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Taking Steps to Preventing Falls
Dr. Bradley Younggren, an Emergency Physician at EvergreenHealth, joins us to discuss what you can do to prevent falls and improve your strength.
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Learn more about Bradley Younggren, MD
Bradley Younggren, MD
Bradley Younggren, MD is an EvergreenHealth Emergency Physician.Learn more about Bradley Younggren, MD
Transcription:
Scott Webb: Hello and welcome to Check-Up Chat with EvergreenHealth. I'm Scott Webb. And when it comes to falls, prevention is the primary goal. And joining me today to discuss falls and why they are more prevalent and dangerous for residents 65 and older is Dr. Bradley Younggren. He's an Evergreen Health Emergency Physician.
Doctor, thanks so much for joining me today. We're on Check-Up Chat, which is always a good place to check in with experts about different things. And today, we're talking about falls. But before we get there, I want to have you tell us a little bit about yourself, brief overview of your experience and why you're an expert on fall prevention.
Dr. Bradley Younggren: My name is Brad Younggren. I'm an emergency physician by background. I've spent the last 11 years administrating the trauma program. My background was military emergency medicine, so I was quite involved in trauma care and trauma prevention. So when I made the transition out of the military, I came to EvergreenHealth, took over that program to help support administrating that, and have done so since that time.
Scott Webb: As I mentioned in my intro, falls are very dangerous for residents 65 and older, I mean, maybe for all of us. I don't think any of us really want to fall, but especially for residents 65 and older. Can you describe how dangerous it is and how common it is for these members of the community, you know, and the propensity for falling?
Dr. Bradley Younggren: It's definitely a huge issue from the perspective of our program. Just as a way to highlight how things have changed, about 80% of our trauma now that we take care of at EvergreenHealth is somehow related to falls, primarily falls in patients over 55 years old. That made up only about 20% to 25% of the total trauma volume when I started in 2010. So in a mere 12 years, we've seen quite a reduction in trauma related to motor vehicle injuries or bicycle, motorcycles, et cetera, and seeing the percentage rise tremendously as it relates to falls, especially those over 55 or 65, depending on the cohort you're looking at. It's very dangerous as people gain years of wisdom, they're more apt to have secondary injuries related to those falls from standing.
More often, we had seen patients who are suffering from hip fractures related to falls. But a large area of focus for us in the trauma program and nationally, for that matter, has been a focus on what is described as trauma of the chest in that age group. There's a large group of patients who fall, suffer multiple rib fractures. And from those fractures, we see a lot of secondary injuries. It can cause popping in the lung or what we call pneumothorax. But often time, there's also just bruising of the lung, and sometimes those injuries require inpatient observation, admission for pain control many times, and sometimes additional therapies. So it's definitely a big problem where we deal with it on a month to month basis on the back end, sort of taking care of the patients that come in through the emergency department, who are suffering secondary injuries from falls.
The other key feature is that the percentage of the population that is on some sort of anticoagulation or blood thinner for a variety of medical reasons has gone up tremendously over the last decade. And that anticoagulation does increase risk as well for a variety of secondary complications from falls. Those include bleeding in the brain or intracranial hemorrhage, a localized hematoma from the fall, bleeding into the chest when you suffer chest trauma or bleeding into the pelvis associated with pelvic fracture or hip fracture. So, quite a significant amount of patients on anticoagulation will get sort of an elevated workup in the emergency department, primarily because of that increased risk associated with the blood thinners.
Scott Webb: Yeah, I see what you mean. I remember my grandma fell when I was a kid and she broke her tailbone. So I was sort of thinking back through to what experiences do I have with this. And I think those of us of a certain generation maybe remember the commercials, the I've-fallen-and-I-can't-get-up commercials, but the reality is it's a very real thing and lots of older adults, they do fall for a variety of reasons. And I'm wondering maybe if you can take us through that a little bit. Like why are they more likely to suffer these falls?
Dr. Bradley Younggren: Part of it is that, as we age, there's both mechanical and balance changes that occur in our body. So, as patients suffer from increased osteoarthritis as an example, they just could have more preponderance to falling just related to the fact that they're suffering from arthritis in the hip or the knee. Also, the percentage of population that has a partial or total replacement of those joints increases as you kind of run up the age ladder, so to speak. And so like those patients are just having a mechanical increased risk potentially of falling compared to someone who's 30 per se and has no osteoarthritis or hip replacements.
Additionally, there's also changes that occur in your balance centers, and so there's an increased risk of becoming imbalanced as you age. And so of course, when you have less of a capacity to maintain balance or what often happens is we don't even notice this subtly when we're younger, is that we just correct our balance. But sometimes those corrections are more difficult to manage in your balance centers of your brain as you age, and so that also increases the risk of falls.
