Afraid of Falling? For Older Adults, the Dutch Have a Cure


A course teaching older people how to fall, and not to fall, in Leusden, the Netherlands. 

LEUSDEN, Netherlands — The shouts of schoolchildren playing outside echoed through the gymnasium where an obstacle course was being set up.

There was the “Belgian sidewalk,” a wooden contraption designed to simulate loose tiles; a “sloping slope,” ramps angled at an ankle-unfriendly 45 degrees; and others like “the slalom” and “the pirouette.”

They were not for the children, though, but for a class where the students ranged in age from 65 to 94. The obstacle course was clinically devised to teach them how to navigate treacherous ground without having to worry about falling, and how to fall if they did.

“It’s not a bad thing to be afraid of falling, but it puts you at higher risk of falling,” said Diedeke van Wijk, a physiotherapist who runs WIJKfysio and teaches the course three times a year in Leusden, a bedroom community just outside Amersfoort, in the center of the country.

The Dutch, like many elsewhere, are living longer than in previous generations, often alone. As they do, courses that teach them not only how to avoid falling, but how to fall correctly, are gaining popularity.

From left, Riet van Velzen, 79, Ria Kocks, 78, Nanda Silkens, 79, Loes Bloemdal, 80, and Hans Kuhn, 85, learning a better way to stand up and sit down. 
Ben Koops, 82, navigating an obstacle called the “tilting shelf.” 

This one, called Vallen Verleden Tijd course, roughly translates as “Falling is in the past.” Hundreds of similar courses are taught by registered by physio- and occupational therapists across the Netherlands.

Yet falling courses — especially clinically tested ones — are a fairly recent phenomenon, according to Richard de Ruiter, of the Sint Maartenskliniek in Nijmegen, the foundation hospital that developed this particular course.

Virtually unheard-of just a decade ago, the courses are now common enough that the government rates them. Certain forms of Dutch health insurance even cover part of the costs.

While the students are older, not all of them seemed particularly frail. Herman van Lovink, 88, arrived on his bike. So did Annie Houtveen, 75. But some arrived with walkers and canes, and others were carefully guided by relatives.

Ms. Kuhn walking in the gym’s schoolyard. 

Falling can be a serious thing for older adults. Aging causes the bones to become brittle, and broken ones do not heal as readily.

Today, 18.5 percent of the Dutch population — roughly 3.2 million people — is 65 or older, according to official statistics. In 1950, about the time some of the younger course participants were born, people 65 or older made up just 7.7 percent of the population.

Across the Netherlands, 3,884 people 65 or older died as result of a fall in 2016, a 38 percent increase from two years earlier.

Experts say the rise in fatalities reflects the overall aging of the population, and also factors such as the growing use of certain medications or general inactivity.

“It’s same as with young children: More and more old people have an inactive lifestyle,” said Saskia Kloet, a program manager at VeiligheidNL, an institution that offers similar courses.

Even inactivity in one’s 30s or 40s could lead to problems later in life, she noted.

Like many people her age, Hans Kuhn, 85, worried that her daily routine — and the ability to live alone — would end if she ever lost her balance and fell.

She has lived in her house for decades, and alone since her partner died years ago. Its steeply winding staircase is equipped with a motorized chair on a rail to help reach upper floors. “I only use it when I have to bring lots of heavy things upstairs,” said Ms. Kuhn, herself a retired physiotherapist.

Ms. Kuhn’s entire house is a study in efficiency and simple modifications that can make all the difference for an older person. Hand grips are installed in just the right places, as well as ramps to accommodate her two walkers.

There is a stationary exercise bike to keep her moving, and a weight machine made from a big can of beans and string to maintain her upper body strength.

Even as she feels herself grow frailer and less flexible, she knows how to stay fit. “My main problem is I’m very afraid of falling,” she said.

Ms. Kuhn’s bedroom, right, and home trainer. The house is a study in simple modifications that can make all the difference for an older person.
Ms. Kuhn exercising at home with a self-made weight system made out of a rope and a can of beans. 

So she joined the course, which meets twice a week. On Tuesdays, the students build confidence by walking and re-walking the obstacle course. Thursdays are reserved for the actual falls.

In order to learn, the students start by approaching the mats slowly, lowering themselves down at first. Over the weeks, they learn to fall.

“Naturally, they are not interested in courses on falling at first, but once they see that they can do it, then it’s fun,” Ms. Kloet said. “But there is also a very important social aspect.”

Indeed, seeing one another helplessly sprawled across the gym mats gave way to giggling and plenty of dry comments, knowing jokes, general ribbing and hilarity.

“Stop your chattering,” Ms. van Wijk warned a group of well-dressed women who were supposed to be concentrating on the correct way to let themselves fall onto the foot-thick blue mat.

“I would,” said Loes Bloemdal, 80, laughing. “But I have no one to talk with all day.”

Ms. Silkens, right, and Frans Poss, 94, left, training on how to fall and get up.
The students start by lowering themselves down onto the mats slowly. Over the weeks, they learn to fall. 

In preparing their bodies for a possibly apocalyptic event, the students appeared to forget about their age.

