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Step safely

Falls are the leading cause of injury-related hospitalization for people 65 years of age or older. Here's how you can reduce your risk of taking an unwanted trip to the ER.

Step safely
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Age statistics

Falls prevention tips

Winnipeg Health Region
Wave, January / February 2011

Ruth Rachlis still doesn't know how it happened.

One moment, the 83-year-old woman was putting some food in her freezer. The next moment, she was on the floor.

"It was kind of scary," Rachlis says of the sudden turn of events last August. "I opened the door and I was on the ground. I had no idea what happened."

Immediately, she felt some pain in her lower body. "I have osteoarthritis so I thought the fall might have triggered something in my right hip."

Nonetheless, Rachlis was able to pick herself up, recover the food and put it in the freezer. A quick inspection revealed that she had some bruising, but, all things considered, Rachlis figured she would be okay.

That optimistic self-diagnosis changed a few hours later when Rachlis tried to get into bed. The pain in her hip was now excruciating. "I was trying to get up on the bed and get comfortable, and it was much too painful."

Unsure of what to do, Rachlis called Health Links, the Winnipeg Health Region's 24-hour health information service. The nurse on call advised her not to move and to call an ambulance. She was taken to Concordia Hospital where it was determined she had a fractured hip.

Surgery was performed in order to put a pin in her hip. Discharged from hospital two days later, Rachlis used a walker and the help of her husband to get around.

Looking back on the events of that traumatic day, Rachlis still isn't sure what caused her to fall. "Nothing I know of caused it. I couldn't see how to prevent it," she says noting that she was wearing well-fitted and safe sandals and there did not appear to be any obstacle or spill that would cause her to trip or slip.

Perhaps she just lost her footing. "As you get older, your balance is not as good. Now I am trying to be careful on my own. I use a cane, especially in the winter. For a while, I asked my husband to come with me when I went out. But the fear (of falling again) fades."

It's a familiar scenario. Every year, about 30,000 Winnipeggers 65 years of age or older experience a fall. Of these, about 2,000 are hospitalized, each staying in hospital for an average of 33 days. About 40 Winnipeggers die each year due injuries from falls.

At first glance, Rachlis might not look like someone who is as risk for a fall. She is a healthy, active senior who exercises regularly. Her bone density was determined to be good just a few months prior to the fall. While she had a heart attack a few years ago, she was not taking medications that she thought might make her dizzy. While a fall can happen anytime, anywhere to anyone, the outcome can be so much more serious in a senior. Rachlis may have had undetected risk factors that contributed to her fall. Rachlis' experience highlights the importance of older people thinking about what they can do to prevent a fall.

"A fall can happen so quickly," says Dr. Lynne Warda, Medical Director of IMPACT, the Winnipeg Health Region's Injury Prevention Program. "And they can have drastic consequences for older adults."

The likelihood of serious injury from a fall grows with age and increased physical frailty. Adults over the age of 65 who fracture a hip, for example, could face a lengthy hospital stay or the loss of their independence with a move to a nursing home. Worst case scenario, a fall down the stairs could cause a bleed in the brain. More often, as a person tries to break their fall, they break a bone like the forearm or hip.

The good news is that most falls are preventable, a point recognized by the Winnipeg Health Region. Last June the Region's Injury Prevention Program piloted a series of falls prevention clinics for older adults living in the community.

Under the project, members of the Region's Healthy Aging Resource Team (HART) identified older adults who might be at risk of injury from a fall. HART members then visited residents to conduct a 90 minute safety assessment of their homes to identify potential issues, such as poor lighting or scatter mats.

Once the assessment was completed, residents were invited to attend a mobile falls prevention clinic in their community where they could talk to health-care providers about specific issues during a series of 15-minute station visits.

"Clients visited seven different stations," explains Wendy French, who headed up the pilot project for the Injury Prevention Program. " First, a nurse reviewed the client's health history to see if they have a health issue such as diabetes, arthritis or high blood pressure. Then we checked things like their medications, vision, nutrition, and activity and fitness levels," says French.

