Great advice on the right way to handle fall risk for seniors. Includes an excellent video.
Elliott Royce takes practice falls at least five times every morning. He doesn’t just practice; he preaches, too. He goes to assisted living centers, senior centers and community centers to talk about how to prevent serious injuries if you take a tumble.
Perhaps because I’ve reached an age where I might be considered a senior my own self, I’m becoming increasingly annoyed by the way public health advisors infantilize seniors.
It’s most obvious with fall risk, where “don’t fall” not only is repeated constantly, it almost always comes with a particular sort of blame-the-victim advice—remove tripping hazards, wear supportive shoes, be careful on wet or icy surfaces, always use your assistive devices (canes, walkers, etc.)—the implication being that if you fall it’s your fault for not having made your environment sufficiently fall-proof.
This advice is not merely useless or insulting; it is actively harmful.
It’s harmful first of all because it conflates “senior” with “frail” in a way that will inevitably lead the public to harass seniors just like the public feels free to harass fat people, smokers, pregnant women (especially those with the temerity to drink alcohol), or anyone who isn’t conforming with whatever the current public health fashion is.
Inevitably too, it will have that effect in the minds of seniors who will start to think of themselves as frail simply because everybody says so.
More to the point, it’s is precisely backwards for what you want if your goal is (as I think it should be) to prevent frailty.
Wrong: Remove tripping hazards. Right: Use pillows, empty boxes, rocks, sticks, 2x4s, and whatever else you have handy to make a little obstacle course on which you can practice navigating tripping hazards.
Wrong: Wear supportive shoes. Right: Wear the least supportive shoes you can handle and do foot exercises to gradually strengthen your feet.
Wrong: Be careful on slippery surfaces. Right: Pay attention to the surfaces you’re walking on and exercise due care on all of them.
Wrong: Always use your assistive devices. Right: Work with a physical therapist if necessary, and then do exercises to make yourself strong enough to obviate the need for an assistive device.
This is perhaps not as harmful as the infantalization of children and youth, which works extra harm because adults have more power to impose their conditions on children, whereas seniors mostly have enough autonomy to ignore inappropriate advice. But it hurts seniors in exactly the same way it hurts children, reducing their ability to become or remain robust actors in the wide world.
Now, I don’t want to fall into reverse-blaming the victim. If you are frail, then taking steps to reduce the risk of injury just makes good sense. My go-to activities to prevent frailty might well put an already frail person at serious risk.
I try to resist the urge to suggest to seniors that they should do hazardous activities in the name of preventing frailty. But the advice I see from professionals (and random strangers) goes too far in the other direction. Following it is going to doom already frail people to becoming steadily more frail.
I have always been an optimizer. I spend way, way too much time, energy, and attention optimizing things. Which is, you know, fine, even though my net benefit is small or zero, largely because I don’t focus my optimization efforts in places where I get the biggest payoff. (I’d say that I don’t optimize my optimization efforts, but I don’t want to tempt my brain into trying to do that. It would not end well.)
One place where my optimization efforts did end well has been in optimizing things for life under late-stage capitalism.
I was helped by a couple of lucky coincidences and a bit of lucky timing.
Purely because I enjoyed doing software, I became a software engineer at the dawn of the personal computer era, which gave me a chance to earn a good salary straight out of college, a salary that grew faster than my expenses for most of the next 25 years.
Whether because of my upbringing or my genes (my grandfather was a banker), I liked thinking about and playing with money, which meant that I was doing my best to save and invest during a period when ordinary people could easily earn outsized investment returns.
It worked out very well for me. I’m as well positioned as anyone who isn’t in the 1% to do okay in late-stage capitalism. (Frankly, better positioned than a lot of the 1%, who find it easy to imagine that they deserve the lifestyles of the 0.1%, and if they live like they imagine they should will quickly ruin their lives.)
This whole post was prompted by a great article that looks mainly at the efforts women make to optimize themselves under the overlapping constraints of health, fitness, appearance, and financial success in the modern economy. Highly recommended—insightful and daunting, but also funny:
It’s very easy, under conditions of artificial but continually escalating obligation, to find yourself organizing your life around practices you find ridiculous and possibly indefensible…. But today, in an economy defined by precarity, more of what was merely stupid and adaptive has turned stupid and compulsory.
