By JUDD MATSUNAGA, ESQ.
When we were kids, falling and tumbling were a daily occurrence. Possibly because Mom bought us shoes that were two sizes too big so we wouldn’t grow out of them too soon.
In judo, they taught us to tumble on purpose so that we would learn to roll and not hurt ourselves. We’d pick ourselves up, dust ourselves off, and carry on with the day. As kids, we had lots of ability to stay on our feet, so it would really take a big push or stumble for us to fall.
Not so when we get old. That ability to stay on our feet, those mechanisms we use, tend to not work as well, and it becomes easier to fall. When a senior falls, it can sometimes cause serious injuries such as hip fractures or head injuries. Frequent falls can also be a reason that an older person ends up needing to move out of their home to an assisted living, board and care, or skilled nursing home.
So when it comes to helping older adults maintain well-being and independence, fall prevention is really important. As we get older, that ability to recover our balance and stability tends to decline. One of the main reasons is that as we get older, we tend to lose muscle strength (unless you are really actively involved in strength training). In geriatrics, strength training is one of the most important things that people can do to maintain mobility, independence, and quality of life.
The information below comes from board-certified geriatrician Dr. Leslie Kernison, founder of the website www.betterhealthwhileaging.net. Dr. Kernison says, “Because I think knowing the basics about fall prevention is something really important that every older adult and family should know something about.” So, why do older adults fall?
As part of our life as humans, our balance is often compromised or challenged by rushing, leaning over, turning around, or maybe by stumbling. Sometimes we’re pushed. And the body is equipped to have all these mechanisms so that we can catch ourselves and recover our balance. That’s our ability to stay on our feet.
But if we get enough of a stimulus that is big enough that it overwhelms our ability to stay on our feet, we fall.
Most mammals are four-legged. The human body, as you have noticed, only has two legs. So, we are inherently a little bit less stable. Basically, a fall happens when we experience a challenge to our balance or strength. It’s often a sudden challenge, you know, a moment of instability or being off balance. And if that challenge is greater than our strength, it overwhelms our current ability to stay upright, and we fall.
So losing muscle strength in our core, in our legs, will make us at higher risk for falls. Another issue that comes up for a lot of older adults is that the blood pressure can drop, at least temporarily, when we stand up. This is called orthostatic hypotension. This becomes very common as we get older, especially if people are also taking medications for blood pressure or other medications that might affect their blood pressure.
According to Dr. Kernison, probably the number one way to prevent falls is to improve strength and balance through structured exercises. “It is very, very common when an older adult has been falling for us to find that their leg strength is not super good.”
It turns out that lots of randomized studies have shown that when people do a structured program designed to help them improve their leg strength and their balance, their strength and balance improve. And also they do reduce their falls as well.
The best way to do this is to refer somebody to physical therapy. If you’ve been having falls, I really recommend working with a physical therapist who can kind of customize the program and help you choose some exercises to start with and level them up. You may want to work with a physical therapist to choose and teach the best exercises for you. For best results, the exercises should feel somewhat challenging.
But if you don’t want to see a physical therapist, there are some widely accepted forms of exercise that have been shown to help people with strength and balance. And just about everybody benefits from working on their strength and balance when it comes to fall prevention.
Tai chi has been studied a fair bit and has a quite good track record. And then there are a few other proven programs as well. The National Council on Aging has a very helpful section of their website, including a page that lists programs that have been specifically studied and shown to be effective.
Walking is a great form of exercise with many benefits, but it does not help your legs get stronger unless you are walking up and down hills or stairs. According to the National Council on Aging (ncoa.org), older adults should combine a strength and balance program with a walking program for the greatest protection against a fall. You should plan on working up to a 30-minute walk, three times a week.
As we get older, we tend to develop other health-related factors that can create increased fall risk.These include being on medications that affect balance or blood pressure, as well as changes such as developing cataracts or other forms of vision impairment. And then there’s a whole variety of chronic conditions that are also associated with increased fall risk, including things like incontinence, depression, neurological conditions, even some heart conditions and more.
