Tom is 72. He has experienced many of the "natural" changes that occur with aging. He has early cataracts and wears bifocals. He used to walk on a regular basis but now believes that exercising is not needed at his age and walks only infrequently. As a result, he has experienced loss of muscle, reduced strength, and poorer balance.

Photo by Dan Burden, www.pedbikeimages.org

One day Tom was out walking with his friend Mary. Mary has experienced losses in vision similar to Tom. But, she has continued to walk daily and has retained her strength and balance.

Tom and Mary were enjoying their walk, chatting as they made their way down the sidewalk. Although they had only been walking 5 minutes, Tom was feeling a little fatigued.

Suddenly, they both stumbled on a crack in the sidewalk. Neither had seen it because of their visual challenges. The fact that they were so busy chatting also likely contributed to their not seeing the crack.

Fortunately for Mary, her regular walks had helped her to maintain her strength and balance. She was able to regain her balance and not fall. It also helped that she was wearing good walking shoes.

Tom was not so lucky. Because Tom no longer walks on a regular basis he became tired easily and his balance and strength were poor (personal factors). As a result, he was not able to regain his balance when he tripped over the crack in the sidewalk (environmental factor).

Tom fell hard and was not able to get up on his own. Mary called for help. When they examined Tom at the hospital, they discovered that he had broken his hip.

Tom never really recovered from the fall. He became fearful of falling and did even less outside of the home. His strength deteriorated even more. That was last year. Today, Tom is in a nursing home.