Tuesday, March 11, 2014

Steady on your feet: The older you are, the more devastating a fall can be

From:  Pittsburgh Post-Gazette

The numbers are depressing.
One in three adults age 65 and older falls each year, and 20 to 30 percent of those who fall suffer moderate to severe injuries. 
The Centers for Disease Control and Prevention also reports that injuries from falls by people older than 65 totaled $30 billion in direct medical costs in 2010.
The outlook, however, isn't entirely grim — many people are working to prevent falls among the older population or at least to decrease the number of falls.
“Falling is not a normal part of aging,” according to information from the National Council on Aging that is given to those who are trained and certified to teach fall-prevention programs. "Most falls can be prevented.”

PG graphic: Checklist to help prevent falls at home
(Click image for larger version)
Falls, however, are a "big issue," said Steven M. Albert, professor and researcher at the University of Pittsburgh. "We all fall all the time. The difference is the consequences of a fall are worse when you’re older. Over 65, you’re likely to break something. When people over 80 fall, many are unable to get up.” 
Fractures of the hip, spine or forearm are the most common fall-related injuries, with hip fractures the most serious.
In 2010, the CDC awarded a $1.5 million grant to Pitt’s Graduate School of Public Health to study the effectiveness of programs that teach seniors how to avoid falls. Mr. Albert, who works in the Department of Behavioral and Community Health Science in the Graduate School of Public Health, is the principal investigator, working in collaboration with the Pennsylvania Department of Aging, which has developed two fall-prevention programs: Healthy Steps for Older Adults and Healthy Steps in Motion.
Research shows that the fall-prevention programs are beneficial, but Mr. Albert could not elaborate on that finding because the results will not be made public until next Thursday, when the study will be published on the website of the American Journal of Public Health. The results also will appear in the May print edition of the journal.
The two Healthy Steps programs aim to reach older people before they fall. Some of the tips and techniques are the same as those taught in rehabilitation programs prescribed for those who have fallen repeatedly.
People age 75 and older have the highest rate of falls, according to CDC statistics based on falls in 2010 that were not fatal but required medical care.
The number of falls among those age 75 and older was 115 per 1,000 population — twice as high as falls in the 65-74 age group.
Children between the ages of 12 and 17 fall at a rate of about 60 per 1,000, which is slightly higher than falls in the 65-74 group. The overall rate of falls for all age groups is 43 per 1,000 population.
What causes falls?
Falls are caused by many factors. Some are associated with diseases that frequently accompany old age.
Neurological problems, neuropathy, vision problems, weak arms and legs, mild dementia and balance problems can all be factors in falls, Mr. Albert said.
Prescription and over-the-counter medications can cause dizziness that leads to falls, especially if the person is taking multiple medicines that may be interacting with each other.
Homes are full of hazards that can cause falls, including throw rugs that slide, electrical and extension cords that can cause a person to trip, and indoor and outdoor stairs that do not have secure handrails.
And then there’s this: “Ten to 15 percent will tell you they were doing something stupid” when they fell, Mr. Albert said.
Healthy Steps
Lois Shelton is a registered nurse who works in Harrisburg as state coordinator for PrimeTime Health. That’s the Pennsylvania Department of Aging’s health promotion and disease prevention program, which works to preserve independent living among senior citizens.
Each county has an Area Agency on Aging that offers a variety of programs, including Healthy Steps for Older Adults and Healthy Steps in Motion for people age 60 and older. The state Department of Aging worked with the University of California at Berkeley to develop the two programs.
Healthy Steps for Older Adults is a four-hour workshop in which participants are tested and evaluated to determine their risk of falling. One of the tests, for example, times how long a person can balance on one leg. In another test, the evaluator counts how many times a person can stand up from a chair and sit back down in 30 seconds.
Participants are given the score from their evaluation, and it is also given to their physicians. Those who are thought to be at high risk of falling may get a referral to a physical therapist or occupational therapist. Some may be advised to get an “assistance device” — a cane or walker sized to their height that includes instructions for proper use.
Participants also are given information that encourages them to get into an exercise program. They learn how to make their homes safer, manage their medications, improve their nutrition and talk to their doctor. They learn fall-prevention tips, and they go home with a 64-page brochure that reinforces information learned in the workshop.
