Jane is taking care of the grandchildren today and truly has her hands full, particularly with her newly walking grandson moving at incredible speeds. While hurrying from one room to the other she trips on an errant toy falling sharply on her right side and fracturing her hip. Bill’s balance isn’t as good as it used to be and he just can’t seem to reach the paint on the top shelf. As he gets up on his tip toes to make himself a little taller, he tumbles off the step ladder suffering a severe head injury. Carolyn has been worried about her osteoporosis and all the advertisements that she sees on television juts add to her concerns. She knows she shouldn’t have all those small throw rugs in her house, but they go perfectly with her décor and she spent years collecting them. Then one day she slips on her favorite rug and falls square on her buttocks, causing a severe compression fracture in her spine.
LIFE IS AN OBSTACLE COURSE
Think for moment about all the close calls that we experience on a regular basis. Our environment is filled with obstacles that may or not undo us. Lawns are filled with rocks and uneven surfaces, while our homes provide a collection of lose throw rugs, misplaced furniture, poorly lighted paths to the bathroom and critical objects placed on shelves that are either too low or too high. We may briefly lose our balance throughout the day and most of us quickly compensate for these brief “balance lapses”, but for the elderly life is truly an obstacle course.
Our ability to respond to these daily health risks is dependent on having all of our “on board” balance systems up and running. Unfortunately, unlike the space shuttle, we don’t have two and three back-up systems. We need all of our systems to stay out of harm’s way and as we age our senses are no longer as keen as before.
- Our vision may be clouded by cataracts or deterioration of the retina, making it difficult to see toys on the floor.
- As our hearing fails we may not be warned by sounds in our environment.
- Numbness and loss of sensation in our feet becomes common when we close our eyes and lose our visual input. We may lose our balance when we close our eyes to shampoo our hair under the shower.
- When we arise quickly our blood vessels respond more slowly and blood drains from our head causing dizziness that may lead to a fall.
Pain, stiff joints and arthritis keep our joints from making the small corrective movements that prevent us from losing our balance.
MAJOR HEALTH RISK
Falls in the elderly are a major health risk factor and are one of the leading causes of disability in people over the age of 50. A winter ice storm in San Antonio causes a dramatic rise in the number of falls and broken hips. With those hip fractures come major life style changes, pain, disability, nursing home admissions and even deaths. Women, being more susceptible to osteoporosis are at a significantly greater risk for injury. Domestic falls can lead to head injuries, fractured hips, wrists, ribs or compression fractures of the spine. It is not just the injury itself that causes the problem, but the medical complications that arise from immobility and bed rest. Pneumonia, phlebitis and pulmonary emboli can all lead to death in the elderly.
FEAR OF FALLING
If the senses that prevent all of those close calls start to fail, we develop fear, fear of falling, and fear of injury. For the elderly falling is one of their greatest fears. The fear of falling decreases their ability to perform functional activities of daily living, but also inhibits social functioning independent of whether they have actually fallen. For the patient who is at risk for falling, simple shopping, reaching into a high or low cabinet and taking a shower can create a great deal of fear and anxiety. Older people find outdoor activities the most difficult. If Anne is afraid of falling, she will no longer risk the uneven surfaces of her garden or the curbs and “speed bumps” of her large urban grocery store. Take just a moment to think about the activities that we all take for granted that require intact senses and can lead to injury if all is not well:
- Dressing and undressing
- Bathing and showering
- Getting in and out of a chair or bed
- Answering the door or phone
- Light housekeeping
- Use of public transportation
- Crossing roads
- Using steps
We do all of those without a thought! But if we can’t, social isolation and depression may follow. Anne may no longer go with her healthy friends to eat out, the theater or community center- a victim of “fear of falling.”
There is help and there are things to do. We need to identify those people who are prone to falls at an early stage, before the fall occurs. A person doesn’t need to have already fallen to get our attention. Rehabilitation specialists can evaluate these individuals looking at their various risk factors. This would include:
- A detailed evaluation of their balance system
- Evaluation of the person’s activity level and environmental risks
- Address their fear of falling
- Examine their vision, hearing, and sensation
- Check their blood pressure for significant drops when standing or sitting
- Assess their pain and any joint restriction that may lead to immobility
Now that we have all the information that a person needs to be engaged in an active program to compensate for any physical problems.
It is time to walk through your home and make it as fall proof as possible:
- Get rid of all those loose throw rugs, no matter how much you like them.
- Put grab bars in the bath tub, shower and next to the commode.
- How slippery is your shower? Make sure the tiles or surface is non-skid and not just a rubber mat.
- Place a chair or stool in the closet or where you get dressed and undressed. Don’t try the balancing act of putting on a sock while standing on one foot.
- Put night lights throughout your entire house, for you never know where you might need to go in the middle of the night- bathroom or glass of water.
- Install railings next to the stairs in your garage or at the entries to your home.
- Buy lace up shoes and get rid of your slip-ons. Fashion doesn’t trump the risk of a broken hip!
An active exercise program has been proven to reduce the risk of falling as we age. That program should include:
- An active stretching program to reduce pain and increase flexibility and mobility
- Postural training to enhance balance and ambulation; body mechanics
- Endurance walking to increase overall endurance and strength
- Repetitive muscle coordination activities
- Education on safety hazards and general safety awareness
Finally, we need to teach “survival maneuvers.” Just like we teach CPR or the Heimlich maneuver to the general population we need to teach the elderly strategies on how to deal with falls. What do you do once you fall? What is the proper way to get off the floor, ascend and descend stairs, or reach into high and low cupboards? Falling and the fear of falling is a major health risk. Get help before you become one of the “fallen.”