Scott Webb: Yeah. You know, I'm only 54-- put that in quotes, only 54. But the other day, you know, I just sort of turned a certain way and my knee started to give out me and I reached out. And fortunately, there was something there for me to grab. And again, the wear and tear, the osteoarthritis, definitely the guilty party in this case. So sometimes, you're lucky enough that something's there that you can sort of reach out and grab it and prevent the fall. Maybe you can give us some ideas and just some general recommendations of how we can avoid falls? Is that sort of like maybe reducing clutter in our home, for example? Whatever it might be from an expert here, how can we prevent these falls?
Dr. Bradley Younggren: It's a great question because certainly prevention is key. It's something we really focus on in the trauma program, both in the context of the discharge instructions we give patients when they fall, utilizing emergency department social work help. We've actually even done programs with the county to try and get people into the home to evaluate the patient's homes for potential risks related to falls.
Patients can obviously use a variety of assistive devices, which can help with balance or mitigate the risk for falls, canes, four-point walkers, things of that nature. Additionally, the house is really the key place where people really can make a significant impact in reducing the risk. The type of rugs they have in the house, making sure there's not throw rugs that people could trip over. One of the assessments we do or teams will typically do when they go in the home is look and see what is the rail status for going upstairs. Are there rails in the bathroom? Because as patients are transferring to the toilet or to the showers example, those are other high-risk activities where railings can help people tremendously if they start to fall off-balance. We see a lot of falls that are in the bathroom itself, certainly because there can be water on the ground. It's a smaller confined space where people have to rotate more quickly. So railings are a key. And then, removing things on the ground, like throw rugs that you typically could trip on is really, really helpful for prevention.
Scott Webb: Yeah, it does seem that whether we're talking about the home, bathroom. You know, it would be good as folks get to be a certain age to maybe just sort of assess things, the level of clutter, the types of rugs, maybe needing some railings and things. And then, also, you deal with outside where you have a little bit less control, right? Uneven sidewalks, whatever it might be. So do you recommend the same types of devices, walkers, canes, whatever it might be to try to maintain some stability?
Dr. Bradley Younggren: Yeah, those devices are very helpful for patients that have some degree of imbalance or problems maintaining balance. So those are worth getting an assessment on early. Again, prevention is key. So anytime we can at least take a look at those early on and get patients what they need, certainly is much, better than addressing this after the first fall and the patient comes to the emergency department secondary to that fall.
Scott Webb: Yeah, it definitely seems better to prevent than to sort of react and try to treat after the fact, especially since you said that there are the initial injuries and secondary injuries and things like that. And along those lines, we think about the preventative steps we can take with our doctors, primary care doctors, things like that to avoid these types of emergencies and just sort of be better prepared for both the primary and perhaps the secondary fallout from things.
Dr. Bradley Younggren: I think that physical therapy or just generally, there's a variety of activities that could be done, which can improve core body strength, reaction time, and balance. What I always tell patients when I'm working clinically is I don't really personally care which one it is, whether it's tai chi, yoga, going to the gym, any of these activities are going to increase your core body strength, improve your balance, and reduce the risk of falling or the secondary impact if you do fall. So anything like, they can really strengthen your legs or core, your core bodies can have a tremendous effect. And certainly, there are activities which are focused directly on balance. There's classes that people can sign up for locally that really are focused on balance and fall prevention. And I think those are really great places to start.
And then, having some sort of device, you know, in the era of mobile phones now, you know, a lot of the phones even can detect falls or Apple Watches, things of that nature. But there are other devices you can wear around your neck. So if there is a fall that you can essentially notify family and/or EMS to help come assist, because many times these patients can't get up off the ground themselves and they're going to need help.
Scott Webb: Yeah, it always comes back to that, right? Like it's just being proactive, speaking with our doctors, our primary care physicians, making sure that we understand what's going on, and try to prevent some of these things as much as possible. It's been really educational today, doctor. As we wrap up, what are your final thoughts and takeaways about falls? How we can prevent them and how you can help folks should they happen to not be able to prevent them?
Dr. Bradley Younggren: Yeah. I think that the key feature is that falls are very, very common. People need to understand the secondary impact of falls and advocate for family members that need evaluations by their primary care physicians, or to really be advocates for reviewing things in the home that could potentially increase the risk for those falls. So it's really a team effort. Families need to work together to really take a multimodal approach to reduce the risk of falls. And working with the patient's primary care provider is critical, not only from the evaluation perspective, but the continued monitoring and maintenance.
Scott Webb: Yeah, I think the messaging is clear today, doctor, that when possible, let's try to prevent these falls, prevent these injuries, and you've given us, pun intended, but sort of a clear path to do that today. So thanks so much. You stay well.
Dr. Bradley Younggren: Appreciate it. Thank you very much.
Scott Webb: Take the steps to prevent falls by talking with your physician. And if you do need to seek care for a fall, you can get help finding one of our convenient locations by calling 425-899-3000.
