Why Seniors Fall and How to Prevent It

Fran Jensen doesn’t remember everything about the fall she suffered in her Antioch backyard last year.

Jensen, 73, was trying to remove something from her pool when she knelt like she’d done so many times before and leaned forward. When it was time to stand, Jensen, who has arthritis in both knees, realized she couldn’t do it. She was stuck. For support, she tried reaching for the nearby retaining wall. Instead, she slipped, and her head slammed on the cement.

“I just lay there and started to hurt,” Jensen recalls. Dizzy, scraped up and bleeding, she adjusted her crushed eyeglasses and crawled to the diving board, using her arms to stand up and limp into the house to call her daughter for help.

“I guess I didn’t realize how weak I’d become,” Jensen says.

She is not alone. Each year, one in three adults 65 and older falls due to lack of balance and strength, poor eye sight and other reasons, according to the Centers for Disease Control. Falls can cause moderate to severe injuries, from lacerations and bone fractures to head trauma, and increase the risk of early death. Among older adults, falls are the most common cause of hospital admission — 2.3 million in 2010 — and the leading cause of death from injury.

Fortunately, falls are largely preventable. Free fall-prevention programs such a those at Kaiser Permanente and Alta Bates Medical Center have cropped up to help older adults assess the safety of their homes and increase balance and mobility with basic strengthening exercises, such as arm curls, leg lifts and neck rolls.

Sometimes, just removing a throw rug or installing a hand rail can greatly reduce the risk of falling, says Gennifer Mountain, program director for Walnut Creek’s Meals on Wheels and Senior Outreach Services, which launched its fall-prevention program in 2008. It has served 650 seniors in Contra Costa County.

“I don’t think it’s far-fetched to call elderly falls an epidemic,” says Mountain, who sends occupational therapists to seniors’ homes to assess and remedy risks, such as uneven floor surfaces. Eighty-two percent of participants lowered their risk of falling as demonstrated by before-and-after assessments. “In a few decades, we’re going to have double the number of 65-year-olds. We need to get people stronger, leaving the house and increasing their confidence in daily activities.”

Prevention is particularly critical among the frail and elderly, because a fall can often be the precipitating event for a downward spiral in their health and independence, explains Chris Rose-Frank, a geriatric care manager with Walnut Creek’s Eldercare Services.

“As a person ages, their physiology changes, and their ability

Rosita Gobbell, shows Blackie Blackwell, 87, of Concord leg lift exercises he can do to improve his strength and balance at the Meals on Wheels and Senior Outreach Services in Walnut Creek, Calif., on Monday, July 15, 2013. (Susan Tripp Pollard/Bay Area News Group)

to rebound is less successful,” says Rose-Frank, who has worked in physical therapy for 20 years. “Particularly if people are living alone, deconditioning or blood pressure or balance deficiency can be a major problem.”

If you take common medications, such as blood thinners, you are at even greater risk of serious injury or even death, explains Chris Bandy, trauma medical director of Kaiser Permanente’s Vacaville Medical Center.

“If you’re 25, and you bump your head, you have a bruise on your scalp and you get up and walk away,” Bandy says. “With a senior on blood thinners, they may not be able to form the clot necessary to keep the blood from (flowing). So the medication can work against them.”

That’s why a close relationship between geriatric patients and their primary doctors is critical.

“Even healthy, active seniors need regular eye exams and bone density screenings,” Bandy says. “We have a unique elderly population in California. I just had a 70-year-old bungee jumper in the ER with a busted rib. But, no matter what fountain of youth you drink from, you need to accept that you are going to heal from an injury slower and harder at 85 than you did at 25. Just recognize that and talk to your doctor.”

Unfortunately, fewer than half of older adults who fall actually report it to their health care providers. According to the CDC’s research, many people who fall, even if they are not injured, develop a fear of falling. This fear may cause them to limit their activities, which leads to reduced mobility and loss of physical fitness. In turn, that increases their actual risk of falling.

“People aren’t willing to talk to their doctors about their falls because they’re afraid of what might happen, like losing independence,” explains Sue Elderkain, clinic coordinator of outpatient rehabilitation for Alta Bates Summit Medical Center in Oakland, which runs a fall-prevention program that has helped 400 seniors. “They don’t want anyone to know. They may even minimize their injuries, like, ‘Oh, it was just a little fall.’ “

However, the No. 1 predictor of falling is having fallen, Elderkain says, so it is important to assuage their fears. “We let them know we’re not going to take anything away,” she says. “We explain that this is about strengthening them and their lives. It really helps build their confidence.”

Jensen, of Antioch, got help through Mountain’s in-home exercise and strength-building program. For 10 weeks, two Cal State University East Bay nursing students came to Jensen’s home Monday mornings and led her through a series of seated exercises, including shoulder presses and ankle rolls. They installed a chair in her shower, moved kitchen appliances to lower cupboards, and put medications in a pill box by her favorite chair.

“They were magnificent,” Jensen says. “I’m a lot stronger now.” She liked the regimen so much, she keeps the same appointment, 10:30 every Monday morning, to do her exercises by herself.

Falls prevention programs

Dozens of agencies in the Bay Area provide fall prevention programs. Here are a few that are free and open to the public:

Meals on Wheels and Senior Outreach Services. Serves Contra Costa County with classes, literature, and in-home exercise and strength-building programs. www.mowsos.org/programs/fall-prevention. 925-937-8311.
Senior Injury Prevention Program. The Alameda County Public Health Department offers free discussion groups on senior fall prevention. To join or organize a discussion group, contact Colleen Campbell at 510-577-3535 or go towww.acphd.org/media/151590/falls_prev_discussion_groups.pdf.
Silicon Valley Healthy Aging Partnership. Serves Santa Clara County through dozens of agencies, including Matter of Balance, which offers eight-week classes with a certified trainer at multiple locations in San Jose.www.svhap.org/evidence-based-programs/falls-prevention-program.


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