support. Your center of mass is a few inches below your belly button or can be thought of as your trunk. Your feet are your base of support (unless you are performing a handstand, then your hands are your base of support!) Since walking is the most functional activity we perform day-in and day-out, we will focus on balance being the ability to maintain our trunk over our feet. Balance is the ability to stay upright when standing (static balance) or when moving and performing activities like walking or climbing stairs (dynamic balance). This ability tends to decline with aging. The most common question I hear from older adult clients is, “Why am I losing balance?” Let’s find out why.

Take a deep breath, close your eyes and take a moment to remember a time you fell in love and the bliss you felt. Perhaps you thought about when you met your soulmate, the birth of a child, or when you discovered your life’s passion. You may remember your heart pounding a little harder, your mood lifted, and an extra spring in your step. How would you like to feel this every day? With physical activity and exercise, you can. Warm feelings of love are caused by chemical reactions that occur with the release of hormones and neurotransmitters inside your body and brain. The same feel good chemicals are secreted when we fall in love and when we are physically active and exercise. First, let’s distinguish the difference between physical activity and exercise. Physical activity is simply adding more movement to your day, like doing housework, gardening or dancing to a favorite song. Exercise is physical activity that is planned or structured for the purpose of training balance, strength or endurance. According to biological anthropologist and Research Professor Dr. Helen Fisher of Rutgers University, who studies love, the chemicals that the body releases when we feel love include: Dopamine creates feelings of euphoria, increased energy, focus, and attention; it also triggers an intense rush of reward and pleasure. Norepinephrine causes the fluttery feeling in your chest. As the heart goes pitter patter, your heart pounds harder and circulation increases throughout the body. Endorphins are the body’s natural pain relievers and are chemically related to morphine. They also create a sense of well-being, security and attachment. Like feelings of love, exercise releases dopamine, norepinephrine and endorphins, but they aren’t the only ones. Exercise releases even more powerful mood and mind-boosting substances into the brain, including: Serotonin which is a natural mood-enhancer that eases feelings of depression. BDNF (Brain-Derived Neurotrophic Factor) which also helps relieve depression and enhances brain health, cognition and memory. GABA (Gamma Amino Butyric Acid) which helps calm the brain’s emotional circuitry, like Xanax® but without the side effects! Exercise is a great outlet to cope with stress better. Then of course, exercise boosts energy and vigor, positively impacting all body and brain systems, so you just feel good. Hippocrates is quoted as saying, “If you are in a bad mood, go for a walk. If you are still in a bad mood, go for another walk”! Focusing on how you feel emotionally following exercise activity is a great way to fall in love with the process. This is a powerful strategy and mindset that you can put into practice so you can sustain exercise habits for your health and longevity. There isn’t a single person who always wants to exercise or do balance training, but when we embrace how much better we feel afterwards, it is motivating to choose to move. Exercise is an act of self-care and self-love. The more connected you get to falling in love with the process, the more connected you feel with yourself and others. Health is all about taking consistent steps that accumulate over time so you can move and feel better over time, too. The more you take care of yourself, the less you’ll need to see doctors. As we age, diet, medications, and stress levels all influence levels of hormones and other chemicals in our bodies and can cause them to become dysregulated, leading to mood changes, anxiety attacks, and aggression. Exercise has widespread effects on the body and brain to help balance the whole system. If there was a pill that had the same wide-ranging effects as exercise, everyone would be popping it. To experience these joyous feelings, you may be wondering how much exercise is needed; glad you asked! Research done by best-selling author Gretchen Reynolds suggests that just 20 minutes of physical activity, like walking, is all that’s needed for the euphoric feeling, and for general health and well-being. We have been led to believe that we need to work out long and hard for health benefits, but the research is mounting to dispel this long-held belief. What are you waiting for? Just put on a pair of sneakers and head out for an invigorating walk, fresh air and sunshine…and feel the love. (For quick tips on getting started, see last month’s blog, “Happy 2024! How to Create a Healthy New Habit.” )

The New Year is always a meaningful time to reflect on your life to see what went well and what needs to change. The most popular changes are usually health-related like losing weight or reducing stress. This year, toss out the resolutions because they don’t work. Resolutions fail because people set unattainable goals, become overwhelmed and ultimately quit. This failure experience leaves you feeling inadequate and unmotivated, yet again. Instead of planning for a desired goal or outcome, design for a desired behavior. By creating and focusing on one, small and easy change at a time, you can create better habits that fuel long-term health success. Here’s how.  First, the best place to jump start better health is to simply move more throughout the day because inactivity is a physical and mental depressant. So let’s focus on increasing activity as the number one behavior to change. Behavioral scientist, BJ Fogg outlines a systematic approach to create habits that can change your life forever.

