As We Get Older, Our Fall Risk Increases
Falling is bad! Let’s face it, falling puts us at greater risk for severe health changes and lifestyle limitations as we get older. When we are young, our bones are strong, our tissues are resilient, and our reflexes are sharp. As we age, we lose ground in all these categories, which increases our risk of falling. Aging diabetics unfortunately face bigger challenges with respect to fall risk and injury. Diabetic peripheral neuropathy affects 50% of the diabetic population and diminishes the sensory information coming from our feet to our brain. Without this input, the risk of falling increased 5-fold.
How Our Bodies Maintain Balance
As human beings, we balance on our two feet against gravity using three main systems: vision, vestibular, and proprioceptive. To put it plainly, we use our sight, our inner ears, and our feet to maintain our balance and move through space safely. Enormous amounts of information from these three systems is processed by a part of the brain called the cerebellum to give us control of our bodies. We need two of these three systems always working to maintain our balance. So, poor vision, vestibular issues, and lack of sensation from the feet can affect our motor control and ability to keep our body over our base and upright.
The Effects of Peripheral Neuropathy
Peripheral neuropathy is most often seen in people with diabetes and is the result of damage to nerves outside of the spinal column. It can affect many systems (sensation, digestion, urination) but frequently affects the lower legs and feet. Patients describe symptoms such as pain, burning, stabbing, or tingling. This loss of sensation can reduce the person’s ability to sense the ground and their feet, which affects leg strength and balance.
How to Improve Your Safety
Beyond making good lifestyle choices like eating a healthy diet, avoiding alcohol, not smoking, and managing diabetes with a good medical regimen, there are other things people with diabetes can do to improve their safety and health despite peripheral neuropathy. Here are just a few:
- Try exercises for the feet that improve circulation and sensation, like the bean box
- Engage in exercises for the legs
- Practice balance activities daily
- Get involved in Tai Chi Chuan. It has been shown to reduce falls and improve confidence when done daily, due to the weight shifting and single-leg stance nature of the activity.
In addition, people with diabetes should be proactive about the things they can control. Installing handrails, using shower seats, using walking aides, and making sure your home is well lit and free of trip hazards are all ways you can protect yourself. A great guide on how to fall-proof your home can be found here. Regular vision exams and proper corrective eyewear are very important, as vision is a major system involved in maintaining our balance. Being honest about your balance and risk tolerance for falling is more important and practical than trying to prevent or reverse the effects of peripheral neuropathy. A little bit of prevention and work can go a long way to improving safety and reducing fall risk for any population, but it’s especially important for people with diabetes who have peripheral neuropathy.
Additional Resources:
Prevention and Treatment Options for Diabetic Neuropathy
Fall risk is REAL, as I’ve broken many bones due to osteoporosis diagnosis @ age 29. I would add taking away throw rugs; adding grab bars to shower or next to toilet; using trekking poles (they look more athletic & take weight off your knees & lower back) when walking if you don’t want to use a cane, walker or rollator. Get rid of shoes that fall off your feet or move around when you walk or turn, to avoid tripping or falling. (My last bad fall was off a step ladder with flip flops on) Having type 1 57 yrs, from age 7, I lost my peripheral vision in my early 20’s from fully treated retinas with laser, but I avoided going blind! Fibromyalgia also causes me to lose my balance, along with the neuropathy & osteoarthritis in my feet, knees & back. It’s all about adapting to your ever-changing body & just being aware of limitations, how to adjust & paying attention to your surroundings. It’s OK to let others know if you’re challenged so they can help in some way to call out an obstacle, curb, threshold, pothole or step. Sending well wishes to all my fellow type1s’! We’re living much longer with all our great technology, which has saved my life past my 20’s and I’m so glad to be here!
Thanks for your comments and additional suggestions, Teri!
I was diagnosed in 1945 when I was 6. I am type 1 for 78 years. I did not have any diabetes related complications until the 1990s. I was diagnosed with insulin resistance in 1998. I had four relatives with type. When I had weight gain in the mid 1990s, I guess that triggered the insulin resistance. I use Metformin, 1000 mg per day. Insulin in my pump, and Metformin give me good diabetes control.
I started having neuropathy in the 1990s, but it was manageable until approximately the year 2020. Now I have trouble walking. Physical therapy prescribed by my podiatrist helped very much. I have exercises I do at home that help, but I will soon need a walker at home to be safe when walking. I also have neuropathy in my bladder, and I have to use catheters to urinate.
Prostate cancer in 2002 and the need for hearing aids in 2010 are the only other problems I have had. I am very fortunate to be doing so well for so long.
You are a trooper, Richard, and 78 years with T1D makes you a legend! Glad the PT has helped with the neuropathy, and you are wise to take extra precautions to stay safe. Thank you for sharing, and stay well.
I’ve had Type1 Diabetes for over 40 years, and at age 66, the effects of neuropathy havre taken their toll on my legs, feet, fingers and arms. My balance is off and I’m prone to falls. I now use a rollator and a shower seat in my daily life. I just moved to an Assisted Living facility and that has helped too. I guess my advice for senior diabetics is to not be hesitant to ask for help. It’s available if you ask.
Good advice, Kaye. It’s important to do what you need to do to be safe. 🙂