By JUDD MATSUNAGA, Esq.
I had a client in the office the other day who told me a very amusing story. She had been her husband’s primary caregiver for many years. She said, “At the beginning, I would assist my husband around the house. As he got weaker, I would be supporting more and more of his weight. Until one day, I couldn’t bear all his weight and we both fell.”
She exclaimed, “Daddy, Daddy, are you OK???” The husband looked up and said, “I don’t know, Mommy. When I touch my leg, it hurts. When I touch my back, it hurts. When I touch by neck, it hurts.” Wife calls the doctor, and the doctor says, “Doesn’t sound good. You better take him to the emergency room.” Turns out he tried to cushion the fall with his hand and broke his finger.
Although this is one of my favorite jokes, falls are no laughing matter — especially if you’re a senior citizen. According to the CDC website (www.cdc.gov), millions of people aged 65 and older fall each year. In fact, every second of every day, an older adult (age 65+) suffers a fall in the U.S. — making falls the leading cause of injury and injury death in this age group. Falls are a threat to the health of older adults and can reduce their ability to remain independent.
Although many falls do not cause injuries, one out of five falls causes a serious injury such as broken bones, e.g., like wrist, arm, ankle, and hip fractures. Falls can also cause head injuries. Each year, 3 million older people are treated in emergency departments for fall injuries, making falls a public health concern, particularly among the aging population.
Falls are the most common cause of traumatic brain injuries. These can be very serious, especially if the person is taking certain medicines (like blood thinners). An older person who falls and hits their head should see their doctor right away to make sure they don’t have a brain injury.
However, falls don’t have to be inevitable as you age. You can reduce your chance of falling or help a loved one prevent falls. How? After a fall, ask your doctor or healthcare provider to evaluate your risk for falling and talk with them about specific things you can do. Even if you’re pretty sure your loved one just tripped and stumbled, a good evaluation from your doctor can uncover issues that made those trips and stumbles more likely.
Less than half of the seniors who fall tell their doctor. However, falling once doubles your chances of falling again. Many people who fall, even if they’re not injured, become afraid of falling. This fear may cause a person to cut down on their everyday activities. When a person is less active, they become weaker and this increases their chances of falling.
THIS IS IMPORTANT! Busy doctors may not be thorough unless caregivers, i.e., you the family member, are proactive about asking questions. Most doctors have the best intentions, but all too often, a medical visit after a fall is mainly about addressing any injuries that the older person may have suffered. Studies have shown that older patients often don’t get recommended care.
If you want to help prevent future falls, it’s also important to make sure the doctors have checked on all the things that could have contributed to the fall. A fall can be a sign of a new and serious medical problem that needs treatment. By being politely proactive, you can make sure that certain things aren’t overlooked (such as medications that worsen balance).
To give you some idea as to what to ask the doctor to look at, here’s a list several key items that you can make sure the doctors check on after a fall. This list is based on the American Geriatrics Society’s Clinical Practice Guidelines on Preventing Falls. (Source: www.betterhealthwhileaging.net) Although not a complete list, the following will help you make sure your loved one has had a thorough work-up, and can reduce the chance of future serious falls.
(1) Medications review. The Centers for Disease Control recommends that older adults concerned about falls request a medication review. Many older adults are taking medications that increase fall risk. These medications can often be reduced, or even eliminated. Be sure to ask the doctor to address the following types of medications:
● Any sedatives, tranquilizers, or sleeping medications. Common examples include Zolpidem (Ambien) for sleep, or Lorazepam (Ativan) for anxiety. Antipsychotic medications for restless dementia behaviors, such as Risperidone or Quetiapine, can also increase sedation and fall risk.
● Blood pressure and diabetes medications. As noted above, it’s not unusual for older adults to be “over-treated” for these conditions, meaning they are taking a level of medication that causes the blood pressure (or blood sugar) to be lower than is really necessary for ideal health.
