According to the Centers for Disease Control and Prevention accidental falls are the leading cause of accidental death in people over the age of 75.
Maryellen Sullivan, PT, MS, DPT, discusses fall prevention, conditions that contribute to falling and how we use several body systems to help maintain our balance so we can prevent those falls in the first place.
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Tips to Prevent Falls
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For more information and questions about your fall risk, talk to your primary care doctor. If you need a primary care doctor, call 1-800-BayCare (1-800-229-2273) or find a doctor
Maryellen Sullivan, PT, MS
Maryellen Sullivan, PT, MS, DPT was born and raised in the Boston area. In 1980, she graduated with a Bachelor of Science degree in physical therapy from Northeastern University in Boston. Maryellen furthered her education and obtained a master’s degree in Healthcare Administration from Lesley University. She was certified in vestibular rehabilitation and started giving lectures on vestibular rehabilitation at St. Petersburg College. In 2004, she obtained her doctorate degree in physical therapy from the University of St. Augustine. She has worked in many states, including Massachusetts, Pennsylvania, Wisconsin and Florida. Maryellen has been employed by BayCare since 1995 where she is the Rehabilitation Services Coordinator at BayCare Fitness Center (Palm Harbor).For more information and questions about your fall risk, talk to your primary care doctor. If you need a primary care doctor, call 1-800-BayCare (1-800-229-2273) or find a doctor
Transcription:
Tips to Prevent Falls
Melanie Cole (Host): Falls are one of the most serious health risks for older adults. They are not only the leading cause of injury related deaths in this population, but they are also a significant cause of disability. My guest today is Dr. Maryellen Sullivan. She’s a physical therapist and the rehabilitation services coordinator at BayCare Health. Dr. Sullivan what are some of the conditions that contribute to falling? Tell us about the body systems that help us to maintain our balance.
Maryellen Sullivan, PT, MS, DPT (Guest): Thank you Melanie. Typically, we use three things to help us maintain our balance. The first is our vision to help us tell how we are oriented to the world around us. This can be important for people who start to have difficulty with cataracts or who are wearing new prescription lenses, particularly transitional lenses that will change the colors during the dusk or progressive lenses that will change the focus point. The second thing that we use to help us maintain our balance is our vestibular system what people typically call their inner ear. That helps us orient ourselves in relationship to gravity and how our body is positioned in relationship to gravity. And then the final thing that we use to help us maintain our balance is what we call the somatosensory system. This is the system that allows us to tell a position of our body in space, to tell the position of our feet in relationship to the ground and to tell how our joints are oriented. So, that we need to use all three of them together and weakness in any of the systems can contribute to falling.
Melanie: When do people first begin to take note that they might have a balance issue? Is there something that signals a red flag that they might have a proprioception problem, that they are not connecting to their feet or just tripping up a little bit, but not quite falling?
Dr. Sullivan: One of the most common complaints that we have when people come in for a balance evaluation is that they feel like they are drunk, that they can’t walk in a straight line or they are starting to have difficulty walking on uneven surfaces. For instance, walking on the yard or walking on gravel or sand. Of course, down here in Florida, we don’t have the issue with walking on slippery ice surfaces, but up north of course people will start to have trouble feeling confident being able to walk out on uncertain surfaces.
Melanie: What about the ever-pervasive fear of falling. That in itself can sometimes contribute to that and make people tend to move a little bit less.
Dr. Sullivan: Exactly. And the problem with moving less is that it starts people on a downward spiral. If you are afraid of moving; you tend to sit more. If you are sitting more, you are going to get weaker from not using your muscles. That weakness causes you to be more unsteady which makes you more fearful of falling which makes you sit more and we keep on going downward. It’s really important in therapy or in anybody who is becoming aware of balance issues is that they not only start to realize that they have to force themselves to move, but that it’s time to have somebody take a look at the different systems and see if there’s anything that can be done to direct them for reasons that they may be having trouble with their balance.
Melanie: Well, as long as you are mentioning that they can have an evaluation. Can you estimate a person’s risk for a fall and what should they do if they feel like they are at risk? Who do they go see?
Dr. Sullivan: Anybody’s primary care physician can refer them to a physical therapist for a balance evaluation. As a matter of fact, it’s one of the things that the Centers for Medical Services the Medicare payors are actually focusing on in the last few years. Physicians are encouraged to discuss fall risk with their patients. We often go out into the communities to community centers to senior centers to schools to do basic evaluations of people’s balance to see if they are more at risk of falling. And it’s pretty easy to direct people in the right way.
