By JUDD MATSUNAGA, Esq.
Falls are a scary thing — especially if you are 65 and older. Just this week, my 70+-year-old neighbor fell. The fire department came, red lights lit up the sky and took her to the hospital. Evidently, she broke her back. You might even know a senior who recently fell. You’ll see them at an event all bandaged up like they got mugged. “What happened?” you might ask. They would respond, “I fell.”
Did you know that millions of people 65 and older fall each year? According to the CDC website (www.cdc.gov/falls/index.html), more than one out of four seniors fall each year. But less than half tell their doctor. One out of five falls causes a serious injury such as a hip fracture or a traumatic brain injury. These injuries can make it hard for a person to get around, do everyday activities, and reduce their ability to remain independent.
Falls can cause broken bones, like wrist, arm, ankle, and hip fractures. Falls can also cause head 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. Falling once doubles your chances of falling again.
Sometimes, falls do not cause injuries. However, 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 and stay at home. DON’T STAY AT HOME!!! When a person is less active, they become weaker and this increases their chances of falling. To go out safely, however, you need to understand what risk factors may contribute to falling.
According to the CDC Fact Sheet “Risk Factors for Falls,” risk factors are categorized as intrinsic or extrinsic. Intrinsic factors are: (1) Advanced age; (2) Previous falls; (3) Muscle weakness; (4) Gait and balance problems; (5) Poor vision; (6) Postural hypotension; (7) Chronic conditions including arthritis, stroke, incontinence, diabetes, Parkinson’s, dementia; and (8) Fear of falling.
Extrinsic factors include (1) Lack of stair handrails; (2) Poor stair design; (3) Lack of bathroom grab bars; (4) Dim lighting or glare; (5) Obstacles and tripping hazards; (6) Slippery or uneven surfaces; (7) Psychoactive medications; and (8) Improper use of assistive devices. The more risk factors a person has, the greater their chances of falling. Most falls are caused by a combination of risk factors., i.e., “falls in older people are almost always multi-factorial.”
Although it’s not possible to prevent all falls, the good news is that it’s almost always possible to reduce the chance of a bad fall by taking action that will reduce the number of risk factors at play. According to the CDC, the best way to reduce and prevent falls is to cut down a person’s risk by reducing the fall risk factors. It can be hard to try to address every single factor, and some, such as slower reflexes, may be impossible to reverse.
The CDC has a brochure titled “What You Can Do to Prevent Falls.” In a nutshell, the brochure says there are “four things YOU can do to prevent falls.” The first thing you can do is to “talk openly with your healthcare provider about fall risks and prevention.” Tell a provider right away if you fall, worry about falling, or feel unsteady.
Have your doctor or pharmacist review all the medicines you take, even over-the-counter medicines. As you get older, the way medicines work in your body can change. Some medicines, or combinations of medicines, can make you sleepy or dizzy and can cause you to fall. Ask your provider about taking vitamin D supplements to improve bone, muscle, and nerve health.
According to doctor board-certified geriatrician Dr. Leslie Kernisan, MD MPH, “Even if you’re pretty sure your loved one just tripped and stumbled, a good medical assessment can uncover potential fall risk factors. A fall can also be a sign of a new and serious medical problem that needs treatment. For instance, an older person can be weakened and fall because of illnesses such as dehydration, or a serious urinary tract infection.
Dr. Kernisan says, “Most doctors have the best intentions, but studies have shown that older patients often don’t get recommended care.” All too often, a medical visit after a fall is mainly about addressing any injuries that the older person may have suffered. Busy doctors often miss opportunities to reduce fall risk. ”By being politely proactive, you can make sure that certain things aren’t overlooked,“ says Dr. Kernisan.
Also, don’t assume that most doctors will identify and manage the most important risk factors for falls. Ask the doctor or healthcare provider to evaluate your senior’s risk for falling. Medications are among the most common causes of increased fall risk in older people. Ask your doctor or pharmacist to review your medicines to see if any might make you dizzy or sleepy. Medications are often a fixable risk factor when it comes to falls in older adults.