About 45 older adults were assessed through the pilot project, which operated three clinics in June and one in November.

Of those who attended, 100 per cent received recommendations to improve their diet, 95 per cent were given suggestions about home safety, 69 per cent received tips for improving their balance and strength, and 44 per cent were asked to consult their doctor about their medications. HART members then did follow ups four and eight weeks later to check on how the clients were doing with the recommendations and to provide assistance and support where needed.

"One of the best things people can do to avoid falls is to maintain balance and strength," says French. "That's why regular exercise is important. But older adults should talk to their doctor or physiotherapist before starting an exercise regime," she says.

Most people were very positive about the clinic and were very receptive to making changes to their environment and other factors that could put them at risk of falling. The success of this pilot project has prompted the Region to explore ways of offering more of these clinics in the future.

In the meantime, the Injury Prevention Program has posted resources online that allow residents to conduct their own falls risk assessments.

Like the falls prevention clinics, these resources aim to help people identify those things that could cause a fall and then make changes to reduce the risk. "Potential problems are not always easy to identify," says Warda. "For example, an uncontrolled bladder problem may cause someone to get up many times in the night. The person may have poor vision, the lighting may be poor, they may be drowsy from their medications, and the scatter rug may cause them to slip. Falls prevention is about assessing many potential personal risks and minimizing them."

Other considerations include footwear worn in the home. Shoes should fit well and have a non-slip sole. If mobility aids like a cane are used, they should be used properly and adjusted to the right height. Clutter and loose rugs should be removed. Lighting should be adequate.

Individuals should review their health history with their health-care provider on a regular basis to identify and manage any new limitations or conditions that may contribute to a potential fall.

Older people should a review over the counter and herbal medications with their doctor or pharmacist every six months to determine whether they are necessary and working in harmony. It's important to know whether any medications being taken might cause dizziness that could potentially contribute to a fall. When seeing more than one doctor, ensure all medications prescribed by all doctors are considered. "And when a new medication is introduced, have them checked accordingly," says Warda.

Being active to the best of a person's ability and improving strength and balance can also help prevent falls. Tai Chi and walking are popular options for many able seniors. Eating nutritious foods throughout the day and staying hydrated by drinking water prevents light-headedness, thereby reducing the risk of falls.

Vision problems can contribute to falls, so people should have their vision checked regularly.

Vitamin D has been proven to help prevent falls and fractures by helping to build stronger bones. In general, seniors should be taking a minimum of 800 to 1,000 units to improve their bone health. But they should consult with their doctor, dietitian or pharmacist to determine the right dose for them.

Because many falls happen around stairs, while climbing up on chairs or ladders, and when using the wrong tools for the job, it is crucial for people to know their limits and put their own personal safety before attempting to reach that high shelf, change the light bulb, or put up the holiday lights.

"It's common sense," says Warda. "If there is even a slight risk of falling, wait for help. Stay off the ladder. The higher the height you fall from, the more awkward the landing may be. Of course, sometimes some people can be stubborn, but when they are fortunate enough to have family and friends to step in and help or preempt them by doing it first, falls can be avoided."

Several months after her injury, Rachlis says she is recovering nicely from her hip injury. But she has learned from her experience. She is now much more aware of how easy it is to fall and also aware of what she can do to help reduce her risk of a fall-related injury.

"I didn't worry too much about fall prevention until I fell," she says. "I am now a lot more careful where I put my feet. I have a feeling of vulnerability. It made me more realistic about the aging process. I still feel 35 but I realize that my body is much older."

Rachlis says it is very important for seniors to be assessed for risk of falling and to be offered support and education on fall prevention. She has compared notes on her experience with an older resident of her building who experienced a similar fall a few months before Rachlis did. "Generally older people need to be aware of these things."

Liz Katynski is a Winnipeg writer.


About Wave

Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books.

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