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Watch your step and prevent falls
By Robert P. Dean
Falls are a serious health problem among older Americans. Each year one out of every three older Americans age 65 or older falls, and two-thirds of these individuals fall again within three months. Although many of these falls do not require medical attention, many others result in emergency room visits and hospital admissions.
Here in Massachusetts, falls are the leading cause of fatal and nonfatal injuries among seniors. Most fractures among older adults are caused by falls, which are also the most common cause of traumatic brain injuries among seniors. According to a 2008 report entitled, “Unintentional Fall-Related Injuries among Massachusetts Seniors in 2006,” there were 340 fall-related deaths, and more than 20,000 hospital stays and 36,000 emergency room discharges associated with non-fatal fall injuries. More than half of all those hospitalized due to a fall-related injury were discharged to a nursing home for rehabilitation, or for an intermediate or long-term stay. According to the 2008 report, 59% of fatal falls occurred at home, 19% occurred in a nursing home, 3% occurred on a street, and 3% occurred in a hospital.
Most falls are caused by a combination of environmental and individual factors, and can be prevented. Chief among environmental factors is the condition of one’s home. In-home safety checks should be conducted to identify environmental modifications that can reduce fall hazards. Because most falls occur at home, the importance of these in-home safety checks cannot be overstated. Clutter, particularly in walkways, and on stairs and steps, contributes to many falls. Worn and broken steps, stairs, and railings should be repaired, and all walkways and stairs kept free of clutter. Good lighting on stairs and throughout the home is very important. Night lights in hallways and bathrooms can help make night trips to the bathroom much safer. A flashlight kept by the night stand can also be helpful. Throw rugs are a tripping hazard. If you have them in the house, they should be securely fastened in place with adhesive double-stick tape. Wet or slippery floors contribute to many falls. Spills should be wiped up quickly. Non-skid bathtub and shower mats should be used, as should properly installed grab bars. If possible, regularly used items should be stored within easy reach between hip and eye level. These are a few suggestions that can help make the home safer and reduce the risk of falls.
With regard to individual risk factors, regular exercise, eye examinations, and medication reviews are very important as is diet. Regular exercise or physical activity such as walking, gardening, or water aerobics helps to maintain strength, balance, and self-confidence. If needed, a properly fitted cane, walker, or other assistive device should be used. Non-assistive devices, such as an umbrella in place of a cane, may be unstable and unsafe, and should not be used.
As we age, our visual acuity decreases, our depth perception declines, and our ability to recover from sudden exposure to bright light or glare decreases. Eyeglass prescriptions should be kept current through regular eye examinations. It is also important to keep eyeglasses clean. Better lighting and higher wattage bulbs can help with depth perception problems. When moving from a dark to brightly lit area, or vice versa, pause to allow the eyes to adjust to the change in lighting.
With respect to medications, keep in mind that new medications or medication changes may have unanticipated side effects such as dizziness, which may increase the risk of a fall. A doctor or pharmacist should review both prescription and over-the-counter medications to reduce side effects and interactions. When considering diet, it is important to eat regular meals that include foods rich in calcium and Vitamin D to help maintain bone density and reduce the likelihood of breaks and fractures.
Although most fall-related injuries among seniors occur at home, ice and snow can contribute falls. To avoid winter slips and falls, choose footwear that provides optimum traction. Rubber soles provide much better traction on ice and snow than plastic or leather. Many slips and falls occur when getting in and out of automobiles. Hold onto the vehicle for support and look before you step. Stick to properly shoveled and sanded paths. Avoid taking shortcuts or walking where snow or ice removal is incomplete. Above all, avoid rushing, and give yourself a little extra time to get where you need to go. When entering a building, use floor mats to remove ice and snow from your shoes. This will prevent snow and ice from sticking to your shoes and melting as your shoes warm up. It will also help to keep you and others from having to walk on wet or slippery surfaces. Once inside a building walk slowly and always hold onto handrails when using stairs.
Falls and fall-related injuries among Massachusetts seniors are a significant and growing health concern, yet many of these falls and injuries can be prevented by exercising care and caution, and by using some of the fall prevention strategies mentioned. For additional information on fall prevention, visit www.mass.gov/dph/injury, scroll down to Injury Prevention and Control topics, and click on “Falls” or call the toll-free safety information line at 1-800-227-7233. Information is also available from the US Department of Health and Human Services’ Centers for Disease Control (CDC) and Prevention at 1-800-232-4636, or visit their website at www.cdc.gov, and search for “fall prevention.” You can also contact the Injury and Prevention and Control Program of the Massachusetts Department of Public Health at 1-617-624-5544.
Robert P. Dean is Executive Director of Elder Services.