An Expert Blind Spot: Fear of Falling

Back in the 1980s…

 

Back in the mid-1980s, my social planning firm did a roaring trade in ageing. Every Sydney developer fantasized about making a fortune in retirement housing. We were a small firm of social planners – trying variously to dissuade them or help them. Most were beyond help: so gripped by greed that they could not discuss matters as banal as gerontology. Blessedly, the fashion passed and we returned to homelessness and poverty (not ours – our subject matter).

Seating Design

Seating Design

 

The good thing was that we learned so much about the physical and psychological factors associated with ageing. Then in my forties, I could not imagine my own elderhood; it was a distant reality. My most brilliant employee, in her early twenties, was a young architecture graduate.


Together we trawled through volumes of research and crafted detailed site-planning and design guidelines for older people’s housing. Tromping around retirement villages, cursing their failings, we became experts in non-slip surfaces, sheltered seating, walking circuits, natural surveillance, ramp design, handrails… And, considering the older residents themselves: limited visual acuity and peripheral vision, susceptibility to glare, inability to hold a mental map, disorientation in space and, most emphatically, fear of falling.

 

Falling down

Recently, a dear friend of mine fell and broke her hip (she’s 79). She was squatting to inspect a cupboard when a mouse jumped out and startled her, causing her to fall backwards. She spent a month in the hospital and is recovering well. But now my feisty friend (who walked the width of England in her early seventies) emails to say she’s afraid of going out for a walk on crutches.

 

Afraid?

 

Once I might have found that hard to believe.

 

But now I understand.

 

Not paying attention

A few years ago, not paying attention (actually peering somewhat rudely at a building under construction), I slipped on roadside gravel and dislocated my shoulder. It hurt a lot. I was terrified of falling again; I began to feel fragile, old and crippled. A wise friend instructed me to return and walk confidently past the house. After I did that repeatedly, my fear abated. To combat my fear of knocking my shoulder, our compassionate local hospital nurse recommended a sling when I travelled by plane. Who would be mean enough to knock a nice old lady with her arm in a sling? It worked a treat. (As did the odd pre-booked wheelchair for long air journeys.)

Boston Sunday Globe storm_crop_small

The Blizzicane

Recently, I spent a month teaching at Harvard: the highlight of my career. And a shocking and salutary experience for a person turning seventy.

I feared my boots (from Myers department store in Adelaide) would not pass muster but my Boston host thought I might survive February.

How wrong she was!

A week into my visit, the fiercest blizzard in 57 years blanketed Boston.

Massive.

A Blizzicane. Nearly a metre of snow fell in a few hours.

 

Outside my friend's house

Outside my colleague’s house after the blizzard and before the snowplows arrived to bank the snow

After we dug ourselves out, I took my credit card to Eastern Mountain Sports in Harvard Square but fear had me in its grip. Now I had warm boots with good tread but I was absolutely terrified.   Terrified of the footpaths at night (our classes ended at 6 pm; taxis were out of the question).

 

Not surprisingly, every path on the campus of America’s premier university was plowed within seconds.

 

 

 

All clear at Harvard!

All clear at Harvard!

That wasn’t my problem.

My problem was low-density suburbia.

Despite Boston’s admirable transit network, suburban Boston is crap for pedestrians.   Everyone drives gigantic cars with snow tyres. There I was in my overpriced `showerproof’ down coat (bought in Melbourne in January) and new boots that weighed a ton. And a backpack full of books and a laptop.

My nightly walk home from the Harvard bus was six long blocks along poorly lit and partly plowed footpaths (and out into the street at the unshovelled patches). Sharing the carriageway with the cars – all of us skeetering between high snowbanks through rutted snow.

 

God!

All I could think of was my dislocated shoulder. And my fear of falling.

 

Actually, that’s not true. My shoulder worries paled in comparison to Fear of the American Medical System! Even with travel insurance, I imagined myself chained to a hospital bed, held to ransom with a broken arm, leg, shoulder, hip . . . you name it . . . in a hospital charging a trillion dollars a day.

I’d taken an elderly Canadian friend to hospital in Honolulu five years ago and she’d barely escaped!

 

Meanwhile, my younger colleague completely discounted my fears. The same fears we’d researched decades earlier.

 

What’s your problem? The snow will melt. It’s only six blocks. You’ve got boots. You’re sorted.

Femme devant paper-board

 


Raffi to the Rescue

My Armenian cousin, a long-time Boston resident (and my age) was my saviour.  Before the snow melted, he took immediate action to avoid my melting down. Brooking no interference, he moved me – coat, books, boots, laptop and decaf tea bags – into his apartment in Charlestown (a dense inner city neighbourhood with well-lit streets, plowed and navigable). Close to the subway and with caf©s and pubs to die for.

 

Raffi's street in Charlestown


And there I stayed for several charmed weeks, happily travelling about Boston on public transit. Grateful for the blessings of his generous hospitality.


(Maybe blood is thicker than water?)


The take-home messages from my story?

 

I wouldn’t be exaggerating if I said that this experience had a profoundly unsettling effect on me.

I cried a lot.

 

And then (finally), I got to thinking. What can I make of this?

What can I learn? What can we learn?

 


First, as our Baby Boomer generation ages, we need to understand mobility – and immobility. It’s not just physical; it’s also psychological.

 

Second, we’d better start talking openly about these matters and not be afraid or ashamed. (What’s there to be ashamed of, in any case?)

 

We're going to have learn how to ask for help

We’re going to have learn how to ask for help

Third, we’ll need supports. And we’d better get them in place before an emergency. We need to know how and where to ask for help.