Melanie: What do you do to assess a person’s balance?
Dr. Sullivan: We’ll look at a couple of different positions that are common. For instance, we’ll have somebody stand with their feet together and their eyes closed. Now when we close the eyes, we have taken away the visual sense, when we have people standing with their feet close together; we have kind of limited their ability to feel the floor, so that we are testing a little bit more what’s going on in the inner ear in the vestibular system. Another thing that we would look at is timing. How long it takes for somebody to stand up from a chair, walk to a marked ten feet away, turn around and come back and sit in the chair. There are standardized times that somebody who is walking at the appropriate speed should be able to do that. We also look at someone’s ability to step over an object without losing their balance or to walk around obstacles to make sure that they can shift their weight appropriately. And then of course, there is always strength testing because one of the most common reasons that people have difficulty with their balance is weakness of the hip muscles. So we will do some strength testing of the gluteus medius and the gluteus maximus muscles, the muscles on the back and on the side of the hip.
Melanie: If you do find that someone’s at high-risk for falls, what are some common recommendations that you might make and also, while you are discussing this Dr. Sullivan; what are some things people can do at home to improve their balance?
Dr. Sullivan: One of the most important things is to make sure that they are discussing all of their medical conditions with their doctor. They need to make sure that they are letting their doctor know that they are having balance concerns or stability concerns and to follow up on the recommendations that physicians make. Since this is really important to keep blood pressure and blood sugar under control, because both of them can affect the systems that help our balance. It’s also really important to make sure that you are taking medications that are given to you for these different conditions only as prescribed because a lot of medications if you read the side effects, dizziness and imbalance can be one of the primary side effects. If somebody is having trouble with feeling that their medications are a problem, I always recommend that they bring all of the medications and supplements that they take to their pharmacist so that the pharmacist can evaluate any possible medication reactions or side effects. Because often side effects can be alleviated just by changing the time that a medication is taken or whether it’s taken with or without food or in combination with other things. And it’s also very important to make sure that you have your eyes checked regularly. Because we depend on our eyes as our primary system and any changes in vision, and development of cataracts or even changes of whether someone is using progressive or bifocal lenses can make it difficult to see where you are walking.
Melanie: Are there some exercises at home that people can do that can help them work on their balance?
Dr. Sullivan: Well it would be surprising for most people to realize that normal balance for somebody who is 80 years old means that you can stand on one foot for ten seconds without holding on. And I think people find it surprising how difficult that can be. So, we often have people, in addition to using some of the strength training exercises that I talked about for the gluteus medius and the gluteus maximus muscles; it’s very easy to scatter balance challenges throughout your day. For instance, if you are standing brushing your teeth, instead of leaning against the counter stand up straight with your feet close together so that you are challenging your balance by standing on a narrow base of support. Or if you are standing at the counter waiting for something in the microwave; stand with your feet together and your eyes closed and practice challenging your system obviously in a safe way, we want people to be near a counter or near a wall so that they can hold on. But it’s very easy to scatter balance challenges throughout the day. And it’s also really important that people pay attention to how long they sit at any one period of time. It’s very easy to sit down at the computer for instance and get lost in cyberspace and realize that you have been sitting in one place for half an hour or an hour or sometimes two hours. So, we need to be able to make sure that we are getting up and moving because you can’t work on your balance if you are not upright.
Melanie: That’s really great advice and great information. Wrap it up for us what you would like listeners to take away from this segment, what advice do you give people to decrease their risk of falling and hopefully prevent it in the first place.
Dr. Sullivan: First of all, I think it’s very important that people recognize that that fear that they have of falling is a sign that something is already wrong. Don’t ignore it. Because if you start limiting your activity then the situation is only going to get worse. We always recommend that people evaluate their home environment, remove scatter rugs that you can trip on, make sure that light switches and lamps are in an easily accessible place so that you don’t have to walk into a dark room. Using nightlights in the bathroom or along hallways will help if you have to get up during the night and of course here in Florida, we always have the issue of power outages with storms, so making sure that you check your flashlight regularly in case of a power outage. Another thing I want to really stress to people is not to be afraid of using appropriate walking aids. Many people are reluctant to use a cane or a walker because they think it makes them look old. But being dependent on somebody else is much more aging than being independent with an assistive device. Nobody thinks twice about wearing glasses to help with visual defects or hearing aid to help with hearing deficits. T hose are assistive devices. Using a cane or a walker can give you enough confidence to maintain your independence and that confidence will allow you to get up and walk more and improve your balance just by the fact that you are up and moving.
