Episode 222: The '20 Foot Rule' for Fall Prevention w/ Dr Wayne Gradman

In this episode of the Aging Well Podcast, hosts Dr. Jeff Armstrong and Corbin Bruton speak with Dr. Wayne Gradman, a renowned vascular surgeon and author of 'The Fall Guy: How to Keep Gravity from Ruining Your Day.' Dr. Gradman shares his expertise on fall prevention, an often overlooked but critical issue affecting older adults. Learn about common risk factors, creating safer environments, and adopting daily practices to prevent falls. Dr. Gradman also discusses the role of exercise, vision care, medication awareness, and overcoming the fear of falling in maintaining safety and confidence as we age. Tune in for practical insights and strategies to help you or your loved ones age well.

BUY 'The Fall Guy' on Amazon and help support the Aging Well Podcast: https://amzn.to/3V8q0LV

TruDiagnostic epigenetic testing
Get a 12% discount using promo code (AGEWELL) and track your pace of aging well.

Disclaimer: This post contains affiliate links. If you make a purchase, I may receive a commission at no extra cost to you.

Have questions you want answered and topics you want discussed on the Aging Well Podcast? Send us an email at agingwell.podcast@gmail.com or record your question for us to use in an upcoming episode:
https://www.speakpipe.com/AgingWellPodcast

Transcript

0:05

Welcome to the Aging World Podcast, I'm Dr. Jeff Armstrong, here with my co host, Corbin Bruton. In today's episode, we have the pleasure of speaking with Dr. Wayne Gradman, a renowned vascular surgeon and author of The Fall Guide, How to Keep Gravity from Ruining Your Day. Dr. Gradman's extensive medical experience and practical approach to fall prevention offer critical insights into a significant but often overlooked issue, preventing falls as we age. Falls remain one of the leading causes of injury and hospitalization, especially among older adults, and they can have lasting effects on independence and quality of life. Today, Dr. Gradman will guide us through identifying common risk factors for falls, creating safer environments and adopting daily practices that can make a real difference in preventing these dangerous incidents. We're thrilled to dive into this vital topic with Dr. Gradman and uncover strategies for maintaining safety and confidence as we age well.

jeff_1_11-23-2024_080939: 0:58

Dr. Gradman, welcome to the Aging Well podcast. Let's have you just start by telling us a little about yourself and what inspired you to write The Fall Guy and why is fall prevention such a central focus for you.

squadcaster-6bbg_1_11-23-2024_080939: 1:12

Well, first, thanks for having me on the show. Uh, I got started because at one time in my life, I fell a lot. I was a super klutz in my, in my, words. And so I began to research why I was falling. And as a result, I wrote this book and then, and I fell less after I wrote the book. another reason I wrote the book is because I love to teach and that's something that's missing in medicine today. enjoy talking with patients. I, I won the teacher of the ward at Cedars, my hospital, and I love talking, talking to the residents. It's a lost art today. Doctors sit behind computers. They never touch their patients. They never talk to them. not very good. And the final reason I wrote the book is that I realized that if I could get this book out I would be reaching more people and doing more good than I ever did doing six hour operations vascular surgery You know piecework. So all those put together. I said I want to write a book. I have a sense of humor so I hired a cartoonist and Awful away we went.

2:19

Dr. Gradman, falls are such a serious risk, especially for older adults. Could you explain some of the reasons they are so prevalent and what common mistakes people make that might unknowingly increase their risk of falling?

squadcaster-6bbg_1_11-23-2024_080939: 2:35

Falling is a terrible risk You know, one person in four over the age of 65 falls every year. There are 45 fall deaths in the United States. And statistics show that 10 percent of people fall down stairs Die of a brain hemorrhage, Joe Lieberman. He died that way, fell downstairs, and I have other examples as well. So, falls are real, and they happen all the time.

jeff_1_11-23-2024_080939: 3:03

So, in your experience, what are some surprising factors that contribute to falls that most people wouldn't think of?

