“I can’t take this anymore. I don’t wanna live anymore.”
Those were the words of Julian Sacks, according to his 81-year-old wife, Lillian.
13 years ago, Julian fell while riding the subway. During the summer, he fell again.
He went on a steady decline. He stopped eating.
8 years later, Julian is dead.
It may seem rather extreme to a middle-aged person. A simple fall shouldn’t have that much of an impact on your life, should it? Like they say, you fall off the horse, you get back up again.
Well, if you’re elderly, that adage is a little hard to take literally.
No Laughing Matter
Patty is her father’s primary caregiver. He suffered a stroke a few years back. As a result, his mobility has deteriorated. He also has a myriad of other illnesses. Despite all that, he still refuses to use the darn walker!
The elderly put a very high premium on their independence. Maybe rebuffing the walker is a matter of pride? Is it too much of a tell that he’s not as agile as he used to be?
Whatever the reason may be, the risk is there. And it’s scary.
Let’s see the numbers:
As of 2010, 13% of the population is 65 years or older. That’s over 40.3 million people. It’s the largest in size and percentage in the US.
The CDC estimate that at least a third of seniors 65 years old and up fall each year. BUT, only half of them will actually talk to their caregivers about it.
In the same year, 2.3 million elderly were treated in emergency departments for non-fatal fall injuries.
662,000 of them were hospitalized. The total cost? $30 BILLION.
That’s 1 older adult going to an emergency room every 18 seconds.
Here’s another set of alarming facts.
Falls are the leading cause of both fatal and non-fatal injuries in the elderly.
- It is the most common cause of traumatic brain injuries.
- Injury risks from falls increase as one grows older.
- People 75 years old and up are 4-5x more likely to be admitted to long-term care facilities. The average stay is one year or longer.
- Most fractures in older adults are caused by falls. These could include spine, hip, forearm, leg, ankle, pelvis, upper arm and hand fractures.
- 95% of hip fractures are caused by falls. In 2010, that translated to over 258,000 cases, with the majority being women.
A Prisoner in Their Own Homes
Eventually, Patty’s fears became reality.
Her old man lost his footing while in the yard one day. He fell on his bottom and fortunately only suffered a bruised tailbone.
Did the walker finally win this round of the battle? Well, yes. He now won’t go anywhere without it.
Unfortunately, what is more crushing,was how he refused to go ANYWHERE. Period.
The crazy thing about falling, sometimes it wouldn’t really cause any physical injuries. But the person who fell still develops a fear of it.
A Precursor to Dying
3 years ago, 21,700 older adults died as a result of unintentional fall injuries.
That’s terrible and terrifying.
Older whites are twice as likely to die from falls than their black counterparts. Men also have a 40% higher fatality risk than women.
It’s “the difference between walking and wheelchair, between living in one’s own home and moving to a nursing home.”
But really, the question is:
How can a functional, happy person suddenly find himself in a nursing facility?
The Inevitable Falling Seniors?
Is it just old age that caused Patty’s father’s fall? What about for your loved ones?
Everyone naturally ages. If that is so, can we all expect falls to be in all our futures?
The answer is NO.
Falls in the elderly are not inevitable. But before we talk about prevention, let’s discuss what causes them.
The American Academy of Family Physicians list down the causes of elderly falls, in order of occurrence:
It’s been said that at least 1/3 of elderly falls are caused by environmental hazards in the home.
Tripping on objects on the floor is the number one culprit here. Other factors include:
- poor lighting
- loose rugs
- lack of, or poorly mounted grab bars
- unsturdy furniture
The lack of grab bars may actually contribute to falls from the bed or in the bathroom.
Gait and balance disorders
The process of walking is more complicated than it sounds. It involves the coordination of ears, eyes, brain and muscles. Problems with any of these can affect balance and may result to falls and injuries.
Arthritis, multiple sclerosis, Parkinson’s disease, gout and muscular dystrophy are just some diseases that can affect gait and balance.
It can also result from pain, muscle weakness and tightness or poor posture.
Vertigo symptoms include a mild to violent spinning sensation. Along with dizziness, vertigo has been identified as one of the more common risk factors in elderly falls.
You may recall Patty’s dad. He said that he felt dizzy while walking in the yard. He wasn’t quite sure where he’s placing his foot on. The ground “may have been swaying a little.” He promptly fell down.
Medications or Alcohol
Some medicines may have the unfortunate side effect of upsetting balance. This increases the risk of falling.
These medications include:
- psychotropic medication – may cause confusion and increase fall risk
- Angiotensin-converting enzyme (ACE) inhibitors
- Tricyclic antidepressants
Alcohol, meanwhile, may cause intoxication. This, in turn, leads to instability.
