Jan. 13, 2016 - Daphne Brown, 65, was putting away the dishes in her Washington kitchen when she fell to the floor. Jane Bulla, 82, fell at home in Laurel, Maryland, but managed to call for help with the cellphone in her pocket.
Susan Le, 63, who has trouble walking due to arthritis, hurt her leg when she tripped on a pile of leaves in Silver Spring. And late one night when no one was around, Jean Esquivel, 72, slipped on the ice in the parking lot outside her Silver Spring apartment.
Falls are the leading cause of injuries for adults 65 and older, and 2.5 million of them end up in hospital emergency departments for treatment every year, according to the Centers for Disease Control and Prevention. The consequences can range from bruises, fractured hips and head injuries to irreversible calamities that can lead to death. And older adults who fall once are twice as likely as their peers to fall again.
Despite these scary statistics, a dangerous fall does not have to be an inevitable part of aging. Risk-reduction programs are offered around the country.
To reduce the odds of falling again, Brown, Bulla, Le and Esquivel signed up for “UpRight! Balance Training,” a free 12-week exercise class aimed at improving gait, balance and muscle strength held at Holy Cross Hospital’s Senior Source center in Silver Spring. People interested in joining the class must first complete balance tests to determine their risk of falling. Those who are too unsteady may be advised to get physical therapy or discuss other fall-prevention options with their doctors.
Last month, 10 women and one man completed the class, which is offered several times a year.
“It definitely made me think first and to make sure I felt comfortable taking my next step,” Brown said after one of the group’s final sessions. Participants took turns, while instructors spotted them, crossing over an imaginary river that instructor Judy Cooper had created with blue yoga mats covered with exercise platforms, small barbells, inflatable cushions and other objects representing rocks and tree branches that they stepped on to get across.
Le nearly tripped on her second turn through the obstacle course. The experience reminded her “to take things slowly, because I walk a lot and I have to watch where I step,” she said.
‘Know What To Avoid’
After decades of walking and rushing, they were learning to be more aware of their surroundings, to watch their posture, maintain their balance and to master a flight of stairs even with less-than-perfect knees. To confront the stairs, they practice going up using their stronger leg first and going down with the weaker leg first. Stepping sideways is another strategy and has the added advantage of allowing the person to hold onto the stair railing with both hands.
Under the careful eye of Cooper and co-instructor Gina Deavers, members of the class practiced stepping off a riser while holding an oversize exercise ball — to simulate a laundry basket — and going down steps facing forward and backward with eyes open and then closed. They also tried walking in a straight line while reading a book. Not everyone was able to do these tasks, and that was part of the lesson.
“If you’re aware of your limitations, you are much less likely to fall because you know what to avoid,” Cooper said.
It’s also important not to be overly cautious, said Thomas Gill, a geriatrician and professor at the Yale School of Medicine and one of the principal investigators for the $30 million federal STRIDE study, the nation’s largest investigation of how to prevent injuries from falling. When older people become afraid of falling, they may cut back on physical activity and eventually grow weaker.
“Paradoxically, that puts them at greater risk of falling,” Gill said. “The fear of falling can be a dysfunctional response, and there is strong evidence that it is a fairly powerful risk factor for serious fall injuries.”
Another free class at Senior Source, “A Matter of Balance,” helps people cope with the fear of falling by discussing how to make their homes safer and how to recognize and modify such risky habits as walking into a dark room or not immediately wiping up a spill on the kitchen floor. Boston University researchers developed the class in 1995, and it is available in 40 states. The average age of class participants is 79, according to Patti League, national program manager at MaineHealth’s Partnership for Healthy Aging, which received a federal grant to train volunteers to teach it.
In a 2015 study, researchers found that people who completed the “Matter of Balance” sessions reduced the number of falls and injuries and saved an average of $938 a year in medical costs.
Despite the need for and success of such programs, some experts are concerned that more people don’t participate. Fewer than half of the usual 16 people signed up for the most recent “Matter of Balance” class, which has been offered since 2007.
“A huge amount of work has gone into fall-prevention research, but many people who could benefit don’t get to [these programs],” said Nancy Latham, director of the STRIDE study, which is recruiting 6,000 patients at 10 clinical sites around the country, including Johns Hopkins Medical Center in Baltimore. The study will test the effectiveness of a “falls care manager” who helps patients enroll in prevention programs like “A Matter of Balance” and addresses problems that can increase the risk of falling, from medications to footwear.
“The fear of falling is real, but people can change it,” said Kristen Wheeden, coordinator for the chronic disease self-management program at Holy Cross, who taught the “Matter of Balance” class last month. “Instead of saying, ‘I can’t do this, no way, I’m going to fall,’ let’s make it so you can, let’s find a buddy system, let’s go out at a certain time of day, and let’s make your world safe.”
What You Can Do
To reduce the risk of a fall, experts recommend that you:
— Stay physically active to improve balance and coordination — even walking helps.
— Fall-proof your home: Install grab bars in the bathroom, increase lighting, remove tripping hazards such as throw rugs and footstools.
— Ask your health care provider to evaluate your risk of falling and to review your medications because some drugs can make you dizzy or sleepy.
— Get vision and hearing checkups at least once a year.
— Join a falls-prevention class. To find one in your area, contact your local senior center or hospital, or find additional resources here.
This KHN story also ran in The Washington Post.