When Gerry Connolly, 73, took a bad fall in the middle of the night, his wife, Marian, was sure they would have to sell their home on Washington's Capitol Hill. They loved the 1865 Italianate house, but Gerry, who has acute peripheral neuropathy, was finding it harder and harder to navigate its multiple levels.
Staying there threatened his health; the thought of moving was traumatic and overwhelming.
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Falls are a significant danger as we age. They cause serious injuries that can limit mobility, diminish quality of life and increase risk of premature death. They also are eminently preventable. The ease with which you can decrease someone's risk of falling makes it a "public health no-brainer," said Rita Wong, a professor of physical therapy at Marymount University in Arlington, Va.
Falls cause 95 percent of hip fractures, and one in five people with hip fractures die within a year of the injury, according to the Centers for Disease Control and Prevention. Annually, falls among seniors are responsible for 20,000 deaths, 2.3 million visits to emergency rooms and more than $30 billion in direct medical costs.
The Connollys are members of Aging in Place, an organization that helps people stay in their homes and maintain independence as they age. Through that program, they took a "health care transitions" seminar and met Tori Goldhammer, an occupational therapist who works with seniors to prevent falls.
Goldhammer came to the Connolly home and evaluated Gerry as he moved through the house. His condition, which involves damage to the nerve network that transmits information from the brain and spinal cord, has affected his balance.
Based on Goldhammer's recommendations, the Connollys had a handrail added to a banister and grab bars installed in several places, including one leading to their patio.
"We were so pleased," Marian said. "I was sure I would have to have a fire sale and sell the house."
Minutes after the grab bar to the patio was put in place, Gerry almost fell, but he used the new safety device to catch himself. Other improvements are also planned, such as widening a narrow path to the backyard.
"It's wonderful to think you can stay in your home," Marian said, noting that the improvements look great and not institutional. She said her husband is now in physical therapy and addressing issues of balance.
Goldhammer is working to bring to Washington "A Matter of Balance," a program that helps seniors reduce their fear of falling while staying active.
"As an occupational therapist, I work with seniors and see what their risks are," Goldhammer said. "The more I learn, the more I need to learn. There are hundreds of reasons why people fall; the CDC defines four categories: medicine, vision, environment (tripping hazards) and balance and strength."
When talking to groups, Goldhammer said she emphasizes the four areas that can help manage risks. But on an individual level there is so much more to explore: Falling may have to do with specific medications, the way one's house is set up or something as simple as not taking off your reading glasses when walking.
"We try to make sure people understand these are things they can do, but if they are unable on their own, they should request professional guidance," Goldhammer said.
A study done at Britain's Nottingham University in 2010 looked at 204 adults older than 60 who had fallen and called an ambulance but were not taken to the hospital.
Researchers concluded that screening those at risk and offering fall prevention services resulted in a sizable reduction -- 55 percent -- in the rate of falls over the subsequent year.
Wong says physical therapy can play a big role in helping prevent falls. Her students lead a class that teaches balance-enhancing exercises at the Walter Reed Senior Center in Arlington. When lecturing about fall prevention, she says, she finds some people who do not admit they are at risk and do not seek out resources.
And there are others who have such a strong fear of falling that they stop functioning.
"The logic is: If I don't get up, I'm not going to fall," Wong said. "And that is the worst thing you can do. If you don't move, you lose muscle tone, agility and balance, and it happens quickly. As you get older, it takes longer to recover."
The CDC's Injury Center recently developed STEADI (Stopping Elderly Accidents, Deaths and Injuries), a "tool kit" of information and assessment tests for helping health professionals identify issues related to balance and strength.
"When we talk about falls in older adults -- from age 60 to 100 -- it is different building balance for someone 85 than someone 65," Wong said. "It is not just that they are older; it is also generational. The 85-year-olds never exercised, while most of the 65-year-olds have."
Wong said it is important to show seniors not only how to exercise safely but also how to exercise more often.
The old idea of keeping seniors in a chair for exercise was based on a fear of injury, Wong said. But even the most frail adults benefit from more vigorous exercise, Wong said.
Between 2000 and 2010, death rates from falls rose 63 percent for men and 83 percent for women, according to the CDC.
Andrea Baumann has been teaching fitness to seniors for 20 years in Arlington County. Her class is offered three times a week and has about 30 to 40 people ages 55 to 95. Participants often bring a son, daughter or friend; some are accompanied by a caregiver.
The classes focus on three areas that Baumann says need strengthening to avoid falls: ankles, hips and what she calls "first step," which are lunges. The classes begin with participants seated in chairs and doing a "fast jog" with their feet and moving their arms to music for three minutes. After the warm-up, there is stretching, soft and slow breathing (often to the Pachelbel Canon in D Major) and 20 minutes of strength exercise using dumbbells, stretch bands, ankle weights and squeeze balls. Then there are 20 minutes of cardio aerobics and a four-minute cool-down.
Everyone works at a different pace. Baumann always asks if people are recovering from injuries or surgeries; if so, their exercises are modified to account for that. Exercises are geared toward helping seniors do everyday activities such as reaching up to take things down from a closet shelf and pushing a grocery cart or lawn mower.
"I have taught seniors for a long time," Baumann said. "Seniors are not fragile; they can do a lot. Their bodies are working fine. My seniors are in real good shape."
Tips to keep seniors safe from falls at home
• Get some exercise; lack of exercise can lead to weak legs. Exercise programs such as tai chi can increase strength and improve balance.
• Review your medications; some medicines or combinations can have side effects such as dizziness or drowsiness.
• Keep your vision sharp; older adults should have their eyes checked every year.
• Eliminate hazards at home:
• Remove things you can trip over.
• Install handrails and lights on all staircases.
• Remove small throw rugs, or use double-sided tape to keep them from slipping.
• Keep items you use often in cabinets you can reach easily without using a step stool.
• Put grab bars inside and next to the tub or shower and next to the toilet.
• Use nonslip mats in the bathtub and on shower floors.
• Improve lighting in your home.
• Wear shoes both inside and outside the house; avoid going barefoot or wearing slippers.
Source: Centers for Disease Control and Prevention