Transcription:
Falls Prevention: How You Can Avoid a Fall

Melanie Cole (Host): Falls are not a normal part of aging; yet one out of every four adults aged 65 and older falls every year and most have significant health and lifestyle consequences as a result. The good news is, falls can be prevented. My guest today is Chris Wellner. She’s a physical therapist and sees clients at the Courage Kenny Rehab Institute at Abbott Northwestern Hospital. She specializes in fall prevention and has a special interest in public health. Welcome to the show Chris. So, falls are a huge problem. Are they, as I said in my intro, they are not a normal part of aging, so I mean what do you tell people about the possibility of preventing falls when people think oh, I’m just going to have a fall at some point?

Chris Wellner, PT (Guest): Right. Yes, we try to really emphasize that it is not a normal part of aging and that they definitely can be prevented. To help prevent falls among older adults, the American and British Geriatric Societies developed a clinical practice guideline which recommends that a fall risk screening be done once a year for adults ages 65 and older. And at Allina Health and Courage Kenny, we are working to educate our older clients and providers about falls, conduct fall risk screenings and provide follow up resources that can help people prevent a fall.

Melanie: So, what are the most common causes of a fall?

Chris: Well some of the risk factors are related to changes that our bodies just experience as we age. We start to lose muscle strength and flexibility which leads to issues with balance and endurance. Our eyesight also changes which increases the risk for falling and certain commonly prescribed or over the counter medications that make us sleepy or dizzy; can also increase the risk. Then in our homes, going up and down stairs, navigating a dark room or a hallway, or an uneven throw rug or an electrical cord in the wrong place; can all lead to a fall.

Melanie: Sure, and even little animals around if you have got a dog, sometimes they walk right in front of you or a cat or something for older people, now tell us about a fall risk screening. What’s involved in that?

Chris: Well, the United States Centers for Disease Control developed a tool kit called the STEADI which stands for Stopping Elderly Accidents, Deaths and Injuries. And the goal of the STEADI is to help primary care clinics and providers incorporate fall prevention screening into the annual physical for people over the age of 65. And the simple STEADI assessment can be completed during one office visit and it recommends that providers do the following things. First ask the person if they feel unsteady on their feet or if they are worried about falling or if they have fallen in the last year. And next the person’s medications should be reviewed and any dosages of drugs that could increase the risk of falls should maybe be switched or reduced. Also, MDs should recommend daily vitamin D supplements to help improve bone and muscle and nerve health and also perform a quick balance and gait assessment which can show if a person is low, medium or high risk for falls and then the doctor can provide recommendations for follow up based on the person’s risk level. And this simple common-sense approach has been estimated to reduce falls by 24%.

Melanie: Wow. You know and like you say, it is simple and common-sense, now not every doctor is going to address this situation with their older patients. So, if somebody is with their mom or dad at an appointment or someone over 65 is having their doctor; how do you recommend they mention this to their doctors without sounding like they are you know asking for something that is maybe not necessary?

Chris: Right, well I would say, if you are 65 and older, and your doctor doesn’t discuss fall prevention with you; that you should feel empowered to just ask about it, especially if you are fearful of falling and maybe just share with your doctor why you are afraid or if you have had a fall, definitely share that with them and just engage in a conversation about maybe some of the things you can do. And you might be appropriate to see a physical therapist or attend a community class and your doctor could recommend those things.

Melanie: So, then what do you tell people are some ways, if you are found to be at high risk for falls; what are some ways that you can re, you mentioned carpets and electrical cords and medications and eyesight. You mentioned all of these things; but what do we do about all those things? How do we kind of walk around our house and look at the medications and see what is going on so that we can prevent falls?

Chris: Right, well I have lots of ideas. So, number one would be to look at your home and one thing that is really important in the home is to keep the lighting in the home consistent and to make sure you have lights in dark areas or use nightlights so that when you are getting up and going to the bathroom at night, that that path is lighted up. You could also have your doctor or your pharmacist look at the medications you take including your over-the-counter medications and if any of them leave you sleepy or dizzy, that can increase your risk, so there is maybe potential for those medications to be adjusted. Wearing proper shoes that give you good support and traction is important and people should avoid wearing socks only or smooth soled shoes or slippers especially if you are on stairs, wood floors or any slippery surfaces, having your eyes and ears checked every year is important just to catch any changes in your vision or your hearing and sometimes people get dizzy when they stand up really fast from a seated position, so it is important just to get up slowly after you have been sitting for a while or even lying down and just make sure you have your bearings before you start walking and then certainly using a cane or another walking aid if you have been directed to do so is important. Also, important to keep emergency numbers in your cell phone contacts or a list near your home phone and if you have a cell phone to keep it with you and close by in case you do a fall so you can call for help. And one of the most important things a person can do to decrease their risk for falling, which is probably one of the hardest, but is to get regular exercise, especially exercise that focuses on improving strength and balance. It has been shown that people can gain strength all the way up into their 90s, if they are challenged appropriately. So, this is really important to keep your fall risk low. And Courage Kenny offers a seven-week class called Stepping On at several locations around the metro area which works on just this; improving a person’s strength and balance as well as instruction and all the fall risk factors we have talked about today, and how to make changes to keep a person safe from falling. Another exercise that has been shown to be very good to help reduce a person’s risk is Tai Chi or Tai Chi Chuan, which are ancient Chinese meditation forms that can also help improve strength, balance and flexibility and is also offered through Courage Kenny.

Melanie: So, that’s some great information Chris and also, the fact is that those kinds of exercise and the American College of Sports Medicine does recommend these for older people, Tai Chi and they are so great. And what about functional exercise, I mean people have a risk of falling just from stepping off the curb and so, you know those kinds of classes are great but what can they also do at home to practice those kinds of same exercises like would balancing in the doorway, standing on one leg, does that carry over? Would that help?

Chris: Definitely. So, we often instruct people to work on balance exercises, maybe standing at the kitchen sink, so that if you do become unsteady, you have something to hold onto. So, just work on standing with your feet close together or work on standing on one leg and holding on if you need to, but just trying to let go as you can so that you are really working your legs on keeping your balance. And also, just practicing sitting to standing from a chair is an excellent exercise to increase strength. And just doing that ten times in a row, like during a commercial break if you are watching TV is a great exercise.

Melanie: Well you will see people too when especially older people and as a trainer, I see this all the time; when people get up from a chair or you are having them do that exercise you have just described off a bench or a chair; they waver a little as they are getting up and that strength and then they have that little balance issue so you can see how really applicable that kind of an exercise is. So now wrap it up for us with your best advice about fall prevention and what you really want people to know about these classes available at Allina.

Chris: Yeah, first I would say talk to your doctor and really be honest about your fear if you have a fear of falling and then really look on getting regular exercise and look for our classes within Allina, talk to your doctor about them. They are on the website, Allinahealth.org, so if your doctor doesn’t’ know about them, they may be able to look there and find them for you.

Melanie: Thank you so much for being with us today, it is great information. Thanks so much. You are listening to the Well Cast with Allina Health and for more information, you can go to allinahealth.org. That’s allinahealth.org. This is Melanie Cole. Thanks so much for listening.