SERIOUS
FALLS
put seniors at risk
Death rates from tumbles are rising for those
over 65, but support from doctors and therapists
can prevent a downward spiral
by Michael Schroeder
Chuck Clifford came to lying
flat on his back on an icy sidewalk,
motionless and unable to move his
limbs. The life of the Angie’s List
member in Mundelein, Ill., changed
with a single, fateful slip during
a 2008 ice storm that fractured
his neck and came within about
a millimeter of completely severing
his spinal cord.
Now 70, the retired car dealership
owner credits Dr. Jack Perlmutter
at A-rated Lake Cook Orthopedic
Associates in nearby Barrington, Ill.,
for helping him get as much of his
life back as possible. The highly rated
orthopedic doctor performed back
and neck surgery on Clifford and
still sees him for pain management.
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Angie’s List® | March 2013
“I can’t say enough good things about
him,” says Clifford, who after intensive physical therapy can now walk
short distances with a cane or walker.
A serious slip can result in everything from a hip fracture to traumatic
brain injury that can change the
course of an older adult’s life —
and shorten it, especially without
proper treatment and rehabilitation.
One-third of adults 65 and older
fall each year, the CDC reports, and
in that same age group, falls are the
Photos by Gilbert Boucher | Pat Pempek, a
certified nursing assistant, performs therapy
on Chuck Clifford’s legs in his Mundelein, Ill.,
home. Following a 2008 fall, Clifford receives
constant support from his wife, Gunnel, and
takes medications for persistent pain and
neurological issues that affect memory.
Courtesy of Sally Aristei Photographs | John Mullins
(right), a client at the Center for Successful Aging,
performs a reaching activity to improve stability with the
help of a kinesiology student.
leading cause of death from injury.
Over the past decade, the rate of fall
deaths per 100,000 adults age 65
and older nearly doubled while injuries rose 25 percent, according to the
latest CDC figures released last year.
However, health professionals
involved in fall recovery and prevention, from geriatricians to physical
and occupational therapists, emphasize seniors shouldn’t view these
incidents as foregone conclusions.
“Falls are preventable. Many people
think it’s an inevitable part of aging
and it doesn’t have to be,” says Dr.
Judy Stevens, a senior epidemiologist
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Angie’s List® | March 2013
and expert on older adult falls at the
CDC. Prevention ranges from exercises to improve balance and strength
to making changes in the home, such
as removing throw rugs or adding
grab bars in the shower.
Still, experts acknowledge as the
population ages, a host of factors
raise the risk of a catastrophic fall in
older Americans, from an increase
in seniors living at home alone to
arthritic joints, diminished eyesight
and medication side effects such as
dizziness or drowsiness. The CDC
says 21,649 seniors died from falls
in 2010, and estimates emergency
departments treated 2.4 million fall
injuries in 2011. “People are living
longer and they’re living with more
chronic conditions than in the past,”
Stevens says. “We have an older,
frailer population.”
Diabetes, for example, can cause
nerve damage, or a condition called
peripheral neuropathy, says Dr.
Elizabeth Phelan, director of the
Fall Prevention Clinic at A-rated
Harborview Medical Center in
Seattle. “People can no longer feel
their feet,” she says, increasing the
likelihood of a fall. In addition, a
drop in blood pressure from medical
conditions can cause lightheadedness, dizziness and falls, Phelan says.
Dr. Steven Castle, clinical director
of geriatrics at highly rated VA
Greater Los Angeles, believes the
growing number of seniors living
at home alone may also play a role.
“There’s not someone to help and
support them,” says Castle, who
serves in an advisory role with the
Fall Prevention Center of Excellence
in Los Angeles. The center develops
and improves fall prevention
programs for seniors, their families
and health professionals.
However, those who choose
to age in place don’t have to face
health challenges alone. Recovery for
Clifford and many other fall victims
includes in-home care, and typically involves physical therapy and
exercise to regain firm footing. But
results don’t come quickly or easily.
“We know that at least 50 hours
“I dropped
like a rock.”
of supervised, progressive balance
training is needed to reduce falls,”
says Debbie Rose, a physical therapist
and co-director of the Fall Prevention
Center of Excellence.
Following back and neck
surgery after his fall, Clifford
underwent two years of physical
therapy to strengthen his back and
legs and improve balance at The
Rehabilitation Institute of Chicago,
a highly rated, nationally renowned
specialty hospital. “At times, it was
very rigorous,” he says, but it allowed
him to regain limited use of his legs
and arms despite persistent nerve
damage. Between in-home care and
doctor visits, he estimates his health
bill runs about $7,000 per month,
nearly all covered by insurance.
STAND UP TO FALLS
Find your footing: Often the fear of
falling leads older adults to limit activity,
but this can hasten a catastrophic
tumble. Instead, commit to an exercise
program that improves strength, balance
and coordination, such as tai chi.
See the eye doctor: Adults over 65
should get vision checked annually.
Consider wearing a separate pair of
glasses with distance vision while on
the move, instead of trying to look
through or over bifocals.
Review your medicines: Ask your
doctor or pharmacist about side effects
that increase fall risk, such as dizziness
or drowsiness, and alternatives.
