Avoiding a fall is no small feat

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Carol Sorgen

While staircases can be the culprit in some falls, Harriet Kohl broke both her kneecaps in recent years, tripping over an uneven sidewalk and a piece of luggage. Falls are the leading cause of injury and accidental death in older adults, but there are many steps, from exercise to better lighting, that can help prevent them.
Photo by Christopher Myers

Two years ago, Harriet Kohl fractured her right kneecap when she tripped over a jutting piece of sidewalk while taking a walk in her Charles Village neighborhood.

Two months ago, while on a long-awaited trip to Amsterdam, she tripped over a suitcase in a crowded train station. That time, Kohl fractured her left kneecap.

“To put it mildly, I was ticked off,” said the 71-year-old artist. (Actually, that’s not the word she used, but you get the drift.)

Fortunately, she didn’t need surgery either time. Spending six to eight weeks in a knee brace, and using a cane for assistance, put her back on track. But Kohl said that the experience of falling is frustrating, to say the least.

“It’s uncomfortable and tiring, and there are days you just want to throw the cane or the crutch across the room,” she said.

Kohl has found out first-hand — twice now — just how debilitating a fall can be. And she’s not alone.

Number of falls not falling

Falls are the leading cause of injury and accidental death in adults over the age of 65. Every 15 seconds, an older adult is treated in an emergency room for an injury related to a fall.

In 2012, nearly 24,000 people over 65 died after a fall — almost twice the number of a decade earlier, according to the Centers for Disease Control and Prevention (CDC).

Clutter, inappropriate footwear, poor balance, distractions and tripping hazards — such as an uneven sidewalk or piece of luggage — can contribute to a stumble or fall.

The increased number of falls has also been partly attributed to a rise in diseases that are often linked to falls — including heart disease, stroke, diabetes, arthritis and Parkinson’s disease — as well as to the medications frequently used to treat these diseases. (Many medications can cause dizziness and lightheadedness.)

Impaired vision and, perhaps surprisingly, hearing loss are additional potential culprits.

According to a recent study by Johns Hopkins School of Medicine, falls are nearly three times more likely to occur among people with mild hearing loss. When people can’t hear well, they may be unaware of their surroundings and struggle more to maintain proper balance, increasing their chance of tripping and falling.

Nancy Jackson is not unfamiliar with falling. She spent many years horseback riding, and even suffered a fractured pelvis after being thrown from a horse.

But she wasn’t prepared for breaking an ankle last summer while hiking with her husband and two nephews. “I stepped on a rock, fell on my leg and heard my ankle snap,” she recalled.

This was Jackson’s second fall in as many years. Her first was caused by tripping over an uneven sidewalk while carrying a box into her office. Instead of trying to save herself, she tried to save the box, and wound up with a sore head and a cracked rib.

“After a fall, you feel old,” said Jackson, who is 56 and lives in Perry Hall. “It changes your life.” Jackson said she now finds herself looking down all the time to try to avoid missteps.

Still, as cautious as she is, she worries. “I like to be active,” Jackson said. “But I’m very nervous about falling again.”

Indeed, the American Occupational Therapy Association (AOTA) reports that some people become so afraid of falling (either before or after an actual fall) that they stop doing activities they used to enjoy.

Ironically, this is exactly the opposite of what they should be doing. “Remaining physically active is an essential part of preventing falls,” advised Marlene Riley, clinical associate professor in Towson University’s Department of Occupational Therapy & Occupational Science, and an OT with University of Maryland St. Joseph Medical Center.

According to the CDC, research shows that doing balance and muscle-strengthening activities each week, along with moderate-intensity aerobic activity like brisk walking, can help reduce the risk of falling.

How to prevent falls

Riley offers some other tips to reduce your fall risk:

• Remove clutter in your home, and walk carefully when there are potential hazards, such as throw rugs and pets underfoot.

• Arrange furniture so that there is plenty of room to maneuver and to create sturdy balance-catching points throughout the home.

• Add light to dimly lit areas.

• Never stand on chairs or similar items to get to something you can’t reach. Ask for help, or use a sturdy stool with hand rail or a ladder.

• Do not use towel bars, sink edges and the like for support, because they could come away from the wall.

• Use a nightlight in the bedroom and bathroom.

• To prevent the bathroom floor from getting wet, immediately wipe spills off the floor, and use a rubber-backed bathmat. Even a small amount of water can lead to a slip.

• Stay active to maintain overall strength, endurance and balance.

• Know your limitations. If there is a task you cannot easily complete, do not risk a fall by trying to do it.

• Have your vision, hearing and medications checked regularly.

While Kohl and Jackson still worry about falling in the future, they are now healed from their latest tumbles.

For Lee Kaufman, however, who will turn 87 in December, the fall she took two months ago while out with friends has left her shaken, and not just because of the broken wrist and fractured pelvis she suffered.

“If I fell again,” she said, “I know that would be it for me.”

Kaufman is still experiencing the effects of her fall, and has been unable to drive, even to doctors’ appointments.

The worst part of falling, she said, is the loss of independence. “It’s hard to find rides. [Her daughters do what they can, but are not always available] and friends don’t want to be bothered,” she said.

Making things worse is that Kaufman has been a passenger in three car accidents since her fall. As a result, she’s not only afraid of falling, she’s now afraid to return to driving even when the doctor gives her permission to do so.

“This has not been a good six months,” she said. “You get very depressed.”

Local programs abound

Falls are such a serious concern as we age that a Maryland-wide falls prevention coalition called Gaitway-2-Better Balance has been formed. So far, the group has implemented a number of programs throughout the state to educate citizens about the issue.

This coalition includes local rehabilitation specialists as well as representatives from the Maryland Department of Health & Mental Hygiene Injury Prevention Unit, the Baltimore County Department of Aging, and from academic programs such as the Towson University Department of Occupational Therapy, the University of Maryland at Baltimore School of Physical Therapy, and the Notre Dame University School of Pharmacy.

The coalition has participated in local programs such as the Baltimore Senior Expo in October and the annual Falls Prevention Week held in September.

The Baltimore County Department of Aging is also partnering with students from the Occupational Therapy Assistant program at the Community College of Baltimore County–Catonsville to provide balance screenings, fall screening evaluations, and fall prevention education at Baltimore County Department of Aging (BDCA) senior centers. Check your local center for a schedule.

In addition, the Towson University Department of Occupational Therapy & Occupational Science is working on a project with the Baltimore County Department of Aging on falls prevention.

Throughout the coming year, senior centers throughout the county will offer classes such as “Tai Chi for Better Balance” and “EnhanceFitness,” which are designed to improve balance, strength, physical performance, postural stability and walking; reduce the risks of falls; improve self-management; and increase quality of life. For more information on how to register for a class, call (410) 887-2040.

For information about a fall prevention exercise study being conducted at the University of Maryland and the VA Maryland Health Care System in Baltimore, see “Help find the best exercise to prevent falls,” on page 15 of this issue.