Healthy Steps in Motion is an eight-week exercise program designed to build strength, increase flexibility and improve balance.
“Many of these people have no exercise history,” Ms. Shelton said. A high percentage of recipients report positive feedback at the end of the eight weeks, she said. “They say they feel healthier and stronger. Fifty-eight percent said they learned how to get up if they do fall. They said they made friends and formed lunch groups.”
Benefits can be measured in little changes that can mean a big improvement in lifestyle, such as the woman who told her instructor she could now carry her own groceries into her house.
Healthy Steps programs operated or overseen by the state are free to people older than 60, but the state is getting an increasing number of requests to offer Healthy Steps through programs that are not operated by the state and which may charge a fee, so participants should check on whether there is a charge for the program.
To find a class, state officials suggest residents contact their county’s Area Agency on Aging. In Allegheny County, call 412-350-5460.
Get out of the house
Melanie Parente is the program coordinator who teaches Healthy Steps for Older Adults at the Plum Senior Center, 499 New Texas Road.
Among the topics covered in the workshop, “we debunk the myths of elder falls,” she said, including this one: “If I limit my activity, I won’t fall.”
“Some people believe the best way to prevent falls is to stay at home and limit activity,” says a fact sheet from the National Council on Aging that is included in the manual given to Ms. Parente and other trainers. “Performing physical activities will actually help you stay independent.”
In addition, “over half of all falls take place at home,” which is why participants in Healthy Steps for Older Adults fill out a home safety checklist.
Registration is due by next Thursday for the free workshop for Allegheny County residents, which will be held from 10 a.m. to 3 p.m. March 27 and will include lunch. For information: 412-795-2330.
The center also offers yoga and exercise classes for older adults.
The Jewish Community Center and the Lutheran Service Society also offer Healthy Steps for Older Adults.
The JCC will hold its workshops March 24 at the Squirrel Hill site and April 29 at the South Hills center in Scott, said Sybil Lieberman, senior center director. Both workshops will run from 1 to 4 p.m. To register: 412-521-8010, ask for the adult department.
The JCC schedules several of the workshops each year, with 20 people in each one. Both locations also offer exercise programs for seniors.
Patricia Pacey is the instructor for Healthy Steps for Older Adults and Healthy Steps in Motion at the Prime Time Activity Center in Bellevue, which is operated by the Lutheran Service Society.
The next Healthy Steps in Motion class will begin March 18 at the center at 440 Lincoln Ave., Bellevue. It will begin at 11 a.m. each Tuesday and Thursday for eight weeks. Classes are free but registration is required by March 14. To register: 412-307-1783.
Dates for Healthy Steps for Older Adults will be announced soon.
A senior citizen herself, Ms. Pacey has been teaching the Healthy Steps programs for four years.
The classes are popular with both men and women, she said. She also teaches yoga and other exercise classes for seniors.
“They get strength back in their legs and become more confident,” she said.
Mary Jo Guercio is project director for Healthy Steps in Motion at Community College of Allegheny County.
“This is our second year, and we offer classes each semester,” Ms. Guercio said. “Last semester, we had seven sites for eight weeks of classes, meeting twice a week for 90 minutes.”
The next classes will start later this month. For dates and locations: 412-237-2723.
Improving mobility 
Jennifer Brach has worked with Mr. Albert. She is an associate professor in Pitt’s Department of Physical Therapy and in the university's Clinical and Translational Science Institute.
She is in the early stages of a new study on classes and education to improve mobility and decrease falls. The study will involve older residents who are living independently in their homes, which can include senior citizen high-rises.
“The work I am doing is primary prevention,” she said, and that includes the prevention of falls.
The classes will be held at 28 sites, which have not been selected yet but are expected to include UPMC senior communities, senior centers and senior high-rises.
Her study is funded by the Patient-Centered Outcomes Research Institute, which gets money from Congress as part of the Patient Protection & Affordable Care Act of 2010.
Many existing programs already teach older people how to prevent falls and how to be healthier, fitter and more active, Ms. Brach said.
“I have talked to a lot of older adults, and I think we can do better,” she said. “That’s why I’m doing the study.”

Read more: http://www.post-gazette.com/local/south/2014/03/06/Pa-Healthy-Steps-for-seniors-The-older-you-are-the-more-devastating-a-fall/stories/201403060004#ixzz2vDYtVA7S