All Fall Down

As children, we played Ring Around the Rosie, ending with “ashes, ashes, we all fall down.”

When small children fall down, it is fun. When older adults fall down, it is anything but fun. Over the course of my career, I saw many frail but independent elders fall, breaking a hip, and ending up in nursing homes for the rest of their lives.

The leading cause of injury and injury deaths among adults 65 and older is falls. At the last census, 14 million older adults – 28% of those 65 and older – reported falling during the prior year. In 2021, 38,742 older adults died due to falls.

How can you avoid adding to these dismal statistics? There are many things you can and should do!

You can do things to your body. Work on balance. An excellent way to do this is to sign up at the Y or your local Senior Center for Tai Chi – an exercise program focused on balance. At home you can do simple exercises on your own, such as standing on one leg – just Google “balance exercises.”

Increase your muscle strength with resistance exercises, including squats. This will both improve your leg strength, which reduces falls, and strengthen your bones, so you are less likely to sustain a fracture if you do fall.

Speaking of bones, do you know your T-score? Women in particular, but older men as well, should be checked for osteoporosis at least once. If your bones are very thin, your fracture risk is higher and you can discuss options with your doctor for improving this.

Beware of medication! Some medications can make you unsteady either by lowering your blood pressure too much or by directly impacting your brain. Sleeping pills and sedatives are a major culprit. A “med review” to look for any that can be stopped should be a regular event with your doctor.

Many simple things can reduce your risk of falls. When going up or down stairs, hold on to the banisters. Have adequate lighting, particularly at the bottom of stairs. If your vision is less than perfect, put bright tape on the last step so you do not miss it.

Be sure that any small rugs have non-skid bottoms or a non-skid pad under them.

Be cautious with ladders. Do not climb any higher than you would feel safe falling. DO use small ladders rather than chairs to get something down from a high shelf – ladders are designed to stay upright when you stand on them; chairs are not. Keep things used often on lower shelves.

Add grab bars to the shower. Closing your eyes to keep soap out of them can make you unsteady.

Both at home and in hotels, have a night light to help you safely navigate from bed to bathroom.

Be proactive! Do not be a statistic!



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Cannabis: panacea or poison?

First, some vocabulary. Cannabis is synonymous with marijuana, and refers to a plant, the chemicals in the plant and products derived from the plant. THC, tetrahydrocannabinol, is the primary psychoactive compound in cannabis. Cannabidiol (CBD) is also psychoactive but does not have the euphoric effect of THC. CBD sold is usually derived directly from the hemp plant, a cousin of marijuana, or manufactured in a laboratory. The cannabis plant contains more than 500 chemicals, many not well understood.

Cannabis use has increased dramatically over the past decade. Once illegal throughout the U.S., cannabis is now legal for medical use in 38 states and the District of Columbia and for recreational use in 24 states and D.C. A Gallup poll in 2019 found that 14% of adults had used cannabis during the preceding year and a 2021 survey found this had increased to 21%.

Seniors are the group who are increasing their use most rapidly. In 2007, only about 0.4% of people age 65 and older in the United States reported using cannabis in the past year. That number rose to almost 3% by 2016 and in 2022 it was over 8%.

Another group who use cannabis heavily are those with cancer. A recent survey of cancer survivors found that almost half were current or past users.

What are the benefits of cannabis? Because cannabis is still classed at the federal level as “Class 1” – a drug with no currently accepted medical use and a high potential for abuse (along with heroin and LSD) – it is hard to do research into its medical benefits. Much of what we know comes from observations rather than controlled trials.

Granting that the evidence is soft, cannabis seems to help reduce chemotherapy-induced nausea. It also has antiseizure effects and has been used in patients with epilepsy not responding well to traditional drugs. It can be useful in reducing pain in chronic pain sufferers, and may be a welcome alternative to narcotics. Patients with multiple sclerosis report less spasticity and pain. Finally, patients with inflammatory bowel diseases report better quality of life with cannabis use. It may be useful in treating insomnia.

The downsides are numerous. Inhaled cannabis, the most common way it is used, has adverse effects on the lungs similar to the effects of tobacco smoking. While THC acutely dilates airways, chronic use makes asthma worse. Several asthma deaths have been linked to inhalation of marijuana. Inhaled cannabis increases the risk of lung cancer.

Recent reports at a national cardiology conference found increased risk of heart attacks, strokes and congestive heart failure in regular cannabis users. Women who use cannabis during pregnancy have a 25% increased risk of adverse pregnancy outcomes.

Some regular cannabis users develop severe vomiting requiring hospitalization and IV fluids.

Cannabis impairs driving ability and is clearly linked to increased motor vehicle accidents, though it is not nearly as bad as alcohol in this regard.

While many or most users are looking for the relaxation effect of cannabis, psychiatric side-effects including panic attacks and psychosis are common. Psychiatric problems are particularly common in adolescents, and there is good evidence that cannabis use by young people interferes with brain development.

Bottom line: if you have a problem that is not responding to traditional medication, cannabis may help but its use comes with risk. Adolescents and young adults should not use cannabis, nor should pregnant women. No one should use cannabis before driving or doing other risky things requiring alertness.



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Suicide

The holidays, Christmas, Hanukah, Kwanza or just “the holiday season,” are for most of us a time for family get-togethers, singalongs, gifts and joy. For people living alone, or struggling with depression, the expectation that they should be happy simply adds to their pain. This season is thus for some a time of increased risk of suicide.

Last year the U.S. experienced a new high in “deaths of despair,” including suicides. In 2022, almost 50,000 people lost their lives to suicide. While all age groups are affected, the highest suicide rate was in men 75 and older. Also striking is that over half of these deaths were carried out by guns.

How can we reduce these horrible events?

If you are contemplating suicide, please reach out. No matter how it may seem, you are not alone. In Massachusetts, you can call 833-773-2445. Most states have a chapter of The Samaritans. From anywhere in the U.S., you can call 988. All of these services are anonymous, free and available 24/7.

If you have guns at home, be a responsible gun owner – keep them locked up.

If you are worried about a friend or loved one, reach out. Talking about suicide does NOT “put the idea in their head.” Talking, and more important, listening, is incredibly helpful. Initiating the conversation is not easy. Make sure they feel safe in being open. Start with something like “You have seemed very down recently. I am worried about you. Would you like to talk?” When it seems appropriate, it is OK to ask “are you considering suicide?”

If they are open to discussing their feelings, be prepared to listen deeply: maintain eye contact, reflect back their words and acknowledge their feelings. Don’t interrupt and/or try to talk them out of their feelings. While you may feel things are not that bad, they do.

Suggest they get professional help or call one of the hot-lines. If they are not ready to do this, tell them you will be available to talk more. Ask them to promise you they will not act on their impulses without more talking.

If they do not want to talk, tell them you will be available when they are. Share your concerns with others in their support network; there may be someone else with whom they feel more comfortable.

Finally, if you feel the risk is very high and they refuse to seek help, reach out to emergency services on their behalf.