With Incidents Increasing, What's Being Done to Prevent Senior Falls?

With Incidents Increasing, What's Being Done to Prevent Senior Falls?

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Photo: Regular exercise is essential for preventing falls. (National Council on Aging Falls Prevention Resource Center)

Judith Fredman fell in her classroom.

The now-retired Spanish and French teacher was talking with students 10 years ago when she caught her foot under her desk, tumbled and fractured her hip.

"I could actually hear the hip crack," Fredman, 77, recalled. "I knew I needed something more than masking tape and Krazy Glue."

After surgery, Fredman spent the next six weeks in a rehabilitation nursing home, followed by intensive physical therapy and further operations. Her husband installed banisters on their stairways and grab rails and nonskid tiles in their bathroom.

Fear of Falling

But the Millburn, N.J., resident said something else has lingered longer than the pain and medical bills.

"Now I have a fear of falling," she admitted. "If I go down even two stairs, I absolutely need a banister. I am always afraid of losing my balance. It's something in my head that just won't go away."

Fredman has made adjustments. "My husband's or son's arm is always there, and I take a balance class and work on my bone strength. Good balance is an absolute gift."

Fredman is not alone. In spite of growing recognition of the problem, fall rates are rising.
And never before has there been such a concerted effort to prevent those falls.

One-third of seniors over 65 fall each year, causing more than 2.5 million injuries treated in ERs, leading to 734,000 hospitalizations and more than 30,200 deaths, with an annual price tag exceeding $40 billion, which is expected to rise to $60 billion by 2020, according to the U.S. Centers for Disease Control and Prevention. The CDC predicted a quadrupling of annual deaths from falls by 2030, to exceed 100,000 if nothing is done to improve prevention.

This is why unprecedented research into falls and prevention programs is underway.

Kathleen Cameron, senior director of the National Falls Prevention Resource Center [http://tinyurl.com/hhc5z8a] at the National Council on Aging, said she is seeing greater resources and attention paid to falls. Cameron said the U.S. Health Department's Administration for Community Living and the Affordable Care Act are financing fall prevention programs along with state public health agencies.

Huge Taxpayer Burden

"People are hearing more about it because of new money going to it," she explained, citing last year's White House Summit on Fall Prevention and the annual Falls Prevention Day. She said the CDC is promoting a program to encourage health care providers to initiate fall risk assessments and interventions. Forty states have fall prevention coalitions. Cameron said nearly 80 percent of the costs of falls among seniors are paid by Medicare, shouldered by taxpayers.

"It's a huge burden for taxpayers and older adults, with the potential for broken bones and traumatic brain injury, as well as the loss of independence and out-of-pocket costs," she said. "The older adult population is increasing as the baby boomer generation turns 65. And many older adults also have multiple chronic conditions (diabetes, heart disease, chronic heart failure), which put them at greater risk of falls. Many take multiple medications, some of which cause dizziness and can lead to falls. And many older adults tend to be more sedentary, with weak balance and strength."

She said many physicians don't screen their patients for fall risks or ask if they've fallen recently. She said the most difficult obstacle is the widespread belief that falls are a normal part of aging and cannot be prevented.

"We can't stop all falls," Cameron conceded. "But we can greatly reduce the rate and severity of falls."
Thomas Gill, MD, professor at the Yale School of Medicine, is a leader in a clinical trial at 10 sites around the country to test whether interventions can reduce the risk of fall injuries among high-risk older populations. He said the work is based on research by his colleague Mary Tinetti, PhD, a MacArthur Foundation "genius" fellow and fall-research pioneer who developed effective programs to prevent falls.

"Falls are a complex geriatric condition that arises because of a confluence of different factors, ranging from visual impairment and balance disorders to medication use that may impair cognition or lower blood pressure," Gill explained.

He said footwear choice and home environment, such as lighting, floor and bathroom surfaces, also contribute. In the study, a nurse fall care manager identifies home and lifestyle risk factors and prioritizes and addresses them.

"This is not a one-size-fits-all approach but is tailored to the specific needs of older persons," Gill said.

Implementing Preventive Knowledge

Helen Lach, professor at the Saint Louis University School of Nursing, said that, since the 1980s, researchers have studied and explored the causes and risk factors of falling and have determined which interventions work.

"We know more about what to do, but we're not implementing those practices as much as we need to," Lach said.

She said more focus should be on educating insurance plans to pay for proven, evidence-backed programs.

"There is a return on investment for providing some of these fall prevention programs."

She said one barrier facing seniors who have fallen is the fear of falling.

"Many are worried to bring it up for fear of losing their independence, that they might have to move or end up in a nursing home," she said. "So providers may not ask and patients won't tell."

Jean Wyman, a professor of nursing at the University of Minnesota, said she's seen growing attention to falls from academic and government researchers.

"This is the first time we've seen such a widespread national effort," Wyman said. "But we're a long way from solving this issue."

Jon Pynoos, a professor at the University of Southern California Leonard Davis School of Gerontology and codirector of the Fall Prevention Center of Excellence in Los Angeles, said that if there is one message recent research conveys it is this: Many falls are preventable.

Pynoos said researchers have learned that exercise programs, including tai chi, can improve balance. He said homes are full of hazards that people don't recognize but can change.

"Throw rugs that are not secured are falls waiting to happen. Grab bars in bathrooms can keep someone from slipping. These are low-cost changes. There are simple things people can do in their own homes, which is where older people tend to spend most of their time."

Pynoos recommended that seniors and their families do quick exams of their homes and look for hazards and fix them. He also said pharmacists need to look for drug interactions that induce drowsiness and dizziness. State and local public health officials can also prioritize falls and prevention programs."

Prevention and Brittle Bones

Sally Fullman has made fall prevention her life's work. Fullman, 74, A former college professor and retired sales rep, she learned she had osteoporosis 12 years ago after an ankle sprain and minor fall. She began to study her condition and later volunteered as an educator to teach balance and fall prevention classes with the National Osteoporosis Foundation.

Fullman fell again while swimming at the Jersey Shore six years ago, fracturing her tibia and suffering multiple hairline fractures.

"There was a lot of pain, and a whirlwind of depression swept over me," she recalled.

"I couldn't walk or exercise or go grocery shopping. I had to depend on others to take a shower or do my laundry. I was totally immobilized," Fullman said.

She said neighbors and friends helped her through that malaise.

"I developed this overwhelming sense of compassion for people who live in chronic pain alone without help," said Fullman, a widow. "I've learned just how much a fall can completely change your life. So it's really important to do what you can to prevent falls."

Mark Taylor wrote this article for the Chicago Tribune and Tribune Media Services with support from the Journalists in Aging Fellows Program, jointly run by New America Media and The Gerontological Society of America, with support from The Retirement Research Foundation.


 

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