Perilous. But Preventable: When Seniors Fall
By PATRICIA LEVINE
Karl Konieczny, left, and friends at the Hadley Senior Center use a stretchy latex band to develop strength during a falls-prevention workshop.
Norma Packard of Hadley thought she was being a good Samaritan when she tried to help someone into her apartment building. As she stepped down to the parking lot from the cement walk in front of the building, her sneaker caught on the lip of the walk, and she fell on her face, knees and hands. "My face was bloodied and bruised, I had bruises all over my body, and my left knee is still sore three months after the accident," she said.
Barbara Sutherland of Amherst has had two falls within one year. In February of 2009, a fall on an uneven sidewalk on the UMass campus resulted in two broken fingers and a bruised cheek. And later that year, she fell again on an inclined sidewalk, hit her forehead, bruised her hip, and got a black eye.
Both women were over 70 when they fell and both were lucky the injuries they sustained were not much worse.
Falls among older people are rising in epidemic proportions. Each year, over 11 million people over the age of 65 fall - one out of every three senior citizens. The number of falls and the severity of the injuries resulting from falls increase as a person grows older. According to the American Academy of Family Physicians, falls are responsible for 70 percent of accidental deaths of people 75 or older, and account for about 9,500 deaths each year.
The disabilities caused by falls are just as devastating. More than 50 percent of seniors who survive a hip fracture are discharged from the hospital to a nursing home, where half of that number remain for at least a year. And many fracture patients never regain their mobility. Falls can be a major life-changing event that robs seniors of their independence. And, most alarming, previous falls are one of the strongest risk predictors for future falls. The Centers for Disease Control and Prevention reports that two-thirds of seniors who fall will fall again within six months. The American Geriatrics Society recommends that anyone who falls should be seen by a doctor. Even with no apparent injuries, a prompt evaluation is important.
Contributing factors
According to Dr. Maura Brennan, director of the Geriatric Consultation Program and program director of the Geriatric Fellowship Program at Baystate Medical Center in Springfield, fall prevention among seniors requires a multifaceted approach. The physical changes of aging involve the complex interplay between our neurological and musculoskeletal systems. The correlation between falls and the way seniors walk is an example.
As we age, our gait, or the way we walk, changes. This is because of neurologic changes that affect the brain, nerves, and muscles. Many times seniors will exhibit what is called a propulsive gait, in which they are propelled forward because their center of gravity is a little too far forward for their center of stance. These people start walking slumped forward, often looking at the ground, with their shoulders hunched. They don't take a long enough step forward to actually catch up to the center of their body mass that's leaning ahead, which can result in a fall.
Other factors add to and compound a senior's tendency to fall. Seniors are more likely to have health problems and physical impairments such as arthritis, osteoporosis, Parkinson's disease, and impaired thinking and memory, and are more likely to be taking medications that can impact balance, strength, reaction time and vision.
Relatively few seniors do the types of exercises that help reduce the declines in muscle strength and balance that come with age. And, equally important, few homes have accommodations that can reduce environmental risk factors for falling. Poor lighting, slippery floors, and unexpected obstacles all contribute to falls among the elderly.
Home hazards
Preventive measures that seniors can take to safeguard their health often begin in the home. John Yount, a physical therapist and fall-prevention coordinator at Cooley-Dickinson Hospitals VNA and Hospice programs, and says that many homes contain conditions that can result in disabling accidents. He says that a room-by-room inspection is the best place to start, and that modifications needed to safety-proof the home don't have to be expensive or difficult to install.
In many homes, floors can be a minefield of hazards. Loose throw rugs, runners and mats, and curled carpet edges are risk factors for accidental falls, as are slippery floors, electrical cords and other small objects in pathways. It's best to rearrange furniture in order to provide a clear path for walking through the home.
Thresholds between rooms should be removed or marked, and Yount recommends a low-nap carpet or nonskid flooring be used in the home as well as motion or light-sensitive lights on pathways.