Host: Please remember to subscribe, rate and review this podcast and all the other EvergreenHealth podcasts. For more health tips and updates, follow us on your social channels.
Scott Webb: Hello and welcome to Check-Up Chat with EvergreenHealth. I'm Scott Webb. And when it comes to falls, prevention is the primary goal. And joining me today to discuss falls and why they are more prevalent and dangerous for residents 65 and older is Dr. Bradley Younggren. He's an Evergreen Health Emergency Physician.
Doctor, thanks so much for joining me today. We're on Check-Up Chat, which is always a good place to check in with experts about different things. And today, we're talking about falls. But before we get there, I want to have you tell us a little bit about yourself, brief overview of your experience and why you're an expert on fall prevention.
Dr. Bradley Younggren: My name is Brad Younggren. I'm an emergency physician by background. I've spent the last 11 years administrating the trauma program. My background was military emergency medicine, so I was quite involved in trauma care and trauma prevention. So when I made the transition out of the military, I came to EvergreenHealth, took over that program to help support administrating that, and have done so since that time.
Scott Webb: As I mentioned in my intro, falls are very dangerous for residents 65 and older, I mean, maybe for all of us. I don't think any of us really want to fall, but especially for residents 65 and older. Can you describe how dangerous it is and how common it is for these members of the community, you know, and the propensity for falling?
Dr. Bradley Younggren: It's definitely a huge issue from the perspective of our program. Just as a way to highlight how things have changed, about 80% of our trauma now that we take care of at EvergreenHealth is somehow related to falls, primarily falls in patients over 55 years old. That made up only about 20% to 25% of the total trauma volume when I started in 2010. So in a mere 12 years, we've seen quite a reduction in trauma related to motor vehicle injuries or bicycle, motorcycles, et cetera, and seeing the percentage rise tremendously as it relates to falls, especially those over 55 or 65, depending on the cohort you're looking at. It's very dangerous as people gain years of wisdom, they're more apt to have secondary injuries related to those falls from standing.
More often, we had seen patients who are suffering from hip fractures related to falls. But a large area of focus for us in the trauma program and nationally, for that matter, has been a focus on what is described as trauma of the chest in that age group. There's a large group of patients who fall, suffer multiple rib fractures. And from those fractures, we see a lot of secondary injuries. It can cause popping in the lung or what we call pneumothorax. But often time, there's also just bruising of the lung, and sometimes those injuries require inpatient observation, admission for pain control many times, and sometimes additional therapies. So it's definitely a big problem where we deal with it on a month to month basis on the back end, sort of taking care of the patients that come in through the emergency department, who are suffering secondary injuries from falls.
The other key feature is that the percentage of the population that is on some sort of anticoagulation or blood thinner for a variety of medical reasons has gone up tremendously over the last decade. And that anticoagulation does increase risk as well for a variety of secondary complications from falls. Those include bleeding in the brain or intracranial hemorrhage, a localized hematoma from the fall, bleeding into the chest when you suffer chest trauma or bleeding into the pelvis associated with pelvic fracture or hip fracture. So, quite a significant amount of patients on anticoagulation will get sort of an elevated workup in the emergency department, primarily because of that increased risk associated with the blood thinners.
Scott Webb: Yeah, I see what you mean. I remember my grandma fell when I was a kid and she broke her tailbone. So I was sort of thinking back through to what experiences do I have with this. And I think those of us of a certain generation maybe remember the commercials, the I've-fallen-and-I-can't-get-up commercials, but the reality is it's a very real thing and lots of older adults, they do fall for a variety of reasons. And I'm wondering maybe if you can take us through that a little bit. Like why are they more likely to suffer these falls?
Dr. Bradley Younggren: Part of it is that, as we age, there's both mechanical and balance changes that occur in our body. So, as patients suffer from increased osteoarthritis as an example, they just could have more preponderance to falling just related to the fact that they're suffering from arthritis in the hip or the knee. Also, the percentage of population that has a partial or total replacement of those joints increases as you kind of run up the age ladder, so to speak. And so like those patients are just having a mechanical increased risk potentially of falling compared to someone who's 30 per se and has no osteoarthritis or hip replacements.
Additionally, there's also changes that occur in your balance centers, and so there's an increased risk of becoming imbalanced as you age. And so of course, when you have less of a capacity to maintain balance or what often happens is we don't even notice this subtly when we're younger, is that we just correct our balance. But sometimes those corrections are more difficult to manage in your balance centers of your brain as you age, and so that also increases the risk of falls.
