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Strength, Balance Key to Preventing Falls in Elderly

  • Nina Keck

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. Nina Keck examines why so many people are falling, what the financial and emotional costs are – and what all of us can do to stay on our feet longer.

Betty Ferraro lifts up her glasses to show the scar on her cheek. The 83-year old Vermont woman says four to five years ago, she noticed she was having trouble walking. Then she began to fall. "And the last time was bringing in the groceries in from the garage, the step from the garage into the kitchen." She stubbed her toe and fell flat on the floor. "My groceries went flying and my glasses went into my cheek. I think that last fall was the most dramatic for me."

Ferraro was lucky. She didn't break any bones and she sought help. Today, she's at her local hospital taking a follow up balance exam. Physical therapist Kelley Odorisio tightens a safety harness around the older woman before starting the machine.

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. A computer records precisely how and when Ferarro's weight shifts. "It 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," Odorisio explains, "so it helps us drive their treatment."

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

Across town at a local recreation center for older adults, an eight-week balance class is underway. The ten women in this class learn simple exercises to improve mobility and balance. They swap tips on how to avoid falls, learn what to do if they do stumble, and learn ways to overcome their fear of falling.

Instructor Laurie Knauer says that fear can be just as debilitating as a fall itself. "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." Inactivity weakens muscles and bones so people become even more fragile.

Knauer says often, people in this situation are too ashamed to say anything. "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."

That's a problem because people who have fallen once are much more likely to fall again, according to Dorothy Baker, who conducts fall research at Yale School of Medicine. She says risk factors such as weight gain, vision problems, inactivity, osteoporosis and other underlying medical issues can make a person more likely to fall. Taking more than four medicines at a time – as many elderly do – is another big risk factor.

Baker points out that by addressing as many risk factors as possible, people can reduce their chances of falling dramatically. Unfortunately, she says, that message isn't getting across. "The common thing that happens nowadays [when a person breaks a hip] is [they] come in through the emergency room and are classified as a hip fracture, go up to the [hospital] 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?" She points to a study she and her colleagues did in New Haven, which found that 12-percent of patients were on their second broken hip.

Once they are hospitalized or in a nursing home, patients become much more susceptible to pneumonia, blood clots and infections. It's a scenario that costs the United States billions of dollars every year. Baker and public health experts say that money would go a lot further if it were spent on prevention and education.

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