Stairs are also common trouble zones. Yount says that seniors experience disturbances in their depth perception that make it difficult for them to tell one step from the next. Tightly woven, non-patterned carpet or nonslip treads with edges marked with tape are best for stairs. Sturdy handrails should be installed on all stairways, and should extend the full length of the stairway. Extra support can be provided for navigating stairs by using dual handrails. The second handrail provides another place to grab if the senior begins to lose balance. Motion- or light-sensitive lights should be installed on the stairways, and light switches should be at both the top and bottom of stairways.
Bathrooms also can be dangerous. Yount recommends two grab bars as well as nonskid mats or abrasive strips in the tub or shower. He also says that seniors should consider replacing the tub with a walk-in shower that includes a seat; a fall can be prevented by not having to climb in and out of the tub. Many toilets are too low to allow older people to sit and rise from them safely, so grab bars should be placed near the toilet. In addition, tall toilets can be purchased as well as platforms that raise the existing toilet by about six inches or commodes that can be placed over the toilet seat.
Kitchens also are risky, often because of slippery floors and poor lighting. Because kitchen falls are most common when seniors are reaching or stooping to perform cooking tasks, Yount suggests that kitchen storage should be rearranged with items that are frequently used placed within easy reach. Seniors should never climb onto a stool or chair to reach high shelves; if they must climb, a sturdy stepstool with handrails is preferable.
Exercise to prevent falls
Remaining physically active throughout your life can significantly reduce your chances of falling. It boils down to a simple equation: Exercise equals better strength and balance, which equals fewer falls and fractures.
Andrea Doubleday, physical therapy supervisor at Cooley-Dickinson Hospital in Northampton, says that there are a variety of exercises that promote balance, coordination and strength for seniors under appropriate supervision. Tai Chi, a gentle form of ancient Chinese martial arts, has been demonstrated to integrate balance and strength. And progressive-resistance training has grown in popularity among older people.
There are several effective strength-building alternatives to "pumping iron" available to seniors. Lifts with two- or three- pound hand and leg weights are useful, as is isometric exercise that uses your own body for resistance to increase strength.
Just about anyone can take part in an aquatics exercise class - the water offers resistance but supports your weight at the same time. Therabands are also useful for resistance training. These latex bands offer resistance by stretching; the more you stretch them, the more resistance they provide.
Vision and medications
According to Dr. Bruce Bleiman, an ophthalmologist with Eye Physicians of Northampton, poor vision is linked to falling, and older adults should have regular checkups of their vision. He says that there are three main vision problems that seniors experience, all of which are treatable.
Glaucoma occurs when there is too much fluid pressure in the eye, causing internal eye damage and gradually diminishing vision. Cataracts cause the lens of the eye to become cloudy until there is no longer enough light passing through to the retina to focus a clear image. Macular degeneration is a condition in which the central part of the retina gradually deteriorates, leading to blurred vision and finally a blind spot in the central area of sight.
Dr. Brennan notes that being aware of the side effects of the multiple medications that many seniors take is another important measure for maintaining balance and avoiding a fall. Certain drugs by themselves, or in combination with others, can cause dizziness, vision impairment, and movement disorders that increase the risk of falls.
For example, sometimes medications used to control high blood pressure can lower blood pressure enough to cause lightheadedness with resultant instability. Many drugs used to treat depression, a disease often under-recognized and undertreated among seniors, can lead to postural sway or an unsteady stance.
When medications are taken is also important. Diuretics given to control blood pressure increase urination and should not be taken before bedtime, avoiding a hurried trip to the bathroom during the night and a possible fall. Even over-the-counter drugs can lead to falls. Most of the sleeping aids and cold-and-sinus remedies have a sedating compound in them. And herbal medications such as kava kava and valerian are sedatives.
Researchers have also attributed the increase in falls among seniors to alcohol consumption. Dr. Brennan says that older people can't metabolize alcohol the same way or as efficiently as they could when younger, so alcohol has a greater effect on reaction time and the integrative abilities for the senses, muscles and balance
For more information contact Senior Solutions at (954) 456-8984 or toll free at 1-800-213-3524
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