Scott Webb: Yeah. You know, I'm only 54-- put that in quotes, only 54. But the other day, you know, I just sort of turned a certain way and my knee started to give out me and I reached out. And fortunately, there was something there for me to grab. And again, the wear and tear, the osteoarthritis, definitely the guilty party in this case. So sometimes, you're lucky enough that something's there that you can sort of reach out and grab it and prevent the fall. Maybe you can give us some ideas and just some general recommendations of how we can avoid falls? Is that sort of like maybe reducing clutter in our home, for example? Whatever it might be from an expert here, how can we prevent these falls?
Dr. Bradley Younggren: It's a great question because certainly prevention is key. It's something we really focus on in the trauma program, both in the context of the discharge instructions we give patients when they fall, utilizing emergency department social work help. We've actually even done programs with the county to try and get people into the home to evaluate the patient's homes for potential risks related to falls.
Patients can obviously use a variety of assistive devices, which can help with balance or mitigate the risk for falls, canes, four-point walkers, things of that nature. Additionally, the house is really the key place where people really can make a significant impact in reducing the risk. The type of rugs they have in the house, making sure there's not throw rugs that people could trip over. One of the assessments we do or teams will typically do when they go in the home is look and see what is the rail status for going upstairs. Are there rails in the bathroom? Because as patients are transferring to the toilet or to the showers example, those are other high-risk activities where railings can help people tremendously if they start to fall off-balance. We see a lot of falls that are in the bathroom itself, certainly because there can be water on the ground. It's a smaller confined space where people have to rotate more quickly. So railings are a key. And then, removing things on the ground, like throw rugs that you typically could trip on is really, really helpful for prevention.
Scott Webb: Yeah, it does seem that whether we're talking about the home, bathroom. You know, it would be good as folks get to be a certain age to maybe just sort of assess things, the level of clutter, the types of rugs, maybe needing some railings and things. And then, also, you deal with outside where you have a little bit less control, right? Uneven sidewalks, whatever it might be. So do you recommend the same types of devices, walkers, canes, whatever it might be to try to maintain some stability?
Dr. Bradley Younggren: Yeah, those devices are very helpful for patients that have some degree of imbalance or problems maintaining balance. So those are worth getting an assessment on early. Again, prevention is key. So anytime we can at least take a look at those early on and get patients what they need, certainly is much, better than addressing this after the first fall and the patient comes to the emergency department secondary to that fall.
Scott Webb: Yeah, it definitely seems better to prevent than to sort of react and try to treat after the fact, especially since you said that there are the initial injuries and secondary injuries and things like that. And along those lines, we think about the preventative steps we can take with our doctors, primary care doctors, things like that to avoid these types of emergencies and just sort of be better prepared for both the primary and perhaps the secondary fallout from things.
Dr. Bradley Younggren: I think that physical therapy or just generally, there's a variety of activities that could be done, which can improve core body strength, reaction time, and balance. What I always tell patients when I'm working clinically is I don't really personally care which one it is, whether it's tai chi, yoga, going to the gym, any of these activities are going to increase your core body strength, improve your balance, and reduce the risk of falling or the secondary impact if you do fall. So anything like, they can really strengthen your legs or core, your core bodies can have a tremendous effect. And certainly, there are activities which are focused directly on balance. There's classes that people can sign up for locally that really are focused on balance and fall prevention. And I think those are really great places to start.
And then, having some sort of device, you know, in the era of mobile phones now, you know, a lot of the phones even can detect falls or Apple Watches, things of that nature. But there are other devices you can wear around your neck. So if there is a fall that you can essentially notify family and/or EMS to help come assist, because many times these patients can't get up off the ground themselves and they're going to need help.
Scott Webb: Yeah, it always comes back to that, right? Like it's just being proactive, speaking with our doctors, our primary care physicians, making sure that we understand what's going on, and try to prevent some of these things as much as possible. It's been really educational today, doctor. As we wrap up, what are your final thoughts and takeaways about falls? How we can prevent them and how you can help folks should they happen to not be able to prevent them?
Dr. Bradley Younggren: Yeah. I think that the key feature is that falls are very, very common. People need to understand the secondary impact of falls and advocate for family members that need evaluations by their primary care physicians, or to really be advocates for reviewing things in the home that could potentially increase the risk for those falls. So it's really a team effort. Families need to work together to really take a multimodal approach to reduce the risk of falls. And working with the patient's primary care provider is critical, not only from the evaluation perspective, but the continued monitoring and maintenance.
Scott Webb: Yeah, I think the messaging is clear today, doctor, that when possible, let's try to prevent these falls, prevent these injuries, and you've given us, pun intended, but sort of a clear path to do that today. So thanks so much. You stay well.
Dr. Bradley Younggren: Appreciate it. Thank you very much.
Scott Webb: Take the steps to prevent falls by talking with your physician. And if you do need to seek care for a fall, you can get help finding one of our convenient locations by calling 425-899-3000.
Host: Please remember to subscribe, rate and review this podcast and all the other EvergreenHealth podcasts. For more health tips and updates, follow us on your social channels.