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Victoria Musheff: Man, that's hope this must be out.

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Victoria Musheff: So, good morning! We've got some people here in the room, we've got some… we've got a good crowd online. That's wonderful. Well, I have to say, in introducing to everyone Dr. Karen Pemper.

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Victoria Musheff: And I have to tell you that I've known Karen for a very long time. I am the lucky person that hired her at Culture University back in 19… 92? 92. Wow. Yeah. That was a long time ago. Karen was about…

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Victoria Musheff: 6 years old now.

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Victoria Musheff: Kenny was so young, she had just finished her PhD at the University of South Carolina in Corum in Health Promotion Education. And if you've spent any time with Karen, you know that she has a love for

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Victoria Musheff: well-being, and health promotion, and exercise in particular, and movement. I guess it's more movement than anything else, and how we move, and what we do to move well. And so she has taught those kinds of classes for undergraduate students for years. She helped develop the doctoral program that's in that program, and has been a

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Victoria Musheff: I guess you chaired the Dr. Graduate Committee for a number of years for help.

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Victoria Musheff: For health sciences. So, I want to welcome Karen today. She's part of our well-being committee, and she's going to talk to us about how not to fall. That's right. Sounds good.

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Victoria Musheff: Welcome, and I want to make sure folks online can hear me okay? Yeah, we chat, there is. And I tend to want to move a lot when I'm doing this, but I'm going to try to be careful, knowing that I have an audience that's seeing me from one angle, and you're going to see me from another.

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Victoria Musheff: And today's talk is, to me, like a little sampler.

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Victoria Musheff: Of some things to think about in fall prevention.

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Victoria Musheff: Hopefully to lead into some other things. I'm gonna talk about, exercise in a couple… in a month or two. I can't remember. We changed the schedule in one month, so next month, I'm gonna talk about exercise. I'm going to link in some things.

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Victoria Musheff: Specifically for fall prevention there as well, so I won't go into as much detail about that here, but I will go into more detail later. And I also want to mention that

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Victoria Musheff: I'm working with two other research faculty at Clemson who I worked with before I retired.

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Victoria Musheff: And, I'll go just say that This is a… been a…

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Victoria Musheff: A desire of mine, kind of a wish of mine, to have more fall prevention, education, and, strategies to help decrease folks' risk.

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Victoria Musheff: And we're seeing some things kind of come to fruition. We've done some small steps, but we're trying to design something, I'm calling it Balance Camp.

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Victoria Musheff: And there'll be several components to it. One, Emeritus College is allowing us to pilot our actual balance component, where we do activities

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Victoria Musheff: to challenge balance and promote balance. So we're going to do a little pilot test in the spring. We can only take about 8 folks, because we're really just trying out that activity, and we want to make sure everybody's safe as we follow some movement. So stay tuned, there will be more things to do, and hopefully more things that get integrated into

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Victoria Musheff: Clemson, as well as other places in the upstate. So, to start out with… see if I've got everybody… let's get our slides up.

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Victoria Musheff: Now, this is an orchestration in itself, so this is going to challenge our…

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Victoria Musheff: multitasking. Dual task activities. All right, so I'm gonna see if this is gonna work with me well. And folks online, let me know, because you're behind me.

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Victoria Musheff: I can't… I'm not being able to see your reactions to things, so if you have a problem, chime in.

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Victoria Musheff: All right, let's get started. So today, what I'd really like to do is just focus on a couple

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Victoria Musheff: broad issues. A little bit about what healthy aging is, just a little sampling.

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Victoria Musheff: fall risk among older adults, so what some of these risk factors are, and a little bit about strategies to remediate them. Try to decrease your risk of falls, but really.

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Victoria Musheff: how can you preserve your independence? Because that's what followed

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Victoria Musheff: Falls are as a challenge to your independence.

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Victoria Musheff: So, when we think about age, which is kind of an interesting concept,

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Victoria Musheff: We can think about age as a chronological number, but it really is more of a functional concept, which could be described in a couple different subcategories, and I'm going to focus more, like, on the concept of biological aging.

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Victoria Musheff: And biological age is based on the accumulation of the wear and tear on your body.

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Victoria Musheff: In conjunction with your genetics.

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Victoria Musheff: and your social circumstances that will influence how that wear and tear manifests in your body. And this…

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Victoria Musheff: Wear and tear leads to the changes, in a not-positive way, the negative changes that we see or associate with aging.

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Victoria Musheff: And Ultimately, we see a decline in function

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Victoria Musheff: And for some folks at the steeper decline, and some folks it's a gradual decline. There may be lurches of decline. We're gonna have steady-steady lurches.

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Victoria Musheff: It's influenced by epigenetic changes, and if you're not familiar with that term, epigenetics, that means on the genes, upon the genes, that describes the interaction of your genes with your environment.

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Victoria Musheff: So we know that environmental factors will either accentuate or tamp down genetic expression. So we all are experiencing that, and those epigenetic changes come through social stress, our diet, our physical activity levels.

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Victoria Musheff: Work exposure, all these things kind of having a role in that.

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Victoria Musheff: So this is driving how we're aging and how fast we're aging. And that means our biological age and chronological age are not necessarily the same. They're correlated, they're associated, but it's not, it's kind of loosely correlated.

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Victoria Musheff: So, aging is occurring across all our body systems.

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Victoria Musheff: Like it or not.

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Victoria Musheff: these, you know, I joke with… I would joke with my college students, like, okay, you get to 25, and you start to have peak in terms of development, and mass and all the things, and then you start to decline. And so it really starts… some of these declines start

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Victoria Musheff: Earlier in life, but how fast they happen, and what kind of patterns

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Victoria Musheff: are going to be determined by all these other factors. But here we are.

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Victoria Musheff: where these things are kind of being realized and manifested. We notice them more as we get into the 50s and 60s and 70s. The young people don't notice it so much, but I like to tell them it is happening.

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Victoria Musheff: So, there. But it's happening across all these systems, and this has an impact on how we're feeling and functioning.

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Victoria Musheff: There's a lot of variability in how we're all aging. Even within a family, you can see that some folks seem to be aging more

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Victoria Musheff: rapidly, and some people seem to have, you know, much more good fortune and aging more slowly. Is it happening at all these different levels of our… of our bodies?

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Victoria Musheff: And this is going to determine a lot of how we're going to experience aging.

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Victoria Musheff: I always joke that I want to, I want to, like, I want to go out like my great-grandmother, Barbara Kemper, who was in her…

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Victoria Musheff: Middle-late 80s, and that's not a very old age anymore, but that's where she was, and that was in the 60s.

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Victoria Musheff: She finished her dishes.

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Victoria Musheff: And said, I'm kind of tired, I'm gonna lie down. And then she went to… she took a nap, and she died in her sleep. That would be, for me, an ideal way to go. You're still in your house, you're doing your dishes, you've got everything done taking care of, you say, I'm feeling tired, and then you're done.

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Victoria Musheff: That's not how we all, you know, a lot of people don't get that blessing, but our bodies are declining, and these things, it's kind of moved to that level.

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Victoria Musheff: And, as I mentioned, a lot of factors are influencing that. So when we think about healthy aging, there are a lot of factors. Some that are way behind us, can't change. But some are in front of us, things that we can still do to impact our experience.

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Victoria Musheff: I talk about, or I highlight in this slide off in the gray box, because I am… I do focus on…

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Victoria Musheff: physical activity and the way the body reacts to that. So these are just examples of how we see changes, and not in a good way, declines in some of these measures of human performance and physical function.

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Victoria Musheff: Our heart… our maximal heart rate changes, our immune system function changes, our muscle mass changes, our bone mass changes, and it's not in a good way. So we're seeing this slow decline.

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Victoria Musheff: researchers who were looking at, kind of looking at the body of research to see what kind of factors seem to be important domains or determinants of healthy aging, and this is what they found. They categorized three major domains. This is not new to us, but it's intuitively sensible to us.

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Victoria Musheff: And… it's important

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Victoria Musheff: for us to acknowledge the importance of these social and cognitive well-being areas, because these play an important role, not only in function, but quality of life. And I say quality of life is as important as

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Victoria Musheff: function, because I'm… I have a chronic illness, and I think

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Victoria Musheff: that I can be healthy in spite of disease. I can feel well in spite of disease. I learn to adapt, I make adjustments. So I do think this concept of social well-being is valuable, because we can't always change some of the physical things, but we can, create

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Victoria Musheff: a higher quality of life through social interaction. But what really struck me with their research was that across these

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Victoria Musheff: three domains and the 10 determinants was independence. And independence overlapped all the domains. So that's kind of my focus with fall prevention, is the things that you will do to decrease your risk of falls are really about protecting independence, protecting your ability.

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Victoria Musheff: to do what you want in your life, to the extent that any of us can do any… all that we want, we can't always do that. But this idea of maintaining a certain amount of autonomy.

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Victoria Musheff: So…

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Victoria Musheff: online and in the room, what kind of changes have you noticed over the decades? I can remember distinct

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Victoria Musheff: What! What's going on? Changes that…

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Victoria Musheff: Really struck me and made me realize

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Victoria Musheff: I can't just kind of cruise on the youth thing, you know, I've got to have to be more proactive at resisting some of these changes. So what did you guys feel?

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Victoria Musheff: In your fifth… what was remarkable to you at certain times?

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Victoria Musheff: I think for me, in my 50s, was I started gaining weight, and I had to actually pay attention for weight. Yeah, metabolic changes?

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Victoria Musheff: That's such an interesting science. That's a whole other thing, because…

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Victoria Musheff: That's kind of a sign, as these metabolic changes are happening, probably we're losing muscle.

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Victoria Musheff: And that is…

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Victoria Musheff: counteracted with this accumulation of body fat. So our weight may not even change a lot, but how we're distributed kind of changes. So that's kind of a sign of changes in muscle mass.

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Victoria Musheff: the need to be more intentional with physical activity in conjunction with that. Yeah, you can't just take for granted, what you can when you're younger, in your 20s and 30s. You know, it really starts in your 40s when you really have these…

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Victoria Musheff: see things, it's just so… you've just got so much capacity that it's hard to notice, like, somebody chewing into your savings, right? Like, you don't start noticing until it's bigger. Graduate school is not a good place to get exercise.

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Victoria Musheff: Right? Except maybe up here, but…

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Victoria Musheff: I, I was diagnosed with diabetes mellitus in my mid-30s.

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Victoria Musheff: Attimes a good job of cleansing.

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Victoria Musheff: And the doctor said, you gotta start exercising and go on a strict, low-fat diet. Yeah. And a low-carb diet. Yeah. So I started jogging, and…

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Victoria Musheff: I really did that for about 25 years.

