Seven Little Known Ways to Stay Active, Maintain Health and Prevent Injuries

As time goes on more of us are living longer. The average life span is greater now than ever before. While that means more years, it can also mean more opportunity for chronic conditions and disability.

Many of us have an image of that “classical retirement” in our heads from all those years of television. Happy, healthy, energetic seniors off for that grand tour of Europe or maybe just an afternoon of golf and drinks at the club. However, the reality of aging in today’s real world is that seniors are often burdened with financial stress, must provide for the care and feeding of grandchildren and even their parents, and face a number of threats ranging from mortgage Ponzi schemes to online identity theft.

It takes a sharp, in shape senior to navigate today’s Golden Age. To counter some of the harsher realities of aging we offer here seven tried and true habits and strategies for feeling better as you live longer. Remember, you’re a seasoned veteran who has seen and done a lot in life. Maybe you’re a bit of a tough cookie, but with a heart of gold. In any case, you’re ready for, and deserve, a path to a better older life.

1.  Be Active Everyday—No Excuses:  Both the World Health Organization and the American Heart Association agree that we as a society have become too sedentary. So the trick is to increase your uptime and to decrease your sit time! But you say "I'm so busy.” Yes, undoubtedly you are busy but think about what you are busy with: sitting in the car, sitting while talking on the phone, sitting at your computer, sitting taking a fun class, sitting having lunch with friends. After being so busy it's hard to go out and be active. Switch it around by going for a short walk in the morning, standing while you are on the phone, limiting your computer and TV screen time and so on. Start small and create easily achievable goals when you begin so you have immediate success. Some movement is always better than none and you’ll be surprised how soon you feel like walking that extra block or doing a few more minutes of gardening. Movement is the building block of increasing your activity. It will also limit undue stress on inactive joints and weak muscles as you get stronger.

2.  Birds of a Feather: Remember that saying from your childhood? Well they do flock together so if your friends and family are sitting around you probably are, too. Now we’re not suggesting you disavow your loved ones, but sometimes simply hanging out with active people will help you get active as well. What’s more, friendships are key to successful emotional health and this is especially true as we age. Try getting together with active friends by attending an exercise class or joining a hiking club. You’ll find many like-minded people doing and looking for the same things you desire. At the same time, don’t give up on your sedentary friends. Try inviting them out for a walk after dinner and before you know it they may be taking you to yoga class.

3.  Lose those extra pounds. Don't go into your golden years overweight. You know this. Diabetes, joint pain and cardiac conditions are improved when you are at your optimal weight and you have sufficient muscle mass. There are numerous educational support groups, many at low cost, that can offer help. At the heart of it is altering what you eat and of course, being active. So as much as a big juicy hamburger with French fries was comfort food in the past, too frequent consumption of this rich chow truly is killing us. Crash diets are not the answer. Often they can do more harm than good. A gradual progression towards a healthy diet is key. If your family is not jumping on board that is a problem. But your health could become their problem. Think of nutrition as a form of medicine.

4. Get the right tools. Being comfortable and staying safe while increasing your activity is very important. Always wear a helmet if the activity calls for it. Protect against the sun with sunscreen, glasses and hats. Wear comfortable clothing and appropriate footwear. If you’re a little rusty consider a refresher course on your activity. if you’ re unsure about your balance then try something easier like tricycling over bicycling. Want to increase your distance walking? Those Scandinavian's really have something going with walking poles. You may be seeing more and more people walking the streets in Long Beach with poles that look like ski equipment but are distinctly different. It takes a bit of an adjustment but the effort is well worth it.

5. Shoes for your feet.  Shoes, especially for women, are a challenge. Don’t be swayed by fashion if the footwear doesn’t fit well and isn’t comfortable. Your feet may be undergoing changes and a supportive shoe can help with those changes. In the end one or two pairs of active footwear will encourage you to be on your feet rather than on your bum.

6. Stay on top of sensory changes. Normal aging does not have to include chronic conditions, weakness or joint pain. But more often than not as we age our sensory systems are likely to change. We are more apt to have a change in our vision as well as changes to the eyes themselves. Our hearing may be challenged and it becomes unpleasant or disorienting to go out to public spaces. We may notice changes in our balance due to a variety of factors. Don't ignore what is going on. Sensory loss may come on slowly but that doesn't mean you can or should avoid seeking help. It might cause you to limit your activity because you are fearful or uncomfortable in surroundings outside your home.