Mr. van Lovink, the cyclist, asked if they would learn standing on one leg. “Why would you want to do that?” replied Ms. van Wijk.

“To be able to put on my pants,” Mr. van Lovink said seriously, but to the amusement of his classmates.

Ms. van Wijk advised them all to always sit when putting on their pants.

“That’s the power of physiotherapy with geriatrics,” she said. “You practice the things you know you can do, and not the things you can’t.”

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Afraid of Falling? For Older Adults, the Dutch Have a Cure


A course teaching older people how to fall, and not to fall, in Leusden, the Netherlands. 

 The shouts of schoolchildren playing outside echoed through the gymnasium where an obstacle course was being set up.

There was the “Belgian sidewalk,” a wooden contraption designed to simulate loose tiles; a “sloping slope,” ramps angled at an ankle-unfriendly 45 degrees; and others like “the slalom” and “the pirouette.”

They were not for the children, though, but for a class where the students ranged in age from 65 to 94. The obstacle course was clinically devised to teach them how to navigate treacherous ground without having to worry about falling, and how to fall if they did.

“It’s not a bad thing to be afraid of falling, but it puts you at higher risk of falling,” said Diedeke van Wijk, a physiotherapist who runs WIJKfysio and teaches the course three times a year in Leusden, a bedroom community just outside Amersfoort, in the center of the country.

The Dutch, like many elsewhere, are living longer than in previous generations, often alone. As they do, courses that teach them not only how to avoid falling, but how to fall correctly, are gaining popularity.

From left, Riet van Velzen, 79, Ria Kocks, 78, Nanda Silkens, 79, Loes Bloemdal, 80, and Hans Kuhn, 85, learning a better way to stand up and sit down.

Ben Koops, 82, navigating an obstacle called the “tilting shelf.”

This one, called Vallen Verleden Tijd course, roughly translates as “Falling is in the past.” Hundreds of similar courses are taught by registered by physio- and occupational therapists across the Netherlands.

Yet falling courses — especially clinically tested ones — are a fairly recent phenomenon, according to Richard de Ruiter, of the Sint Maartenskliniek in Nijmegen, the foundation hospital that developed this particular course.

Virtually unheard-of just a decade ago, the courses are now common enough that the government rates them. Certain forms of Dutch health insurance even cover part of the costs.

While the students are older, not all of them seemed particularly frail. Herman van Lovink, 88, arrived on his bike. So did Annie Houtveen, 75. But some arrived with walkers and canes, and others were carefully guided by relatives.

Ms. Kuhn walking in the gym’s schoolyard. Credit Jasper Juinen for The New York Times

Falling can be a serious thing for older adults. Aging causes the bones to become brittle, and broken ones do not heal as readily.

Today, 18.5 percent of the Dutch population — roughly 3.2 million people — is 65 or older, according to official statistics. In 1950, about the time some of the younger course participants were born, people 65 or older made up just 7.7 percent of the population.

Across the Netherlands, 3,884 people 65 or older died as result of a fall in 2016, a 38 percent increase from two years earlier.

Experts say the rise in fatalities reflects the overall aging of the population, and also factors such as the growing use of certain medications or general inactivity.

“It’s same as with young children: More and more old people have an inactive lifestyle,” said Saskia Kloet, a program manager at VeiligheidNL, an institution that offers similar courses.

Even inactivity in one’s 30s or 40s could lead to problems later in life, she noted.

Like many people her age, Hans Kuhn, 85, worried that her daily routine — and the ability to live alone — would end if she ever lost her balance and fell.

She has lived in her house for decades, and alone since her partner died years ago. Its steeply winding staircase is equipped with a motorized chair on a rail to help reach upper floors. “I only use it when I have to bring lots of heavy things upstairs,” said Ms. Kuhn, herself a retired physiotherapist

Ms. Kuhn’s entire house is a study in efficiency and simple modifications that can make all the difference for an older person. Hand grips are installed in just the right places, as well as ramps to accommodate her two walkers.

There is a stationary exercise bike to keep her moving, and a weight machine made from a big can of beans and string to maintain her upper body strength.

Even as she feels herself grow frailer and less flexible, she knows how to stay fit. “My main problem is I’m very afraid of falling,” she said.

Ms. Kuhn’s bedroom, right, and home trainer. The house is a study in simple modifications that can make all the difference for an older person.

Ms. Kuhn exercising at home with a self-made weight system made out of a rope and a can of beans. Credit Jasper Juinen for The New York Times

So she joined the course, which meets twice a week. On Tuesdays, the students build confidence by walking and re-walking the obstacle course. Thursdays are reserved for the actual falls.

In order to learn, the students start by approaching the mats slowly, lowering themselves down at first. Over the weeks, they learn to fall

“Naturally, they are not interested in courses on falling at first, but once they see that they can do it, then it’s fun,” Ms. Kloet said. “But there is also a very important social aspect.”

Indeed, seeing one another helplessly sprawled across the gym mats gave way to giggling and plenty of dry comments, knowing jokes, general ribbing and hilarity.