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Victoria Musheff: And… Until the body says, maybe you should, transition to walking.

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Victoria Musheff: Excellent. I think that is a key… when we think about the long game.

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Victoria Musheff: Being independent and well for the long game, the key will be knowing when to adapt. I was a runner also, and shifted after about 22 years.

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Victoria Musheff: Because my body… I never had a problem, but my body was starting to tell me something, and if I ignored it because I was so determined I would be a runner, I would probably look like some of my friends who did that, and they'd walk hunched over, and their joints hurt, and I think that

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Victoria Musheff: Listening to your body, and adjusting with the goal of the

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Victoria Musheff: Continuing to be a mover, however that is.

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Victoria Musheff: Victoria, you said somebody online has… Yeah, Vicki Gillis said she noticed bone loss, balance problems, hearing problems, and being cold all the time. Oh, that's great! So, bone loss, muscle, strength loss, being cold, what else was severe? Hearing problems, balance problems, being cold all the time. Yeah, all those factors coming into play, and when we're noticing them, they be different decades.

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Victoria Musheff: I remember noticing some things in my 50s.

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Victoria Musheff: But in my… as I approached 60s?

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Victoria Musheff: Some things became more startling, like balance changes and confidence

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Victoria Musheff: Going downstairs, all of a sudden, I'm second-guessing, like, what?

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Victoria Musheff: Bye.

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Victoria Musheff: I've been going downstairs without any help since I was 3 years old. Why is this suddenly feeling so insecure? I'm feeling so insecure, and it has a lot to do with some of the things I've talked about, these changes where my brain and my body are having a problem communicating well.

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Victoria Musheff: So we asked how these changes?

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Victoria Musheff: And it each…

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Victoria Musheff: Decade of… as we move into the young, old, to the older-old, will have changes, and some folks will have… and everybody's going to have a different pattern.

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Victoria Musheff: But these things are going to happen. And it is important to be, as my father would say, to have enlightened self-interest.

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Victoria Musheff: That you acknowledge these changes are happening in the system, and to kind of make some decisions purposefully.

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Victoria Musheff: how to… Reduce their impact as much as you can, or slow it down.

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Victoria Musheff: So, all these changes… Are contributing to our fall risk.

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Victoria Musheff: Let me hear how your thoughts about fall risk. How do you… are you worried about falling? Are you feeling…

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Victoria Musheff: less confident about navigating, and I recognize I have some folks in the room who've been in our fall prevention class a year or so ago, so I know that this is front of mind, at least, yeah.

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Victoria Musheff: The worst for me.

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Victoria Musheff: is reactions to medicine. Yeah. Reacting to challenge to your balance. Yeah, well, I would black out.

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Victoria Musheff: we've lost track. I've just heard before. So, you know, that's got me…

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Victoria Musheff: you know, I keep canes with me, I've got walkers, I got all that stuff. But if you lose consciousness, there's no… there's not much you can do. That really is… Yeah, but that is… that's… that's at the extreme of what…

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Victoria Musheff: when we have system dysfunction, where something puts us at great risk.

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Victoria Musheff: Arthritis, and all these joint problems in my 30s.

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Victoria Musheff: Because I… I mean, my college students, I drove them nuts. I could beat them on a road bike or a mountain bike any day, whether it was 5 miles or 20.

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Victoria Musheff: And, they were just… they're like, they're ancient, man. So that's changed. Yeah, so that's, again, that kind of being strategic. I…

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Victoria Musheff: when I was younger, I thought, I always… I want to be a runner all my life, and I knew people that were runners well until 70s and 80s. But when I started to… and since I have a chronic illness, I didn't want to do things that were counterproductive to my management of that, like, make things worse.

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Victoria Musheff: So then my goal shifted to, I want to be a mover for the rest of my life, and if that was running, that's great.

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Victoria Musheff: But, Milwaukee is the thing that I really want to protect and be able to do the rest of my life. So how can I do that? So, adjusting the goals and really thinking, what is most important?

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Victoria Musheff: For me, running had to… had to take a backseat.

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Victoria Musheff: So, I noticed that I… I don't really… I don't fall, but I noticed that I…

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Victoria Musheff: It's like my shoe catches, like I'm… I don't know, I don't know what a… Yeah, we hang up, like, you know, I sort of, you know… Yeah. So we… it's like tripping. I saw this comedian talk about getting older. He said, well, when we're younger, we trip. When we're older, we fall.

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Victoria Musheff: So, some trifting, where you're… you have this unexpected challenge to your balance.

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Victoria Musheff: And I'll say, when I hear that, I would say, hmm, shoes are the right shoes, but also, and, online.

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Victoria Musheff: If you think about how your foot moves, bringing your toes up and pushing them down as you walk.

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Victoria Musheff: Sometimes those lower leg muscles, Aren't as strong, and you think you've raised your toes up enough?

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Victoria Musheff: And you have, and you're talking to those body parts, and it's not… it's not working as well as it used to, or the, you know, flexing your hip to raise that foot up, you think you've told it up high enough how to come up high enough?

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Victoria Musheff: You haven't, and so you're noticing, why am I tripping on these things that didn't seem to be such a problem? I'm glad you're saying that, because I call it, like, a shuffle, like, I know what you're saying, but I didn't know that it was supposed to happen. But what I wanted to mention and change is, if I sit in the car for 2 hours.

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Victoria Musheff: anywhere for 2 hours, and then I get up.

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Victoria Musheff: I think it's just since I turned 70 a year ago, that I… it takes me a while to not feel weird, to know where we are. Yeah, so there's… so it's not unusual, right? Yeah, it's not… that also is why we…

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Victoria Musheff: recommend, so I would tell the student, my students.

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Victoria Musheff: The best posture, the best position, is the next position. You should not sit in one position for long periods of time without interruption. You should not stand for long periods of time without interruption. It's the going back and forth between seated and standing and walking

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Victoria Musheff: It's that mixing it up regularly helps your body Feel better? Don't stumble.

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Victoria Musheff: Yeah, and if you lose feeling, right, some of us lose feeling in our feet when we're prolonged seat, sitting.

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Victoria Musheff: That could involve a lot of neurological things, but that's important to become mindful of, to know how long… like, I need interruption, I need to get up.

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Victoria Musheff: Well, I was just gonna say.

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Victoria Musheff: part of mine is, I have a friend who is the same age that, bringing a laundry basket down the stairs, she missed a couple of steps, and had both bones in her lower leg broken, had to have metalwork put in that had to later be taken out. I mean, major issues, and that's one of the things. Now, going down the steps, I'm always looking for the rail. I can't let that happen.

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Victoria Musheff: Yeah, so… and you know, but it's like the warning of what happened to someone else. And part of what's happening as we get older is we're not as…

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Victoria Musheff: Our ability, our communication ability with our body is not as good at judging

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Victoria Musheff: And also, reacting. So, when we have a challenge, we don't react as fast to just trip, we go down. And then, we're not as good at judging, because some of the receptors, I say they kind of get hard of hearing. They don't work as well.

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Victoria Musheff: Especially if you're sedentary and you're not challenging those tissues as much.

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Victoria Musheff: And I would even say, with the walking down the stairs with the

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Victoria Musheff: basket. That's a risk for anybody, but she can't see the steps. Right, right, right. When she's younger, her body figures it out, right? Her body's proprioception is freaking it out. You have a young person or a child running down the steps… Yeah. Right? No rails or whatever. Yeah. And that's just, you know… Yeah, that was a day, right? That day's passed. That day's gone.

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Victoria Musheff: used to have season basketball tickets, but when they, remodeled Blue John, it seemed like the level

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Victoria Musheff: On the steps has increased in terms of,

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Victoria Musheff: Wow. I mean, they should have a sign and say, all you seniors, be careful question, you seniors. Well, we should get lower, everybody should be careful.

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Victoria Musheff: Yeah, so then what… once you, like, your brain kind of detects that.

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Victoria Musheff: It's not feeling as confident, and we start to second guess.

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Victoria Musheff: our decisions, our body's decisions of where to put the step, or how, like, my center of gravity might go down, fall too forward. It's very… makes you feel very uncomfortable, and once you're a little fearful.

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Victoria Musheff: you actually increase your risk of falling, because you become a little more rigid. It's like choking in athletics. You overthink it. Now, the risk is real. You're sensing

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Victoria Musheff: that this is steep, and my brain's not feeling very confident about this, and you sh… you do need to respect your brain's telling you something. It is a good sign that some kind of remediation might help you feel more comfortable on those stairs. Definitely holding on railing. Yeah.

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Victoria Musheff: It's… when you get increased confidence with holding a railing, you'll notice it's not because you're gripping it, it's not bearing your weight, it's even just touching the railing.

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Victoria Musheff: Because it's giving you extra data points in your brain to say, okay, here's where I am, and the brain says, okay, that helped. Now I know what to do, now I know how to instruct the body, so those extra data points help. But that's telling you

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Victoria Musheff: when you need that, that the system as was isn't gonna be enough. It needs a little help. Yeah, steps give me so much trouble. I carry things in bags, you know, grocery bags, anything will keep my hands free. Yeah. One on the rail, one with my hand.

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Victoria Musheff: take multiple trips, yeah. You said something that really rang a bell for me, which was not being able to see the step. When I notice that I'm walking out, because I've turned my ankle many times, sitting on a rock. Yeah. I'm walking in, there's just a little…

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Victoria Musheff: piece of gravel there that I didn't, you know, if it turns your ankle or something. So I've gotten to where I'll walk with my hand down, and I know as I'm doing this, I'm walking, looking down to see… to make sure I don't step on something that I didn't know was taken.

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Victoria Musheff: Yeah, so that's kind of a… that's a mixed blessing of things.

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Victoria Musheff: Because you're looking… when you're looking down, you do need to check. Yeah, but I don't see the cars behind… I don't hear the cars behind me, and I don't see what's in front of me. Well, yeah, but your brain works better, like, if you can look out and make judgments about risk.

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Victoria Musheff: So that you should have been walking, you said, oh, there's gravel up here, now my brain is getting ready for that.

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Victoria Musheff: But…

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Victoria Musheff: if it comes up unexpectedly, then you're starting to get nervous, and you're looking down. So they even say, you know, when you dance, they say, don't look at your feet, right? Because now you try to tell your feet what to do. Like, don't, you know, quit telling me what to do.

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Victoria Musheff: But when you're feeling…

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Victoria Musheff: a threat. Like, I'm gonna fall, I don't feel confident, your brain is going to go to that kind of vigilant state. Have you been in a car, or have you been, you know, remember a time when you were driving?

