Hugh Hardy died last week. Paul Goldberger said of the talented New York architect, famous for his renovation of Radio City Music Hall: “Every one of us has lived more intensely in New York because of Hugh, understood the city better because of him, and loved the city more because of him.” Hardy fell getting out of a taxi but felt fine, went to dinner and then the theater, where he lost consciousness and later died in the hospital of a cerebral hemorrhage.

Debby Alter didn’t die when she fell in downtown Toronto last year after a fancy lunch at the Arcadian Court. My mom was going down three stairs, arm held by a young woman, when she missed the tiny bottom step and fell, hitting her head on the pavement. The doctors thought she would die, as she was bleeding in her brain in a number of places, but when you get to be 96, your brain shrinks, and there was room for the blood. But it was like instant dementia; she doesn’t know us anymore, cannot hold a conversation. We pretty much lost her that day.

stairs in Toronto Watch out for that last step. It's a doozy. (Photo: Lloyd Alter)

That 2-inch high step that she missed was in front of an important building from the '70s when the rules were different; it was OK to have steps without a lot of handrails, not marked or easily visible. There was construction going on, so there was not enough light to really see the stair. I wanted to sue the builder for not putting in enough light, and for not marking the steps, but no lawyer would touch the case; at 96, it's hard to put a price on the years lost. I tried to get the city to do something, and wrote a letter to the chief building official, the person in charge of building code enforcement for the entire city. I have known her personally for 40 years. I didn't even get a reply.

Why are we ignoring this problem?

This is a big issue and it's getting bigger all the time as baby boomers get older. A recent study from the Centers for Disease Control and Prevention reports that in 2013, there were 2.8 million traumatic brain injuries (TBI) in the United States, including 56,000 deaths. Most are still from car crashes (leading me to wonder why people never complain about drivers not wearing helmets.) But the number of older people falling has increased significantly. According to the study:

Cognitive and physical reserve are diminished at older ages, so TBIs might have a greater impact on daily living. TBIs in older adults are more likely to lead to hospitalization, and these hospitalizations can be complicated by the presence of comorbidities. Furthermore, more frequent use of anticoagulants among older adults can result in a greater likelihood of secondary effects because of an increased likelihood of intracranial hemorrhage.

According to coverage by the Associated Press,

One in every 45 Americans 75 and older suffered brain injuries that resulted in emergency department visits, hospitalizations, or deaths in 2013. The rate for that age group jumped 76 percent from 2007. The rate of these injuries for people of all ages rose 39 percent over that time, hitting a record level, the CDC found.

So what's causing the increase? It may just be the demographics, with more older people living on their own. “One likely factor is that a growing number of elderly people are living at home and taking repeated tumbles, said one expert.”

Or there might be other conditions, such as the one that probably contributed to my mother’s injury: our cities are not accommodating to people with reduced vision, hearing and the ability to react. The crossing signals are so short that they don’t hold up cars long enough. Nobody thinks of the impaired when they build hoardings and canopies during construction.

broken sidewalk Atlanta Walk this way on this sidewalk (Photo: PEDS)

We have let our cities fall apart to the point that everything is a trip hazard, and our sidewalks are a flat-out disaster area in some cities, like Atlanta. The assumption is that really, you should just get into a car and when you can't drive, you should just get into a nursing home.

But it's time to change that paradigm. Boomers and seniors want to be out walking, getting exercise. Losing the car should not be a death sentence. In many ways, cities are the best places to get old; that’s where the doctors are, the takeout food joints, the people to talk to, the public transit.

And that means a lot more attention must be paid to trip hazards, to broken sidewalks, to traffic light timing, to all those things politicians and traffic engineers prefer to ignore. Yet according to the CDC, “falls were the top cause of injuries and deaths from injury among older people”, and many of them never had to happen.

If the president really wants to invest in infrastructure and give something back to the people who voted him in, this would be a great place to start.

Lloyd Alter ( @lloydalter ) writes about smart (and dumb) tech with a side of design and a dash of boomer angst.

Traumatic brain injuries are hurting (and killing) too many of us
New CDC study finds the rate of injury among seniors from traumatic brain injuries or TBI is rising fast.