A Cane Can Save a Life: Prevention of Falls
Sometimes it's hard to recognize cause and effect. This is especially true in medicine as we continually put patches on various problems without getting to the root cause. We treat repeated infections in kids without teaching them about washing their hands. We treat high blood pressure with pills, but glance over the fact that weight loss could often fix the problem. Over recent years, a large public health problem has come to light as the cause of numerous injuries in our older population - falls, but once again it's too rare that the root causes of these falls are addressed.
Among older adults (over age 65), falls are the number one cause of both fatal and non-fatal injuries. In fact, one in three older adults will fall each year. Data from 2010 reveals that falls accounted for 2.3 million ER visits and 662,000 hospitalizations. In this year, an estimated 21,700 persons died as a result of a fall. Compounding the problem, though, is the fact that an estimated 50% of falls go unreported, swept under the rug until a more serious injury occurs.
As humans, we are like bicycles in that if we slow down and stop moving, we cease to function and end up on the ground. Falls are a common problem that slow us down and often the beginning impulse in a cascade of health problems and these health problems can lead to death. I've seen too many cases where prevention of a fall could have saved a life, so let's discuss the problem of falls and some effective measures you can take to prevent them.
The Biggest Barriers in Fall Prevention
In addressing falls, fear and pride hinder open communication. Falls are seen to lead the way for a loss of independence - something that is fiercely guarded by most individuals. As such, with independence at risk, it is understandable that a person with issues falling or at risk of falling would hold their cards close with any sort of inquisition on their independence. Understandable, but ultimately keeping mum about falling or fall risk endangers independence more than it guards it!
There is the tendency among my older patients to think that if they are at risk of a fall, they are at risk of being thrown into a nursing home.On the contrary, I am trying to prevent the need for this care by preventing injury from falls and addressing any problems at an early stage! Addressing fall risk also brings items that can jab at the pride of a person. Canes and walkers are seen by some as symbols of weakness or vulnerability, when in actuality they make people stronger and more empowered.
Tips for Preventing Falls
Address Risks: Many falls are caused by environmental factors. Loose rugs or elevation changes in the home can lead to falls. Taping rugs down or removing them all together is a good idea. Placing a railing or alert by steps or where elevation changes occur can reduce risk of fall. Also, keeping items off the floor and cords hidden can prevent tripping. Another risk for fall can come in the form of medications. Some medications can cause sedation or dizziness leading to falls. Talking to prescribers or pharmacists about any medication risks is helpful.
Maintain Vision: Many falls are caused by problems seeing hazards in the way. Like driving with a foggy windshield, poor eyesight can lead to disaster. In order to reduce risk, vision should be optimized. Glasses or contacts should be monitored with regular check-ups to ensure that the prescription is the best it can be. Cataracts should be removed when they become a problem for vision.
Physical/Occupational Therapy: Physical therapists and/or occupational therapists can do wonders with gait training programs which improve strength and balance. These professionals can also visit the home to help with any potential pitfalls or risks for injury and if a cane or walker is needed, they can ensure that it is being used right.
Tai Chi: This ancient Chinese practice is a wonderful way to improve balance and reduce falls. In fact, Tai Chi has been shown in studies to reduce falls up to an astounding 45%! This is especially true of patients with Parkinson's Disease. The beauty of Tai Chi is that it helps with both physical and emotional balance. Experts believe that it not only helps with the brain-muscle connection which keeps us graceful but also with the confidence to remain firm on our feet. Studies have shown that a fear of falling is one of the biggest predictors of future falling and Tai Chi addresses this issue as well.
Strong Bones: If a fall happens, weak bones can be disastrous. Hip and spine fractures are the more serious complications of falls and can lead to loss of independence and chronic pain. Keeping the bones strong is important armor to don beyond preventing falls. The current school of thought in maintaining healthy bones is to keep a well-balanced diet rich in vitamin D and calcium. Pill supplementation with calcium and vitamin D has recently fallen out of favor based on new evidence. (See my recent blogs on this topic of calcium and vitamin D supplementation for more information.) Weight-bearing exercise such as walking, aerobics or running, is also important in maintaining strong bones. After menopause, bone mineral density testing is important to screen for osteoporosis (severe bone loss and weakening). Treatment of osteoporosis has been shown to prevent fractures in the face of falls.
Ask You Doctor!
This issue can be summed up quite simply - ask. Anyone over age 65 is at statistical risk of a fall. If you have a loved one in this demographic, address any potential issues sensitively, mindful of the barriers addressed above. If you are over age 65 or at risk of a fall, the US Center for Disease Control has a screening tool to help address the problem. It can be accessed at http://www.cdc.gov/HomeandRecreationalSafety/pdf/steadi/stay_independent.pdf. By confronting the issue and pushing through the barriers we really have little to lose and so much to potentially gain.
When it comes to the barrier of the undesirable cane or walker, I encourage my patients to approach them as they would with their wardrobe or their car. Make it an extension of your personality with a color or an embellishment. I've seen some wonderfully decorated canes or walkers that add a flair, squashing any perceived vulnerability.