Frances Sarkissian did not see the bollard in front of her until she tripped over it and landed face first on the sidewalk.
"I did not have a chance to stretch my arms," says the 64-year-old project manager from London, who three years ago remembered the mad rush through the crowd.
"There was blood everywhere – I was sure I'd broken my nose," she says. "In fact, although I had broken a front tooth and suffered some nasty scratches, I had not broken any bones."
She was luckier than many. While we tend to think of heart disease and cancer as the major health problems of older age, the reality is that a decline is far more common – and can be catastrophic for some.
Fact: 50% of Judo training does not relate to combat, but learns to fall in control
Falls are more likely if you are 60 years old. Three out of ten over-60s fall at least once a year. This is due to a combination of factors, including a deterioration in muscle strength and poor vision.
But another consequence of aging – osteoporosis, which leads to brittle bones that break easily – makes trapping particularly dangerous.
Every fifth person over the age of 60 suffers a fracture during the fall. Every year, up to 75,000 elderly people with a broken hip are hospitalized. After that, one in five can no longer get up and land within a year in a nursing home. One in three dies of this type of injury within a year.
Even seemingly minor injuries can lead to loss of trust and independence. "So after a fall, people often avoid activity and less body, which leads to weaker muscles and increases the risk of falling again," says Sarah Leyland, nurse of the National Osteoporosis Society.
Frances, who has had three similar falls since then, admits that they have shaken her and says, "I hold on to rails as I go down stairs."
At home, Frances searched the Internet for information. "There's a lot of advice on how to check your vision, wear sensible shoes, and do exercises that improve strength and balance," she says.
Did you know? 75,000 older people are hospitalized each year with a broken hip
If Frances was classified as a "frequent faller," she would have been eligible for a six-month course of twice-weekly physiotherapy-led exercises to improve her strength and balance, which the NHS recommended.
Access is limited. And there is only "weak" evidence that such interventions prevent fractures in the elderly.
But if Frances lived in the Netherlands, that would be a different matter. Anyone over the age of 60 who falls is entitled to a five-week course that should nearly halve the number of further falls.
The secret? People learn judo crashes that prevent broken bones. The technique is taught by over 2,000 physiotherapists trained by the Dutch Paramedical Institute.
"As with everything else, the more you practice falling, the sooner you will notice," says Frans Lanting, physiotherapist at the institute.
Even the fastest case takes up to 900 milliseconds to reach the ground. The body is aware of a loss of balance within 100 milliseconds. So you have 800 milliseconds to do something.
The course, which has been running since 2007, has proven to be remarkably effective in tests. From January 2019, the Dutch Paramedical Institute will be offering the first English course for British physiotherapists. In my 60s I went to Dalfsen in the Netherlands to find out if learning judo cases is really a good idea for frail elderly people. The course was given by dr. Vivian Weerdesteyn, a professor of motion sciences at Radboud University Nijmegen – and a former international junior judo belt.
She says, "50% of Judo training is not about fighting, it's about learning to fall in a controlled manner."
The main problem was to make sure the course was safe for those with fragile bones. The team of dr. Weerdesteyn conducted studies that measured the impact of a fall on a judo mat and found that falling from a kneeling position to a thick mat would be safe for those with severe osteoporosis, provided that hip pads were used.
"We teach people to both stand and kneel," she says. "However, it's important that people with brittle bones can complete the course as they are most affected by severe falls."
When I turn up, I am disappointed to find that I could not try to stand up for two weeks. But I get the idea after half an hour of exercise on a judo mat. A safe fall is to roll backwards as slowly as possible, curl the body in a C shape, poke the head back, and pull the arms into the chest.
Is there time in real life to change the course of a fall? The first thing Frances knew about her accident was to see herself hidden on the sidewalk – and that's terribly typical.
"Everyone thinks there is no time" Weerdesteyn on. "You're wrong, even the fastest case takes up to 900 milliseconds to reach the bottom, and the body is aware of a loss of balance within 100 milliseconds, so you have 800 milliseconds to do anything.
"That sounds no time at all. In fact, it's the difference between the first and the last person to reach the finish line in an Olympic 100-meter race. If you stumble a few steps before you fall, you still have a few seconds left. "
The course costs £ 310, with part or all of the bill being collected by the Dutch health insurance.
I meet Corry Freijling, a 76-year-old retired kindergarten teacher with osteoporosis, who was referred to the course after three crashes. I still have crashes – I recently lost my bike in heavy traffic, "she says. "But while I got a black eye, I did not break anything because I fell better. I did not throw my arms out or get stiff as it might have happened before. "
During the half of each two-hour session, participants complete a low-tech obstacle course that replicates daily runoff hazards.
"We know there's a moment when you're out of whack, either recovering or losing and falling over," Dr. Weerdesteyn. "So many people lose this ability to restore balance as they get older."
However, research shows that it is possible to re-learn the skill – repeatedly experiencing loss of balance or disruption.
In fact, "balance therapy training" that deliberately causes people to restore balance is a "workable and effective approach to reducing falls in a clinical setting," according to a review in the journal Gerontology & Geriatrics.
I enter the obstacle course, which consists of stepping stones of different carpet structure, a slippery oilcloth with wood and narrow beams for walking.
You then repeat it with darkened lights or while listening to a recorded story in which you have to count the number of times a word is distracted from the obstacles under your feet.
"There are two types of people who are particularly prone to falling," says Dr. Weerdesteyn.
The first step was very slow and careful, limbs rigid to keep control. However, this increases the risk of falling, says dr. Weerdesteyn, a fact confirmed by research done by Brunel University's Sports Medicine and Human Performance Center. The second group hurries around the course without paying proper attention.
Ananda Nanu, former president of the British Orthopedic Association, says the program is an "interesting innovation," but adds, "We should not forget that sidewalks and pedestrian walkways need to be improved."