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Victoria Musheff: and you didn't feel confident about the situation, you've become stiff. You may… you're not turning that wheel normally, you're maybe pushing too fast on the brake, like you're feeling a sense of risk, that vigilance

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Victoria Musheff: When that's chronic, you're driving like that all the time, this is problematic.

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Victoria Musheff: That happens also with walking. You have a dog, you go walking with a dog, they don't like a surface. I had a dog who didn't like shiny surfaces. She would go into a little squat, and then walk, like, on all fours, and that was to get through that period, but we do that, too.

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Victoria Musheff: We do that, too. We will… we'll widen our stance, we'll lower our butt down a little bit, and then we're not walking normally, a normal gait, and I'll talk a little bit about why that's… that's a problem. Anybody in…

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Victoria Musheff: Karen? Dee has something. Yeah.

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Dolores Stegelin: Yeah, I wanted to share something that others may have experienced, but as I've gotten older, I've inherited some foot conditions, and one of them is hammer toe. So, I went to see a foot doctor, and.

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Victoria Musheff: Trustee.

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Dolores Stegelin: he told… he advised me to go to a place called Fleet Feet, In Columbia.

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Dolores Stegelin: So, I went there, and they assessed my feet, and they measured them.

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Dolores Stegelin: And I learned that I was wearing the wrong size of shoe.

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Dolores Stegelin: That was contributing to some of my balance issues. And it was… it was quite educational, because I thought once you reached a certain age, that was your shoe size. They said, no, your feet grow… your feet change over time.

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Dolores Stegelin: And so, I thought one foot was larger than the other, and I was wrong. The other one was longer than the other. But at any rate, I wear a different size of shoe now, and my balance is much better.

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Victoria Musheff: That's an excellent point, Dee. I, I do believe

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Victoria Musheff: We start with the feet when we think about fall risk prevention, because the foot is where… from which everything

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Victoria Musheff: You know, the kinetic chain moves up, and if your feet are not healthy, or there's pain, or you… it alters the way you walk.

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Victoria Musheff: This is going to put you at risk for a fall. And shoes are critical, and a shoe can be too cushiony.

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Victoria Musheff: If it's too cushiony, too thick.

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Victoria Musheff: then the receptors in the bottom of your feet don't get data about the surface as well, so you need enough. It's gotta be Goldilocks, it's gotta be enough, not too little, not too much.

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Victoria Musheff: So that the feet and the communication systems in the body of the people work well.

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Victoria Musheff: The thing that helps me the most, because I have a lot of issues with my feet.

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Victoria Musheff: is I wear different shoes. I've got a bunch of different sizes. My foot's gone from a C width in high school to a double E width now. And so, I just… I change shoes throughout the day. Yeah, and for different activities, you may need different kind of surface.

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Victoria Musheff: You know, the general running shoe…

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Victoria Musheff: Type of waffling that's on the bottom of that type of shoe.

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Victoria Musheff: is not…

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Victoria Musheff: a good match if you're doing a lot of lateral movement, like side-to-side movement, to different activities that might involve, like, tennis or something. You don't want a running shoe with a flared, waffled sole. You want a more of a court shoe that isn't going to snag or catch you if you do lateral moves. Running shoes aren't designed for lateral movement. So, great point.

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Victoria Musheff: I'm gonna push on just to get through some things, because I… I'm gonna yak away.

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Victoria Musheff: Why are… it's important to take falls seriously, and to be… to give it attention.

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Victoria Musheff: But to try to not allow it to make you fearful. You need to respect if you're not feeling confident, but that means giving your attention to problem solve, versus making it

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Victoria Musheff: Something that starts to restrict your activity. You may alter your activity, but not to restrict you, make you less active, because becoming less active actually will self-perpetuate your risk for falls.

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Victoria Musheff: I don't need to go through all of the details of the epidemiology and the risk, but I do want to point out, and Deb, you kind of talked about, you kind of led into this, I almost jumped into it.

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Victoria Musheff: what does it mean to fall? I'm gonna tell you, dude, all this fall work, people tend to say, well, I fell, but it really didn't fail. It wasn't really a fall, like, we are always…

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Victoria Musheff: kind of dismissing, or denying, and don't want to report it to the doctor. So, in the technical definition, it's here. It's a fall as an unintentional change in position. Unintentional change in position.

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Victoria Musheff: Where you come to rest, And placed lower from… than what you started, I think.

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Victoria Musheff: So you can fall on a bed, that counts.

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Victoria Musheff: You can fall from a chair, that counts!

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Victoria Musheff: That's where you've lost control, and you've moved to a lower surface. So, thinking about it that way,

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Victoria Musheff: people don't… so we know that people tend to under-report falls. In the previous slides, there were about 25, 1 in 4 older adults report a fall the last year, and it's probably more like 1 in 3 are falling, but we tend to under-report. And it's because of some of this one…

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Victoria Musheff: I'm trying to rationalize, but also, there's a fear about reporting a fall, that you may be restricted

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Victoria Musheff: by your loved ones, who are healthcare professionals, if you admit that, and you think, well, I can make the changes, and I can adjust it on my own, I don't have to tell.

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Victoria Musheff: That's something to think about, that enlightened self-interest, you have to think about. Is this counterproductive for you to not address it?

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Victoria Musheff: So… Unintentional is the key. That unexpected, right?

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Victoria Musheff: I do want to put… this slide's kind of traumatic, but we're getting ready to submit a grant looking at, trying to reduce falls in Greenville County with a grant there.

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Victoria Musheff: And this is data from

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Victoria Musheff: the South Carolina Vital Statistics over a 4-5 year period, and it's looking at deaths.

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Victoria Musheff: Related to injury.

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Victoria Musheff: in Greenville County. And we see, for older adults.

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Victoria Musheff: Debt related to injury is caused by falls. Younger automobile accidents, all this stuff about

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Victoria Musheff: Accidental poisoning. I'm… I'm mystified. I don't know that much about it. I'd like to… what do you mean, accidental poisoning? Or exposure to noxicide? This must be substance abuse, drug overdoses and things. But for older adults, it's false. So this is just for deaths, not injuries.

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Victoria Musheff: Emergency room business, or you've… you fall…

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Victoria Musheff: emergency services come and get you up, but you refuse to go to the emergency room. All that is, like, more and more numbers. It's like a little ice, you know, like a iceberg. This is the tip of it, is the deaths.

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Victoria Musheff: So, there are a lot of things we know about falls and fall risk. We know that our… we have these changes that are occurring that increase our risk of falling.

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Victoria Musheff: of losing balance when it's been challenged, but also we're more risk of being hurt from a fall. So when we were younger, we kind of were more likely to bounce off, you know, kind of shake it off, maybe get bruised, maybe even broke a bone if it was…

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Victoria Musheff: of having a fall, but we would fall, and there would be not great consequences.

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Victoria Musheff: As we get older, the consequences are greater. Broken bones.

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Victoria Musheff: Damaged joints. We don't heal them as well. So now we've kind of created, added a new element of challenge to our body and function and well-being and movement.

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Victoria Musheff: We also, the way we think about falls, so that was… kind of goes back to the idea of fear of fall. Being fearful once you've had a fall, or what we would see also in our fall prevention class.

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Victoria Musheff: A friend fell, so Roseanne, your friend falls, and now your vigilance kind of goes up a notch. And if you're adapting to it wisely, it's not so problematic, but if you start to say, oh, I… I can't go down those stairs, then somebody else has to do it for me.

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Victoria Musheff: Then you start to see somebody restricting their behavior, which could lead to more restrictions, because as you become deconditioned, or as you lose your confidence more and more.

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Victoria Musheff: Also, lifestyle changes. We get older, we're changing what we may be. Not being as active, we're changing our activity level, maybe on more medications.

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Victoria Musheff: Maybe our social world gets smaller as we have… we lose people, so things are changing that may increase our risk.

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Victoria Musheff: We can categorize these risk factors as internal and external.

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Victoria Musheff: The external ones are kind of obvious. We say, if I have a house that doesn't have proper hand railings, or support devices, or I have rugs that I can trip on.

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Victoria Musheff: Unfortunately, pets are a leading…

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Victoria Musheff: reason for falls, you know? And that… I don't say get rid of your pets, but we may need to do a little training, a little talking, right? A little slow down, get that pet to slow down. But these are a list of the factors in your home that you can modify.

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Victoria Musheff: To decrease your risk, to make it less… you know, take away some of those challenges that your body would have to navigate if you did lose your balance because of them.

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Victoria Musheff: Internal factors are more about what's going on within you, as far as medication, changes in muscle function, but also, if you've fallen in the past.

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Victoria Musheff: your risk for falls in the future are greater. Now, That's…

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Victoria Musheff: Because if you follow them, it's an example of an event where your system couldn't

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Victoria Musheff: Overcome the challenge to your balance and keep you up.

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Victoria Musheff: So if that happened once, there might be something going on. Now, it doesn't mean you will fall, but your risk is increasing, and so it has to do, well, why did I fall?

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Victoria Musheff: Why did I lose my balance? What can I do about that?

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Victoria Musheff: We change the way we walk, our gait changes, so we're talking about the shuffling, like, that's not…

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Victoria Musheff: That's not a way of walking that allows you to

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Victoria Musheff: deal with a challenge to your balances easily. It feels like we're safer, because we feel like we're taking little steps and things like that, but it's… it is, an adaptation that could be counterproductive in the long run. But it is showing a sign that the person's not feeling confident or strong, and, they're… that's…

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Victoria Musheff: That's the sign, like, could we do something?

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Victoria Musheff: We also see other changes, and I don't have to go through all of these, but chronic illness I did want to highlight, because

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Victoria Musheff: As we get older, more likely to have, kind of, layering of different chronic health problems. This does seem to compound our risk of falling.

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Victoria Musheff: These listed here are kind of obvious, but, there are plenty of other ones, even just hypertension, where you might be on a hypertensive medication, or if you have some depression, you might be on something to help manage that. All these chronic illnesses

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Victoria Musheff: either of…

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Victoria Musheff: changing how our systems function, or we're being treated for them, and that can change how the systems are functioning. It worries me how much medication we end up on. If you have a symptom, it seems like you get a pill. You do, and that…

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Victoria Musheff: brings us to this, because medication reviews are… so polypharmacy is a problem. Like, that just makes me crazy, too, like…

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Victoria Musheff: especially when my doctors would say, what is it, evidence-based? I say, well, I'll put me on all these drugs at the same time. It's not evidence-based. We thought these studies show that this is okay. But we do know that as we get older, more likely to be on medications.

