Preventing Falls and Staying Safe with Dr. Wayne Gradman

Welcome to the Living to 100 Club Podcast. Here's our host, Dr. Joseph Casciani.

Well, hello to all of our listeners joining us today on our podcast. You're listening to one of our successful aging episodes this month on the Living to 100 Club program. And I'm your host, Joe Casciani. On each program, our conversations educate and inspire, helping you get the best out of all the years we're given. Regardless of what obstacles come our way. You can learn more about my club at my website. Be sure to take a look at my new training and activities manual, Better, Longer, and Happier: A Guide to Aging with Purpose and Positivity. It's a series of 12 modules in a card deck format developed for activities directors at senior living communities and related organizations. Visit the website livingto100.club/blh. Now on to today's program. In today's episode, I'm speaking with Dr. Wayne Gradman, a retired vascular surgeon and author of The Fall Guy: How to Keep Gravity from Ruining Your Day. With a wealth of experience in healthcare, Dr. Gradman shares insights from his career and his recent book on fall prevention. We discuss the significant risks of falls, even for the healthiest individuals, and offer practical strategies to reduce those risks, such as the importance of exercise, balance, and home safety modifications like proper lighting and grab bars. First, a little background. Dr. Wayne Gradman is a retired vascular surgeon with a long and distinguished career in healthcare. At 82 years old, he's recently ventured into writing with his first book, The Fall Guy: How to Keep Gravity from Ruining Your Day, focusing on fall prevention for older adults. Drawing on his decades of experience, Dr. Gradman emphasizes the importance of exercise, balance, and home safety features to help people of all ages avoid falls. His dedication to longevity and well-being continues through his work in education and advocacy on fall prevention. Dr. Gradman, welcome to our program.

Joe, thank you so much for having me today.

You're very welcome. Glad to have you. I'm looking forward to our conversation. It's such an important topic. I always like to open by asking our guests to maybe share some of the highlights. You've had a long history in health care, successful career. Tell us maybe the highlights that brought you to where you are today.

I mean, to being retired? No, I, I went to Harvard Medical School, and I jumped over Chicago where my mother lived because the place wasn't big enough for the two of us. I landed at Cedars-Sinai, which is at the time was not as big as it is today. It's a behemoth and it's a wonderful, wonderful teaching hospital today. And one of my specialties was teaching. I love teaching the residents. I love teaching my patients. I don't see that much anymore with physicians. They sit behind their computers and pontificate and you don't get— they don't touch you anymore. I missed that. I also felt that writing this book would probably bring me a larger audience than my vascular surgeon did, because as a vascular surgeon, I would spend 4 or 5 hours at a time fixing the arteries of some smoker, which has both mixed blessings. Sure. Because many times they continue to smoke. And if I write a book and I can somehow or other communicate tips on how to prevent falls, I would probably do more for people than I did during my entire 40 years as a vascular surgeon.

Yeah, yeah, extending your reach, so to speak. Yeah, for sure. Yeah, yeah. So you wrote The Fall Guy. You mentioned that— we'll talk a lot about this, but you say falls can happen to anyone regardless of age. Why is everyone at risk, and what makes falls so dangerous?

Well, they come unexpected. You can prevent so many different kinds of falls, but so many people don't pay attention to those means of preventing falls, and so they fall. One person over the age of 65, one in four, will fall every year. There are 45,000 deaths in the United States every year that are attributable to fall. So it's not an uncommon thing. And some simple measure, the simplest measures of all, like holding onto a banister when you walk downstairs is a great measure to just keep in your mind to prevent a fall. I, in my book, I described 3 falls of people that were not exactly close to me, but, uh, that fell and fractured their skull. One of them, Joseph Lieberman, died of a fall, and he wasn't holding on to a banister.

Well, now, 45,000 deaths a year, that's, that's huge. That's huge. So what is— we, we'll get more into the specifics, but from a maybe a deeper perspective, what can we do as a society to raise awareness about these risks, especially we got distractions with cell phones and texting? What can society say? What can we do to?

