For Better Health
THE NEWTOWN BEE, FRIDAY, MAY 18, 2018
C-ONE
Falls And The Elderly: Potentially Fatal, But Most Are Preventable By Shannon Hicks The US Preventive Services Task Force (USPSTF) recently published recommendations to prevent falls in older adults. In a feature published in the April 24, 2018 Journal of the American Medical Association (“Prevention of Falls in Older Adults”), Jill Jin, MD, MPH, says falls “are the leading cause of injury in adults aged 65 years or older.” William V. Begg III, MD, FACEP, vice chair of Danbury Hospital Emergency Department, concurs. Danbury Hospital data, he said, indicates that 50 percent of the injured patients who arrive at the hospital are age 65 or older, and they are “most commonly injured from a simple fall from standing.” Many have a long recovery and struggle to return to their previous level of independence, the local hospital’s data also shows. In her April article, Dr Jin agreed, saying a serious fall can result in decreased functional independence and quality of life. According to the Centers for Disease Control and Prevention (CDC), more than 25 percent of older people fall each year, but less than half tell their doctor. And falling once doubles the chance of falling again, the agency reports. The good news is, there are simple steps most can take to reduce the risk of falls. Injuries & Resulting Concerns According to USPSTF, the risk of falling increases with age for many reasons, including overall weakness and frailty, balance problems, cognitive problems, vision problems, medications, acute illness, and other environmental haz-
ards. The most common injuries for those 65 and older are hip fractures, head injuries, and rib fractures. More than 95 percent of hip fractures, according to the CDC, are caused by falling, usually by falling sideways. Nationally, half the people who break their hip die within a year. Many, according to the CDC, are not able to live on their own again. There are a number of reasons this happens, according to Dr Begg. “One of the main reason is, when you’re unable to move around like you previously had done, you’re at increased risk for a number of illnesses, including blood clots, because you’re immobile,” Dr Begg said. Pneumonia — an infection of one or both lungs — often follows a fractured or broken hip, he said, “because you’re not moving around, you’re not using your lungs as much” as you had been before the fall, when breathing was not such an effort. Patients recovering from that type of injury are also at risk for severe infections, he said, “either from not moving too much, bed sores, skin breakdown, urinary infections, and the like.” In addition, those who had previous medical issues before a fall that injures their hip have additional concerns. “When people get hip fractures and they weren’t doing well otherwise,” said Dr Begg, “that can be the final medical issue they have. “You could have a heart attack and fall down, or a stroke and you went down, or your blood sugar was out of control, or blood pressure out of control — so there’s other medical issues that lead to having a hip fracture, and then those medical issues are out there and still
Dr William Begg, vice chairman of Danbury Hospital Emergency Department, has seen falls ruin the lives of multiple elderly patients during his 25 years of medical practice. —Photo courtesy Danbury Hospital/Western Connecticut Health Network need to be addressed,” he explained. Blood thinners do not mix well with falls and the elderly. Blood Thinner Dilemma Of all the things that have changed in recent years, Dr Begg, said, there has been “a significant [increase] in the number of serious head injuries, including bleeding on the brain, due to blood thinners.” When someone who is not on blood thinners has a fall and bumps their head, they
will most likely have a bruise on the outside of the head. Falls, according to the CDC, are the most common cause of traumatic brain injury. For those on thinners, however, “when you fall, you’re probably going to bruise inside your head, and that’s bleeding on the brain, which is in the family of a stroke,” Dr Begg explained. Normally, people have vessels that move blood to and from their brain. “When you fall and you’re on blood thinners,” Dr Begg
said, “those vessels can break.” When the brain swells, it squeezes brain tissues, “and that’s when people cannot think well, or pass out, or actually die from the swelling,” he added. Rib fractures come into play due to how they affect the lungs. “Say you’re a high school kid and you’re playing soccer or football, and you fall on your ribs,” Dr Begg said. “They’re pliable — they bend; they don’t break.” Fast forward a half dozen decades, and those ribs are no longer pliable. “They break, and they break in numbers, sometimes four and five at once,” Dr Begg said. When ribs break, lung tissue is also injured, which increases the risk of pneumonia. “When your ribs are injured, you don’t want to take a deep breath,” he explained, “and that’s when bacteria sets in. And that’s when you can get pneumonia.” Many people who fall, even if they do not get injured, become afraid of falling again. This, according to the CDC, may cause a person to cut down on their everyday activities. Ironically, when that happens — when a person becomes less active — they become weaker, and therefore more prone to a fall. Preventive Steps Fortunately, there are easy ways to prevent falls. There are also things that can be done to lessen the extent of an injury from a fall. Dr Begg sees at least two different subsets of things people can do to begin fall prevention measures: “Take care of yourself, and take care of your home,” he said. “As you get older,” said Dr