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Victoria Musheff: And we need those medications for a variety of things. It's helpful to re-evaluate these medications, especially the ones that are considered

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Victoria Musheff: psychoactive, that have… that affect brain function. Maybe make you sleepy, drowsy, maybe alter… alter your alertness or motor function.

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Victoria Musheff: Maybe cause dehydration, make some… changes your plasma volumes, and you're more likely to feel dizzy.

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Victoria Musheff: So, this is a little bit old data. This comes off a CDC website. You know, 30% of older adults are at least one drug that would meet the criteria for psychoactive or affecting possibly brain function.

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Victoria Musheff: And I know I… I want a medication that makes me dizzy. I need to take that medication, but I also have to learn how to adapt myself

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Victoria Musheff: when I'm doing activities where I know I'll get dizzy, I need to slow down, and pay attention, and act accordingly. But…

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Victoria Musheff: You may also want, especially if you're taking multiple, as you were saying, Debbie.

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Victoria Musheff: Maybe talk to the doctor or your pharmacist about

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Victoria Musheff: Is there… do I need to adjust doses, or do I need all of this, or do I still need this? Can I make some adjustments?

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Victoria Musheff: Now, there's some researchers out of Europe that… and it's… we're seeing this concept brought to, the U.S, and so, Roseanne, here's something to dig into a little bit. They're called FRIDS, Fall Risk Increasing Drugs.

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Victoria Musheff: Through a study, 14 particular types of drugs were identified as

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Victoria Musheff: Particularly increasing risk of falls. Now, that doesn't mean you shouldn't take them, but it does mean you may need counseling, special, counseling about how to reduce your risk, or maybe adjust doses, or not have multiple, if there's a way to adjust that.

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Victoria Musheff: So, some of these, affect, brain function, but some also just change our blood pressure and our, how our blood is,

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Victoria Musheff: Perfusing the brain, if you have drops in pressure when you change your posture.

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Victoria Musheff: So, there is an increased risk observed with folks on these drugs for falls.

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Victoria Musheff: But they're still doing research to see if you remove these drugs, does it decrease your risk of fall? That we don't know yet, because these drugs are being taken for a reason, and that chronic illness linked to it still is in place. So, maybe we would detect a change, maybe not.

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Victoria Musheff: But did they also ask the question about what over-the-counter things they were taking? I look at antihistamine. Yes.

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Victoria Musheff: everybody I know has ouch, or seems to, and I can't take most antihistamines. I will… if I take a zerking, I'll sleep for 3 minutes. Yeah, drowsiness, that's right. And they warn you on that label, but I think

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Victoria Musheff: You know, we kind of become numb to some of that. So, there… ideally, Unfortunately, over-the-counter stuff, is…

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Victoria Musheff: You know, the pharmacist doesn't necessarily know you're taking that, you know.

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Victoria Musheff: Your doctor, they ask about it, maybe you forget to mention it, but this is where we do need to be more proactive, and that's what some of these guys at Fruits, they're trying to be more proactive about

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Victoria Musheff: screening for and asking about these medications? Yeah, they have me on, basically, it's like Humira for my arthritis, and…

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Victoria Musheff: when I do the injections, the methotrexated net, I don't go anywhere for a couple hours. Yeah. Yeah, that's… and we have to be careful that we know that as we're older.

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Victoria Musheff: It's not only the drug, but we're older, and so our systems may be… like, you don't have quite the same reserve to navigate that, so it won't take as much to get the tipping point.

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Victoria Musheff: For somebody to have problems. And getting rid of it, actually metabolizing it out of your body is what takes a lot longer. I know one of the drugs I take, which makes me dizzy, but it helps my circulation to help with my condition.

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Victoria Musheff: But in the summer, it's too much.

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Victoria Musheff: Because between that drug and the heat, I have too much vasodilation, so she'll do not have some activities. So I just kind of back off the drug.

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Victoria Musheff: And that helps a lot. And also, being warmer means the drug may not be as essential, but you might have to talk with your doctor about making adjustments during different circumstances with activities, especially if you're worried.

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Victoria Musheff: I'm worried I might fall with… if I'm doing this gardening out in the yard, and I'm on this drug, do I really need to take the drug during these summer months for my situation? So you might talk a little bit about that. But I'm afraid there won't be an easy answer. It'll be…

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Victoria Musheff: Experimenting, you're gonna be experimenting with yourself.

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Victoria Musheff: Alright, so let's talk about baths.

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Victoria Musheff: to me, I do find all this stuff so fascinating, I like to yak away about it for a long time. But balance, in a lot of ways, is kind of constant movement, and your body is making adjustments to allow you to stay up.

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Victoria Musheff: And so you might say I'm static, but forces are playing on your body all the time. There's little movement that's happening.

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Victoria Musheff: So when we think about the components of balance, we say we have our center of gravity, which is, and for my folks online, it's kind of around the lower pelvis area. That's where our center of gravity is, and we have a gravitational line of support kind of comes through that.

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Victoria Musheff: And we have a base support, which is where our two feet are.

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Victoria Musheff: So if my feet are together, my base of support is narrow. If my feet are wide, my base of support is wide. Ideally, my center of gravity is within the base of support. If I lean forward, my center of gravity moves out, my body has to make all these muscle contractions to hold me up.

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Victoria Musheff: If I move this way, or this way outside the base of support, my muscles are contracting and adjusting.

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Victoria Musheff: So we're counting on our body to know what to do, and that you don't push it beyond what it can do. Like, if I push myself too far out, I'm gonna go down.

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Victoria Musheff: But… If I'm really strong, I might be able to push well out

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Victoria Musheff: amazingly out, right? Like, dancers who can do it, because they're so strong. There's Cirque du Soleil people, but I'm not in Cirque du Soleil, so I can't do that. So, that is kind of the mechanics of it, but within our bodies, we have three main systems of communication and data collection that are

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Victoria Musheff: constantly bringing in data to the brain to say, where am I? How am I moving? Am I up? Am I down? What's the surface like? Does it hurt?

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Victoria Musheff: And so, those three systems are the main systems that we're collecting data to process, to allow the brain to make some decisions about what muscles to contract or how to shift your position.

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Victoria Musheff: The proprioceptive system is the one that is sending the most data to the brain.

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Victoria Musheff: And when that is compromised or changed in some ways, that means the other systems are kind of being more relied on, but it's important to realize they're all integrated, they're talking to each other, they're comparing and matching to say, this is reality. And when those things don't align and match.

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Victoria Musheff: then the brain is not so sure about what to do, and that's when we start to feel that insecurity going down the stairs. I'm not sure where to step. The data the brain's getting is like, this isn't making sense to me, I'm not really sure what to do, and you…

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Victoria Musheff: Hesitate in your action, and what action to take?

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Victoria Musheff: We'll talk a little bit more about those systems, and I'm not sure what my time is. You're okay. Okay. So…

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Victoria Musheff: The other thing we do, and I'm gonna step out My…

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Victoria Musheff: online folks probably aren't going to see me, but I'm going to talk a minute about when our balance is challenged.

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Victoria Musheff: what movement strategies does our body have? And we start at the ankle, so if I'm walking, and I have a challenge, so Debbie, you talked about your ankle, that's the first line of defense. It seems to be the, like, the most efficient. Got it, you know, got it? Got it in place.

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Victoria Musheff: The next one is, like, the hips. Whoa, if I have to correct, like, my center of gravity went out, and I'm trying to bring it back in, that's the next line strategy. The final one is a step.

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Victoria Musheff: So let me step back.

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Victoria Musheff: Or step forward. And so that's the last…

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Victoria Musheff: strategy of defense when your bounce has been challenged. We do know as we get older, We…

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Victoria Musheff: have more problems, like, let's say, joint problems, arthritis, etc, or the talking to the ankle, those receptors, we don't do that as well, so we might not get that correction like we used to. Also, with the stepping.

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Victoria Musheff: We're not as fast.

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Victoria Musheff: So it's kind of like that delay. It might be too late. We also aren't very good at correcting laterally.

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Victoria Musheff: So…

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Victoria Musheff: we should practice that, right? We should do… like, we don't walk laterally, so we're walking… this is our movements, right? You be good at what you practice. We don't do this a lot. So when that challenge happens, what they see is a lot of older adults will actually step forward.

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Victoria Musheff: When they needed a step to the side. So, those are changes that you might be able to do some things about with practice and physical activity and training.

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Victoria Musheff: But I always think about that with… with the stepping. So if you have shoes,

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Victoria Musheff: That our… our hearts…

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Victoria Musheff: For you to know what the surface is like, and there's a challenge, then you might not be able to get that correction at the ankle level, or if your shoes are… don't let your ankle move normally, the high-heel shoes, you may…

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Victoria Musheff: put your body in a position where you're relying on those other strategies. The big thing for me is recognizing my day.

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Victoria Musheff: You're what? My day. Oh. How I'm doing. Because some days y'all see me on walkers, crutches, hangs.

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Victoria Musheff: Yeah. I just make sure if I'm having a bad day, I gotta walk, or… Yeah, and that… that assistive device is important.

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Victoria Musheff: thing to think about… because it's an extra data point. It's not necessarily you're burying all your wick on it. It's a data point that allows your brain to make better adjustments so you can stay safer.

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Victoria Musheff: I see more people misusing those things than anything. I've seen people carry their walkers in front of them.

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Victoria Musheff: So I'm determined to not eat it. Yeah! Well…

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Victoria Musheff: I'm gonna… I'm gonna link it back to posture in a second. So… so the… we talked about the vestibular system, so the brain is collecting data in the joints, in the skin.

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Victoria Musheff: pressure receptors, visually, vestibularly, which is what is kind of, John, you were talking about the vestibular problems.

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Victoria Musheff: You can have these problems that make you feel dizzy. Some of these things can be corrected, some of them become lifelong child. My aunt had vertigo, and it never really got resolved well for her, but…

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Victoria Musheff: All of that data's coming in.

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Victoria Musheff: And it's telling your brain what's going on.

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Victoria Musheff: So this is kind of a complex size. I'll do my best to…

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Victoria Musheff: Let's see if I can use this as I talk. Here we go. So here we are. Here we are with our body in a given environment, and we're interacting with that environment, and the body is collecting data through these systems.

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Victoria Musheff: And depending on how well the systems are working or talk to each other, it's compiling this data, sending it back to the brain.

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Victoria Musheff: And when it's compiling, it's looking for congruence. Like, this should all make sense, right? We're sending it up to the brain. And then the brain makes decisions. I need to contract, I need to react, I need to shift my weight, and it sends messages back to these various body systems.

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Victoria Musheff: Gotta move my head, gotta look up.

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Victoria Musheff: Whatever. And the body makes these corrective movements.