Melanie: Great information. Thank you so much for joining us today and explaining to the listeners about fall prevention. It’s so important for us to hear and to learn some of these techniques you have gone over with us today. Thanks again. You’re listening to BayCare HealthChat. For more information please visit www.baycare.org, that’s www.baycare.org. This is Melanie Cole. Thanks so much for listening.
Tips to Prevent Falls
Melanie Cole (Host): Falls are one of the most serious health risks for older adults. They are not only the leading cause of injury related deaths in this population, but they are also a significant cause of disability. My guest today is Dr. Maryellen Sullivan. She’s a physical therapist and the rehabilitation services coordinator at BayCare Health. Dr. Sullivan what are some of the conditions that contribute to falling? Tell us about the body systems that help us to maintain our balance.
Maryellen Sullivan, PT, MS, DPT (Guest): Thank you Melanie. Typically, we use three things to help us maintain our balance. The first is our vision to help us tell how we are oriented to the world around us. This can be important for people who start to have difficulty with cataracts or who are wearing new prescription lenses, particularly transitional lenses that will change the colors during the dusk or progressive lenses that will change the focus point. The second thing that we use to help us maintain our balance is our vestibular system what people typically call their inner ear. That helps us orient ourselves in relationship to gravity and how our body is positioned in relationship to gravity. And then the final thing that we use to help us maintain our balance is what we call the somatosensory system. This is the system that allows us to tell a position of our body in space, to tell the position of our feet in relationship to the ground and to tell how our joints are oriented. So, that we need to use all three of them together and weakness in any of the systems can contribute to falling.
Melanie: When do people first begin to take note that they might have a balance issue? Is there something that signals a red flag that they might have a proprioception problem, that they are not connecting to their feet or just tripping up a little bit, but not quite falling?
Dr. Sullivan: One of the most common complaints that we have when people come in for a balance evaluation is that they feel like they are drunk, that they can’t walk in a straight line or they are starting to have difficulty walking on uneven surfaces. For instance, walking on the yard or walking on gravel or sand. Of course, down here in Florida, we don’t have the issue with walking on slippery ice surfaces, but up north of course people will start to have trouble feeling confident being able to walk out on uncertain surfaces.
Melanie: What about the ever-pervasive fear of falling. That in itself can sometimes contribute to that and make people tend to move a little bit less.
Dr. Sullivan: Exactly. And the problem with moving less is that it starts people on a downward spiral. If you are afraid of moving; you tend to sit more. If you are sitting more, you are going to get weaker from not using your muscles. That weakness causes you to be more unsteady which makes you more fearful of falling which makes you sit more and we keep on going downward. It’s really important in therapy or in anybody who is becoming aware of balance issues is that they not only start to realize that they have to force themselves to move, but that it’s time to have somebody take a look at the different systems and see if there’s anything that can be done to direct them for reasons that they may be having trouble with their balance.
Melanie: Well, as long as you are mentioning that they can have an evaluation. Can you estimate a person’s risk for a fall and what should they do if they feel like they are at risk? Who do they go see?
Dr. Sullivan: Anybody’s primary care physician can refer them to a physical therapist for a balance evaluation. As a matter of fact, it’s one of the things that the Centers for Medical Services the Medicare payors are actually focusing on in the last few years. Physicians are encouraged to discuss fall risk with their patients. We often go out into the communities to community centers to senior centers to schools to do basic evaluations of people’s balance to see if they are more at risk of falling. And it’s pretty easy to direct people in the right way.
Melanie: What do you do to assess a person’s balance?
Dr. Sullivan: We’ll look at a couple of different positions that are common. For instance, we’ll have somebody stand with their feet together and their eyes closed. Now when we close the eyes, we have taken away the visual sense, when we have people standing with their feet close together; we have kind of limited their ability to feel the floor, so that we are testing a little bit more what’s going on in the inner ear in the vestibular system. Another thing that we would look at is timing. How long it takes for somebody to stand up from a chair, walk to a marked ten feet away, turn around and come back and sit in the chair. There are standardized times that somebody who is walking at the appropriate speed should be able to do that. We also look at someone’s ability to step over an object without losing their balance or to walk around obstacles to make sure that they can shift their weight appropriately. And then of course, there is always strength testing because one of the most common reasons that people have difficulty with their balance is weakness of the hip muscles. So we will do some strength testing of the gluteus medius and the gluteus maximus muscles, the muscles on the back and on the side of the hip.
