Cures for the Common Fall – Preventing Falls
Monday, November 17, 2008 6:33 AM EST
By Sandi Kahn Shelton, Register Staff
Dorothy Baker has a silver high heel perched on the shelf above her desk at Yale. It’s more a cautionary high heel than something someone would ever wear. In fact, she takes it along sometimes when she talks about the dangers of falling.
Baker is a research scientist, you see, and is the director of a new statewide effort to prevent falls. It turns out that Connecticut’s most common and costly injuries are due to falling — and, she says, research has shown that many falls are perfectly preventable.
“It’s never too early to start thinking about getting rid of some risky behaviors that cause falls, and that’s where the high heel comes in,” says Baker, who started studying falls back in the 1990s, when she was part of a multidisciplinary study that included Dr. Mary Tinetti, a professor of medicine; Margaret Gottschalk, a physical therapist; Denise Acampora, a public health researcher; and Luann Bianco, a research associate in internal medicine and geriatrics.
Mention “fall prevention” to most people and they automatically think, “Get rid of the scatter rugs and put the electrical cords out of sight,” according to Baker.
But the truth is that, although the environment does cause some falls, there are plenty of reasons for people’s falls, and those reasons tend to multiply with age. As people get older, they often don’t realize that their abilities are diminishing over time.
“They can’t do things mindlessly, assuming their bodies can run on autopilot the way they used to,” says Baker. “An older person coming up the steps of the house, with her purse on her shoulder, groceries in her arm, and then the screen door bangs, and she’s leaning forward to turn the key, and maybe she has to go to the bathroom so her knees are together — she has the potential to be knocked off balance very easily.”
And as people become more sedentary, Baker explains, they stop doing the very things that help them maintain strength and balance and reflexes.
“It’s easy to start a movement that then you can’t stop. You lean forward to put a piece of toast in the toaster, thinking you can stop that movement when you get to the right point, but then you pitch forward because you don’t have the strength anymore to pull back.”
Another problem, she says, is that older adults are at a high risk for being overmedicated. “We don’t advocate anyone stop taking medications, of course, but it can help to sit down with their health care provider and discuss what prescriptions they’re using and the ways these might be interacting, and if there’s any other way other than taking a pill,” she says.
Research has shown that Medicare patients take an average of five medications daily, which can cause potent interactions that might interfere with balance and coordination.
In a recent study, performed in the Hartford area, Baker’s group discovered that in two years of providing intervention to prevent falls through a multi-prong approach, serious injuries were reduced by 9 percent, and in that two-year period alone, there were 1,800 fewer hospital admissions, saving Medicare $21 million. Because of the success of that study, Baker now has a grant to take this information statewide. She’s working with senior citizens’ groups, churches, synagogues, visiting nurse associations, senior centers — anywhere that older adults might go and could hear the message that falls can be prevented.
What can help prevent falls? Baker’s group advocates a multidisciplinary approach.
– Exercise! “Do balancing exercises. Concentrate on your posture, and on not being sedentary. If you sit around like a question mark all day, you’re not going to look like an exclamation mark when you stand up,” she says.
– Get your eyes checked. There is some data that multi-focal lenses can be a problem, so make sure with your doctor that you’re able to focus. If you have cataracts, get them fixed.
– Take care of your feet. Don’t squeeze them into tight shoes anymore. “That high heel wedges your toes into a space meant for a goat or a deer, not a human foot,” says Baker, “and not only does it cut off the circulation, it reduces the area of your foot that is touching the ground and which aids you in balancing.”
– Clean your ears! Accumulated ear wax can affect your balance.
– Don’t move around when you’re confused. Wait until you’re oriented before you get up at night. And get a night light to help you find your way to the bathroom.
– Get your blood pressure checked, in both the standing and the prone positions. It’s important to see how it can change from those positions.
– Drink water. “Older people sometimes stop drinking enough water because they don’t want to go to the bathroom so often, but dehydration is a real problem,” says Baker.
– Practice balancing on one leg for a few seconds at a time. If you can’t balance, you’re at risk of tripping even just by doing regular walking.
– Practice getting up from the ground. “We’ve found that when people do fall, if they can get themselves up, they recover much better,” says Baker. “Sometimes they feel that they should just stay put and wait to be found, but this can cause many other health problems.”
– Above all, let people know your situation. Many older people feel that if they start talking about falling, their caregivers will feel they need to go to a nursing home. “But with prevention, so many falls can be prevented,” says Baker. “And it’s never too early to start thinking about this.”
For more information, go to www.fallprevention.org.
If you have questions about a fall in a nursing home or other care facility and believe it would have been preventable with proper care contact Elder Abuse and Neglect Attorney Kenneth LaBore at 612-743-9048 or by email at KLaBore@MNnursinghomeneglect.com