That's my first rule. The first rule is very simple. It's looking where you're going. I call it the 20-foot rule. Always know what's 20 feet in front of you. That is how I tripped many times and fell a couple times. It is especially important that you not walk and use a cell phone. That is a real no-no. It's on my cover. And that includes people who are young. I mean, you, I stood on a street corner once watching people cross the street looking at their cell phone. It was just insane. And Interestingly enough, even when you cross the street, there is an offset between the tarmac and the concrete that's there. You think you're walking off a curb, you paid attention, you looked at the curb, but you didn't see this offset. And I've seen people fall out right in the middle of the street because of that. So awareness is so, so important. And my first rule I think is a very important one because I'm the prime, I'm a big-time faller in my day. That's one motivation I didn't mention, but for a long time I was a faller. When I did my research for this book, I learned so much that I actually, well, I know that these measures can work because I stopped falling.

Yeah. Yeah. Much more mindful of the risks and how to avoid them. Sure. Sure. Yeah. I see so many people, especially younger people, looking at their phones, and I always wonder what they're looking at. I mean, they're really concentrating, and I wonder, what am I missing here that they're seeing? I don't pay attention.

They're looking at directions. People look at directions all the time.

Yeah.

When they're in a new city or new environment, you know, 4 blocks to such and such. Do I take a right turn here or not? And then bam, down they go.

Yeah. Well, how about, let's start with medications then. You mentioned that there are certain medications that really increase that risk. What should people taking these medications do to stay safe?

They can ask their doctor to lower the number of them that they take. One of the big actors in this field is a classification of medicine called benzodiazepines. That's not so important as what's in that group. They're the sleeping pills, which older people take quite frequently, and I take them. And frankly, I'd like to get off them. They're, they're addicting, and you get up in the middle of the night, and you may be a little wobbly, a little dizzy. You may not be aware of your surroundings, especially if you don't have a lit path to your bathroom, or if you get up too quickly, you're a little dizzy, and then you fall, and that's not a good scenario. So those medicines include not only sleeping pills, but drugs that are directed to treating anxiety. So those medications can lead to falls. Another classification are pain medicines. They also can lead to falls. There is a guideline for how at risk you are on a point scale. So for every benzodiazepine that you take, or sleeping pill, some people take sleeping pills and anxiety pills, you're given 3 points. For every pain pill or antihypertensive you take, you get 2 points. And if you reach 6, you should tell your doctor that you are at increased risk of a fall, and you would like to know if he has any way you could get off of some of these medications. So that's the role of medicine, excuse me, of medicines in falls. Antidiuretics also, but have a point value of 1, so they're not all that bad, but the ones I mentioned do increase the risk of fall and should be, be observed carefully in selected individuals.

So if they give you 2 or 3 on a scale of 6, or that, that's certainly going to raise the risk. But what is it in the meds that contribute to the fall? Is it balance or is it dizziness or what?

Oh, it's a combination of all of the above. Balance is a very difficult thing to get your finger and get your head around. It's hard to improve balance. You know, you could do— it has been shown that tai chi helps, but who's going to do that for an hour a day? We're not going to do that medicine. So in my book, I have, I designed a set of exercises that I originally said, oh, who needs another set of exercises? But really, This set of exercises has several virtues. First of all, you could do them in 10 minutes, and if you do them regularly, that's the key to exercise, regularity. If you do them 10 minutes, 3 times a week, you gain strength in your legs, flexibility in your lower extremities, and balance. So that's why I really think my set of exercises is appropriate for reducing fall risks. Other exercises, of course, you need to do to take control of your overall strength and well-being, like walking or bicycling or what have you. But these exercises are so easy to do. They really work on your lower extremities, the core a little bit, and they will go a long way to preventing falls. And flexibility is one key feature of this. I always say that Djokovic, Novak Djokovic, I saw a 60 Minutes segment where he doesn't exercise by playing tennis, he exercises by stretching.

