Experts say more should be done to prevent falls

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(Host) This year, one out of every three older Americans will fall.

Their injuries will account for almost half of new nursing home admissions and many will die from complications.

VPR’s Nina Keck examines why so many people are falling, what the financial and emotional costs are – and what we can do to stay on our feet longer.

(Keck) Betty Ferraro lifts up her glasses to show the scar on her cheek. A former state and local lawmaker, the 83-year old Rutland woman is used to being busy. But 4 to 5 years ago, after retiring from politics, Ferraro noticed she was having trouble walking. Then she began to fall.

(Ferraro) "And the last time was bringing in the groceries in from the garage – the step from the garage into the kitchen I again stubbed my toe and I went flat on the floor and my groceries went flying and my glasses went into my cheek. I think that last fall was the most dramatic for me."

(Keck) Ferraro was lucky. She didn’t break any bones and she sought help. Today, she’s at Rutland Regional Medical Center taking a follow-up balance exam.

(sound of snapping) "Hang on to the walls a second while I get your feet where I want them."

(Keck) Physical Therapist Kelley Odorisio tightens a safety harness before starting the machine.

(Odorisio) "So stand quietly – eyes open…"

(Keck) Ferraro tries not to sway too much as the metal plates beneath her feet begin to move. It gets noticeably harder when she has to do the tests with her eyes closed. Kelley Odorisio says a computer records precisely how and when Ferarro’s weight shifts.

(Odorisi) "And if helps us figure out how well our patient is using their vision, their legs and their inner ear and brain to help maintain their balance – so it helps us drive their treatment."

(Keck) The test shows Ferraro has improved. The physical therapy and exercises she’s been doing have helped. Still, she admits her fear of falling remains.

(Ferarro) "I guess I’m doing more at home, but I still don’t have the confidence to go on walks like I used to."

(Keck) She pauses for a moment and shakes her head.

(Ferraro) "I’ve always been so active and it’s humiliating not being able to do all the things I always did."

(Keck) Across town at the Godnick Senior Center, an eight-week balance class is underway. It’s targeted to people just like Betty Ferraro.

(balance class) "Hi, how are you? Okay Kate is here and Ruth is here…"

(Keck) The ten women in this class learn simple exercises to improve mobility and balance. They swap tips on how to avoid falls, provide each other with moral support and learn ways to overcome their fear of falling. Laurie Knauer, one of several instructors, says fear can be just as debilitating as a fall itself.

(Knauer) "They’re afraid to get up and do any exercising. They’re afraid to do their laundry; they don’t want to go to their neighbors’ house for dinner. The problem is the more they’re inactive the worse it gets."

(Keck) Because inactivity weakens muscles and bones and makes people even more fragile. And Knauer says often, people in this situation are too ashamed to say anything.

(Knauer) "One of the biggest fears is if I tell my children that I fell or my doctor that I fell, they will think that I’m incompetent and can’t take care of myself and therefore I will go to a nursing home. So they keep it to themselves."

(Keck) And that’s a problem. People who have fallen once are much more likely to fall again. In a study looking at people over 70 who fell and were not injured, nearly half couldn’t get up off the floor without help. Laurie Knauer encourages the men and women who take her class to develop a plan in case they do fall. Have a cell phone handy, she says, and practice how to get up. Don’t’ try to do a sit up. Instead, roll over onto your hands and knees and use a chair to help pull yourself up.

(Knauer) "So a lot of people said I put a chair in my bedroom, I keep a nightlight on in my hall. I keep a nightlight on in my bathroom now. Flashlights, they carry with them in their pockets or their purse."

(Keck) Even with precautions, some people are still more likely to fall than others. Dorothy Baker is a research scientist in Geriatrics at Yale School of Medicine. She says much of it has to do with the number of risk factors a person has. Weight gain, vision problems, inactivity, osteoporosis and other underyling medical issues are some of the most common in older adults. She says taking four or more medicines on a regular basis also increases the chance of falling. But Baker points out that by addressing as many risk factors as possible – people can reduce their chances of falling dramatically. Unfortunately, she says, the message isn’t getting across.

(Baker) "The common thing that happens nowadays is a person breaks a hip – come in through the emergency room and get acute care, go off and get short term rehab, maybe go home and get home care and be discharged and nobody figures out that this was a fall related fracture which these almost always are and why did she fall in the first place? So when we did a study in New Haven, we found that 12% of patients were on their second broken hip."

(Keck) That’s painful as well as expensive. Barbara Hansen works for the Southwestern Vermont Council on Aging. She says according to the state health department, Vermont spends almost thirty million dollars a year on hospitalizations due to falls.

(Hansen) "But that doesn’t include all the soft costs or indirect costs that have to do with the person’s quality of life – the loss of independence or loss of productivity – for example if they were still working or volunteering – they can’t do those things anymore. So these quality of life costs, I’m almost more concerned about those than I am about the cost costs."

(Keck) And what people don’t realize, she says is that even a simple slip in the kitchen can be deadly. Once a fall victim is hospitalized or in a nursing home, they become much more susceptible to pneumonia, blood clots and infections. In Vermont last year more than twice as many people died from complications due to falls than from car accidents.

(Shapiro) "I think these numbers are very unreported."

(Keck) That’s Dr. Steven Shapiro, Vermont’s Medical Examiner.

(Shapiro) "I remember my grandmother who was early in her 90s and she used to hold on to me so tightly when we walked. But she knew – if she fell down it was a death sentence. And really, that’s what we see. And why isn’t this on the front page is because – you know what they’re old and they’re supposed to die. But these people are dying in agony."

(Keck) Shapiro says more needs to be done to prevent that. Rather than spend millions for nursing home and hospital care after a fall, he says the money would be much better spent on education and prevention. State and federal lawmakers seem to agree. Just this year, Governor Douglas made balance and falls one of two top priority initiatives for elderly Vermonters.

For VPR News, I’m Nina Keck.

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