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Victoria Musheff: and you stay up. But now, if you have problems here.

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Victoria Musheff: Where your brain doesn't get good data, you're at more risk of falling.

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Victoria Musheff: And if you're…

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Victoria Musheff: body is weak, not flexible, has pain, doesn't communicate well because you have been inactive a long time, it's not going to be able to make the corrective adjustments to keep you up. So there are a couple places in this

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Victoria Musheff: kind of pathway that could get you into trouble. And so, various forms of

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Victoria Musheff: Intervention can help you do that.

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Victoria Musheff: And I do like to mention posture as part of our challenges. When we have our posture… That's me all down. Yeah, we have this bad posture, so I'll go… so here, if we have forward head.

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Victoria Musheff: If you sit up, forward head looks like this.

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Victoria Musheff: Like this, I'm watching the computer, if I sit up, it's like this. That means these posterior muscles are tight, and these back muscles are kind of overstretched and weak, chest muscles are tight.

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Victoria Musheff: Hip flexors are tight, hamstrings are tight.

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Victoria Musheff: But also, it's changing how the body's receiving data. So…

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Victoria Musheff: when my head is in an altered position, I'm receiving data, so Debbie, you're talking about looking down, but if you can't… if your head is kind of in a suboptimal position, you can't even maybe look ahead and see things well, or make good judgments.

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Victoria Musheff: But also, it's changing how the vestibular system is. We're about, you know, registering, where am I in space?

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Victoria Musheff: And… The proprioceptive systems is not doing a good communication back and forth.

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Victoria Musheff: So, when we're using a walker, and we're leaning forward, we think about our center of gravity's just moved forward, I gotta tilt my head up, and then I'm not gonna walk with a natural gait. So all these elements are in place.

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Victoria Musheff: If that walker isn't positioned properly where I stay up, and I'm able to walk more naturally, but also my… all my data collection systems are in a proper alignment to see where I'm going.

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Victoria Musheff: So, bad posture… It's exacerbating our balance challenges.

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Victoria Musheff: Now, there are different types of ballads, and I really like to emphasize this

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Victoria Musheff: concept, because when we think about physical activity.

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Victoria Musheff: Training has to be specific to the thing you want to change.

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Victoria Musheff: So, because you have different types of balance, you have to have different types of training. So, the first type of balance

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Victoria Musheff: that we're most familiar with is this steady-state balance. This is where you're stationary, and the doctor says, can you stand on one foot? Yes, I can. But that's not how you spend your life. I mean, that's important. But unless you plan on staying there, that's not enough. Necessary, but not sufficient.

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Victoria Musheff: It is important, it's a good screening tool, actually, because if you can't do that well, you're probably having other problems, it's a good predictor. But dynamic balance is where you're moving through space and also stabilizing, so when you're walking.

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Victoria Musheff: You're not only moving your body through space, you're stabilizing the core so it's not…

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Victoria Musheff: all over the place, so I'm holding up place, and then I'm moving the body through space, so there's more dynamic balance. Then we have proactive balance, and that's a little bit of what I was thinking about when you were talking about, Eddie. This is where we're able to anticipate a challenge.

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Victoria Musheff: And the brain can make an adaptation about how it's going to step over something, how it's going to navigate around.

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Victoria Musheff: We've all probably gone downstairs where we thought maybe there was one more step and there wasn't, and your brain said, contract the muscles like this and go down, and it's like, whoa, that didn't happen. That's a mismatch between what the brain was thinking it had to do and what was actually required of the body.

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Victoria Musheff: Proactive balance is your brains collecting data about how to navigate through a space, Shopping.

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Victoria Musheff: Going to the farmer's market, going through your yard, I… when I have dogs.

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Victoria Musheff: We would walk down the hall, and they thought this was, like, a speedway or something, like, who was gonna get down first, right? And they were gonna run through our legs so that they could beat each other down the hall like some game.

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Victoria Musheff: So, I'm navigating that, like, I'm looking at how these dogs are gonna maybe challenge me. Where we kind of get into trouble is reactive balance, where we have to make an adjustment to an unpredicted challenge, where it may cause… catch us off guard. That's that trip on something. We didn't expect it.

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Victoria Musheff: Each of these requires a different kind of training. Now, reactive balance.

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Victoria Musheff: Really need to do with, like, a spotter and somebody training, because

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Victoria Musheff: They've got to kind of challenge you So that you're reactive.

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Victoria Musheff: responses, your reflexes can… to get practice, but that's risky.

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Victoria Musheff: So you need to do it safely. The researcher who's working with me, Jessica, who's… we're all working together in the fall prevention, she actually tests and assesses reactive balance, puts folks on a treadmill, now they're in a harness.

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Victoria Musheff: They're a horse, so they won't fall. They're on that treadmill, and she'll lurch it.

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Victoria Musheff: practice recovery. And what she finds is, if you practice it, you get better at it.

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Victoria Musheff: And once you quit practicing, like all fitness things, you don't store fitness, you only store fat. It will see. It will diminish!

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Victoria Musheff: So… That's where staying physically active

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Victoria Musheff: It's so protective, because it's keeping those communications going, and hopefully

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Victoria Musheff: maintaining strength, etc. But you really do, you know, as you pointed out, Rosen, you have to be very purposeful about it, and we have to be more careful about it. And where walking and cardiovascular health was kind of the message emphasized in our youth.

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Victoria Musheff: It has its place, but strength and balance really need to be top of strategy as we're older. Strength and balance.

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Victoria Musheff: So this is an important concept to think about in terms of

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Victoria Musheff: You can't just practice standing on one foot. That won't be enough. It'll… it'll…

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Victoria Musheff: It has its place, but that's not adequate.

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Victoria Musheff: So, other things we know, as we age, all these things are changing. I won't go through all of them again, just for the sake of time.

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Victoria Musheff: With these, Proreceptive, the things highlighted in… in,

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Victoria Musheff: purple, and what is our time? It is 11 a.m. exactly. Okay. So, I'll go into one activity.

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Victoria Musheff: Now, folks online, I think you should do it here so they can see. Yeah, so, well, I'm gonna actually get a person to do it, so… so…

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Victoria Musheff: You wanna do it? Sure.

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Victoria Musheff: So, they can see her, so he knows they see you. Because anytime I would do this, I would want them to see, because I don't know if you'll fall down.

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Victoria Musheff: I don't want to say about anything, but we can't help. So, when we think about proprioception.

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Victoria Musheff: Think about also when you drive your car. It's your body and your first perceptions, but you also…

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Victoria Musheff: Our practicing proprioceptive

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Victoria Musheff: communication in your car, you know where to get it in that spot, right? You know how far the car's at, they get turned. So, a lot of this is the brain collecting data, and then knowing how to tell the body what to do. So, I'm going to put this here.

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Victoria Musheff: And I want you to look at it, and then I want you to close your eyes.

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Victoria Musheff: And pick it up.

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Victoria Musheff: The brain knows how to do that, because she said data.

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Victoria Musheff: Said where I have to contract muscles to get it, so close your eyes… You were a little bit on the trouble. Now I want to do it this way, I want to do this.

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Victoria Musheff: No one started. So, reach forth.

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Victoria Musheff: So, hearing, we don't talk about it as much, but hearing probably is playing more of a role than I think.

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Victoria Musheff: So, if you… you can move this around, like, you give people a chance to see how they would react, but your brain…

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Victoria Musheff: collects data, you make a decision. I changed something, but I gave you a different cue in your brain, so do I know where that is. And I know how to tell the muscles to move towards that sound that I got. So,

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Victoria Musheff: These things are changing all the time, but they're… they also are interacting with each other.

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Victoria Musheff: And there's so much fun stuff, but…

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Victoria Musheff: That's why we have to have balanced camp.

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Victoria Musheff: We have to have more. I do want to mention this sympathetic nervous system activation. This is the stress response.

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Victoria Musheff: When we're more stressed, we've…

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Victoria Musheff: our system isn't going to work as well, and so that's where I talk about that fear. Having high amounts of fear, increase of vigilance, it does tend to interfere with normal motor control, normal judgments made by the body.

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Victoria Musheff: We do know interventions help. We do know that if you can attend a fall prevention class, that can decrease fear of falling, it provides education about how to clean up your environment, and also if it's introducing you to some movements. Now, in our Matter of Balance class, the movements were very basic.

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Victoria Musheff: And sometimes people felt like, that's not very much. I do more in my fitness class. These movements were only meant to reinforce talking to the muscles. We weren't trying to promote a training effect of strength, but just talking to the muscles.

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Victoria Musheff: So, I'm gonna get you guys to sit in your seats, and at home, if you can do this too, I'll describe it and see if you can feel it.

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Victoria Musheff: I'm going to roll out for you.

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Victoria Musheff: So… Proprioception happens And it kind of tells your body, kind of gauges from

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Victoria Musheff: how much force to generate, right? And how to generate those muscles. But one of the things we find with strategies is

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Victoria Musheff: that we need a certain amount of impact and stresses placed on these body parts. So one of the things I want you to do is just kind of tap on your foot here.

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Victoria Musheff: This is…

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Victoria Musheff: Creating a communication pathway with the impact of the foot on the floor. If you did that harder, like jumping, you get different kind of messages. You can try to see if you can do this fast.

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Victoria Musheff: Not everything is fast and seated up, we're, like, falling!

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Victoria Musheff: But ideally, you could also… Try to do tap, tap, tap, like, move your feet, and practice

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Victoria Musheff: So you can see where this is going.

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Victoria Musheff: So practicing the movement safely, right? First, just get used to talking, and then putting load-bearing and weight-bearing, that kind of adds to it. So this idea of tapping.

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Victoria Musheff: But this marks you?

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Victoria Musheff: for… Folks who might have osteoporosis, or you might not feel comfortable jumping, stomping.

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Victoria Musheff: It's a way to create a certain…

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Victoria Musheff: Impact stress on the skeleton to help promote bone health.

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Victoria Musheff: Because you might not feel… you might not be safe to do higher impact activities.

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Victoria Musheff: So, we know prevention works. John, you mentioned getting vestibular rehabilitation. You had called that, but that's what it was. I just called self-pointing. Good! So, if you're having vestibular problems, dizziness.

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Victoria Musheff: getting rehab for that can be very helpful. I want to stress enough diet assessment. If you are losing lean tissue.

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Victoria Musheff: You've got to do a diet assessment to try to remediate and make sure you're getting enough protein in combination with your strength activities so that you can

416
01:05:01.430 --> 01:05:05.250
Victoria Musheff: rebuild muscle or preserve the muscle?

417
01:05:06.030 --> 01:05:12.590
Victoria Musheff: I have a highlight here for certain conditions called SSC, stands for scleroderma.