One focus of that article is on “fitness.” I put fitness in quotes because of the way, especially for women, so much of fitness is actually about appearance. Perhaps because I’m not a woman—also perhaps because I’m already married, and because I’m older—my own perspective on fitness has gotten very literal: I want my body to be fit for purpose—fit for a set of purposes which I have chosen. I want to be able to do certain things because I have found the capability to be useful. (I also want to be able to do certain things that I can’t do, because I imagine that the capability would be useful, and much of the exercise I do now is intended to achieve those capabilities.)
In a sense, optimizing for fitness is really neither here nor there as far as optimizing for late-stage capitalism, which is mostly about money. And yet, really it is. My fitness suffered during the period I was working a regular job. Getting fit and staying fit takes time. To a modest extent, you can substitute money for time—you can pay up for the fancy gym where the equipment you want to use is more available, or take a job that doesn’t pay as much but allows you to squeeze in a midday run. But now we’re right where we started: optimizing for life in late-stage capitalism.
I should say that I’m delighted with how well my life has turned out. If I’d had any idea how little I could spend and still have everything I really want, or how early I’d have saved up enough money to support that modest lifestyle, perhaps I could have avoided a lot of anxiety and unhappiness along the way. But who among us has such luck? And more to the point, maybe some of that anxiety and unhappiness were crucial to my making the choices I did that got me to where I am.
I worry just a bit about my irresistible impulse to optimize, but like everything else about me, it got me to where I am. And, as I say, I’m delighted to be here.
I used to make fun of our culture’s weird fixation on dangers from ordinary things, but now that I’ve seen it have its effect on Jackie’s mom (labeled a “fall risk” at the hospital and now confined to a wheelchair), it’s not so funny any more.
My theory is that this phenomenon has its roots in how safe daily life has gotten: Eliminate any particular danger and there’s always the next most dangerous thing.
I have been predicting for years—only partially tongue-in-cheek—that we’re dangerously close to feeling like it’s a “reasonable” precaution that everyone wear a helmet while taking a shower, because bathroom slip-and-fall injuries are probably the greatest non-motor-vehicle risk that ordinary people face.
Hospitals’ fear of elderly people falling is so great that they are preventing them from walking, reports The Washington Post. This is ostensibly for the patients’ own good — yet not getting up for even just a few days is crippling them…
Just as an aside: One thing about this that drives me crazy is that safety advocates have pushed for all sorts of changes to cars to make things safer for drivers and passengers, but I’ve seen almost no push to make cars safer for bicyclists and pedestrians. If you want to make things safer, there’s a place to start.
While @jackieLbrewer was working at the bakery there was a cash register glitch. For several days they took credit card payments on paper, writing the number down by hand, and then entering them manually at the end of the day.
Those customers would have been totally secure from being able to buy bread.
To be completely honest I mainly want this because without it the watch pocket in 5-pocket jeans is worthless. But it also occurs to me it might be appropriate as an alternative to a burner phone.
I don’t have the device fully characterized yet, and in fact there are multiple versions that might be differently useful in different circumstances, but here’s a sketch of what I’m thinking about.
First of all, the device has to fit comfortably in the watch pocket of a pair of 5-pocket jeans. That’s its whole raison d’être.
Almost certainly it needs to have:
This is enough to enable all sorts of use cases: Geo-tagged images, navigation, listening to podcasts, tracking workouts, etc.
If I could get just that—and if it were reasonably cheap, and designed with good security—I’d buy one in a heartbeat, simply to have a workout tracking device that fit in the media pocket of my workout shorts. (My phones get bigger faster than I need to buy new running shorts.)
At this point, we need to make a big binary decision: Does the device have a phone?
Without a phone, it’s just a teeny-tiny tablet. As I say, I’d buy one, but without a phone it’s pretty limited—no connectivity unless you’re on somebody’s WiFi.
For most of the use cases I have in mind, this would work great. I could connect my headset & heart-rate monitor, kick off a podcast, start up my work-out tracking app, and go for a run. Along the way I could pause to take photos to document my workout. And the end I could share photos and workout details to social media. (Everybody I know cares deeply about my workouts.)
Some very minor software tweaks would let you use it your pocket watch phone as if you were connected. For example, you could still write texts and social media posts, they’d just be queued up until you went on WiFi someplace at which point they’d all be delivered.