Yes.

And so you can't get a ball past the guy.

Yeah.

He never falls because he's stretching and he gets everything. And he's the most amazing athlete. Yeah. So that's my take on exercise.

And when you see him playing and he doesn't fall, but when he stretches, yeah, yeah, right. Split that kind of extend his feet almost 8 feet.

And yeah, right.

I mean, really amazing. So can you give us an example of maybe some exercises for balance so we I won't go into all 10 minutes, but what's one or two exercises for balance?

Well, I think lunges are good for balance. They're probably the best one that I have for balance. I think also that standing on one foot is a good balance test. As a matter of fact, it's used as a test. Frequently to determine whether you can balance. I don't know how much it helps your balance. And to the extent that a lunge helps your balance, it's not all that clear. There's one exercise that doesn't, that's been actually, someone wrote a paper on, it's standing on one foot while brushing your teeth.

Yeah.

It doesn't work to improve your balance.

Does it improve your balance?

Yes, to improve your balance. So I like, I do like lunges.

Okay, that's good, that's good. And then flexibility and strength all included in your 10-minute routine?

Yes, I especially am interested in stretches and flexibility of the hip. You want to be able to stretch your hip out you want to be able to stretch your quadriceps muscle in front of your leg, and you definitely want to stretch the back of your calf, your gastroc muscles. Those are the 3 groups, muscle groups and joints that need a little pushing around so that you are better equipped to handle a situation where you might just fall but can actually avoid it by dancing around a little bit. Sure.

Yeah, I've heard also that walking on uneven surfaces like cobblestones, yes, as long as you're, you know, you're balanced and you're safe, that can kind of position your feet so that you're more aware of the risk.

Yeah, that's true as well. Yeah, yeah.

Yeah, so let's talk about accidents at home. We know about the throw rugs that contribute to a nasty fall, but what are some of the accidents that take place that really create—

Well, the worst ones are on steps. Steps are very, very dangerous, especially if you live in a two-floor home, and a lot of us do. The walking downstairs is the riskiest part. That's why I emphasize the use of a banister at all times. All these falls that I describe in my book that relate to stairs, they were falling downstairs. Falling upstairs doesn't have much risk because you're not going to break a bone or fracture your skull. You may fall, but it, but you're not, your life is not at risk., and also if you happen to have, uh, I have a cute chapter— it's cute— a chapter on circular helical staircases. Oh yes, because closer to the inside of those helical stairs, the stairs are shallower, are not as wide, and so you lose your balance. What you want— I talk about the importance, if you have a helical staircase in a, in a 2-story building, and builders love these helical staircases because they take less space, you should consider putting a banister on the opposite wall of that staircase because chances are you're not going to walk down the staircase using the inner banister, the one that automatically comes with it. The other thing I do in homes, talk about, about in homes is the bathroom. Bathroom is one of the riskiest places in the home. And you mentioned fall bars. There are, the government provides codes for fall bars and they should be followed. If you have an older home, get your plumber in or somebody like that and get those fall bars on every wall in your shower that you can or around your bathroom if you're a bathroom person. And make sure that you have non-slip rug when you get out of the shower. You know, sometimes we put a towel down there and think that that's it, but if the floor is wet, you increase your chance of falling. Not that you will, but the best way is to have a non-slip carpet out there. When I went to Europe with my wife to the 60th— 80th anniversary of D-Day, I stayed in a lot of European hotels of all kinds, 3-star, 4-star, 5-star, and not one of them had— few of them had any fall bars at all. I honestly, I was embarrassed for Europe. And we all travel a lot.

Sure.

When we get older, this is what we enjoy doing. And when we go to Europe, your guard is down. So you have to be very careful. They don't put any non-slip surfaces in the showers. Uh, I've practically fallen, broken my neck in a shower because they just don't pay attention like we do. Uh, so that's my advice of the day for Europe.