418
01:05:12.910 --> 01:05:21.010
Victoria Musheff: And diet intervention did reverse folks out of sarcopenia. I'll talk about sarcopenia and the physical activity next month.

419
01:05:21.240 --> 01:05:22.510
Victoria Musheff: It does!

420
01:05:22.740 --> 01:05:36.660
Victoria Musheff: remediate, to fix things, so we need to be purposeful about that. Medication reviews, if you're on hypertensive medication, where you get dizzy when you shift your posture from a lower position to a higher position.

421
01:05:36.760 --> 01:05:43.960
Victoria Musheff: You should talk to your doctor about adjusting medications, or learning strategies to try to

422
01:05:44.410 --> 01:05:49.459
Victoria Musheff: decrease that impact. Unfortunately, I get that.

423
01:05:49.740 --> 01:05:59.959
Victoria Musheff: hypotension. One of the things to do is to contract your abdominal muscles, and that helps keep the pressure up, but I usually think about it afterwards.

424
01:06:00.920 --> 01:06:08.170
Victoria Musheff: It's like, oh… So you do have to… you have to build some habits and routines to make some of those behavior change.

425
01:06:08.400 --> 01:06:23.099
Victoria Musheff: work. Now, vision and hearing correction, well, vision changes. Your brain isn't able to help collect data, even though it isn't relied on as much for balance as proprioceptive. It's still an important part. If you have cataracts.

426
01:06:23.430 --> 01:06:31.950
Victoria Musheff: or your vision is changing, or low light is problematic, getting that fixed. Or, making sure your house is well lit can help you.

427
01:06:32.470 --> 01:06:36.670
Victoria Musheff: Any kind of foot or ankle disorder, this is going to be important to

428
01:06:37.130 --> 01:06:46.120
Victoria Musheff: start at the source or the beginning of a walk, right? This is… the foot has to be healthy, as healthy as possible, good shoes, like Dee mentioned.

429
01:06:46.360 --> 01:06:47.880
Victoria Musheff: proper shoes.

430
01:06:48.100 --> 01:06:53.350
Victoria Musheff: But, also, You know, maybe issues…

431
01:06:53.680 --> 01:07:01.779
Victoria Musheff: where you're… I'll just say with proprioception. As we get older, proprioception diminishes. When we're fatigued.

432
01:07:02.020 --> 01:07:06.469
Victoria Musheff: Proprioception. Proprioception diminishes when we have pain.

433
01:07:06.620 --> 01:07:22.449
Victoria Musheff: proprioception decreases. So, if you're really tired, or you have pain, your body's ability to navigate and collect data properly is not going to be as good. So, you need to try to address the pain, or try to

434
01:07:22.590 --> 01:07:23.530
Victoria Musheff: help.

435
01:07:24.330 --> 01:07:27.730
Victoria Musheff: Manage that, so it doesn't increase your risk for falls.

436
01:07:28.310 --> 01:07:30.129
Victoria Musheff: Home hazard reduction.

437
01:07:31.400 --> 01:07:34.449
Victoria Musheff: How many… what kind of changes have you put in your homes?

438
01:07:34.750 --> 01:07:36.539
Victoria Musheff: To make them a little safer.

439
01:07:37.010 --> 01:07:50.630
Victoria Musheff: I don't know what we learned in your class with the rug, get rid of all the rugs. Get rid of the rugs, railings, the lights. I mean, we've had most of that already, but… Well, and making sure you have clear pathways. Yes, declutter. Declutter.

440
01:07:50.750 --> 01:08:00.899
Victoria Musheff: Rug mats that slip in the bathroom or in the entrance to your home. People are coming in, it's raining.

441
01:08:00.950 --> 01:08:01.929
Victoria Musheff: And you…

442
01:08:01.950 --> 01:08:12.049
Victoria Musheff: your rug slides out from underneath. That's right. So you've got to have either the proper crypters on the rug, or you have to give up the rug, right, and have other ways of

443
01:08:12.050 --> 01:08:24.460
Victoria Musheff: catching the dirt coming in and out of the house. So those home hazards are critical, easy things, I should say easy, not always easy, like getting handrails is not necessarily easy, but those are doable things, I should say.

444
01:08:24.470 --> 01:08:42.299
Victoria Musheff: They can happen more quickly than maybe changing your body. I know I need more lights, but… Yes. I put a lot of my lights on a little switcher that I can have at right at the door. Yeah. I can turn the lights off and on before having to find the light switch. Yes. Or let's say you're in bed.

445
01:08:42.560 --> 01:09:00.060
Victoria Musheff: And in order to turn your light off, you have to… you have to go like this to not be wrong. Remember, fall is just an unintentional movement from one start to the next. So, you know what? I've had people who crack their heads on their nightstands, rolling out of bed, trying to turn the light off.

446
01:09:00.939 --> 01:09:18.119
Victoria Musheff: I have switches. What do you mean by switches? Can you define that? All you do is you buy at Lowe's, and you put your light into a particular system, and it has a remote control, and you can run, like, 4 lights on one.

447
01:09:18.220 --> 01:09:30.609
Victoria Musheff: So they're pretty easy. That's really easy to install. Or Alexa, right? You have Alexa to turn all your lights on. I don't have a laptop. But also, night lights,

448
01:09:30.880 --> 01:09:35.370
Victoria Musheff: Let's see, actually, I'm gonna jump to this… Gonna jump to this.

449
01:09:36.810 --> 01:09:42.670
Victoria Musheff: Well, I'm jumping too many steps.

450
01:09:42.979 --> 01:09:45.270
Victoria Musheff: Will you have to rush to the bathroom?

451
01:09:45.550 --> 01:09:49.310
Victoria Musheff: Because now we have to build a first call you.

452
01:09:49.359 --> 01:10:04.860
Victoria Musheff: Rushing to the bathroom, you need to make sure there are nightlights, and a clear path, right, no surprises, you're gonna have to have a routine of keeping things tidy. But that kind of rushing actually is an example of a dual-task kind of challenge.

453
01:10:04.860 --> 01:10:12.289
Victoria Musheff: My brain is like, oh my god, I gotta get to the bathroom, gotta have an accident. And then you're… I gotta walk in the dark.

454
01:10:12.320 --> 01:10:20.779
Victoria Musheff: With this sense of urgency, you're much more likely to have a misstep. So having night lights will help a little bit.

455
01:10:22.990 --> 01:10:38.499
Victoria Musheff: rethinking what it takes to not have nighttime. My brother was so surprised at how he didn't have… sorry, Richard, I'm exposing. He's not having to get up in the middle of the night, now that he doesn't drink so much beer. Like, how bad is that?

456
01:10:40.340 --> 01:10:47.049
Victoria Musheff: Hi, New York! So…

457
01:10:47.100 --> 01:11:00.590
Victoria Musheff: What can you do? This is… these are the key strategies to think about. You've got to get baseline information about your risk. Balance, strength, medications, nutrition, do an inventory of risk assessment.

458
01:11:00.690 --> 01:11:04.859
Victoria Musheff: Get education, and then get more active.

459
01:11:05.020 --> 01:11:11.429
Victoria Musheff: And maybe get more active in a certain way, right? Try to be strategic about what that activity is going to do for you.

460
01:11:12.350 --> 01:11:23.619
Victoria Musheff: This is a checklist. You can go online to go to this website, it's called Falls Free Checkup, and you can do this checklist online. It's a list of all of these

461
01:11:24.110 --> 01:11:29.430
Victoria Musheff: Kind of key factors that are predictive associated with fall risk.

462
01:11:29.560 --> 01:11:42.389
Victoria Musheff: If you say yes to 4 or more, or accumulate 4 more points on the checklist, your risk for falling in the next year is increased. It doesn't mean you will, but there's some things that you might want to become aware of.

463
01:11:42.500 --> 01:11:51.869
Victoria Musheff: I won't go through all of these just for the sake of time, but what I want you to kind of notice is that these are associated with certain things like medication.

464
01:11:52.030 --> 01:11:55.580
Victoria Musheff: Or mental states, like fearfulness.

465
01:11:55.690 --> 01:12:08.569
Victoria Musheff: If you've been advised to use a cane, it's not that the cane is the problem, it's that there was a need for a cane that says, okay, you've had some balance challenges sufficient to need assistance.

466
01:12:08.770 --> 01:12:11.620
Victoria Musheff: That doesn't mean you should… if you get rid of the cane.

467
01:12:11.800 --> 01:12:19.539
Victoria Musheff: you lower your risk score if you still need the cane. You don't need the cane anymore, that's the bonus, but…

468
01:12:19.570 --> 01:12:32.969
Victoria Musheff: It's not detained, it's not the problem. If you're starting to find yourself compensating more through touching things and needing help to get up, because you have a muscle strength, there's just red flags, things that you might be able to address.

469
01:12:33.240 --> 01:12:39.060
Victoria Musheff: Losing feeling in your feet, so with, diabetes.

470
01:12:39.390 --> 01:12:45.770
Victoria Musheff: Peripheral neuropathy is a more common thing. If you don't have good communication in your feet.

471
01:12:45.880 --> 01:12:52.789
Victoria Musheff: You're going to find… you're relying more on your vision to tell your body where your feet are.

472
01:12:53.200 --> 01:12:54.629
Victoria Musheff: And that might…

473
01:12:54.740 --> 01:13:03.730
Victoria Musheff: You might not have a choice about that, but that would mean you have to be more careful in moving through unfamiliar places, and you might need to

474
01:13:04.170 --> 01:13:11.720
Victoria Musheff: really think about your shoes, too, to not make that neuropic. Like, there's a fine balance between the discomfort as well as the communication.

475
01:13:14.390 --> 01:13:22.860
Victoria Musheff: So that's a great checklist. We also can do some assessments. The one that probably is the easiest that you can do at home

476
01:13:23.110 --> 01:13:26.910
Victoria Musheff: is called the four-stage balance test, and it's… I put it up here.

477
01:13:27.130 --> 01:13:37.400
Victoria Musheff: You would start standing with your feet together, if you could hold that for 10 seconds. Then you would move your base of support and make it a little smaller with your feet tandem.

478
01:13:37.600 --> 01:13:38.759
Victoria Musheff: a little bit…

479
01:13:38.900 --> 01:13:45.860
Victoria Musheff: Diagonally positioned. If you could hold that for 10 seconds, then you could do your feet in a tandem position.

480
01:13:46.100 --> 01:13:52.949
Victoria Musheff: You can hold that for 10 seconds. You could try standing on one foot, But the key thing is.