The biggest issue with a pocket-watch non-phone phone would be the inability to make emergency calls. Less of a big deal but important to a lot of people is just generally being connected—making and taking calls, sending and receiving texts, keeping up on and posting to social media, etc.
The downside of adding a phone is that it loses the potential to be a purely off-the-grid device.
It might be possible to compromise: You could have a phone that’s turned off (with a burner SIM). Then you’re covered: In case of an emergency turn the phone on.
Proper burner phone security would require that you dispose of the phone as well as the SIM once you’ve powered it up. That need could probably be avoided if the phone generated a new IMEI on each power-up the way some devices are now generating new MAC addresses on power-up for the same reason. (There might be other numbers that would need to be regenerated. There’d also probably be other software changes necessary, such as obfuscating the list of installed apps, to keep the phones from being self-fingerprinting in all sorts of ways.)
If you can make the phone cheap enough, which having a very small screen would help a lot with, maybe none of that matters. Buy the phones in three-packs for a few dollars, and then give them to homeless shelters as soon as you’re done with one.
I’ve read several novels lately with characters engaging in the sort of OPSEC that you need to do nowadays if you’re undertaking activities the federal government would consider nefarious—beginning with not carrying your smartphone around everywhere you go.
Of course you wouldn’t want to leave your phone behind only when you were doing something nefarious. To do that would be like announcing “Nefarious activity beginning now!” Instead, you need to start playing at going off the grid now for no particular reason, so that when you go off the grid for reals it won’t be so obvious what’s going on.
The necessary OPSEC is hard to get right. One of the novels I mentioned, (The God’s Eye View by Barry Eisler) has as a significant plot element how easy it is to screw up. In the novel a character’s actions are discovered due to her turning on her burner phone at a point close in time and place to where she turned off her regular phone.
As a slightly more sophisticated example, the NSA is known to have a system for “fingerprinting” burner phones, which works by spotting when one cluster of related burner phones all go dark at the same time, and then a similar-sized cluster, with a similar pattern of connectedness, starts up right after.
Just spending some time out and about without a cell phone is probably a good start. Establish a pattern of turning your phone off (or leaving it at home) for a couple of hours every day. It might make sense to establish a regular pattern of doing so, but one can easily go awry trying to set up false patterns. Perhaps it would make more sense to have no particular pattern of when the phone might be on or off.
Purely whimsically, I’m inclined to do this.
In fact, I’m going to have to: Next month I’m on jury duty for a week and cell phones aren’t allowed in the courthouse. I’m sure most people leave their phones in the car, so they can return to them over their lunch break, or at least get back to it as soon as they’re released at the end of the day. But the courthouse is in downtown Urbana, a place that’s easy to get to by bus, so I’m disinclined to drive there. But without a car in which to leave my phone, I’ll probably have to leave it at home.
That might mean 8 hours or more being out and about without my phone, which seems like a great opportunity to establish a pattern of my phone being left home while I do something else—serve on jury duty next month, but who knows what the month after? Nothing nefarious, of course. I’d never do anything nefarious.
Even places where cell service is spotty, such as this spot on the trail in Kennekuk Cove County Park, having a smartphone is completely normalized for me. I expect to be able to just take a picture like this. (And the idea that I might instead bring a camera almost doesn’t fit in my brain any more.)
As an aside: I wrote a couple of articles about going off the grid back when I was writing for Wise Bread. One was a book review of a rather interesting book titled Off the Grid. The other was an article about the trade-offs in choosing to live “off the grid” in the broader sense—not just off the surveillance grid, or even the power, gas and water grids, but more broadly the globalized economy, industrial agriculture, consumerism, etc. I can’t remember what I called the post, but Wise Bread published it as Going Off the Grid Is a Lot Harder Than You Think.
I marvel that the 1% is being so indifferent to the large and widening leftward political shift in the U.S. and elsewhere. It seems to me they should have already started telling their politicians, “Give the poor folks 20% of what they want, quick! We need to nip this in the bud!”
Of course, maybe they’re right and I’m wrong.
They got away with globalization, after all. And then they got away with the financial crisis. And so far they’ve gotten away with Trump’s tax cut.
