An older adult falls every second of every day, according to the Centers for Disease Control and Prevention, but less than half of them tell their doctor.
Even more alarming, says Laura Cahill, a certified geriatric specialist and physical therapist at Billings Clinic, is that every 20 minutes, an older adult dies from a fall.
“Falling is not a normal process of aging,” Cahill said. “Usually it happens because of mobility, physiological changes or barriers in the home. But it’s not something we’re supposed to do.”
Dr. Barry McKenzie, a trauma surgeon at St. Vincent Healthcare, said a lot of ground-level falls result in “surprisingly significant injuries.” They include extremity fractures, pelvic fractures and brain injuries requiring surgery.
“The other part of that is the elderly population, as far as recovery from even a minor injury, they have less muscle mass, poor balance, all those things needed to recover,” he said.
Keeping seniors from falling is the bottom line, said Eric Fisher, a trauma educator who works in injury prevention at St. Vincent.
“My goal is to prevent those people from ever getting here because once a fall happens, the damage is done,” he said. “Prevention is the key for this.”
Part of Cahill’s job at Billings Clinic is assessing patients to figure out why they’re falling, or what puts them at risk for falls. The number of patients she sees has gone up, in part because Medicare now requires physicians to ask patients whether they’ve fallen. If they have, they must be given an action plan, she said.
There are some definite steps people can take to decrease their risk of falling, she said. Getting an annual vision exam “is a huge piece for balance.” Another one is checking with a pharmacist about the medications they take.
“Some medications definitely put people more at risk to fall due to confusion or dizziness or blood pressure changes,” she said.
People with diabetes may suffer from neuropathy, which can decrease the sense of touch in their feet and make them vulnerable to falling. People who spend much of their day sitting and inactive also can lose a significant amount of muscle mass, Cahill said.
When a patient is referred to Cahill for a 45-minute assessment, she takes them through a number of tests to evaluate their strength and balance. For instance, during a 30-second chair stand, a patient sits in a straight-back chair with no arm rests and comes to a full stand as many times as possible in 30 seconds. A woman aged 65 to 69 who completes the movement less than 11 times in 30 seconds is at risk for falling.
At home there’s another tell-tale sign for someone at risk.
“Even something as simple as if somebody gets out of their chair and has to use their arms to get up, they can be at risk for a fall,” she said.
Cahill has them walk, while she looks for any deficits. A limp could indicate weakness on one side, or maybe it’s a sign of pain.
She studies their spatial orientation to see if they have difficulty staying on track when they walk. Cahill looks at their feet, saying if they’re flat-footed, for instance, they may need orthotics.
“I feel like our job is to look at the whole person to see where deficits are as far as balance and control,” Cahill said.
Treatment sessions, typically six or eight per person, last 30 minutes. Cahill will also assign homework, asking patients to continue balance exercises at home.
“A huge part of therapy is linking it to function,” she said. “We break down functional tasks, and see where they’re at risk to fall.”
She will have them practice something as simple as walking and picking an object up off the ground, noting where the potential for falling comes in that movement.
When it comes to prevention, one way Fisher at St. Vincent helps seniors is by teaching a class called “Stepping On.” It will be offered again in April.
At the start of the multi-week program, most participants will say that at some point in the past six months, they have taken a fall, no matter whether they were injured.
“They all say the same thing,” Fisher said. “If they weren’t injured, they experience a fear or lack of confidence in being outside of their home, doing a lot of things they’d previously done, walking or exercising.”
The biggest thing, he said, is not to let a fear of falling prevent you for doing what you want. The way to get past that fear, Fisher said, is to examine the situation where the fall occurred and look for the specific reason it happened.
Then begin to practice the movement, slowly at first, until you feel confident doing it with ease.
The goal of the class is to boost their strength and balance, as well as their confidence, he said.
He’ll bring in a pharmacist to talk about medications. People on blood thinners can be at special risk when they fall, he said, since internal bleeding can happen for a period of time without any symptoms.
A physical therapist will come in to show participants how to do exercises safely, and an eye expert will talk about vision.
“A lot of people have loss of vision or decreasing vision over time and may not be aware of how much it’s affecting them,” Fisher said.
So can wearing inappropriate footwear or loose-fitting clothing. A baggy bathrobe “is a big one,” he said.
Safe at home
He talks about how to make a home trip-free. Getting rid of area rugs is a start. Making sure walking pathways throughout the house are well-lit is crucial. So is learning how to work with pets.
“The benefits people get from pets, including exercise, outweigh the fall potential,” Fisher said. “We teach people how to work with pets to get outside. One of the big ones for dogs is putting on a leash.”
Handrails that attach with suction cups are very common because they’re easy to put up, he said. But they frequently fail, which can lead to a fall.
Instead, when an assistive device such as a handle in the shower is needed, have it installed.
“They’re inexpensive, they’re easy to place and they don’t detract from your home,” Fisher said.
Exercise is part of the program, since core strength and leg strength both are critical to maintaining balance. And in a town like Billings where ice and snow in winter can make the outdoors a dangerous place, Fisher suggests people consider using a cane, traction cleats or something else to assist with walking.
And sometimes it’s best to ask for help.
“Have someone shovel a path through your grass or maybe get a post office box so you don’t have to deal with the snow, or ask a neighbor,” Fisher said. “Utilize your resources, your family, your friends, your neighbors. There are people out there willing to help.”