3 Key Steps to Protect Against Falls -- and Prevent a "Cascade" of Health Problems
3 Key Steps to Protect Against Falls -- and Prevent a "Cascade" of Health Problems
As many of us in the role of caring for older family members have found out the hard way, a fall that leads to a broken hip or other fracture can set of a chain reaction of health problems that can leave a formerly strong and independent person weakened and frail. Thanks to the "cascade" effect, a fall can trigger a series of serious health problems, and often leads to death. The Centers for Disease Control reports that falls are the leading cause of injury deaths among older adults, as well as the most common cause of hospital admissions for trauma. So it's important to take steps to prevent falls, including these:
1. Prevent and Treat Osteoporosis. Making sure everyone's getting enough calcium and vitamin D is key here. Many older adults stop drinking milk, and don't realize that the lack of low fat dairy in their diets is sabotaging their intake of nutrients necessary for bone health. Vitamin D is particularly troublesome, since it's found primarily in fortified milk, and there are few other dietary sources. Many older folks stay inside more and get less sun exposure, so they end up with low vitamin D levels without knowing it. Find ways to sneak more calcium and other bone-building nutrients into your diet and see your doctor for a bone density test. Most experts recommend regular bone density tests after the age of 65, but if you're thin, eat a diet low in dairy, have a family history of osteoporosis, or have any other risk factors, ask for a bone density screening now.
2. Improve Strength and Balance with Exercise. Exercise classes designed with the safety, confidence, and special needs of older adults are springing up at community centers, gyms, senior centers, and elsewhere across the country. No matter where you live, it shouldn't be hard to find a gentle movement, dance, or yoga class designed with older bodies in mind. For example, the Arthritis Foundation offers a variety of classes through local chapters. Another option becoming more and more popular is Tai Chi, an ancient Chinese martial art, that's now offered through many health centers such as Kaiser Permanente facilities. Several studies have shown that Tai Chi improves balance and reduces the risk and the fear of falling among older adults. In one study, people between the ages of 70 and 92 who took Tai Chi three times a week for six months had a 55 percent lower risk of falling than a comparable group who didn't take classes.
3. Treat Balance Problems. When an older adult starts feeling dizzy and having balance problems, the culprit is often the inner ear. One recent study found that 35 percent of all older adults had balance problems caused by changes within the inner ear due to aging. And most of these are treatable. People who have BPPV (Benign paroxysmal positional vertigo), which accounts for about 20 percent of all cases of inner ear dizziness, swear by a new procedure called the Epley maneuver -- also called canalith repositioning procedure (CRP). BPPV is caused by a buildup of tiny calcium carbonate crystals in the inner ear, and the CRP effectively repositions the crystals.
Treatment for other types of inner ear dysfunction typically starts with specialized physical therapy called vestibular rehabilitation therapy. Working with a specialized therapist, you learn a series of exercises to retrain the brain to recognize and process signals from the inner ear.
There are also several medications that your doctor can prescribe, alone or in combination, to treat various types of inner ear problems. And as a last resort, there are also surgical options.
These aren't the only conditions that cause falling, of course. A number of other health issues, such as low blood pressure, can cause dizziness, balance problems, and weakness in older adults. Also, many medications have dizziness as a side effect, so it's important to be on the alert for medication side effects and errors. The bottom line: If you or someone you're caring for seems unstable or weak on their feet, don't hesitate to call the doctor and ask for a workup to determine what might be going on.
I am a physical therapist with over 20 years in long term care. The bulk of my case load deals with fall prevention. Here are some basic environmental tips-- 1. get rid of throw rugs 2. get rid of clutter--as we age, "less is more" 3. use night lights 4. consider a bedside commode for urgency during the night--people who hurry tend to fall 5. many older folks use 25 watt bulbs to save money--they already have compromised vision--low light can contribute to confusion about shadows/shapes on the floor, leading to falls 6. check shoes/slippers--if they fit poorly, they can contribute to a fall 7. avoid "lift chairs" and other aids that make life "easier"--they also make muscles weaker, eventually leading to a fall. All adaptive equipment should be evaluated for the individual person, not just used because it's available--consult a PT with experience in long term care 8. Strengthening the trunk and lower extremities is key--maintaining good range of motion is important--avoid sleeping with pillows under the knees--it leads to stiff knees and ankles. If anything, pillows are used under the calves, to keep pressure off the heels. For people who move freely, I'd stick to no pillows. I love working on fall prevention. Hope some of these tips are helpful! Sunshine
These are wonderful ideas! Thanks so much and i'll be sure to write about them in future posts. Really appreciate your feedback.
My mother has vascular dementia and possibly Alzheimer's disease, and when she fell and fractured her pelvis two years ago, the physical therapist at her rehab center suggested HipSavers--a girdle-like garment you wear under your pants, with three soft disc pads built in, one pad in the back over the tailbone and one on each hip. Mom has been wearing them since she recovered from her fracture, and though she's been found on the floor of her memory care facility a few times (she forgets to use her walker), she has had no more injuries. Some people object to wearing them, but in my mother's case she does not, as she forgets she has them on. If falling is a concern, and you want to avoid your loved one having to spend weeks or months in the hospital and rehab, I highly recommend HipSavers. They're fairly new, but you can find them online.
There are many missing pieces in fall prevention efforts. For example: A recent study published in the Journal of Clinical Nursing showed that 1 in 6 older people who lived at home were under-nourished and at risk of malnutrition. Low levels of certain minerals can cause dizziness and balance problems. Another report showed vitamin D helped reduce falls. It’s hard to get strength or balance if you lack the nutrients that help improve either problem. Another issue is how drugs deplete certain nutrients. This is an area that gets too little attention. A research report in the January 2009 Journal of American Geriatrics Society showed a lack of effect of Tai Chi had on preventing falls. Then there is another that says exercise is good. No doubt exercise is beneficial but it seems everyone needs to be properly assessed to make sure the benefits out weigh the risks. The CDC focuses on exercise and overlooks bed falls while statistics show it is an issue. The statistic below is from the CDC: Difficulty performing activities of daily living among Medicare beneficiaries, ages 65+: US, 2006 figures: Non-institutionalized Getting In/Out of Bed/Chair 11.9% Using Toilet 4.8% We have big gaps in getting important information out about falls causes. Too many programs rely on those who are not well informed about leading causes of falls and fall deaths or how to prevent them. According to the National Safety Council (nsc.org) falls from bed are the second leading cause of fall death after stairs and steps. Here is the web address for the quiz: http://nsc.org/resources/issues/falquiz.aspx Device safety in fall prevention programs are another area of concern where the focus is on cheap cost not safety or effectiveness. Too many devices are not used as intended while the recommenders don't know the intended use. We have a long way to go in fall prevention this includes educating the educators.