My friend with the mending hip is well networked into her community where she’s lived since 1974. She’s having gourmet meals delivered and local people come to clean her house as part of a community program. She’ll be fine.



The age-friendly neighbourhoods initiative is a good way to start. South Austalia has made a good beginning:

https://www.sa.gov.au/upload/franchise/Seniors/Office%20for%20the%20Ageing%20-%20Publications/Publications/Age%20friendly%20local%20gov.pdf

 

Fourth, we must accept that some of our younger colleagues are firmly in denial about ageing – ours and theirs. You know the types: the cyclists, yoga enthusiasts, marathon runners, extreme athletes”¦ (Please pass the chocolate”¦)

 

As an example, take my younger colleague. She has a lot to learn.

 

Sad but true: ageing is an expert blind spot.

 

By speaking out about our fear and demonstrating our resourcefulness, we can teach her.

 

So that she can teach her students.

 

And we all can benefit.

 

I guess, in the end, that it’s all about care. (Didn’t I write a PhD thesis about that?)

 

care

Community engagement with people with disability

 

This week, I’ve been reflecting on the responses I’ve received to my recent blog post about Mary Ann Hiserman, my friend in Berkeley who was a wheelchair user and activist for people with disability. I’ve been thinking about the actual experience of being “locked out” of an environment. And comparing it to being “locked out” of community engagement processes. And the whole issue of community engagement with people with disability.

 

Mary Ann had a challenging life but I am confident that she would not have considered herself “disabled”. I believe that was largely because of her courage but also partly because of the culture of Berkeley and northern California in the 1970s. With its mild climate, California has always been an attractive place to live for people with mobility impairments. It’s much easier, year-round, managing in a wheelchair, with a cane or walker than it is in the snow of the Midwest or the eastern United States.

 

Separate is not equal

 

As our communities age and more of us live longer and with disability, we will finally have to accept what Mary Ann taught me in the seventies: separate is not equal. As with accessibility, so with engagement.

 

Two principles can guide our engagement policies, planning and design.

 

Mainstreaming

 

The first principle is mainstreaming. This means that if I am travelling anywhere with Mary Ann, I do not continue through the front entrance while she has to go via the freight elevator or a back entrance.

 

A shocking example of the lack of mainstreaming is prize-winning, Canadian-born architect Frank Gehry’s much-lauded Guggenheim Museum in Bilbao, Spain.

 

See: https://www.guggenheim-bilbao.es/?idioma=en

 

Getting into the Guggenheim

 

As you approach the building, set in a sparking sea of light-coloured treeless plaza (very hard for older eyes to adapt to this high level of glare), you face a daunting array of steps down to the building’s lower-level “front door”.

 

Entry stairs, Bilbao, 2007

 

 

And an equal number to the building’s lower level riverside walk.

 

 

Stairs to riverside plaza, Bilbao, 2007

 

If you cannot manage steps, a hard-to-find interior elevator awaits you. But you have to ask where it is. It’s clearly the “second-best” entrance.

 

Not for all people

 

When I questioned the Museum staff about this separation, one said, “Take it up with Mr Gehry.”

 

I replied that in my country and Mr Gehry’s, this sort of approach would be illegal, given federal government accessibility policies and regulations. The Spanish museum guide had nothing more to say.

 

I believe it’s a serious problem, socially and from equity perspective, however, as it makes the person who cannot navigate the steps “less than” an able-bodied person.

 

I was thrilled to read that Ethan Kent of People for Public Spaces (PPS) calls it the “Hall of Shame”: https://www.pps.org/great_public_spaces/one?public_place_id=827

 

Continuous Accessibility

 

The second principle is continuous accessibility. This means that a person with mobility impairment (or any disability, for that matter) should be able to enter, use and exit a place or a facility with minimum amount of inconvenience. To get around with ease and without confusion. It’s all very well to be able to go to a so-called “accessible” restaurant, but if the restrooms or the bar are inaccessible it hardy makes for a good night out.

 

Community engagement and disability

 

Over the years, I’ve found that our engagement processes often ignore the needs of people with disability. Yet we forget that a high proportion of the population has a disability at any given time – even if it is a broken foot or temporary vision impairment. Making processes – and the places where they occur – accessible to as wide a group as possible is an important equity consideration in any engagement exercise. It’s also a way of demonstrating commitment to listening to everyone’s voices.

 

There are no hard and fast rules and many people prefer one-to-one discussions. We need to seek context-specific advice from advocacy groups.

 

It is critical that, in approaching the issue of how to make engagement processes accessible to people with disability, we do not imagine that all people with disability are those with visible disabilities (such as wheelchair users). Understanding the complexity of disability, in the first place, can help us as practitioners to be less blind to “invisible” disability and therefore target our engagement processes more effectively.

 

Short summary of engagement suggestions

 

The suggestions in this short summary may be of help to you. Click here: Community Engagement People with Disability

 

Comments welcome!

 

When you get right down to it, barriers are barriers, however they appear. I’d welcome comments from those more expert than I am so that we can improve all our engagement processes for all people.

2 Comments

  1. Wolfgang Haufe
    Posted December 1, 2009 at 12:47 pm

    You talk about the difficulty with accessability at the Guggenheim.
    As I am going to Bilbao next year (I’m using a wheelchair) can you possibly give me a useful website about places to stay and places where I can go.
    Thank you!
    Cheers, Wolf

  2. Posted March 11, 2010 at 9:23 pm |

    Dear Wolf, I am sorry that I missed your comment amid so much spam. Many apologies. I am very sorry that I do not know the answer to your question. I just took a bus there for half a day.
    Hope you have a good visit and love to hear YOUR comments. Wendy