squadcaster-6bbg_1_11-23-2024_080939: 3:11

Well, the most common one is just simply not looking where you're going. I call that the 20 foot rule. You should be looking 20 feet ahead of you and seeing if there are any obstacles. uh, my problem a lot of times is the sidewalk slabs are lined up irregularly, or tree. I have a picture of that in my book that shows that roots can do all kinds of things to trees and people trip over them. are dangerous. Step off curbs. They don't realize that there's asphalt on the street that meets the cement and there's a little difference in bump and you think you walk off the curb, you're safe. you wind up tripping on that little thing. And then my, my real bugaboo is, are people that use their cell phone when they're walking. I have that on my cover. Uh, People just. Are unbelievably casual about walking with a cell phone. that is one of the reasons I fell at one time. So these are very, very common things. There are a lot of many, many other reasons people fall. The most, most falls call, in the home. it's very, very important fall proof your home. And I emphasize that. In my second chapter, and that I talk about the importance of full bars in your showers. my wife and I went to the 80th anniversary of D Day this year. We stayed in all kinds of European hotels, both large, small, luxury, you name it. None of them had hand bars, and they didn't have non slip floors. And frankly, we were petrified. We thought we'd break our necks somewhere in Europe. Um, Here we have codes, and they may not be followed all the time, but it's very important to fall proof your bathroom. And also, the next Most commonplace of? falls is stairs. People tend not to use their, their banister, especially when walking down the stairs that that's the risky element of of stairs. Of stairs, and it's also important to put traction tape at the top and bottom of your stairs, wherever you go in the commercial world, you'll see traction tape, but you won't find it as often in the home and particularly on the front steps is very important to put a contrasting, Traction tape there, and you can even do it for your carpets, but it requires a special installation. So those are the main reasons that people fall another 25 percent of people fall in their bedroom when they get up at night to go to the bathroom. They don't have floor lights. They don't sit down when they put their clothes on. They have the wrong shoes. There are myriad reasons why people fall.

jeff_1_11-23-2024_080939: 6:09

So are there any other like adjustments that you could recommend that people can make right now to increase the safety in their homes?

squadcaster-6bbg_1_11-23-2024_080939: 6:18

Well, I always tell people, uh, to be careful of throw rugs. That's why they call them throw rugs. And also, uh, cords. There are many errant cords in people's homes? and people can trip over them. I've also observed that, many people walk barefoot, or at least with socks. In their shoes, and they have shiny wax floors. They're slippery. Be careful when you walk on those services. Outside the house is also important that you should you should uh, outdoor lighting, uh, to get to your car at night. Uh, That's very important and also try to avoid slippery surfaces, especially around the pool. People fall in the pool area and enter some enter themselves quite frequently. You should be at least flip flops or something, uh, your bare feet on, on a marble or, floor outside is, is quite dangerous. I also talk about vision. Vision is a surprising fall risk. Because you don't know when your clarity is diminishing and I found some statistics that were very interesting for me anyway, and that is that once you reach the page, uh, the age of 50 or 60, you start to get cataracts and, when that happens. You're not aware that your vision clarity is diminishing that came true to me when I had my first Cataract fix. I honestly didn't think I needed cataract surgery, but I thought I could see perfectly Well, but once I had the first eye fix so I could compare one eye with the other I realized What I was missing the world brightened up. It was clear. It was obvious that I had a deficit And so uh, couldn't wait to get the second one down, but statistics show that if you fix the first cataract Your incidence of falls drops dramatically. If you fix the second cataract, it doesn't add anything. But you want to fix it anyway because you realize just how much you're missing by not having that increased vision. So if your doctor says, you know, you're getting a cataract, I think it's time, don't stall. Just go ahead and go ahead and do it. Uh, You'll be absolutely stunned with the result.

jeff_1_11-23-2024_080939: 8:45

Yeah, I think in my house, the greatest risk of falls is my daughter's cat. I get up in the morning, that thing is at my feet, and I think is hell bent on trying to trip me up when I go to feed her. So book introduces, as you mentioned, that concept of the 20 foot rule. Can you explain this a little bit further, what the rule is, and why is this such a powerful tool in fall prevention?

squadcaster-6bbg_1_11-23-2024_080939: 9:10

Well, because people don't look where they're going. Uh, It's, it's, it's that simple. It's nothing more than that. It's just a way of, uh, capsulizing that very simple principle. I find now that I, I wrote, wrote the book that I'm constantly looking ahead to see if there's a mismatch in, uh, sidewalk slabs, I'm particularly careful about curbs. Uh, It's so easy to trip on a curb and that, that's what happens so often. And, and the, and the corners uh, and, and yeah, the corners are very dangerous. So that was the basis of the 20 foot rule. It could be a 30 foot rule. It could be a 10 foot rule. Just, just be aware of what's in front of you and don't be looking at your cell phone because today that's an endemic that that's a, that's a disease. I, we were standing on a corner, my wife and I, and we looked across the street and there are five people with their heads buried in cell phones. And people fall because of that. Over the age of 40, you get something called presbyopia, which means that you start to need glasses. And if you're using glasses to read your cell phone, you're not looking 40 feet in front of you or 20 feet in front of you, you're not looking for hazards, and you will fall, and I've seen people trip and fall all the time, myself personally.

