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By Dr. Audrey M. Provenzano
One word comes to mind when I think about Mr. H: grit.
I met him while he was in the hospital with pneumonia, the latest in a long string of hospitalizations after he broke his hip in a fall. I would see him in the halls with the physical therapist, gripping his walker, utterly absorbed in the work of lifting each foot and placing it back down.
Every morning on rounds, Mr. H would joke with us: “You’re going to throw me outta this place today, right, doc? Don’t pass go, just go home!” But beneath his humor lurked true sorrow, anger and frustration over his loss of independence. Before his fall, Mr. H had never stayed overnight in the hospital; he took only a few medicines for high blood pressure, and lived alone with his cat — a simple life he lost in a second, and yearned each day to get back.
Many of us harbor secret fears about growing older, and what many of us fear most is the loss of independence, a tragic and terrifying possibility. I'd suggest a very specific focus for those fears: falls. The most common but least talked-about reason that older adults like Mr. H lose their independence is falling down.
Here is what I most wish everyone knew about falls: They are are common, they can be devastating and, most importantly, falls are preventable.
• Falls are common
Incredibly common. Thirty percent of adults over 65 fall each year. Because falls happen all the time, we don’t think about how dangerous they are. Unfortunately, one in five falls results in serious injuries, including broken bones.
• Falls can be devastating
Mr. H’s story is the story of hundreds of thousands of older adults. A fall may lead to surgery, and sometimes that leads to complications, like pneumonia. Some older adults in this situation regain enough function to go back home; sadly, many do not, and one in three is still living in a nursing home a year later.
Even worse, these types of injuries often lead to declining health overall, and 20 percent of older adults who break a hip die within one year from the medical complications that frequently attend such devastating injuries.
• Falls can be prevented
How? Six key recommendations, backed by the CDC, some obvious, some less so:
1) Staying active is the most important way to prevent falls.
Any kind of exercise is helpful, but studies have shown that exercises integrating balance and strength, such as Tai Chi, are particularly beneficial. There is an exercise program called Matter of Balance that was designed specifically to help prevent falls among older adults -- look for those classes through your primary care doctor’s office or local aging services.
2) Modify your home to prevent falls.
Rearrange your furniture so that you can walk easily from room to room. Drape power cords for lamps and computers behind furniture rather than across a path so that you don’t trip on them. Remove area rugs, which may have corners that stick up and can catch your toes. Think about adding grab bars in your bathroom to make it easier to get in and out of the tub or shower, and additional lighting throughout your home so that you can see where you are going. The CDC has some helpful information on how to make your home safer here.
3) Ask your doctor to review your medication list.
Some medications can increase the risk of having a fall. If you are concerned about falling, it may be reasonable to stop certain medications or to switch to alternatives. This has to be a personal conversation with your doctor, weighing the risks and benefits of the medicine for you as an individual patient.
4) Get your eyes checked.
If you need glasses, make sure to wear them. If you can’t see where you are going, you will be sure to fall.
5) Make sure your bones are as strong as possible, so that in case you do fall you are less likely to break a bone.
Some people benefit from taking calcium and vitamin D supplements or other medications to strengthen their bones. Ask your doctor about what is best for you. Exercise that puts force on your bones, such as walking or lifting weights, strengthens your bones and is good for just about everyone.
We're hoping to make fall prevention a part of everyone's routine health care, just like a mammogram or colonoscopy.
6) Talk about falls.
Spread the word about how important this issue is for older adults in our communities.
At the Dimock Center, we've successfully put in place a program to screen patients to find out who is at risk for falling. But once we identify older adults at risk, convincing them that fall risk is important is another story.
Patients can be reluctant to try a new type of exercise or change how their home is set up. When I asked a patient about why she didn't want to add grab bars in her bathroom, she whispered, "It makes me feel old to have those things in my house." Fall risk can be stigmatizing, but at the Dimock Center, we're hoping to make fall prevention a part of everyone's routine health care, just like a mammogram or colonoscopy.
So, talk to your loved ones -- even if they don't necessarily want to talk about it. Make sure they are doing everything possible to reduce their fall risk. If you are an older adult and you are worried about falling, don’t worry alone. Talk to your doctor and talk to your family and friends.
From time to time, we all need help staying on our feet.
Dr. Audrey M. Provenzano is the director of Quality Improvement for Health Services and a staff physician at The Dimock Center in Boston.
Further reading: The National Council on Aging's page on Sept. 23 as Falls Prevention Awareness Day
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