Photo: Shown above are Ursula Robitschek and her partner, Johann Moennich, who suffered a fall last year. (Tony Caldwell/Postmedia Network)
Part 1. Read Part 2 on High-Tech Ways to Stop Falls.
OTTAWA, Ontario--At age 90, Johann Moennich had been enjoying the warm May weather on his porch last year when he decided to head back into the house.
He stepped inside and looked over at his partner, Ursula Robitschek, 80, in what she recalls was a strange way. And then, with no other warning, Moennich fell back and hit the ground with a thud.
Robitschek picked up the phone to call 911, but Moennich, still conscious on the ground, told her not to bother. “I’m OK, don’t do that.”
Two days later, the retired barber began to wonder if he really was OK: He was stiff and his back was sore.
The couple went to the hospital where, like thousands of seniors in Ottawa, as well as across Canada and the United States every year, Moennich was examined in the emergency department after taking a fall.
A Downward Spiral
It is a common scenario, and one that can be the beginning of a downward health spiral for seniors. But the active nonagenarian, who survived a prisoner-of-war camp in his native Yugoslavia during the Second World War, was more fortunate than many.
He had no obvious injuries aside from bruising (although he was later diagnosed with a fractured vertebrate). But his fall and earlier dizzy spells raised flags among health professionals who
Rising Falls by the Numbers
Because the population is aging internationally, both the number of falls and the costs to treat those injuries are likely to rise, says the U.S. Centers for Disease Control and Prevention (CDC). How many people at what cost? Here are some facts:
800,000+ - U.S. patients hospitalized each year because of a fall injury — most often a hip fracture or head injury. In Canada, more than 250,000 seniors reported a fall-related injury in 2010.
$31B -- The U.S. fall-related cost to Medicare in 2015; $2B - the yearly cost to Canada.
2.8 million -- U.S. elders treated yearly in emergency departments for fall injuries.
95% - Hip fractures in seniors that result from a fall. And one-in-five seniors injured from a fall incur broken bones or a head injury.
$30,000+ -- Average U.S. hospital cost for a fall injury.
Over 25% -- Proportion of U.S. seniors who fall annually -- with less than half telling their doctor.
Free from the CDC: "Preventing Falls: A Guide to Implementing Effective Community-Based Fall Prevention Programs."
The relatively new clinic is one of a number of local programs and services developed and expanded in recent years in an attempt to slow what public health officials say is an often overlooked health crisis — falls among seniors.
Fall-related injuries are costly to individuals and society, but unlike, say, cancer or heart disease, they are something people seldom give much thought to until they are affected. And many people will be.
A fall precipitated singer Leonard Cohen’s death in November at age 82, according to his son.
Ottawa’s former mayor, Marion Dewar, died in in 2008, at age 80, after sustaining serious injuries in a fall.
Nearly one in three older Canadians fall every year. For many, that moment forever changes their lives. Ninety-five per cent of hip fractures among seniors are the result of a fall.
Some falls shorten a senior’s life, and others lead quickly to death. Older adults who are admitted to hospital after a fall are sometimes forced to linger in hospital beds while awaiting a more suitable level of care. Those who return home can become isolated and less active, afraid of another fall. Their health and quality of life often deteriorates and the health system bears the burden.
That is why there has been a growing focus on the issue international in recent years. Between 2005 and 2013, according to Canada’s Public Health Agency, fall-related injures among seniors increased from 49.4 to 58.8 per 1,000 people.
In Ottawa, Canada’s capital city, and the surrounding region, the concern is urgent. The area has among the highest rates of falls in the province of Ontario — 6,592 per 100,000 people over 65 in 2015-16 — a fact that both worries and baffles health officials who have been trying to understand the trend and reverse it. The number of seniors in the region is expected to increase from 16 percent to 21 percent of the population over the next decades, making the issue more urgent. But, despite a concerted effort, the numbers have not gone down.