481
01:13:53.140 --> 01:13:58.969
Victoria Musheff: is being able to hold your feet in tandem for 10 seconds. If you can't stand on one foot.

482
01:13:59.610 --> 01:14:07.299
Victoria Musheff: That's just an added bonus if you can do that, but if you can't stand in tandem, this means your risk for falls.

483
01:14:07.470 --> 01:14:09.659
Victoria Musheff: Is increased, so that would tell me.

484
01:14:09.940 --> 01:14:14.410
Victoria Musheff: This is where you need to practice some balance strategies. We need that.

485
01:14:14.530 --> 01:14:23.650
Victoria Musheff: Standing on one foot could ultimately be helpful and good, because when you're walking, you're actually standing on one foot over and over.

486
01:14:24.270 --> 01:14:33.130
Victoria Musheff: Unless you shuffle, right? If you don't feel confident, you're shuffling. But if you feel confident, you're on one foot, balancing, balancing, balancing.

487
01:14:33.640 --> 01:14:41.520
Victoria Musheff: So this is a good one. The 30-second, chair stand test is where you're seated in a chair, pushed against a wall.

488
01:14:41.670 --> 01:14:54.490
Victoria Musheff: And you see how many times you can come to sit to stand in 30 seconds. And there's a chart that shows, you know, you can only do this so many times, it's at different age levels.

489
01:14:56.580 --> 01:15:02.420
Victoria Musheff: your risk for falls increases. But the nice thing about the chair stand test is the chair stand is the assessment.

490
01:15:02.530 --> 01:15:18.980
Victoria Musheff: And the intervention. So, if you can only do 5 chair stands, that's… you say, oh, I'm gonna work up to 6, and work up to 7. I assume that's without pushing up. That's right. Yeah, ideally. You're doing it…

491
01:15:19.110 --> 01:15:29.799
Victoria Musheff: without using your hands. Now, if you have to use your hands, that's where you start, right? Like, if you have to use your hands, start with your hands, and then see if you can move towards not using your hands.

492
01:15:30.650 --> 01:15:36.460
Victoria Musheff: I would say… hmm… The chair state test, when we think about independence.

493
01:15:37.370 --> 01:15:40.550
Victoria Musheff: This might be one of the most important things to work on.

494
01:15:42.230 --> 01:15:44.190
Victoria Musheff: This means I can run alone.

495
01:15:44.690 --> 01:15:49.369
Victoria Musheff: I can get on and off the toilet by myself. I can get in and out of the car by myself.

496
01:15:49.590 --> 01:15:54.109
Victoria Musheff: I can get out of the chair of my home by myself. And if you can't do this.

497
01:15:54.480 --> 01:16:03.650
Victoria Musheff: you are gonna have trouble living on your own and being independent. So, being able to do this movement is really important.

498
01:16:09.780 --> 01:16:17.140
Victoria Musheff: Get assessments for these other areas. We do see some important… we can see improvements in body composition.

499
01:16:17.300 --> 01:16:20.960
Victoria Musheff: As we do some more strength activity and improve our diet quality.

500
01:16:21.170 --> 01:16:23.029
Victoria Musheff: That's gonna make a big difference.

501
01:16:24.250 --> 01:16:30.579
Victoria Musheff: Changing how you think, Being more knowledgeable, focusing on problem solving with

502
01:16:30.790 --> 01:16:35.779
Victoria Musheff: fall risk versus fearfulness, right? The problem-solving issue.

503
01:16:38.040 --> 01:16:39.389
Victoria Musheff: Mind you, I'm sorry.

504
01:16:40.020 --> 01:16:59.640
Victoria Musheff: Also on the slide here is this great tool that one of our former doctoral students helped design, as she got a job with the CDC Foundation. If you go to this, lifefallprevention.com website, you can go through a series of modules on your own. It's going to be part of Balance Camp, but you can do it right now.

505
01:16:59.650 --> 01:17:03.420
Victoria Musheff: And it'll walk you through some basic things to self-check.

506
01:17:03.460 --> 01:17:09.410
Victoria Musheff: Home safety, etc. Just a great way to start and get more information, and it's easily accessible to you.

507
01:17:14.960 --> 01:17:28.550
Victoria Musheff: Then there's some activities. So here are a list of activities that you could start with if you are wise and light self-interest, and you do it where you can stand and hold onto a table or some kind of surface.

508
01:17:28.690 --> 01:17:29.640
Victoria Musheff: So…

509
01:17:30.450 --> 01:17:49.950
Victoria Musheff: Heel raises are one of the most important things to practice if you can, because every time you take a step, you're actually doing… it's called plantar flexion, you're actually pushing off with your toes, and what they find with older adults is as we get older, we have more sway.

510
01:17:50.410 --> 01:18:00.240
Victoria Musheff: Because it's harder for our body to maintain balance without sway. And they find that we're trying… because we're weaker, we're trying… we're activating more muscles.

511
01:18:00.830 --> 01:18:07.689
Victoria Musheff: than we normally would need to, to save balance, and this creates fatigue. And what did I say about fatigue?

512
01:18:07.950 --> 01:18:17.540
Victoria Musheff: diminishes proprioception, so it's kind of like a vicious cycle. So, calf raises, they call our toe raises. You could also raise your toes up.

513
01:18:18.080 --> 01:18:25.539
Victoria Musheff: Because that's also part of walking, and you don't want to trip. So just being able to raise your toes up with your heels down, calf raises.

514
01:18:27.560 --> 01:18:31.969
Victoria Musheff: The toe tapping, so I had you start that with seated, but you can raise

515
01:18:32.340 --> 01:18:37.889
Victoria Musheff: You can stand and do it against a step in your house when you just raise your foot up. What you're practicing is this.

516
01:18:38.260 --> 01:18:44.170
Victoria Musheff: Over and over, that makes this muscle stronger, and the tapping is the proprioception is talking.

517
01:18:44.480 --> 01:18:47.270
Victoria Musheff: To those receptors in the bottom of your feet.

518
01:18:48.400 --> 01:18:51.830
Victoria Musheff: Walking heel to toe. Now, you need… do that in the kitchen.

519
01:18:52.170 --> 01:19:00.480
Victoria Musheff: Until you get better, right? But also, you're paying attention. How is I'm talking to me? Is it happy? Is it…

520
01:19:00.630 --> 01:19:04.799
Victoria Musheff: Is it like, what are you doing? I don't know what to do. So, the more you practice it.

521
01:19:05.150 --> 01:19:09.829
Victoria Musheff: We don't talk about backward movement as much, but you should practice some backward movement.

522
01:19:10.380 --> 01:19:14.160
Victoria Musheff: While holding onto the counter, or having a friend with you.

523
01:19:17.250 --> 01:19:32.129
Victoria Musheff: walk backwards a little bit. I found out by walking backwards, I get off off the side of the roof, so when I do fall on the grass. Oh my gosh!

524
01:19:34.180 --> 01:19:40.900
Victoria Musheff: Maybe not out in the open. No, no, when you walk through 400 feet backwards.

525
01:19:41.120 --> 01:19:57.280
Victoria Musheff: You're eventually gonna… You're just eventually gonna fall. All this prevention I know, I'm… you're gonna fall, so… That's a whole other topic, I'm not even… But, I'll say, as an aside, I was at a…

526
01:19:57.280 --> 01:20:04.800
Victoria Musheff: at a retreat, with a lot of older adults, and the leaders of the retreat were in their 80s, 85. The husband and wife team?

527
01:20:05.190 --> 01:20:13.529
Victoria Musheff: And… We were, in between lectures, so we were at break, And the husband, Peter.

528
01:20:13.660 --> 01:20:24.739
Victoria Musheff: was talking, and we had a lot of stuff, like, here, there's a lot of cords and stuff. He tripped on it, and he fell backwards, and I thought, oh my god, I'm seeing this happen!

529
01:20:24.870 --> 01:20:35.859
Victoria Musheff: This guy's gonna have an injury. He fell, he just collapsed down, and he rolled up, his feet came up, and he rolled back up, and he popped up. What just happened?

530
01:20:36.220 --> 01:20:40.659
Victoria Musheff: How did he do that? He was… he would do,

531
01:20:41.850 --> 01:20:44.610
Victoria Musheff: What is it, when you skydiving?

532
01:20:44.950 --> 01:20:46.600
Victoria Musheff: He was a parachuter.

533
01:20:46.850 --> 01:20:52.969
Victoria Musheff: And he learned how to fall at a young age, which he retained as an older man.

534
01:20:53.100 --> 01:20:56.480
Victoria Musheff: I would personally feel not so confident

535
01:20:56.630 --> 01:21:01.299
Victoria Musheff: Practicing falling now? Yeah. I have osteoporosis, I'm like, oh…

536
01:21:01.440 --> 01:21:16.109
Victoria Musheff: I strongly encourage that we should get all the young people to practice welding. While it's easier for them, it's like CPR. They can learn it, and be good at it, and then when they get to our age, it'll be easier. I, you know, there's some strategies.

537
01:21:16.140 --> 01:21:24.720
Victoria Musheff: for following that I've read about, I don't feel like I've got the expertise to teach it. I could talk about it for the teachers.

538
01:21:24.890 --> 01:21:32.340
Victoria Musheff: These external challenges and the changing the base of support, so in your own… in your chair.

539
01:21:32.620 --> 01:21:35.069
Victoria Musheff: Do you reach, pick something up.

540
01:21:35.390 --> 01:21:45.019
Victoria Musheff: Off the floor, pretend, reach, pick something. You're using core stabilization muscles. That's a good exercise to practice, picking that up.

541
01:21:45.070 --> 01:21:56.269
Victoria Musheff: Stabilizing, forward, stabilizing. Even if you sit up in your chair and you lean back a little, stabilizing. It's just a safe way to practice some core stabilization.

542
01:21:56.650 --> 01:22:02.150
Victoria Musheff: But also, if you're standing, just moving your base of support, shifting weight from side to side.

543
01:22:02.930 --> 01:22:07.910
Victoria Musheff: And it can get more challenging, like if you play a sport, right? Sport, or throw the ball?

544
01:22:10.930 --> 01:22:15.820
Victoria Musheff: Now, oh, I… did I perform? You know?

545
01:22:16.400 --> 01:22:20.169
Victoria Musheff: I'll hit the wrong button.

546
01:22:21.660 --> 01:22:26.030
Victoria Musheff: Well, we just are… give each other grace.

547
01:22:26.660 --> 01:22:27.889
Victoria Musheff: So, if…

548
01:22:28.030 --> 01:22:45.620
Victoria Musheff: If you're not really active right now… now, I don't… I believe most folks who are online and here are probably active already. We tend to have a more active group of folks, but if you haven't been active for a while, by that, doing something at least 2 to 3 days a week, regularly, 20 to 30 minutes.