Grab bars are important, and the non-slip rugs, and the grab bars that are secured to the walls and to the studs or beams, and not those stick-on kinds and the suction kinds, because those are—

yeah, those won't work, of course. Yeah, I agree.

Is that what the codes are? Is that what the US codes are? They dictate what type of bars to use or how to install them?

Yes, absolutely, absolutely. The codes are there, and Just getting back to stairs, you know, we all have to be careful when we go up and down stairs. Not even if you don't have stairs in your home, you're going to encounter them outside the home. And there are codes that are designed to put traction strips at the bottom and top of stairs. Those are important as well. I was surprised my mother-in-law is moving into a new board and care place. She's 98 years old, and she— when I walked in and I talked to the owner of the place, I saw stairs outside, and I said, you know, you really should have a traction slip out here because somebody could slip and fall. Just— no, that's not part of the code. I said, yes it is, and it's there. And I sent her the code link. And she put them in. Good. So, you know, you have to be alert. You have to know that these things exist and these are, we're trying to find a way. Society is finding a way, 'cause these are obviously regulations to find a way to mitigate fall risk.

Yeah. Yeah. Yeah. And then when the lawsuits happen, the owners learn what they should have done and it's too late. But Yeah, you're staying on top of that is important. So what other kind of risks are there outdoors? I mean, once we leave the home, you mentioned public stairways and all, but what other kind of risks are there? I guess sidewalks and—

Yeah, yeah, sidewalks are specific risks related to sidewalks are that trees bury under them and lift up one slab compared to another, and that falls under the the 20-foot rule, you know, just stay alert and see what you're doing. If you're looking for other outdoor risks, I have a thing about people that participate in sports and don't use the right equipment. I see that at the beach when I see these rollerbladers. They're extraordinary athletes. They rollerblade hockey. Without a helmet. And I just don't understand it. And these are just all without knee guards or ankle guards. Yeah. These are just accidents waiting to happen. It's going to happen.

Yeah.

Even if they play 10 games in a row, but they're gonna fall eventually. Yeah. Anyway, that's, that's my—

No, that's good. That's important because we have to be aware of the, the kind of mitigating those risks. And certainly for motorcycle riders, I used to, ride a motorcycle and you have to make sure you follow the helmet guidelines and all that.

You know, I, uh, I should have mentioned ice.

Uh, ice, sure.

Yeah, I live in Southern California and, um, no ice. When I first wrote the book, I didn't even have a chapter on ice. And then when I went to Europe a couple times, uh, over the last 3, 4 years, um, I, I've, I quickly learned what ice is and the risk that it poses to people. Uh,— it's— well, you will encounter ice if you live in a cold clime, and especially now with— there was this last couple days, there was cold everywhere except for Southern California. And if you don't take baby steps, if you take larger step, you're at risk of falling. And that happens often when you encounter something called black ice, which is asphalt that's covered with a thin layer of water, which turns to ice. And that is particularly risky. You think you're on solid ground because it's black. Oh, that's the asphalt. And before you know it, you're on your fanny. That's a particularly bad risk. In Europe, I saw many people that get around in icy conditions wearing poles, using poles like walking poles, right, the kind that they originated for Nordic walking. These poles are great for ice. So that's a solution, and there are other solutions including special shoes and Yaktrax and shoes that have coverings that you can actually, if your plan is to walk in ice, you can actually prevent falls that way.

Yeah. Yeah, it's really, we're really talking about prevention, right? I mean, yes, there are risks and we have to mitigate those risks. We do whatever we can and take steps to plan and prepare. And if we anticipate there's going to be ice in the sidewalk or, you know, stairways without a, you know, railing. We just need to be more mindful of that. And that, that's where risk prevention comes into play. And that's what you've written your book about, how to, how to be aware of these risks and avoid them so we can avoid falls.

