Catching Seniors Before They Fall

By Jane Gross
nytimes.com

Your elderly mother
just told you she fell
in the bathroom
last night at 4 A.M.
Now what?

This chilling bit of street poetry now hangs in bus shelters throughout New York City, part of a new advertising campaign by the Visiting Nurse Service of New York. Scary? You bet.
But not unrealistic.

While a slip on the kitchen floor may not have the “jarring drama of a diagnosis of cancer or Alzheimer’s Disease,” as the newsletter Aging Today recently noted, “the consequences can be devastating.” Fortunately, researchers finally are figuring out why falls happen and, better yet, how to prevent them. The findings could mitigate what has been an underappreciated cause of disability and death in the elderly.

Falls are the leading cause of injury among Americans over age 65, according to the federal Centers for Disease Control and Prevention. Each year, nearly one-third of older adults experience a fall, and 20 to 30 percent of them wind up with moderate to severe injuries, ranging from broken teeth to broken hips. In 2005, the C.D.C. reports, 1.8 million elderly patients were treated in emergency rooms for non-fatal falls, and 15,800 died of their injuries.

Some 20 to 40 percent of those suffering a hip fracture will die within a year, researchers estimate, but even lesser injuries can precipitate a cascade of medical problems, the onset of severe disability, and the end of independent living and the beginning of round-the clock care.

This spiral is tragic for the elderly patient, devastating for the family and expensive for the federal Medicare program. In 2000, falls cost more than $19 billion overall, the C.D.C. estimates, with $12 billion going to hospitalizations, $4 billion to emergency room visits and $3 billion to outpatient care. By the year 2020, The Centers for Medicare and Medicaid Services projects, the annual price tag for care related to falls among seniors will more than double to $43.8 billion.

Experts say that a third of these falls are avoidable, and efforts are afoot all over the country to design prevention programs. One of the most rigorous, and closely watched, is in progress in Southern California, where four organizations — the University of Southern California, the federal Veteran’s Administration, the University of California, Los Angeles and California State University, Fullerton — have joined forces to create and evaluate model fall prevention programs that could be replicated at reasonable cost in community settings like senior centers.

What the experts do know is that effective fall prevention requires three elements, which the Southern California research consortium is attempting to evaluate more closely: a physical examination and risk assessment conducted by a doctor or other medical professional, a progressive exercise regime implemented by a physical therapist, and an analysis and remediation of potential hazards in the home conducted by an occupational therapist.

The medical exam is designed to check risk factors like poor vision, overmedication, muscle weakness, gait or balance problems, and a history of earlier falls. The exercise piece aims to improve muscle strength and endurance in the legs, hips and trunk, which affect postural alignment and stability while walking. Home modification may include grab bars in the bathroom, handrails or ramps near stairways, wider doorways for walkers or wheelchairs, and the removal of stray power cords or throw rugs.

As co-director Jon Pynoos explained in an interview, the cooperative research project is taking a hard look at various medical, exercise and home modification techniques at six senior centers in Orange County and Los Angeles County. At each site, the three standard preventive measures are being offered at different levels of intensity (and thus cost). For the medical assessment, for instance, one group of seniors is seen by a doctor or nurse practitioner, another group by a public health nurse, while a third group is educated in calculating their own risks and given a referral if necessary. The ongoing clinical trial is 18 months from completion, Mr. Pynoos said, and will determine which level of intensity in each of the three areas is sufficient to have an impact on the incidence of falls.

Source:
http://newoldage.blogs.nytimes.com/2008/09/11/catching-seniors-before-they-fall/

Some resources are listed below, as well as links to articles in the special issue of the newsletter “Aging Today,” dedicated to preventing falls.

A video called “The Good News on Fall Prevention,” from Seattle Pacific University.

A list of medications that can increase the risk of falls (PDF), from the University of North Carolina.

Data, fact sheets and prevention suggestions, from the Centers for Disease Control and Prevention.

“10 Questions to Ask Your Parent About a Fall” and other checklists from Caring.com. The commercial Web site also offers a calculator for assessing your risk of a broken hip plus short essays on “universal design,’’ expert blogs, quick tips for caregivers and the like.

From “Aging Today,” an article about the federal Safety for Seniors Act, another article about fall prevention (PDF), and a third about the Fall Prevention Center for Excellence, the Southern California group featured in my earlier post.

A list of products, catalogs, publications and many other resources from Fall Prevention Advisors, a New Jersey company run by two physical therapists.

Various fall prevention tools from the Home Safety Council.

And more checklists and information on universal design and so-called aging in place from AARP.

This is an incomplete and somewhat arbitrary selection — although each Web site will direct you to others, as will many of the resource links on the home page of The New Old Age.

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