7. Recliner? Think again. Don't get me wrong recliners have their place, especially for medical conditions. But make sure you are going in the right direction when altering your living room furniture to accommodate a recliner. Recliners are made for rest; and they are very effective, so much so, it is difficult to get out of them. Make sure you have other supportive seating in your home like a captain's chair with comfortable cushion and arm rests. This type of seating promotes good posture and is easier to exit than a low slung seat.

Where to start? Your neighborhood. Walk your block every day. As you get comfortable go a little further, change direction, take different routes and go new places. In my neighborhood of Rose Park we have Tai Chi class every Tuesday morning and we are looking forward to a bike boulevard along 6th St. next year. You are more likely to connect with people you know or might develop a relationship with. Respect the days you don't feel so hot and remember that rest, replenishment and recovery are all part of staying active as well. Support your friends and family when they need encouragement. We are in this together and we are all each other’s best reason to stay healthy and active!

Dr. Gretchen Swanson, DPT, MPH - creator of the Long Beach based Health and Function blog: http://healthandfunction.blogspot.com/

Falls are Personal

Louise was well on her way to living out her days in a nursing home. She'd had debilitating knee and back pain; refused surgeries and was finding it more difficult to get out and about. Her family had to pitch in more and more but they had their limits. And then the 911 call. She'd fallen on her way to the bathroom. She'd had her umpteenth urinary tract infection, always treated by antibiotics which seemed to upset her 'system' as she recalled and sapped her strength.

And that is where the storyline changed. She could have been transported to an emergency department with a short hospital stay and then a few weeks in a rehab facility, which even with the best of care would have increased her risk of falls even further. But instead, the paramedics checked her out, put her back in her chair and with  her personal safety alarm notified her daughter who arrived promptly and then made an appointment for her PT and her MD.

That was three years ago. Since then her family has convinced her to have day time help, periodic physical therapy -included a fall prevention protocol - to maintain her strength which has resulted in her remaining at home and doing all the things she really likes.

Long Beach has established a new baseline for fall prevention. Falls are no longer an inevitable part of aging. Fall prevention is no longer a simple awareness campaign or installation of grab bars upon hospital discharge. The causes and prevention of falls are better understood by organizations, hospitals and older adults.

With little or no financial support the purpose and vision of re-thinking fall prevention came from our ranks. Serendipity played as much a role as 'planning'. Heart of Ida, local non-profit, was able to take the need for a training site by the California Department of Public Health and turn it into a larger scale analysis of what should be occurring in a city of our size. This led to developing relations with SCAN Independence at Home, St. Mary's Medical Center, Long Beach's Department of Parks, Recreation and Marine Senior Center, and the Long Beach Department of Health and Human Services, and that was just the beginning. 

Three years ago there was not a single evidence based fall prevention strategy offered in the city limits of Long Beach; and almost none in LA County. Today the city is populated with a series of proven and highly regarded programs to reduce falls, fall risks and fear of falling. Throughout the year fall risk assessments are offered free at several convenient community locations. The city now boasts 7 community fall risk screeners. These screens are essential for older adults to understand the nature of their fall risk - a personalized assessment that helps direct their next step.

By 2014 we had developed a fall prevention faculty: 2 master trainers and 8 leaders with on-going classes all done at the community level. Mapping these opportunities shows that an older adult in LB is within 5 miles or less of a fall prevention program.  Most are closer.

Physicians and seniors alike are relieved but more importantly empowered with these changes. Seniors can arrive at their physician's office with a completed fall risk assessment that includes test data and solutions available in the community. The physician can confirm and discuss issues with their patient while their patient doesn't have to struggle trying to describe their concerns about falling and potential injury.

At the same time this means older adults are no longer stymied by denial and avoidance. With very little prompting an older adult realizes that falls and loss of function as we get older are no longer inevitable.

Seniors are not stubborn! But they seem so resistant to change, why is that? Older adults need personal information with their own action plan. Studies have proven and the Centers for Disease Control programs reinforce that personal action plans are key to reducing fall risk. Whether the issue is 'fear of falling'; or experiencing multiple fall risk factors; or just not taking care of oneself a personal action plan based on readiness to change is the tipping point. At a recent evidence based Tai Chi class at Houghton Park, older adults expressed that they no longer accept that "getting older means getting weaker" or the impossible task of remaining "independent" which translates to being alone and compromised. They believe that getting informed is the key to successful aging.