● “Anticholinergic” medications. These medications are commonly taken by older adults, who often have no idea that these medications worsen balance and thinking! They include medications for allergies, overactive bladder, vertigo, nausea, and certain types of antidepressants that may also be given for nerve pain.
● Opiate pain medications, especially if they are new.
(2) A blood pressure and pulse reading when sitting, and when standing. This is especially important if you’ve been worried about falls — or near falls — that are associated with light-headedness, or fainting. If your older relative takes blood pressure medication, you should make sure the doctor confirms that he or she isn’t experiencing a drop in blood pressure with standing.
A 2009 study of Medicare patients coming to the emergency room after fainting found that checking sitting and standing blood pressure was the most useful test. However, it was only done by doctors one-third of the time. (Note that Tamsulosin — brand name Flomax — is a popular prostate medication that also causes drops in blood pressure.)
(3) Gait and balance. At a minimum, a gait assessment means that the doctor carefully watches the way the older person is walking. There are also some simple ways to check balance.
Simple things to do, if gait and balance don’t seem completely fine, are:
● Address any pain or discomfort, if that seems to be a cause of problems. Many older people are reacting to pain in their feet, joints, or back.
● Consider a physical therapy referral for gait and balance assessment. A physical therapist can often recommend suitable strengthening exercises, and also can help fit the older person for an assistive device (e.g. a walker) if appropriate.
(4) Vitamin D level. If your older loved one spends a lot of time indoors and doesn’t take a daily vitamin D supplement, there is a fairly high chance of having a low vitamin D level. Studies suggest that treating low vitamin D levels (e.g. less than 20ng/ml) might help reduce falls in older adults. Low vitamin D levels can also contribute to fragile bones.
When vitamin D levels are very low, doctors sometimes treat with higher doses of vitamin D for a few months. Taking a daily supplement of 800-1000 IU will eventually maintain vitamin D at a normal level in most people, but if you are very concerned about falls or vitamin D, talk to your doctor about getting a level checked.
(5) Vision. Have your eyes checked by an eye doctor at least once a year and be sure to update your eyeglasses if needed. If you have bifocal or progressive lenses, you may want to get a pair of glasses with only your distance prescription for outdoor activities, such as walking. Sometimes these types of lenses can make things seem closer or farther away than they really are.
(6) An assessment for underlying new illness. Doctors almost always do this if an older person has been having generalized weakness, delirium, or other signs of feeling unwell. Be sure to bring up any symptoms you’ve noticed, and let the doctor know how quickly the changes came on. Just about any new health problem that makes an older person weak can bring on a fall. Some common ones include:
● Urinary tract infection
● Dehydration
● Anemia (low red blood cell count), which can be brought on by bleeding in the bowel or by other causes
● Pneumonia
● Heart problems such as atrial fibrillation
● Strokes, including mini-strokes that don’t cause weakness on one side
In conclusion, if your aging loved one falls and breaks a hip, life might never be the same. After a fall (or near-fall), it’s important that you the caregiver be “proactive” in the doctor’s office. Ask about ways to reduce the risk of falling again. In addition, here are some simple things the experts say you can do to keep your loved one from falling:
● Do Strength and Balance Exercises. Do exercises that make your legs stronger and improve your balance. Tai chi is a good example of this kind of exercise.
● Make Your Home Safer
– Get rid of things you could trip over.
– Add grab bars inside and outside your tub or shower and next to the toilet.
– Put railings on both sides of stairs.
– Make sure your home has lots of light by adding more or brighter light bulbs.
– Keep items you use often in cabinets you can reach easily without using a step stool.
– Use non-slip mats in the bathtub and on shower floors.
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Judd Matsunaga, Esq. is the founding partner of the Law Offices of Matsunaga & Associates, specializing in estate/Medi-Cal planning, probate, personal inury and real estate law. With offices in Torrance, Hollywood, Sherman Oaks, Pasadena and Fountain Valley, he can be reached at (800) 411-0546. Opinions expressed in this column are not necessarily those of The Rafu Shimpo.