The holiday season can be a wonderful time for gathering and celebrating with family and friends, but it can also be a source of much added stress. You may be fretting about any number of circumstances like: how to manage your weight or chronic condition like diabetes during all the “feastivities”; choosing the perfect gifts and worried if you can afford them; missing a loved one who can’t be with you or who has passed away; or perhaps you feel unwell or someone close has been diagnosed with a disease. Whatever personal challenges you are experiencing, research shows that grateful people are happier and healthier; can make better decisions; and are more joyful (1). It’s a skill anyone can learn and benefit from and best of all, it’s free!

Short answer: Absolutely. 

Are you concerned about losing your ability to balance and walk smoothly? Improving your ankle mobility is arguably the fastest way to move steadier and stronger with more confidence. That’s because when you walk, your ankles control the movement of your feet. Ankles and feet need to be able to move freely in all directions across all three planes of motion to become a mobile adaptor of the ground beneath your feet and then instantly transition to become a stable platform to push toes off of the ground with stability, speed and power.  With age, injury or disease like arthritis or diabetes, joint range of motion is gradually lost, especially at ankles, and is a root cause of why it becomes more difficult to walk, balance and prevent falls. Ankles are the foundation of the body, balance and movement. Increasing ankle range of motion is foundational to improve how you walk, move and feel. When you fix the foundation of an issue, you see the biggest movement improvements in the least amount of time.

Did you know that mobility is the fastest growing disability? I was shocked to learn that the Center of Disease Control and Prevention estimates that fourteen percent of adults in the United States (1 in 7) have difficulty walking ¼-mile or climbing stairs. For people aged 65 and up, this number skyrockets to forty percent! That’s 2 in 5 people having a hard time moving safely. This is sobering because mobility is foundational to age well and live independently. What is causing this growing epidemic? Let’s dig into some potential root causes of mobility disability and action steps to prevent it.

We all love our mobility because it offers us the freedom to move more freely and live more fully. When we are young we can run, jump, climb, skip and move our body in all directions, freely and easily. As we grow older and more sedentary, our mobility begins to decline gradually.  We barely notice the small incremental losses until we are challenged to perform out-of-the-ordinary tasks like walking uphill, dancing at a wedding or climbing several flights of stairs. That’s when we feel fatigue, stiffness and weakness. Difficulty performing an activity that was once easy is a marker of diminution and a wake-up call to be proactive to regain vitality. We have control over how we age, and we can prevent functional decline regardless of what we are repeatedly told. I find it disturbing that many friends and colleagues in the healthcare world chalk up difficulty walking, climbing stairs or performing activities of daily living to “just part of aging.” Mobility disability might be common, but it doesn’t mean it’s inevitable. Forty percent of Americans 65 years of age and up have difficulty walking ¼ mile and climbing stairs (1). People in the Blue Zones live healthier and longer, largely because of positive lifestyle choices including daily physical activity and a healthy plant-based diet. Let’s pull the curtain back on where mobility comes from, so we can see that our lifestyle choices play a starring role in how well we age or how rapidly we decline.

Awareness is the first step to making changes to live healthier, stronger, and longer. Being a life-long learner is essential to aging well because it typically takes 17 years for what’s discovered in research to be applied in clinical practice. Who wants to wait 17 years for a blueprint to better health? That’s why we are focusing on the phenomenon called “inflammaging.” So what is inflammaging and why should you care? First and foremost, inflammaging is a key concept to understand because it contributes to the global decline of the body and brain, threatening functional independence, and increasing the risk of a devastating fall. In 2000, Italian researcher Claudio Franceschi coined the term “inflammaging” to describe the chronic, low-grade, and systemic inflammation that accumulates over time and drives age-related diseases, disabilities, and mortality. Acute inflammation is short-lived and is how the immune system heals and repairs the body from an infection or injury. When you sprain an ankle, the swelling that follows is a sign of the immune system working to heal the ligament damage. When you cut your finger or catch a cold, it’s your immune system that responds to mend that cut and fight off the viral infection. Acute inflammation is restorative. When inflammation becomes chronic, the body’s cells, tissues, organs and systems begin to breakdown. Chronic inflammation is degenerative. Being systemic in nature, damage occurs throughout the body and brain. As the years and decades pass, the “wear and tear” accumulates and is also known as the “allostatic load.” The higher the body’s burden, the greater the risk of dysregulation and malfunctioning of the body’s systems. This damage may go unnoticed until a clinical diagnosis of a chronic condition like diabetes, heart disease, cancer, dementia, or even sarcopenia: the age-related loss of muscle mass, strength, and function.