jeff_1_11-23-2024_080939: 10:31

I think there should be some laws. Just like there are for driving, you should not be allowed to walk while talking on your cell phone.

squadcaster-6bbg_1_11-23-2024_080939: 10:38

Yeah, I don't, I don't argue with that. I, I, I think that's a great idea. You know, everybody, uh, at one time we had this rule about, Driving and texting in your car, but I everybody, it's such a lax rule. Now. I see everybody doing it and I'm sure it's a cause of some, some accident for sure.

10:59

Maintaining a healthy weight and regular physical activities are important to aging well in general. Can you discuss how they specifically support fall prevention?

squadcaster-6bbg_1_11-23-2024_080939: 11:11

Yes. Exercise is very, very important for overall health. I certainly would tell uh, to, to continue doing what they're doing. But, think about it. Falls really occur because of problems in the lower extremities and what you're looking for there is, are exercises that increase flexibility, strength and balance in the lower extremities. Those are not easy to direct your attention to flexibility. Uh, I always think uh, Djokovic, the tennis player who doesn't play tennis to warm up, he stretches. He stretches. That's why no one can get a ball past the guy. There's the strength that you need is found in your, femoral muscles, the quads and also your buttocks. They're very, very important. And flexibility is Extremely important, when you're talking about your hip, the, your, your knees, and so I devised a group of exercises that can be done in 10 minutes, uh, because you don't need much. You really just want to stretch those muscles out. You want to gain a little balance. I like lunges a lot because it combines the lower extremity strength and, and, and uh, balance issues, balances, uh, another difficult one to define, you know, studies have shown that Tai Chi, if you do it an hour a day, Uh, your balance will get better. Who has that time? No one has the time, unless you're Chinese, of course, to do Tai Chi. So I just combine a small group of exercise that are very focused to the lower extremities, 10, 15 minutes, three, four times a week. They're so easy to do, that you, you could do it, some of them even while watching TV. But the important thing in every, in exercise as it is in weight, is that you have to stick to it. You have to really do these things constantly. And I find that my limited exercise regimen is very helpful for people. I, I, I stay quite limber. I'm not a young guy, uh, but I can do anything. And I walk four or five miles a day, every day.

jeff_1_11-23-2024_080939: 13:27

In my pathophysiology and exercise textbook, I coined Carmine's law, which is kind of first stated by one of our early podcast guests. And it basically states that strength plus posture equals balance and that importance of building strength, but also Correcting our posture so that we're maintaining that center of mass and being able to maintain balance both dynamically and statically.

squadcaster-6bbg_1_11-23-2024_080939: 13:54

the posture is very, very important. Uh, I, but there are a lot of reasons why people have poor posture and it's not something that is easily correctable all the time. And particularly when you you can get something called spinal stenosis and people, many people that I see bent over actually have it. They have back pain. And you should be aware that, uh, if you have back Uh, there are, the, the field of neurosurgery has improved so much in the past 10 years that for instance, I thought, I thought I was headed for a humongous operation. My back pain was terrible. I was hunched over. My wife was on me every day, day and night. And I went in finally, I said, okay, I give up. I need the surgery. And it's an outpatient surgery. I mean, I was just blown away. And my back, I stand up straight. I don't hunch anymore. And I'm very, very grateful that I moved ahead. And even if you've had back surgery in the past, these procedures may still be available for you. So many people are discouraged with their back surgeries. Uh, but today, uh, the new techniques are phenomenal. They're done minimally invasive with scopes and whatnot. And you're out of the hospital in no time and actually quite normal. I've referred many Are my friends for that?

