Serious falls put seniors at risk
Senior fall rehabilitation
Chuck Clifford came to lying flat on his back on an icy sidewalk, motionless and unable to move his limbs. The life of the Angie’s List member in Mundelein, Ill., changed with a single, fateful slip during a 2008 ice storm that fractured his neck and came within about a millimeter of completely severing his spinal cord.
Now 70, the retired car dealership owner credits Dr. Jack Perlmutter at highly rated Lake Cook Orthopedic Associates in nearby Barrington, Ill., for helping him get as much of his life back as possible. The highly rated orthopedic doctor performed back and neck surgery on Clifford and still sees him for pain management. “I can’t say enough good things about him,” says Clifford, who after intensive physical therapy can now walk short distances with a cane or walker.
Falls pose serious risk for older adults
A serious slip can result in everything from a hip fracture to traumatic brain injury that can change the course of an older adult’s life — and shorten it, especially without proper treatment and rehabilitation. One-third of adults 65 and older fall each year, the CDC reports, and in that same age group, falls are the leading cause of death from injury. Over the past decade, the rate of fall deaths per 100,000 adults age 65 and older nearly doubled while injuries rose 25 percent, according to the latest CDC figures released last year.
However, health professionals involved in fall recovery and prevention, from geriatricians to physical and occupational therapists, emphasize seniors shouldn’t view these incidents as foregone conclusions. “Falls are preventable. Many people think it’s an inevitable part of aging and it doesn’t have to be,” says Dr. Judy Stevens, a senior epidemiologist and expert on older adult falls at the CDC. Prevention ranges from exercises to improve balance and strength to making changes in the home, such as removing throw rugs or adding grab bars in the shower.
Still, experts acknowledge as the population ages, a host of factors raise the risk of a catastrophic fall in older Americans, from an increase in seniors living at home alone to arthritic joints, diminished eyesight and medication side effects such as dizziness or drowsiness. The CDC says 21,649 seniors died from falls in 2010, and estimates emergency departments treated 2.4 million fall injuries in 2011. “People are living longer and they’re living with more chronic conditions than in the past,” Stevens says. “We have an older, frailer population.”
Medical conditions can increase the likelihood of falling
Diabetes, for example, can cause nerve damage, or a condition called peripheral neuropathy, says Dr. Elizabeth Phelan, director of the Fall Prevention Clinic at highly rated Harborview Medical Center in Seattle. “People can no longer feel their feet,” she says, increasing the likelihood of a fall. In addition, a drop in blood pressure from medical conditions can cause lightheadedness, dizziness and falls, Phelan says.
Dr. Steven Castle, clinical director of geriatrics at highly rated VA Greater Los Angeles, believes the growing number of seniors living at home alone may also play a role. “There’s not someone to help and support them,” says Castle, who serves in an advisory role with the Fall Prevention Center of Excellence in Los Angeles. The center develops and improves fall prevention programs for seniors, their families and health professionals.
However, those who choose to age in place don’t have to face health challenges alone. Recovery for Clifford and many other fall victims includes in-home care, and typically involves physical therapy and exercise to regain firm footing. But results don’t come quickly or easily. “We know that at least 50 hours of supervised, progressive balance training is needed to reduce falls,” says Debbie Rose, a physical therapist and co-director of the Fall Prevention Center of Excellence.
Following back and neck surgery after his fall, Clifford underwent two years of physical therapy to strengthen his back and legs and improve balance at The Rehabilitation Institute of Chicago, a highly rated, nationally renowned specialty hospital. “At times, it was very rigorous,” he says, but it allowed him to regain limited use of his legs and arms despite persistent nerve damage. Between in-home care and doctor visits, he estimates his health bill runs about $7,000 per month, nearly all covered by insurance. “It’s a big change for me because I was very active before [the fall] both in family and business,” Clifford says.
Those who fall face higher risk
Rose and other clinicians note that seniors who fall find themselves at higher risk for subsequent falls, especially when injuries occur that can weaken their body or prevent them from staying active. She’s developed a balance and mobility training program called Fallproof! offered to seniors at the Center for Successful Aging at California State University, Fullerton, and used by therapists elsewhere. The program teaches clients to make prudent decisions, such as inquiring about medication side effects and understanding physical limitations. “It’s predominantly an exercise-based program that has a strong behavioral change component to it,” Rose says. Therapists also recommend exercises like tai chi that can improve balance and strengthen legs.
Penny Leisch, 60, closely follows advice to exercise and strengthen muscles in her legs and improve balance, and now treads with special care when she’s out walking. In 2010, she slipped on mud, which caused whiplash and left her dizzy and reeling from headaches. “It was just like watching a cartoon, everything went straight out from under me and I dropped like a rock,” she recalls.
In the years since, she’s undergone rehab, including with highly rated physical therapist Carolyn Antilley at St. David’s Urgent Care and Physical Therapy in Pflugerville, Texas. Massage eased muscle tension, and she says therapy greatly reduced her neck pain and headaches. Leisch paid $112 for four recent sessions with Antilley; insurance covered the balance, at a negotiated rate of $1,010. Recovery and prevention didn’t stop at the clinic, either. “We talked about how we could make the home safer,” says Leisch, who had grab bars installed in her shower and uses night-lights around the house.
Fear of falling makes some less active
Despite her arthritis, and lingering nerve damage from the fall, Leisch says she maintains her active lifestyle. That’s important, say experts, because fear of falling makes some seniors less active. “This activity restriction leads to muscle weakness, which leads to a higher likelihood of falling,” says Stevens of the CDC. Add to that quality of life issues, such as social isolation and depression, providers say, and the impact of fear alone can prove as debilitating as a serious fall.
Depending on an individual’s fall risk, some clinicians like Castle, an adviser with the Fall Prevention Center, recommend considering a medical alert system to provide an additional safety net. Bryan Stapp, president of highy rated Medical Care Alert based in Novi, Mich., says his national company’s alarm system gives seniors who are more likely to fall the assurance of help. By pushing the button on a necklace, wristband or clip-on, they’re put in contact with an operator who can call their emergency contacts or paramedics. The system starts at $90 per quarter.
Harold Spriesterbach, an Angie’s List member in Las Vegas, says he bought the alert system for himself and his wife, Frances, 66, after she fell and broke her ankle in their backyard. “My granddaughter finally heard her ... after a half an hour of her yelling,” says the 68-year-old. “I never want her to be in a situation like that again.”
Talk to your doctor about incidents and risks
While alarm systems are a good backup, experts say often seniors don’t take prevention seriously, and fail to tell their provider when they fall. If an older adult has fallen recently or feels unsteady on their feet, they should speak with a doctor, says Phelan of Seattle’s Harborview. A doctor should assess future fall risk, by looking at balance, health history and other factors, she adds.
Susan Pullman, an occupational therapist at highly rated Moorestown Visiting Nurse Association in Moorestown, N.J., goes into mostly older patients’ homes to provide care and instruction to those aging in place with chronic conditions and other health concerns. Along with advising caregivers, she assesses patients for fall risk. In encouraging prevention strategies — whether how to fry an egg while using a walker or placing a non-skid mat in the bathroom — she focuses her education efforts on what they can do for themselves and improving safety, not gloom and doom scenarios.
“When you have a positive end result, that is it’s own reinforcement,” Pullman says. “By preventing falls and injuries you’re looking at keeping people more functional ... and out of the hospital,” she says.