A Falls Hotspot on Ice
What makes Ottawa and Eastern Ontario a hotspot for falls among older people? Is it the icy winter sidewalks? The way fall-related injuries are calculated? The concentration of elders living in seniors’ residences in the region?
There is no clear answer.
“We have tried to look at various reasons and there is no obvious cause as to why seniors would have higher rates of falls in Champlain than anywhere else,” said Chantale LeClerc, CEO of the Champlain Local Integrated Health Network (LHIN), which oversees health services in Ottawa and much of Eastern Ontario.
The reasons for falls can be complex — including balance issues, low blood pressure, drug interactions, unsafe footwear, tripping hazards and lack of physical activity — but a significant number of them are preventable. And the benefits of prevention are huge.
“A simple fall can set in motion a whole cascade of events that is detrimental to seniors and also to the health-care system,” LeClerc said.
The Champlain LHIN invests $1.5 million a year in programs, such as free fitness classes, fall clinics, community supports and home-visit programs aimed at reducing the rate of falls.
Balance and strength training classes, offered free to anyone over 65 in the region, are popular and usually have long waiting lists.
The LHIN has also developed an algorithm to help family physicians and others determine their patients’ fall risk.
LeClerc notes that the efforts are making a difference. Fall rates have stabilized in recent years. It will take time, she said, but interventions being put in place have worked elsewhere and will reduce fall rates here as well.
“It is a serious issue and that is why we are paying attention to it, investing some resources and trying to bring different partners together so we can collectively take this on.”
Private industry is paying attention to fall prevention as well. Alarm systems that alert call centers when a senior falls are a multimillion-dollar business in North America. In addition, researchers and startups across the continent are working on technology, some of it built into shoe insoles that can predict when a senior is at risk of falling.
“In the past, it was thought that falls were a normal part of aging,” said Suzanne Shaw, coordinator of the West End Integrated Falls Prevention Program, based at the Pinecrest-Queensway Community Health Centre. “They are not.”
In Moennich’s case, his fall came after some small strokes and dizzy spells. At the Civic hospital’s Falls Assessment and Streamlined Treatment Clinic, where he was referred from the emergency department, he saw a geriatrician, a physiotherapist and a nurse during a standard three-hour assessment.
Among other things, his gait, balance, blood pressure and muscle strength were assessed. The number and combination of drugs he takes were looked at. And, like all patients who go through the clinic, Moennich was sent home with a falls-prevention exercise program and recommendations about wearing safe, stable footwear and getting rid of fall risks in the home.
Moennich follows the exercise program, which includes practicing standing up slowly to avoid low-blood pressure related dizziness.
The clinic cannot realistically prevent all subsequent falls, said geriatrician Shirley Huang, MD, but it aims to identify risk factors and to mitigate them.
At the West End Falls Prevention Program, run out of Pinecrest-Queensway Community Health Centre, patients who have fallen are visited at their homes over a period of weeks by teams that include an occupational therapist, a nurse and a physiotherapist. The patients are then followed up at three months, six moths and a year to see if they had a subsequent fall.
Most of the patients had no further falls during the year they were part of the program, said coordinator Suzanne Shaw.
The programs to help prevent falls are popular and demand already outweighs services, but those who work with seniors to prevent falls believe the message is getting across.
The key is to reach people before they become elderly and at risk. “We are trying to get upstream as much as we can with messages about exercise and strength, and not just to seniors,” said Caroline Desrochers, director of primary health care services at Pinecrest-Queensway Community Health Centre.
Moennich and his partner, Robitschek, meanwhile, have a new respect for the risk of falls and how to prevent them. Almost a year after his incident, Moennich remains fall free.
This is the first of two articles by The Ottawa Citizen’s Elizabeth Payne, who wrote the series with support from the Journalists in Aging Fellowships, a program of New American Media, The Gerontological Society of America and the Silver Century Foundation.