jeff_1_11-23-2024_080939: 15:16

as we preach aging, well, we really emphasize the importance of preventative strengthening and, you know, balance training and posture and all this thing so that we can prevent falls. But older adults, developing that fear of falling, which can really have an effect on their lifestyle, even kind of lead them to a little bit more isolation. What are some steps that individuals can take to address this fear of falling and

squadcaster-6bbg_1_11-23-2024_080939: 15:44

That is, that is an amazing question. It's become an obsession with me about fear of falling. Because I have a 98 year old grandmother that just dislocated her grandmother. She's my mother in law that just dislocated her shoulder. And she developed fear of falling after that. And a fear of falling is a risk factor for falling. That is an amazing statistic. So if you have a fear of falling, two things, first of you may be using a cane, you may need a walker because a walker uh, will help you steady your, uh, equilibrate your, your, your weight uh, you're far less likely to walk or fall with, with, with a walker. The second thing is an interesting discovery. Made by a friend of mine that, fear of falling has an element of depression at it. if you take a small dose of antidepressants, uh, sometimes your fear of falling, uh, made will disappear. So that is a new thing for me. And I'm going to start encouraging it in people that have that fear. Uh, It's very, very common. I just. Anybody who falls doesn't want to walk out outside anymore. They stay inside, they mope, and they're at greater risk.

17:10

You also touch on how certain medications can increase fall risk. What type of medication should people and caregivers be especially mindful of and what precautions would you suggest?

squadcaster-6bbg_1_11-23-2024_080939: 17:23

Well, medications are a risk factor for falls. If you look through all your fall medications, or all your medications, you'll find many that list drowsiness, lightheadedness as risk factors. And the most dangerous category are a group of medicines called benzodiazepines. That's a very broad class of drugs. They include like Xanax, sleeping pills, Valium, all those pills that make you drowsy. Another class of drugs that, are risk factors for fall are high blood pressure medicines because Doctors have a real problem, I mean this is one of the big problems in medicine, is adjusting the dose of your high blood pressure medicine. You don't want it too high, you can get a stroke. You don't want it too low, you can fall. Many times a doctor will increase the dose and you will get lightheadedness and dizziness or arrhythmia in your heart. And, you're not aware of it. So I recommend that any time you have a change in blood pressure medicine, you should be taking your blood pressure on a frequent basis to make sure it doesn't drop below 90 systolic, which is the high number of the two. And there are risk scales for patients. Uh, For instance, if you take a benzodiazepine, like I take a sleeping pill practically every night. I'm unfortunately, I'm addicted. I'm trying to stop it, but they call it cognitive behavioral therapy. We'll see. But I, I take a sleeping pill every night, that's worth three points and high blood pressure pills are worth two, but you can be taking more than one of these medicines. So he'd get up to six. You've got to see your doctor and say, hey, look, you know, you've got to de prescribe for me. I am taking too many of these medicines that are causing, lightheadedness and fainting tendencies and I've got to, you've got to get me in a better range so that I can avoid falling because one day I'll fall asleep at the wheel, or something similar. So yes, medicines have a great role to play in this. Uh, But, but the, the, the category of benzodiazepines, it's not going to say that on your, on on uh, insert, but any medicine that has drowsiness or faint lightheadedness on it is suspicious and you have to be very, very careful and These things are additive.

jeff_1_11-23-2024_080939: 19:56

These are also drugs that are linked to increased risk of Alzheimer's disease, too. So, you know, we often preach to our listeners and viewers that they need to really communicate with their pharmacist about what drugs they're taking and what are those risks and you know, what should they be trying to get off of so that they can mitigate some of these risks of falls and

squadcaster-6bbg_1_11-23-2024_080939: 20:15

Yeah, I am totally unfamiliar with the Alzheimer drugs. I've been a skeptic, for some time, about drugs for Alzheimer's They haven't hit the nail yet, I,

jeff_1_11-23-2024_080939: 20:27

Well, this isn't for treatment. This is as a risk for Alzheimer's disease. We had an episode earlier this year with Mitch and Emily. Konski and talking about kind of protecting your brain from Alzheimer's. And they had a pretty lengthy list of drugs that have been linked to an increased risk of Alzheimer's disease. And you know, those, those were on the list. And so they're also on the list now for the increased risk of falling. So they should be certainly drugs that we at least should caution any of our. listeners and viewers that want to age well, keep them from taking

squadcaster-6bbg_1_11-23-2024_080939: 21:06

I

jeff_1_11-23-2024_080939: 21:07

as

squadcaster-6bbg_1_11-23-2024_080939: 21:07

couldn't, I couldn't agree more, really.