Another way to reduce falls is to de-prescribe medications that affect balance and falls.
Of course, see your doctor first before you try to taper off of medications that may contribute to falls. First identify them, and then you can taper them off, because every bit of reduction hopefully will help. If the doctor won’t agree to reduce the dose, ask your doctor to switch to a safer option.
If the issue is that the person was having orthostatic blood pressure changes when we checked, then we might also want to consider reducing the blood pressure medications as well, and maybe allowing the person to have a slightly higher blood pressure goal.
If there’s any sign that vision might be impaired, go see your eye doctor to get that further evaluated. Some studies have shown that if people with cataracts are surgically corrected, falls are reduced.
Home safety evaluations can be very helpful as well. The studies show that the best home safety evaluations are actually done by trained occupational therapists. These might include things like home hazards like slippery floors or loose rugs or poorly lit spaces at night. They might also include outside hazards, snow, ice, uneven sidewalks, steep hills in some cases.
And we also usually group poor footwear in there. Sometimes older adults are wearing footwear that doesn’t have a nice, stable sole that might slide around on their foot, maybe has a slippery sole, maybe is a really high heel, or maybe just doesn’t have quite the balance and stability that one used to have. Some of you are wearing shoes where the shoestrings don’t stay tied.
“What about mobility aids? Can those reduce falls?” you might ask. Mobility aids are basically devices such as canes and walkers. And the answer is sometimes. If there have been falls, it can be very appropriate to consider a mobility device. But for a cane or a walker to be effective, it has to be the right device for a person’s health or mobility situation. So canes, for instance, are best used to help take weight off of a limb that is weak or painful, and they need to be used correctly.
Walkers provide more stability, for sure, than canes, but also need to be properly fitted and properly used. Make sure the person has the capacity to use this device correctly. Does the person have problems with their memory or thinking, such as Alzheimer’s or another form of dementia? This could make it harder for them to use a mobility device correctly and safely.
The CDC’s “Stay Independent” brochure recommends seniors keep moving, get an annual eye exam, and make your home safer. Dr. Kernison suggests that seniors answer a questionnaire on the CDC’s website to help you check your risk for falling. The following statements are “yes” or “no” statements. They include:
- I have fallen in the past year.
- I use or have been advised to use a cane or walker to get around safely.
- Sometimes I feel unsteady when I’m walking.
- I steady myself by holding onto furniture when walking at home.
- I’m worried about falling. I need to push with my hands to stand up from a chair.
- I have some trouble stepping up onto a curb.
- I often have to rush the toilet.
- I have lost some feeling in my feet.
- I take medicine that sometimes makes me light-headed or more tired than usual.
- I take medicine to help me sleep or improve my mood.
- And lastly, I often feel sad or depressed.
So if you answer “yes” to four or more of these questions, that’s associated with being at higher risk for falling. And it becomes especially important to bring this up and talk with a health provider. i.e., GO GET A MEDICAL EVALUATION. So that’s what the screening is supposed to involve.
And again, if an older person reports a fall in the past year or seems to be at risk, then providers should continue with a medical evaluation for fall prevention.
In conclusion, as we get older and lose strength or vision, we’re more likely to have the things happen to us that create increased fall risk. Some older adults are waving off a fall evaluation, e.g., “This is just part of getting old.” They don’t want to trouble anyone, or they may be embarrassed about it, or they may feel like there’s nothing to do. Not true.
So if an older person falls, it’s really important that they get a good evaluation to check for common underlying causes and risk factors. Although there are some strategies for fall prevention that tend to work in almost every older adult, everybody’s fall prevention plan should really be customized to them.
Judd Matsunaga, Esq., is the founding partner of the Elder Law Services of California, specializing in estate/Medi-Cal planning, probate, personal injury and real estate law. With offices in Torrance, Encino, Pasadena and Fountain Valley, he can be reached at (310) 318-2995. Opinions expressed in this column are not necessarily those of The Rafu Shimpo.