Now, I can understand the first two. Globalization, despite how it crushed many individuals, families, and communities, did make people better off on average. Having the average person end up better off makes a policy supportable at some level. I can see it providing enough political cover for them to get away with it. Who doesn’t like buying cheap crap at WalMart? Nobody but freaks and weirdos like me.
The financial crisis is harder to understand, which I think is due mainly to it being harder to understand. There was a real sense that our whole economy could implode—and it was a real sense because it was actually true. The technocrats managed to save the economy, so they get some credit for that. They did it in a way that crushed homeowners, which is bad. They did it in a way that subverted the rule of law, which is bad. And they did it in a way that crushed a whole generation, which is also bad. But they did save the economy.
But now we’ve got multiple cohorts of people who have already turned against the system. It’s no longer just the freaks and weirdos who care about their local community and the natural systems that support life. It’s no longer just former homeowners whose homes were seized to save the banks. It’s no longer just millennials who graduated into a job market so bad that they’re a decade behind their parents’ generation in things like family formation (and further than that in preparing to retire).
Now it’s basically everybody except the 1% who is being harmed, and they’re being harmed right now, every day.
The Trump tax cut is just a naked grab at wealth by the wealthy. It didn’t help anybody else. Trump’s tariffs aren’t even that—they don’t help anything but Trump’s ego.
I cannot imagine that any amount of voter suppression and gerrymandering—even with the structural anti-democratic features of our constitution—will keep the supermajority of people being harmed by our current system from making some major changes.
If the 1% had any sense they’d have thrown some bones to the people already. I can’t imagine that the smart ones haven’t figured this out already.
Sure, there are plenty of dumb ones who figure that they can build a survival bunker in Alaska or New Zealand and survive the ensuing revolution and climate catastrophe. But are they really all that dumb?
I used to play on the monkey bars all the time when I was a kid. My mom encouraged it. She knew it built upper-body strength, and that the ability to traverse monkey bars was an important capability for any human. (She could traverse monkey bars herself, when I was a boy.)
I quit doing the monkey bars, probably when I was college age, and quickly lost the capability. Then for three decades would have been afraid to even try, because I’d definitely have hurt myself. A few years ago I wanted to regain that capability, so I started looking for monkey bars to practice on, and found that they’ve gotten quite scarce. Many playgrounds don’t have them at all.
Winfield Village has a playground in every quad, but the only playground with any sort of monkey bars is the big one close to the office, and it has a rather strange curving monkey bar that over the course of 5 rungs makes a 90° turn—a particularly challenging version. (Like most these days, this one has weird triangular bars hanging from a single support, rather than a series of rungs supported on both sides.)
The reason for both the near disappearance and the switch to triangular bars seems to be that monkey bars are “dangerous.” Many playground safety experts recommend that monkey bars be excluded from playgrounds altogether, and I think the weird shape is designed to make them harder to climb on top of, in the hopes that kids would then not do so.
I spent a chunk of yesterday afternoon at an “alignment play day” with folks from CU Movement (and kids), getting some hanging and balancing and barefoot walking on various textures. One thing I did was traverse the monkey bars at Clark Park in Champaign—an old-style set of monkey bars, rather like the ones I remember as a kid.
One of the kids in our group—small enough that it was a challenge to reach the next bar, and at a height that the experts would no doubt claim was “too high” for a kid of that size—did the monkey bars, and then immediately wanted to climb on top of them. He asked for help getting on top, which his mom declined to provide—except that she pointed out that one of the supporting poles could probably provide the necessary foot purchase for him to get on top on his own. And he did manage to find two ways to get up there. Having gotten up there, he decided against traversing the top of the monkey bars, and simply swung back down under them.
A new school of thought is emerging (finally!) that “dangerous” playground equipment offers valuable opportunities for kids to do exactly what this boy did: evaluate a hazard and decide how much risk was appropriate. The only way to learn to make that sort of evaluation is to actually practice it. Making playgrounds so safe that children cannot hurt themselves reduces their opportunity to develop a good sense for what is safe and what is dangerous, and what is and is not within their capability.
It has also made it a lot harder for me to find a set of monkey bars to practice on.
I crossed the monkey bars three times in the afternoon, but I forgot to attempt my next big trick: Cross from one end to the other, turn around (without putting my feet down) and cross back again.