As previously mentioned, certain health conditions that cause the weakening of extremities and grip strength are high risks for falls.
Parkinson’s disease and arthritis are common examples.
Confusion and cognitive impairment
People with Alzheimer’s or dementia are often confused about their surroundings. They may also have some problems with depth perception. These all add up to falling hazards.
Also called orthostatic hypotension, this is more commonly known as a “head rush” or a “dizzy spell.”
It’s actually a form of hypotension. A person’s blood pressure may suddenly fall when standing up or stretching. This quick decrease in blood pressure triggers the dizziness.
It is a chronic and debilitating illness and quite difficult to treat.
Among the older adults, age-related macular degeneration (AMD) is the leading cause of irreversible visual impairment. An NCBI study was conducted on elderly with AMD. The mean age was 77 years old.
They found that 54% of them had a fall. A further 30% had more than one fall.
This was enough to conclude that visual impairment significantly increased incidence of falls and other injuries
Syncope, Drop attacks, and Epilepsy
What am I even talking about there, you might be asking?
Syncope, in regular-speak, is a “blackout.” Scientifically speaking, it’s a loss of consciousness. The cause? Diminished oxygen to the brain.
Drop attacks are sudden falls that does not result to unconsciousness. There’s usually no warning.
Epilepsy occurs when there is a disturbance in the neurological function. There is an abnormal excessive electrical discharge in the brain. This may alter consciousness.
Not all falls will have the same results.
Patty’s father was merely bruised. But the more debilitating effect was on his psyche.
87-year-old Margaret’s case was different.
When the electricity went out in her home, she found herself tripping and toppling down the stairs. She broke several vertebrae and fractured her hip.
She spent weeks in rehab.
One year later, she’s back doing tai chi at the park. Of course, her balance was never quite the way it was.
Understanding what the likely outcome of a fall will help caregivers identify what sort of help and assistance to provide.
A Yale study, published in the JAMA Network, found a correlation in the elderly’s health before the fall and his recovery rate after. Simply, those with minor disabilities recovered. Some quickly. Some more gradually.
The severely disabled prognosis was more grim.
Fall-proofing the Elderly
Seeing the effects of a fall on your parent can be devastating.
Even normal and healthy seniors are not exempt from the risks. How can we keep them as safe as we can, for as long as possible?
1) Risk Assessment
Here’s a simple questionnaire that may help you identify if your loved one is at an increased risk of falling.
- Is he 75 years or older?
- Does he live alone?
- Is he using a walking aide?
- Has he fallen before?
- Is he suffering from any acute illnesses or chronic conditions?
- Is he on any medication that may cause dizziness?
- Does he have vision problems?
I HATE FALLING!
The AAFP gives this handy menomonic for physical findings in people who are at risk or has already fallen.
I - Inflammation of Joints
H - Hypotension
A - Auditory and visual abnormallity
T – Tremor
E - Equilibrium problem
F - Foot problems
A - Arrythmia
L - Leg-length discrepancy
L - Lack of conditioning
I - Illness
N - Nutrition (Poor)
G - Gait disturbance
2) Making the Home Safe
Whether your parent lives alone, or with you, these safety tips can help you lower the risks of falling.
- Have him wear non-skid shoes instead of slippers. And make sure they fit well.
- Ensure that the house is well-lit.
- Use nighlights in the bedroom and hallways.
- If you can do without throw rugs, remove them. Otherwise, fasten them on the floor. Better yet, just use non-slip rugs and mats.
- Install grab bars and handrails.
- Ensure hallways are clutter-free.
- Repair loose wooden floorboards and carpets.
- Have them wear an alert pendant so you will know if they fell.
3) Good Health is a Weapon
Make sure that your parent gets regular checkups and is taking good care of himself.
Set up a doctor’s appointment. He may be asking what medications your parent is taking. Or if he has fallen before. Come prepared.
Exercise strengthens the muscles and improve balance.
A simple exercise that is good for the elderly is walking. He may also consider tai chi and yoga. They’re relatively gentle and has slow movements.
Ryan Malone of insideeldercare.com even suggests that the elderly get more active especially in the winter. Winter increases falls in the elderly. He posits that stretching loosens and strengthens the muscles. A less stiff senior would mean a more mobile senior. And less susceptible to falls.
Falls may not be inevitable. But they do happen.
Care.com’s Jody Gastfriend admits that even as a senior care specialist, she was still caught unprepared when her 84-year-old mother became part of this scary statistic.
She has this nugget to share, “Planning ahead may not prevent a fall, but it may prevent you from falling apart.”
What about you?
What preparations have you done to prevent your loved one from falling?
Have you had any difficulties with it?
Let’s share stories in the comments.