Begg, “people need to reevaluate their lifestyle choices, whether cycling, hiking, or other activities. Your body changes, and you cannot maintain the exact same activities without realizing that you may not be able to tolerate it all as well.” Eyesight and hearing also evolve with age, as do dosages for medications. “If you are on the same blood pressure medication for years, and you don’t need as much as when you began taking it, your blood pressure can be off, and you can fall,” said Dr Begg, who suggests everyone checks in with their physician to reassess prescriptions. “You may not need the same dose of blood thinners, or cholesterol medications, or any of them,” he said, “and those are good things that need to be evaluated.” A new generation of blood thinners allows doctors to consider different approaching for bleeding risks, Dr Begg mentioned. “That’s why a medical evaluation is so important,” he said. On the flip side, he added, more people are exercising these days, especially stretching, which keeps them limber and decreases the chance for a fall. A lot of things can be done at home. Danbury Hospital has a list of simple things that can be done around any home to lessen the risk of a fall. (See sidebar.) “People have a tendency to have cluttered homes, or apartments, and that’s one of the worst things you can have,” Dr Begg said. “Clutter increases the risk for tipping. Or even when you lean over to grab something, you can fall over.” Falls and injuries from them are not relegated to ( continued on page C - 3 )
Fall Prevention Tips
Many falls do not cause injuries, including for those age 65 and older. According to the Center for Disease Control and Prevention (CDC), however, one of five falls does cause a serious injury such as a broken bone or head injury. The CDC and Danbury Hospital offer the following fall prevention tips: *Ask your doctor or healthcare provider to evaluate your risk for falling, and talk with them about specific things you can do. *Ask your doctor or pharmacist to review your medicines to see if any might cause dizziness or sleepiness. This should include prescription and over-the-counter medications. According to Danbury Hospital staff, blood thinners, including Aggrenox, Brilanta, Coumadin, Effient, Eliquis, Lovenox, Plavix, Pradaxa, and Xarelto, are particularly high risk following a fall. *Have a yearly exam of your hearing. *Ask your doctor or healthcare provider about taking vitamin D supplements. **(see note below) *Do exercises that make your legs stronger and improve your balance. Tai chi is a good example of this kind of exercise. *Have your eyes checked by an optometrist at least once a year, and update eyeglasses if needed. For those who wear bifocal or progressive lenses, consider a pair of glasses with only the distance prescription for outdoor activities such as walking. These types of lenses can sometimes make things seem closer or farther away than they really are. *Get rid of things than can be tripped over. Move items off the floor that can cause trips (shoes, newspapers, books, etc). *Add grab bars inside and outside the tub and shower and next to the toilet. *Use nonslip mats in the bathroom and on shower floors. *Remove small throw rugs or have them taped down. *Have broken or uneven steps repaired. *Put railings on both sides of stairs. *Have plenty of lighting, including brighter light bulbs. *Keep items commonly used in close reach to avoid bending over or standing on a stool to reach them. *Wear shoes at all times, and avoid slippers or going barefoot. *Do not walk while using a cell phone. Doing so can increase the risk of falling, as one hand will be using the phone. *Put a phone near the floor in case you fall and cannot get back up. *Keep emergency numbers in large print near each phone. *Consider a personal alarm device that will bring help in the event of a fall when no one is around to offer help. *Keep in mind that bad weather increases the chance of falling around the home. Most falls, according to the CDC, are caused by a combination of risk factors. The more risk factors a person has, the greater their chances of falling. **Interestingly, while Vitamin D has long been thought to be associated with strengthening bones, Dr Jill Jin’s April 24 JAMA article supports research published in December 2017, also by JAMA, that says the use of supplements that included calcium, Vitamin D, or both “was not associated with a significant difference in the risk of hip fractures with placebo or no treatment” (“Association Between Calcium or Vitamin D Supplementation and Fracture Incidence in Community-Dwelling Older Adults,” Jia-Guo Zhao, MD; Xian-Tie Zeng, MD; Jia Wang, MD; et al). “Community-dwelling” refers to people who continue to live at home, not in a nursing home or other institutional setting. The USPSTF, Dr Jin pointed out, did not recommend Vitamin D supplementation. It did recommend exercise and “multifactorial interventions,” dependent on each patient’s situation.
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