The second thing YOU can do to prevent falls is to “exercise to improve your balance and strength.” Exercises that improve balance and make your legs stronger, lower your chances of falling. It also helps you feel better and more confident. An example of this kind of exercise is tai chi. Lack of exercise leads to weakness and increases your chances of falling. Ask your doctor or healthcare provider about the best type of exercise program for you.
The third thing YOU can do to prevent falls is to “have your eyes and feet checked.” Once a year, check with your eye doctor, and update your eyeglasses, if needed. You may have a condition like glaucoma or cataracts that limits your vision. Poor vision can increase your chances of falling.
Lighting can be used to reduce fall risks in older adults. Older eyes have more difficulty discerning objects with little contrast. By age 60, you’ll need about three to four times more light to see than you did in your 30s. Aging can also throw off your depth perception. It’s also harder for aging eyes to adjust to changing light conditions, increasing the risk of falling.
Because your eyes take longer now to adjust to changing light conditions, keep the light strength uniform from room to room. Install a dimmer switch by your front door, so you can turn on the light gradually as you enter the house at night. Increase illumination where you need it, such as at the front entrance, in hallways, in the bathroom, and on stairs. Marking each stair with a white or brightly colored tape stripe will help you see it.
The fourth thing YOU can do to prevent falls is to “make your home safer.”
- Remove things you can trip over (like papers, books, clothes, and shoes) from stairs and places where you walk.
- Remove small throw rugs or use double-sided tape to keep the rugs from slipping.
- Keep items you use often in cabinets you can reach easily without using a stepstool.
- Have grab bars put in next to and inside the tub, and next to the toilet.
- Use non-slip mats in the bathtub and on shower floors.
- Improve the lighting in your home. As you get older, you need brighter lights to see well. Hang lightweight curtains or shades to reduce glare.
- Have handrails and lights installed on all staircases.
- Wear well-fitting shoes with good support inside and outside the house.
Learning why your senior has fallen means that you’ll be able to figure out why he or she is likely to fall — and take steps to help them. It’s easier to take action once we understand more about why an older person has fallen. Once you understand the particular risk factors for your senior, it will be easier to focus on the fall prevention strategies that are most relevant to your situation. In other words, you’ll be able to personalize your approach to fall prevention.
A Special Health Report from Harvard Medical School, “Aging in Place,” says that rather than live in fear of falling, seniors should try the following 10 fall-prevention strategies. Since I’ve already discussed four of these fall-prevention strategies above, I’ve removed them from the list, leaving only six:
• Try tai chi. Better balance translates into fewer falls. Tai chi has been shown very effective for improving balance, in part by improving your strength and muscle control and partly by making you more aware of your body’s position in relation to your surroundings.
• Check your vitamin D status. The U.S. Preventive Services Task Force (USPSTF) recommends vitamin D (along with calcium) for preventing fractures in people who are deficient in this vitamin. A quick blood test from your doctor can determine whether you’re low on vitamin D and need a supplement.
• Wear the right shoes. To prevent falls, wear shoes that fit your foot snugly and that have a low heel and a non-skid sole. The wrong shoes can throw off your balance and stability. High heels and slippery leather soles are among the worst offenders. Walking barefoot or in socks can have risks, too. In one study, 52% of participants who fell were barefoot or wearing socks or slippers.
• Treat chronic pain. It’s important to see your doctor or a pain specialist to address and control your pain. Constant aches and pains can disrupt your life in many ways, one of them being an increased risk for falls. Researchers who’ve studied the connection have found higher rates of falls among people with chronic pain — especially those who had pain in more than one area of the body or in their feet.
• Treat health issues. A number of health issues that become more common with age contribute to the risk of falls. Alzheimer’s and other types of dementia can rob you of the judgment you need to navigate your surroundings. See your doctor to assess your risks for these conditions, and get treated if you have any of them.
• Avoid alcohol. Your body metabolizes alcohol differently now than it did when you were younger. Certain medicines can also intensify the effects of alcohol. As a result, even a single drink may be enough to intoxicate you. Alcohol can throw off both your balance and judgment, making a fall more likely.
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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 injury 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.