jeff_1_11-23-2024_080939: 21:10

So is this air is our listeners and viewers in the northern hemisphere are going to be in their winter season. Eso conditions like ice and rain can create extra hazards for them. you have any specific advice for staying safe in

squadcaster-6bbg_1_11-23-2024_080939: 21:25

Well, I see environments uh, when I first wrote this book, I, I, I thought of it from the perspective of somebody who lives in Los Angeles and I, it wasn't until I visited Eastern Europe last year that I realized that I needed a chapter on ice, uh, and slippery surfaces. And so I discovered that it's very easy to fall on ice. I grew up in Chicago, so I'm very familiar with that. With ice, but I haven't fallen in a lot of years because of it. first of ice and slipperiness has to do with physics and friction. So, if you really want to know about this stuff, you have to learn a little bit about that. But one of the best ways to avoid falling on ice is the most obvious one and intuitive one, and that is to take baby steps, or what are often called penguin steps, because penguins don't fall as much as babies. So small steps are very, very important when you encounter ice. There's such a thing called black ice, which is nothing but a very thin surface of ice over asphalt and You you think oh, that's safe. That's that's that's that's great. I can walk on asphalt. That'll be good, but it's extremely slippery It's called black ice and you see it all over the place So you have to be especially careful there. There are Many shoes that now have gritty, uh, bottoms uh, uh, help you walk on ice. And there are even devices you can place over your shoe that are good if you're walking a long distance in ice. But I find uh, many people take, like ski poles, uh, Nordic poles, and they use those, uh, as adjuncts to walking on ice. And that is extremely helpful because it distributes your weight, uh, over three points rather than just two. And Nordic poles can be great if you're, if you think about them. and you're walking out outside on ice. Some of these things you have to take off before you go in the home, otherwise you'll destroy your floor. But, but those are the main reasons of And use banisters, whatever possible. And if you have to sit down on the stair to get down it, because stairs are incredibly slippery when they get icy, hang on to that banister or just sit down and bump your way down. Falling on ice downstairs, is a pathway to death.

23:53

Technology like mobile phones and alert systems can be increasingly helpful, but sometimes they also pose risk, as you've mentioned in this podcast. How can we use technology effectively to prevent falls or respond quickly for when one happens?

squadcaster-6bbg_1_11-23-2024_080939: 24:39

Well, I, I'm not sure technology has a, in any respect, has a, has a role in fall prevention uh, or treatment. Uh, Yeah, you can call, with your phone, you can call 9 1 1, but uh, falls occur when you're not looking, it comes out of the blue, you have no control over it. There's nothing, there's no follow meter risk thing out there where you could survey your next 100 feet and say, oh, don't step over that or not. Technology hasn't yet expressed its full potential in falls, unless you're thinking of something. I sure like to know about it. I know that there are devices in the home that can actually, uh, help you get up from a fall. You don't have to call 9 1 1 to call people. There are simple ways at home that if you fall, uh, you, you can just use these simple devices to get uh, straight up. Because we have somebody across the street from me, uh, the paramedics are out there every other day to get him up from a fall. That's ridiculous. There are websites that you can buy, balloons of various sorts or devices that stand you up straight from a fall. And that's technology that helps, but I'm at a loss for finding something that magic bullet, that AI, AI, you know, it's going to tell you where, where the next fall is. I don't, that's not out yet.

jeff_1_11-23-2024_080939: 26:07

I know there's been some research on like motion trackers and some of those kind of things in the home where they can kind of monitor individuals that might be at higher risk and see some of the factors that might be contributing to their so on. But fall prevention is, know, it's a topic that's really full of a lot of myths and misconceptions. What are some of the most common ones you've encountered and how do you

squadcaster-6bbg_1_11-23-2024_080939: 26:31

well,

jeff_1_11-23-2024_080939: 26:32

them?

squadcaster-6bbg_1_11-23-2024_080939: 26:34

first of all, the two main ones that I, I think of are that you can control how you fall. That is a misconception. Every, every year or so, I read an article that tells me how to fall without injuring myself. That's not the way people fall. When people fall, They crumple to the ground. They have no way of protecting their heads or or hips or what have you. Uh, You, when you start to fall, you have no control over it. That's been my experience and the experience of most people who actually fall. So people that say, oh you just make sure you land on your butt are way off the mark. It's almost impossible to do. The second misconception is That it only involves old people, you know, I, I go down to the beach. I watch guys roller blade hockey. They're beautiful. They're absolutely marvelous people, but they don't wear equipment. I just don't understand that. I mean, just damn it, put on a helmet, uh, bicycles, put on a helmet, rollerblading, put on a Whenever I see somebody that doesn't do uh, I know that they're in for trouble. So young people can fall. That's, that's what I'm getting at. If you don't use the right equipment in your sports, uh, you're asking for trouble. And that happens all too frequently. So between the cell phones on, on the street and the kit that you need when you're, uh, exercising and those are a misconception about falls. I'm too, too young to fall and break something. Well, the sports clinics are full of those people and orthopods that make a good living doing that.