Melanie: If you do find that someone’s at high-risk for falls, what are some common recommendations that you might make and also, while you are discussing this Dr. Sullivan; what are some things people can do at home to improve their balance?
Dr. Sullivan: One of the most important things is to make sure that they are discussing all of their medical conditions with their doctor. They need to make sure that they are letting their doctor know that they are having balance concerns or stability concerns and to follow up on the recommendations that physicians make. Since this is really important to keep blood pressure and blood sugar under control, because both of them can affect the systems that help our balance. It’s also really important to make sure that you are taking medications that are given to you for these different conditions only as prescribed because a lot of medications if you read the side effects, dizziness and imbalance can be one of the primary side effects. If somebody is having trouble with feeling that their medications are a problem, I always recommend that they bring all of the medications and supplements that they take to their pharmacist so that the pharmacist can evaluate any possible medication reactions or side effects. Because often side effects can be alleviated just by changing the time that a medication is taken or whether it’s taken with or without food or in combination with other things. And it’s also very important to make sure that you have your eyes checked regularly. Because we depend on our eyes as our primary system and any changes in vision, and development of cataracts or even changes of whether someone is using progressive or bifocal lenses can make it difficult to see where you are walking.
Melanie: Are there some exercises at home that people can do that can help them work on their balance?
Dr. Sullivan: Well it would be surprising for most people to realize that normal balance for somebody who is 80 years old means that you can stand on one foot for ten seconds without holding on. And I think people find it surprising how difficult that can be. So, we often have people, in addition to using some of the strength training exercises that I talked about for the gluteus medius and the gluteus maximus muscles; it’s very easy to scatter balance challenges throughout your day. For instance, if you are standing brushing your teeth, instead of leaning against the counter stand up straight with your feet close together so that you are challenging your balance by standing on a narrow base of support. Or if you are standing at the counter waiting for something in the microwave; stand with your feet together and your eyes closed and practice challenging your system obviously in a safe way, we want people to be near a counter or near a wall so that they can hold on. But it’s very easy to scatter balance challenges throughout the day. And it’s also really important that people pay attention to how long they sit at any one period of time. It’s very easy to sit down at the computer for instance and get lost in cyberspace and realize that you have been sitting in one place for half an hour or an hour or sometimes two hours. So, we need to be able to make sure that we are getting up and moving because you can’t work on your balance if you are not upright.
Melanie: That’s really great advice and great information. Wrap it up for us what you would like listeners to take away from this segment, what advice do you give people to decrease their risk of falling and hopefully prevent it in the first place.
Dr. Sullivan: First of all, I think it’s very important that people recognize that that fear that they have of falling is a sign that something is already wrong. Don’t ignore it. Because if you start limiting your activity then the situation is only going to get worse. We always recommend that people evaluate their home environment, remove scatter rugs that you can trip on, make sure that light switches and lamps are in an easily accessible place so that you don’t have to walk into a dark room. Using nightlights in the bathroom or along hallways will help if you have to get up during the night and of course here in Florida, we always have the issue of power outages with storms, so making sure that you check your flashlight regularly in case of a power outage. Another thing I want to really stress to people is not to be afraid of using appropriate walking aids. Many people are reluctant to use a cane or a walker because they think it makes them look old. But being dependent on somebody else is much more aging than being independent with an assistive device. Nobody thinks twice about wearing glasses to help with visual defects or hearing aid to help with hearing deficits. T hose are assistive devices. Using a cane or a walker can give you enough confidence to maintain your independence and that confidence will allow you to get up and walk more and improve your balance just by the fact that you are up and moving.
Melanie: Great information. Thank you so much for joining us today and explaining to the listeners about fall prevention. It’s so important for us to hear and to learn some of these techniques you have gone over with us today. Thanks again. You’re listening to BayCare HealthChat. For more information please visit www.baycare.org, that’s www.baycare.org. This is Melanie Cole. Thanks so much for listening.