A new way of thinking is emerging. In June, the Long Beach Department of Health and Human Services hosted a Call to Action conference – rather than just complaining about what we didn't have, the 100 attendees were energized to plunge forward to create a falls prevention pathway. More community nurses have been trained in Fall Risk Assessment, more evidence based programs are being offered and supported. Hospital environments are considering how they can refer to the community. People are thinking outside of their box. "Our community has the all the right ingredients to offer fall prevention to our older adults", Pam Shaw, RN, MSN/MPH, Nursing Services Officer, Long Beach Department of Health and Human Services.

There are pathways for each older adult to follow. Some involve medical procedures e.g. joint surgery, while others are as simple as a wellness check-up and continuation in routine exercises. At specific times, such as after an infection or bout of depression, there is a risk for a loss of function, leading to an increased risk for a fall. Families and friends can now, with confidence and care, encourage their family member to develop a personal action plan for fall prevention, and get back out there and enjoy life. 

To be sure Louise had family and resources that not all our older adults have. However, she posed, like so many, a series of seemingly insurmountable problems that in the old way of thinking inevitably lead to falls. By taking Louise's personal risk factors into consideration and making the necessary changes, she is able to remain at home without subsequent falls, injuries or hospitalizations.  "Families are an important member of the fall prevention team. In Long Beach, family members serve as advocates and identify resources to help their older family member remain independent", Nancy Blair, Patient Family Adviser, Long Beach Memorial, Miller Children’s Women’s Hospital, Community Hospital Long Beach.

And the partnerships that have been forged still need a track record and refinement. "Long Beach has made great strides in fall prevention and our older adults and their families will reap the benefits for years to come", Kit Katz, Director of Community Benefits, Bazzeni Wellness Center, Dignity Health.

Plans continue to be made by our City's Department of Health and Human Services to host and facilitate work groups to identify the gaps and solutions in our fall prevention system. These discussions will offer community institutions and older adults a way to re-think the inevitable fall and establish sure footing on a course of prevention.

No longer are we confined to the 'help help' scenario of being trapped and panicked after a fall. LB's fall prevention programs teach older adults how to get up and recover. Watch out Long Beach - there is a tsunami coming of seniors ready and willing to stay healthy.

Nurses are key to fall prevention

Long Beach Health Department along with Heart of Ida is offering a training workshop for nurses to assess fall risk. This is a strong developmental step towards improving and maintaining the health of our community's older adults.

Is care management part of the solution?

I've been pondering for nearly 40 years if a person or a system manager a positively effect a person's care. I started working on this question at one of my very first positions at a cancer rehabilitation research project. One of the primary objectives was to reduce the use of the emergency room by person's with receiving cancer therapies. We were successful in identifying more social determinants and the unanticipated consequences of interjecting a 'care manager' between the patient and their clinician.  The conversation has been added to substantively by a recent brief "Finding a Match: How Successful Complex Care Programs Identify Patients"

check out page 10 for Seven Take-Aways from Successful CCM Programs.

It's personal

When asked to present on fall prevention, inevitably a member of the audience shares a story. Which I've come to refer to as the 'grandmother story'. And so that is where I start. Whether presenting to community decision-makers, clinicians, or older adults I have one or two people relate their 'grandmother story'.

You see falls are personal. We all know the statistics but what isn't getting through with current messaging is that falls are not a normal part of aging. And an older adult needs to pay personal attention to remaining risk free or risk reduced.  So on April 9th, 2015 I'll be testing out an expanded version of this idea. I'm supported in this by my colleague Dr. Yakura and two very able public health nursing interns, Nate and Nicole.

Resource: Reducing older adult falls in institutions

The past 12 months have been filled with an extraordinary number of fall prevention tactics. Community screenings, teaching professionals how to screen, implementing an education program for those who've developed a 'fear of falling', expanding Tai Chi Moving for Better Balance in different settings and on and on.
One of the most troublesome is reducing falls in institutions or those who qualify such as in CBAS programs. I presented at a local nursing home the other day. Much of the information has been well developed and compiled into a toolkit. I highly recommend for those involved with fall risk reduction or fall prevention to review and implement as 'prescribed'!

http://www.ahrq.gov/professionals/systems/hospital/fallpxtoolkit/fallpxtoolkit.pdf