28:18

can you share a story or an example of someone who has benefited from making simple changes to reduce their risk of falls?

squadcaster-6bbg_1_11-23-2024_080939: 28:27

Actually, it was short of what I've been discussing. I don't have recommendations for people that have fallen, specifically to prevent the next I'm not sure I'm aware of that, but I like what you said about, uh, hip exercises. The hip is really an important joint, uh, in our body. And, uh, it's amazing how little flexibility Or how limited the hip movement is in older people. And that's definitely a risk fall. Uh, For falls, but as far as, telling people who have already fallen, what to do just, just take the whole regimen and read the book, you know, that's, that's probably the best thing you can do.

jeff_1_11-23-2024_080939: 29:08

All right. Well, now for the question we ask of all our guests. What are you doing personally to age

squadcaster-6bbg_1_11-23-2024_080939: 29:13

Well, I eat well, first of uh, I try to eat, I avoid all, processed grains and foods, anything that comes out Out of a vending machine is off the table. Uh, I try to eat as few starches as I can. I think eating is, is one of the keys to aging well. And of course, in addition, I do, I do my own exercises. I walk, I, I was biking quite a bit, but I, I'm doing less of that. I don't know why I, I still do it, but I, uh, not as much. I'm talking about a stationary bike. I like, I like, I like to listen to podcasts when I want, I like to watch, uh, my iPad when I'm on my stationary bike. And the time goes very, very quickly. If you put the hours into that, I think uh, you will age well. And of course, staying busy is very important. I retired, uh, six years ago, and I started taking online courses. I was reading a lot, but then I said, you know what? I do like to write. I do like to teach. I do like to travel. And so having curiosity about life, I think, and keeping your mind young and open and reading a fair amount are all, uh, magic bullets for aging. Well, I don't want to go out, with, well, I certainly don't want to have Alzheimer's hard to control, hard to control.

30:41

Where can our listeners find the Fall Guide and follow your ongoing work and fall prevention? Do you have a webpage? Social media?

squadcaster-6bbg_1_11-23-2024_080939: 30:49

I have both. I'm not a social media person. I'm too old for that. I apologize. Uh, I wish I knew how to use that stuff, because I understand that's a good way to sell books. But I'm not in this to sell books. I really, you don't make money publishing, I don't know if you knew that, you make money, your, your satisfaction comes from knowing that you help people, at least that's the way I feel. And I'm trying to get the books in as many, the hands of as many people I can, and so I say. This book is a great one for the holiday season, because you can give it to all your old friends. Older friends, and even some of your younger friends who have parents who are falling, because you are your parents. You have to watch out for your parents. You don't want any problems with them. My book can be found on Amazon, The Fall Guy, How to Prevent Gravity from Ruining Your Day. And I also have a website. It's w gradman dot com. It has a couple of my blogs from my next book, which will be a memoir. I think they're pretty interesting and a lot of fun to read. Uh, They give great insights into me because it is a memoir yeah, that Amazon is the best way. I, I like the paperback edition rather than Kindle, but they're all good.

jeff_1_11-23-2024_080939: 32:06

Well, we will certainly include links to all those in the description notes so that people can find the book on Amazon. It should just be

squadcaster-6bbg_1_11-23-2024_080939: 32:15

Yep.

jeff_1_11-23-2024_080939: 32:16

right to the book and get to the web page. You know, thank you for a very interesting conversation. Hopefully our listeners are paying attention, not only to this podcast, but now as they're out walking about to use the banisters, watch for those cracks, particularly here in Portland, the way they plant trees along the roads, they tend to really pull up the concrete and they'll go down, they'll shave them down and everything. it's still really rough sometimes walking out there and we're in our wet rainy season, probably start getting a little bit slippery here in a bit. hopefully they're paying attention and staying off their phones. They're not listening to this podcast and looking at the phone as they walk.

squadcaster-6bbg_1_11-23-2024_080939: 32:57

Bye.

jeff_1_11-23-2024_080939: 32:57

and hopefully they just continue to kind of do the things that are prevent falls and keep aging. Well,

33:07

thank you for listening. I hope you benefited from today's podcast and until next time, keep aging well.