549
01:22:45.880 --> 01:22:51.599
Victoria Musheff: We're strongly encouraged to get started is to focus on strength first.

550
01:22:52.230 --> 01:22:57.989
Victoria Musheff: then balance, and then cardiorespiratory endurance. And the reason for that is…

551
01:22:58.220 --> 01:23:00.220
Victoria Musheff: The… when you go through your walk.

552
01:23:00.520 --> 01:23:17.379
Victoria Musheff: you are using strength and balance to do that safely, and so, not that I would say if you're walking now, you have to go back and quit walking, but if you're not active at all, the place to start isn't necessarily walking out

553
01:23:17.660 --> 01:23:25.270
Victoria Musheff: side in your neighborhood when you may not have the strength to navigate a curb, or you may get fatigued and not…

554
01:23:25.470 --> 01:23:30.929
Victoria Musheff: be able to, you know, keep your balance if you were challenged. So start with lower body strength.

555
01:23:31.240 --> 01:23:34.540
Victoria Musheff: Then balance exercises, and then walking. Now.

556
01:23:34.770 --> 01:23:43.920
Victoria Musheff: You should be doing those all the time anyway, so if you're already a walker, go back and see if you can work on the strength and the balance to build that in, make your walk safer.

557
01:23:45.290 --> 01:23:52.320
Victoria Musheff: We do see a lot of falls when we're reported at… when folks are out Away from home.

558
01:23:52.460 --> 01:23:58.759
Victoria Musheff: Like, at the farmer's market, and in places that are unfamiliar. So, it's,

559
01:23:59.040 --> 01:24:06.220
Victoria Musheff: It's something to be mindful of. All right, so optimize your function, assess your risk.

560
01:24:06.470 --> 01:24:17.880
Victoria Musheff: Get some education about fall prevention. Take a class. Classes emphasize different things, so get a mix of classes would probably be helpful. Stay active, clean up your environment, review medications.

561
01:24:18.400 --> 01:24:20.090
Victoria Musheff: Get your vision checked!

562
01:24:20.910 --> 01:24:23.730
Victoria Musheff: Hereinto,

563
01:24:24.400 --> 01:24:34.590
Victoria Musheff: But especially your vision, and if you can improve your diet quality to try to preserve your muscle or rebuild your muscle, it will be a good investment.

564
01:24:34.740 --> 01:24:42.610
Victoria Musheff: And I will finish with practice mindfulness. Because we don't do dual tasks well.

565
01:24:43.110 --> 01:24:51.580
Victoria Musheff: as well as we used to, like, you know, multitasking as we get older. So, slowing down, trying to do one thing at a time.

566
01:24:51.740 --> 01:24:55.410
Victoria Musheff: This is a good… this is a good habit.

567
01:24:55.630 --> 01:24:59.979
Victoria Musheff: A habit that's gonna be in your favor.

568
01:25:00.430 --> 01:25:05.130
Victoria Musheff: We do actually practice dual task in our balance camp.

569
01:25:05.420 --> 01:25:13.300
Victoria Musheff: Because you can improve your body's brain's ability to do that, but you need to do that really safely. And…

570
01:25:13.630 --> 01:25:15.210
Victoria Musheff: Purposefully.

571
01:25:15.490 --> 01:25:20.889
Victoria Musheff: So, you know, if you're trying to talk on the phone, walk down the hall, and grab a bag of something.

572
01:25:21.150 --> 01:25:26.259
Victoria Musheff: You are inviting… A misstep, some kind of mishap.

573
01:25:26.610 --> 01:25:30.170
Victoria Musheff: So, I'm going to end it here, see if you guys have any

574
01:25:30.330 --> 01:25:35.469
Victoria Musheff: Questions or things you feel like would be useful to hear about?

575
01:25:36.350 --> 01:25:45.200
Victoria Musheff: In your own experience, Yeah. I'm still concerned about depth perception. Yes.

576
01:25:45.410 --> 01:25:48.319
Victoria Musheff: So that's part of that vision challenge.

577
01:25:48.560 --> 01:25:54.999
Victoria Musheff: Especially if you're using bifocals or progressive lenses.

578
01:25:55.270 --> 01:26:02.729
Victoria Musheff: And your brain doesn't adapt as well, so everybody's brain will maybe react to that differently. I didn't have challenges.

579
01:26:03.050 --> 01:26:05.190
Victoria Musheff: with depth perception.

580
01:26:05.530 --> 01:26:16.990
Victoria Musheff: with progressive lenses, I don't think it was strong enough, but when I had my cataracts fixed, I have one eye that can see close and one could see far, and for a little while, I was…

581
01:26:17.300 --> 01:26:19.879
Victoria Musheff: I was noticing, like, oh, my brain…

582
01:26:20.030 --> 01:26:30.770
Victoria Musheff: is kind of saying, what am I supposed to do with this? Like, how am I… and then it did figure it out, and then I didn't notice it anymore. So, depth perception.

583
01:26:31.820 --> 01:26:33.480
Victoria Musheff: Nathan Falls.

584
01:26:33.590 --> 01:26:40.009
Victoria Musheff: Like, making sure you have the proper prescription, or that you're not using a progressive lens.

585
01:26:40.280 --> 01:26:44.090
Victoria Musheff: And you're out and about daily activities, it might not be a good match.

586
01:26:44.650 --> 01:26:46.370
Victoria Musheff: Do you find that happening?

587
01:26:46.930 --> 01:26:50.929
Victoria Musheff: I use drugs for glasses, to read. Yeah. Because…

588
01:26:51.080 --> 01:27:05.199
Victoria Musheff: My eyes are totally different, and just about everybody I know has different, eye power. Yes. With the two eyes. That's right, so you have to get… so, with depth perception.

589
01:27:07.490 --> 01:27:11.470
Victoria Musheff: That, depending… you have… part of what you want to know is why.

590
01:27:11.700 --> 01:27:24.470
Victoria Musheff: you know, having travelers' depth perception? Why? And can that be adjusted? Or is there some training I could do to help my brain get past it? Because a lot of it is the brain figures it out. You know, like, it tunes things out all the time.

591
01:27:24.630 --> 01:27:40.710
Victoria Musheff: So, with vision, it seems like, for older people, the older you get, the more floaters you have. Yeah. And the floaters might be… might change your… what you see. In other words, you think you're seeing something, but you're really not seeing something.

592
01:27:40.710 --> 01:27:50.620
Victoria Musheff: And then the hearing piece is really of interest, of course, to me, because I'm almost dead in one ear, and the other ear… I mean, I can hear.

593
01:27:50.620 --> 01:27:52.089
Victoria Musheff: But I know…

594
01:27:52.270 --> 01:28:02.219
Victoria Musheff: The other day, my… I was at the audiologist's office, and they took my hearing aids to go do something, and they came again, they were talking to me, and I said, you do work in an audiology office?

595
01:28:03.380 --> 01:28:06.840
Victoria Musheff: Did you get where we were?

596
01:28:07.850 --> 01:28:15.800
Victoria Musheff: No, but I do think that the relationship between balance and vision and theory… Yeah, the senses.

597
01:28:15.890 --> 01:28:19.129
Victoria Musheff: And we also know if some of those senses

598
01:28:19.160 --> 01:28:38.029
Victoria Musheff: those communication pathways are changing, and we know that there's a lot of integration, that this is going to have impact. So, I believe the speaker we had was excellent about audiology. She was cautioning not to overstate the role of hearing with balance, but we do know that there's some

599
01:28:38.450 --> 01:28:55.149
Victoria Musheff: integration, that there's something going on, and so if you're having trouble there, that's a sign that you probably need to take stock of the other senses to see. Your senses will try to compensate where there's a weakness, but you have to realize that

600
01:28:55.500 --> 01:29:10.359
Victoria Musheff: you've got all these compensations, and then your body can't react as well, and can't react as quickly. So, do you really want to give your body a stress test all the time? Like, to react to the challenge, so trying to

601
01:29:11.910 --> 01:29:19.660
Victoria Musheff: Reduce that risk, but also give your body as much advantage as it can by doing physical activity and rehab and training.

602
01:29:20.110 --> 01:29:32.719
Victoria Musheff: But the hearing is going to be interesting. But what are you talking about next time? So, next time we're going to look at… I'm going to talk about physical activity. You know, I'll say, okay, here's general guidelines, but then I'm going to talk a lot more about

603
01:29:32.810 --> 01:29:45.830
Victoria Musheff: some of these strategies and what we're learning, and maybe… it's very hard to do in a hybrid way, movement things, but I'll try to have a few movement things that you can take away.

604
01:29:46.030 --> 01:29:57.590
Victoria Musheff: And we'll look at some of these balance activities. Functional movement, which I am just fascinated by. How… I'll say how I recovered my…

605
01:29:58.380 --> 01:30:09.210
Victoria Musheff: confidence with the stairs when I was having that challenge is I did a lot of functional activities of hop, like, hopping and stepping and movement, and…

606
01:30:09.560 --> 01:30:12.679
Victoria Musheff: Making my proprioceptive system kind of wake back up.

607
01:30:12.980 --> 01:30:20.539
Victoria Musheff: And it was amazing, like, now I go downstairs, like, I didn't think about it anymore. If I think about it, I undermine myself, like.

608
01:30:20.690 --> 01:30:23.820
Victoria Musheff: If, you know, you start to over… you overthink.

609
01:30:23.930 --> 01:30:37.360
Victoria Musheff: But I went from feeling uncertain going downstairs, like, oh my gosh, I gotta hold on, to forgetting that I'm going downstairs. That's the goal for me. So we'll talk about some of those strategies.

610
01:30:37.530 --> 01:30:40.320
Victoria Musheff: Because most people know about,

611
01:30:44.190 --> 01:31:03.649
Victoria Musheff: I need to walk, I need to engage in, you know, 150 minutes a week. That's kind of common knowledge. I will also bring in a few caveats for some chronic illnesses, because there's some chronic conditions you have to be careful with, or modify your exercise approach, or talk to your doctor about it. Osteoporosis, hypertension.

612
01:31:05.090 --> 01:31:06.490
Victoria Musheff: those times.

613
01:31:06.980 --> 01:31:08.350
Victoria Musheff: I feel like this.

614
01:31:08.510 --> 01:31:22.189
Victoria Musheff: You guys were great. Thank you for the great input. Thank you online, hope you, were able to at least hear adequately. Yeah, they… okay. Thank you for joining us!

615
01:31:22.890 --> 01:31:25.610
Victoria Musheff: Harry, you're a master of this. Awesome.