Yeah.

How about lighting and kind of environments that might be unsafe for older adults?

Well, you mentioned throw rugs. Obviously, they're a risk factor. And even walking around your home with socks, slippery socks on wax wood floors poses a set of risks, and you can fall with that. Lighting, of course, is important. It's important in the kitchen for general purposes, but it's also important at night when you wake up in the middle of the night and have to go pee, that you have, if you don't have them, you should install nightlights to get your way to the bathroom and back. I think that's important. Somewhere else I can think in my memory, I can think of something.

But yeah, no, I understand that. It is being aware of the possible risks when it's dark and we're trying to feel our way to the bathroom or down the hall for a glass of water, whatever.

Yeah, yeah. I have a, uh, we have a pool and it gets very slippery around the pool, uh, and people don't wear the right shoes around the pool, or they wear shoes and they slip. Uh, so pools have their own set of risks, uh, and Just be careful when you're walking around a pool because it's slippery and the surfaces are slippery.

Sure.

Yeah.

How about visual changes when some people may experience some loss of vision or partial loss of vision and maybe some surgery like cataract surgery? How does that, that multiplies the risk or exists?

Well, yes, because you don't realize you have a problem. If you have cataracts. That was my experience. I went to my ophthalmologist when I was in my mid-50s. She said, "Oh, you're starting to get cataracts, but you don't need to do anything now." I said, "Okay, I didn't even know I had cataracts. How do you know?" And then when I reached 60, I went in, or 65, I went in and she said, "Well, your cataracts got worse. It's time to do them." And You know, I said to her, I said, but I'm seeing the same as I did when I was here 10 years ago. And she said, no, your cataracts are pretty bad. I said, I cannot believe it. Then I had my first cataract done, and that was such a revelation because I now could compare one eye with the other eye, and suddenly I realized that I had been missing the brilliance of the, of the universe. I had been seeing it through a yellow haze, foggy haze, that I didn't know. Yeah, that I, I didn't know I was seeing things that way. So I couldn't wait to get the second cataract done, uh, because you don't want to have that tint in your eye all the time. But interestingly enough, I read the statistics. Your fall risk is mitigated, gets less when you fix the first cataract, but not the second. You don't add anything to the second. And I thought about that for a long time, and I realized that there are a lot of people that have vision only in one eye. If it's good vision, they're not going to fall. Adding two good eyes helps your three-dimensional abilities, but it doesn't help the clarity, the absolute brilliance of the vision that you have if you fix just one.

Interesting.

Yeah, that's interesting.

There's no boost when you have the second surgery. It all comes from the first one. Yeah. And as you describe it, it's a process that happens so slowly I mean, when you have the eye exam, I had the eye exam and the doctor said, well, you have a trace of cataract and that doesn't warrant surgery. If it progresses to stage 1 and certainly stage 2, then you got to think about it. But it does progress and we don't know how it affects our vision. So that's important.

Yeah, you don't know when is the right time. Yeah. To get your cataracts. No one gives you a, okay, you now have stage 2. You know, you have to see a doctor for that.

So, you know, I work with older adults a lot, and there's, you know, it's sometimes very difficult for some people to recognize that aging brings these changes, maybe loss in hearing or vision, and, you know, balance and muscle strength. And what do you say to folks who are just reluctant to kind of face these risks and manage them? They just deny that there's the risk. And what do you say to people that they're reluctant to make changes in their world because they don't want to think about being old?