Take your vitamins: Ask a provider
about Vitamin D and calcium to
strengthen bones, discussing risks
and benefits.
Fall proof your home: Remove tripping hazards; amp up lighting; and toss
out house slippers in favor of sensible,
treaded shoes. Depending upon risk,
an occupational therapist can make a
house call to suggest further changes.
Hire help for home modifications.
Seek out a highly rated contractor, preferably with a Certified Aging-in-Place
Specialist designation, to make necessary changes, such as installing grab
bars in the shower, higher toilet seats
or a railing on both sides of stairs.
Consider a medical alert system: For
seniors aging in place, especially those
at higher fall risk, this could prove to be
a lifeline, but shop around, test customer
service before making any commitment,
and try to avoid multi-year contracts.
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“It’s a big change for me because I
was very active before [the fall] both
in family and business,” Clifford says.
Rose and other clinicians note
that seniors who fall find themselves
at higher risk for subsequent falls,
especially when injuries occur that
can weaken their body or prevent
them from staying active. She’s
developed a balance and mobility
training program called Fallproof!
offered to seniors at the Center for
Successful Aging at California State
University, Fullerton, and used by
“Many people think
[falling is] an inevitable
part of aging and it
doesn’t have to be.”
therapists elsewhere. The program
teaches clients to make prudent
decisions, such as inquiring about
medication side effects and understanding physical limitations. “It’s
predominantly an exercise-based
program that has a strong behavioral
change component to it,” Rose says.
Therapists also recommend exercises
like tai chi that can improve balance
and strengthen legs.
Penny Leisch, 60, closely follows
advice to exercise and strengthen
muscles in her legs and improve
balance, and now treads with special
care when she’s out walking. In 2010,
she slipped on mud, which caused
whiplash and left her dizzy and
reeling from headaches. “It was just
like watching a cartoon, everything
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Angie’s List® | March 2013
went straight out from under me and
I dropped like a rock,” she recalls.
In the years since, she’s undergone rehab, including with highly
rated physical therapist Carolyn
Antilley at St. David’s Urgent Care
and Physical Therapy in Pflugerville,
Texas. Massage eased muscle tension,
and she says therapy greatly reduced
her neck pain and headaches. Leisch
paid $112 for four recent sessions
with Antilley; insurance covered
the balance, at a negotiated rate
of $1,010. Recovery and prevention
didn’t stop at the clinic, either. “We
talked about how we could make the
home safer,” says Leisch, who had
grab bars installed in her shower and
uses night-lights around the house.
Despite her arthritis, and
lingering nerve damage from the
fall, Leisch says she maintains her
active lifestyle. That’s important,
say experts, because fear of falling
makes some seniors less active. “This
activity restriction leads to muscle
weakness, which leads to a higher
likelihood of falling,” says Stevens
of the CDC. Add to that quality of
life issues, such as social isolation
and depression, providers say, and
the impact of fear alone can prove
as debilitating as a serious fall.
Depending on an individual’s
fall risk, some clinicians like Castle,
an adviser with the Fall Prevention
Center, recommend considering a
medical alert system to provide an
additional safety net. Bryan Stapp,
president of A-rated Medical Care
Alert based in Novi, Mich., says his
national company’s alarm system
gives seniors who are more likely to
fall the assurance of help. By pushing
the button on a necklace, wristband
or clip-on, they’re put in contact with
an operator who can call their emergency contacts or paramedics. The
system starts at $90 per quarter.
Harold Spriesterbach, an Angie’s
List member in Las Vegas, says he
bought the alert system for himself
and his wife, Frances, 66, after she
fell and broke her ankle in their
backyard. “My granddaughter finally
heard her ... after a half an hour of
her yelling,” says the 68-year-old.
“I never want her to be in a situation
like that again.”
While alarm systems are a good
backup, experts say often seniors
don’t take prevention seriously,
and fail to tell their provider when
they fall. If an older adult has fallen
recently or feels unsteady on their
feet, they should speak with a doctor,
says Phelan of Seattle’s Harborview.
A doctor should assess future fall
risk, by looking at balance, health
history and other factors, she adds.
Susan Pullman, an occupational
therapist at highly rated Moorestown
Visiting Nurse Association in
Moorestown, N.J., goes into mostly
older patients’ homes to provide
care and instruction to those aging
in place with chronic conditions and
other health concerns. Along with
advising caregivers, she assesses
patients for fall risk. In encouraging
Courtesy of Sally Aristei Photographs | Kimiko Kinoshita
performs a “creek walk” activity designed to improve body
control at the Center for Successful Aging.
prevention strategies — whether how
to fry an egg while using a walker
or placing a non-skid mat in the
bathroom — she focuses her education efforts on what they can do for
themselves and improving safety, not
gloom and doom scenarios.
“When you have a positive end
result, that is it’s own reinforcement,” Pullman says. “By preventing
falls and injuries you’re looking at
keeping people more functional ...
and out of the hospital,” she says.B
Submit reviews on Angie’s List
about health care providers who’ve
helped to get you back on your feet.
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