“Stop your chattering,” Ms. van Wijk warned a group of well-dressed women who were supposed to be concentrating on the correct way to let themselves fall onto the foot-thick blue mat.

“I would,” said Loes Bloemdal, 80, laughing. “But I have no one to talk with all day.”

Ms. Silkens, right, and Frans Poss, 94, left, training on how to fall and get up.

The students start by lowering themselves down onto the mats slowly. Over the weeks, they learn to fall. Credit Jasper Juinen for The New York Times

In preparing their bodies for a possibly apocalyptic event, the students appeared to forget about their age.

Mr. van Lovink, the cyclist, asked if they would learn standing on one leg. “Why would you want to do that?” replied Ms. van Wijk.

“To be able to put on my pants,” Mr. van Lovink said seriously, but to the amusement of his classmates.

Ms. van Wijk advised them all to always sit when putting on their pants.

“That’s the power of physiotherapy with geriatrics,” she said. “You practice the things you know you can do, and not the things you can’t.”

Mediterranean diet may help protect older adults from becoming frail


https://speciality.medicaldialogues.in/mediterranean-diet-may-help-protect-older-adults-from-becoming-frail/

Whey protein may increase lean trunk mass in older adults


In older adults, whey protein supplementation may result in a higher lean trunk mass without compromising bone mineral density or renal function, according to recent findings.

In the randomized double-blind placebo-controlled trial, Jane E. Kerstetter, PhD, RD, of the University of Connecticut, and colleagues evaluated the impact of 18 months of dietary supplementation with either whey protein (Provon 290, Glambia Nutritionals) or maltodextrin (Maltrin M100, Grain Processing Corporation) on bone mass in 208 older adults. Men recruited to the study were older than 70 years and women were older than 60 years. Eligible participants had BMI between 19 and 32 kg/m2 and self-reported protein consumption between 0.6 and 1 g/kg.

Participants were randomly assigned to an 18-month intervention with either 45 g whey protein (protein group; n = 106) or the control maltodextrin supplement (carbohydrate group; n = 102). All study participants and researchers, with the exception of research pharmacists, were blinded to treatment assignment. At baseline, 9 months and 18 months, the researchers measured BMD by DXA as well as body composition and biochemical markers of skeletal and mineral metabolism.

Change in lumber spine BMD was defined as the study’s primary outcome, and secondary outcomes included changes in BMD at the hip and trabecular and cortical skeletal envelopes, estimated glomerular filtration rate (eGFR), urine calcium, insulin-like growth factor-1 (IGF-1) and body composition indices.

The researchers found no significant disparities between the groups in terms of lumbar spine BMD or the other skeletal outcome variables. At 18 months, the protein group had a significantly higher trunk lean mass than the carbohydrate group (P = .048).

By the conclusion of the study period, the protein group also had higher levels of serum C-terminal telopeptide (P = .0414), IGF-1 (P = .0054) and urinary urea (P < .001) compared with the carbohydrate group. At the 18 month follow-up, eGFR did not differ between the groups.

“In conclusion, there was no beneficial or detrimental effect on BMD of a whey protein supplement administered over 18-months to older adults who had an adequate dietary protein intake; however, protein supplementation resulted in a higher lean trunk mass,” the researchers wrote. “In this group with normal renal function at baseline protein supplementation had no detrimental effect on eGFR. Based on our experience larger and/or longer nutrition intervention trials using whole protein supplements will be challenging. The development of amino acid-based nutriceuticals could make larger and longer-term clinical trials more feasible.” – by Jennifer Byrne

Does Sodium Intake Affect Mortality and CV Event Risk?


Sodium intake may not be associated with mortality or incident cardiovascular events in older adults, according to a study published Jan. 19 in the JAMA: Internal Medicine.

In the Health, Aging and Body Composition (Health ABC) Study, initiated in 1997, researchers assessed self-reported sodium intake from 2,642 Medicare beneficiaries, ages 71-80 years old. Participants were excluded for difficulties with walking or activities of daily life, cognitive impairment, inability to communicate, and previous heart failure (HF). At the first annual follow-up visit, researchers recorded food intake as reported by participants, specifically examining sodium intake. After 10 years, 34 percent of patients had died, while 29 percent and 15 percent had developed cardiovascular disease and HF, respectively.

The results of the study showed that there was no association between participant-reported sodium intake and 10-year mortality, incident HF or incident cardiovascular disease. Further, there was no indication that consuming less than 1,500 mg/d of sodium benefitted participants any more than consuming the recommended amount (1,500-2,300 mg/d). However, the study showed a slight potential for harm when participants had a sodium intake of greater than 2,300 mg/d, especially in women and African Americans.

The authors note that while the food frequency questionnaire used by participants at the first annual follow-up has limitations in its accuracy, “self-reported adoption of a low-salt diet was not associated with significantly higher risk for [any] events.” They conclude that moving forward, there is a need for further research and stronger evidence in order to create better recommendations for older adults.

– See more at: http://www.acc.org/latest-in-cardiology/articles/2015/01/16/15/47/does-sodium-intake-affect-mortality-and-cv-event-risk-acc-news-story?wt.mc_id=fb#sthash.vE0R3iGF.dpuf