Yeah, you're, you're, you're absolutely right about that. Uh, that's what, uh, caring children are for. Uh, you need— that's why I encourage younger people to purchase this book. Uh, believe me, you don't make money publishing. You know, I can promote it all I want, but you want to get it in the right hands. Yeah.. And I recall 2 days in a row where children in their 50s, both of them were in their 50s, talked about their parents falling. The parents fell and they didn't know what to do. The children didn't know what to do about their parents. Their parents were stubborn mules and wouldn't listen to anything even if you told them what to do. And I said, you are your parents' best advocate. You must be the one to tell them to use a cane or to use a walker if necessary. And, uh, both of them listened. Yeah, they listened and they said, yeah, yeah, where's your book? Yeah. And, uh, it's true. I think you have to be your parents' advocate. And I called it, I wanted to write that in my book as if you don't do that, it's elder abuse. But somebody made me write that out, you know, and justifiably so. It's not elder abuse if you don't tell your parents and they don't listen to you.

But the absence of good advice doesn't make it elder abuse. Yeah, I know, I understand your point. Yeah, well, it sounds like a valuable book, Wayne. It sounds like it's really filled with so many tips and recommendations and, you know, strategies for prevention. That's what we talked about. What do you want the reader to take away from your book? I mean, we know the obvious tips, but what do you hope to kind of— what's the overriding message for the readers?

Well, I think it's a very broad message. The broad message is the risks are everywhere. You have to be, general awareness is probably the overriding message. You have to be aware. Falls have to come into your mind now. After you reach the age of 60 or 70, think falls because they're common and they will affect your life. They will ruin your life and you may die from them. Yeah. Yeah. So that's my main message. My book is just full of tips. To, uh, prevent them. Uh, we've just scratched the surface. Uh, and that, that's, that's— but being aware, just like one of my friends told me, and I put it in the book, I said, you know, or she said, uh, when you're driving your car, you always have to be looking around for some idiot that, that's breaking rules. And you have to be constantly alert when you drive. That's something that older people lose. They assume they trust other people. They shouldn't.

Yeah.

So yeah, the message is just stay aware.

I think that's really good. That's really important because what you're saying is the risk is everywhere. You're not safe necessarily in your home. You're not safe necessarily out. There's a risk everywhere, it's 360 degrees. Whatever we may be doing, be aware that the potential is there. It's— we can't always control everything. Sure, that's important. Yeah. Well, great. Thanks very much. That was good information. I know our listeners will appreciate that education and kind of way to face our senior years with a positive frame of mind. I think we manage these risks, we bring in the aids, the assistance, whatever we need, and helps us to stay positive and continue moving forward. I like that.

Yeah, right.

Yeah, good, good. Yeah. Well, it looks like we're out of time for today, though. Before we wrap up, I just want to remind my listeners to visit my website, livingto100.club, sign up for my email list, and download a free copy of my 9 Tips to Make Living Longer Enjoyable. And if you're affiliated with a senior living setting, be sure to look for my new training activity guide, Better, Longer, and Happier. Wayne, thanks so much for being a guest on our show today. How can people pick up a copy of your book?

Well, right now, the easiest and best way is to just go through Amazon Books. I like the paperback copy myself. It's— you can get it on Kindle or hardbook, but I find the paperback is— it's a small little thing. You can read it in 3 hours. It has a lot of humor in it. My sense of humor is kind of quirky, but it's there in spades. And, uh, uh, I'm not yet in bookstores. I hope to be, but I'm not there yet. So I have to do it on Amazon.

Okay, good. And do you have a website? People can learn?

I do. You can purchase the book on the website, uh, it's wgradman.com. Uh, I have some interesting blogs on that, uh, website, uh, that, uh, I'm teeing up for my next book, which will be a memoir. Uh, they're a very— I think they're very interesting reads. I really love to write, and I'd love for people to read them and comment, uh, to my email address, which is wayne@gradman.com. I I just, I, I just like to pass messages along. Yeah, my friends.

Yeah, I love that. That's great. Thank you. So wgradman.com is the—

yeah, no period in there, wgradman.com.

And we can look for your new book, your personal memoir.

Yeah, you'll have— there's a link there that, that will take you right to the page.

Great. Okay, well, thanks again for being a guest on the program, and thanks to all of our listeners for tuning in. Hope to see you next time.