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Robin Kish: Welcome to the Healthcare District of Palm Beach Counties podcast, Here for Your Health. I'm your host Robin Kish. The Healthcare District is a unique healthcare system located in Palm Beach County, Florida. We provide County residents access to primary care hospital and school health services, skilled nursing and long-term care, and life saving trauma and air ambulance services. Through all of these programs, the Healthcare District focuses on filling the gaps in the healthcare delivery system and being the healthcare safety net for Palm Beach County. On this edition of Here For Your Health, we'll discuss one of the top causes of traumatic injury. And one of the most preventable falls. Our guest today is David Summers, Trauma Nurse Outreach Coordinator with the Healthcare District of Palm Beach Counties Trauma Agency. Welcome David.

David Summers: Thanks Robin. Thanks for bringing me in to talk about this.

Host: David you've cared for many patients over the years in your former role as a resuscitation nurse in one of Palm Beach Counties two level one trauma centers. For those who may not know, what is a traumatic injury?

David Summers: Well, a traumatic injury in itself could be something well, can't use the word simple, but simple as in a, your child falls from a tree and breaks her arm or slip trip and fall. And you injure your knee, a little burn injury while you're cooking Thanksgiving dinner, or it could be something much more severe that would require specialty care like here at one of our two trauma centers here in Palm Beach County. That would provide you with some rapid evaluation and we can address any of your life threatening type injuries. And that could be anything from falls to car crashes, to where you're severely injured. A shooting, a stabbing, a burn injury from a campfire. Anyone who's severely injured would require the care of our specialty teams, which include trauma surgeons, anesthesiologists, specially trained nurses and nurse practitioners, radiology. And one of the most important parts is having an operating room bed available at a moment's notice.

Host: Trauma is said to be the leading cause of death among Americans between the ages of one and 45 years. And over 4,600 trauma patients were treated in Palm Beach County’s trauma system last year. How many of these cases involved patients who fell?

David Summers: Well, the issue that we have is our population is aging. We're becoming a, what I call them a seasoned citizens, but the U S population as we get older falls remain most common and basically compromise a higher level of overall trauma injuries. I feel looking at numbers like from the CDC, the centers for disease control and prevention, one in four adults will fall in any given year. Here in Palm Beach County, we have a unique ability to be able to look at our numbers that come from the trauma center falls are accounting for about 44% of our trauma system. So of all the patients that come to the trauma center as a trauma patient, and that we care for them, 44% of those are from fall injuries, nearly 39,000 people in Palm Beach County went to a hospital emergency room in the year 2019. Over half of those were 65 years or older. From the ones that fall and die from their injuries, about 300 per year here in Palm Beach County die from fall injuries, nearly 250 of those are 65 years or older. If you look a little back, look at the statewide numbers. There's about five and a half million senior adults in Florida. And in the year 2019, there were over half a million fall related visits to the hospital emergency rooms. So statewide there's about five and a half million senior adults. In 2019, there are over a half a million fall related visits to the emergency department at the hospitals. More than 75,000 were hospitalized. 3,300 people died last year in Florida as a result from falling. And you think about it, that's mostly somebody's grandmother, grandfather.

Host: So, this is not falling off a ladder, or like you had given an example, a child falling from a tree. These are senior adults who are more prone to falling. Why is that?

David Summers: Well, as we age, we have loss of vision, our balances, and as good, they might not be lifting their feet when they're walking and they're shuffling. They could be on a blood thinner. So many people who fall, even if they're not injured, become very afraid of falling. And that leads to less activity, become weaker and ultimately more prone to falling again and having a more serious outcome.

Host: David, the month of September marks the beginning of Fall and September 21st is appropriately the beginning of falls awareness week. What are the most common causes of falls among senior adults?

David Summers: Well, seniors, most often fall while they're getting in and out of bed. And when they're getting on and off, actually the toilet. Walking at night down a hallway when the lights are off is another very common way for people to fall.

Host: So, I guess the good news, if there is some is that falls are preventable. What are some of the tips you give to families and senior adults?

David Summers: Well, ensure that there's adequate lighting and if not improve it and make it better. Observe if there's changes in their vision, get your hearing and vision checked every year and update your eyeglasses. It's critical to identify and eliminate trip hazards within the home. Like those area rugs or power cords, extension cords. Encourage the use of assisted devices like using walkers using grab bars. So you don't have to bend over, especially in bathrooms and showers. Wear proper footwear, like a flat rubber soled shoes, something that grips review, make sure the physician orders are properly followed. And one of the best tips is to remain physically active and exercise.

Host: So interesting. You mentioned exercise. What kind of exercise is the best for preventing falls?

David Summers: Well, evidence-base medicine, evidence-based research shows that some sort of a flexibility strength training and building balance is the key. Things like yoga, Tai Chi, a program called Matter of Balance. You can do it with a family member. You can do it in a class, but in COVID time, they're learning to adapt on doing it online.

Host: It seems like that's the key, right? Doing your exercising and everything else that you can safely virtually, but continuing that routine, you also mentioned it's important to review medications, to align with the physician's order. Why is that recommended?

David Summers: It's important to make sure that these side effects are not increasing your risk of falling. As the medicines are taken only as prescribed. Some medicines can make you lightheaded that will increase your risk of falling. You should regularly review your medicines with your loved ones. Provider can also talk to the pharmacist, bring all of your medicines, including those over the counter medicines to your pharmacist, when he's not so busy, and make an appointment. And that way you can lay everything out and he can look to see which medicines might interact with another medicine that your doctor or doctors might not have realized that have an interaction. And it's also important to talk to your doctor or your loved one's doctor about any recent falls. He needs, or she needs to know that you've had some challenges and that you have fallen recently.

Host: I imagine it's hard to connect with senior adults and their families when in person outreach events are not safe to hold. And I know you've held so many of them to help educate families and seniors about all of these prevention tips. What's the biggest challenge in educating the community during the COVID-19 pandemic?

David Summers: Well, really one of the only things we have to keep the message out there is through virtual online type classes. But you know, when I'm thinking of my parents, not all of them are as electronically astute to be able to sign onto a zoom class and be able to follow through. So it's a huge challenge. Another would be humidity, newspaper articles, or different events like that, or have some flyers up at the pharmacy just to keep fall prevention in the forefront.

Host: Podcasts like this one. How important is it for family members to be involved in falls prevention for the elders in their family?

David Summers: Oh, that's extremely important. Their observations and action is key to prevent falling. Just spending time with your parents or the grandparents or your elder friends, reduces their feeling of isolation. Right now with COVID many people are locked in. They're not having the social interaction, even if it's through an open window of the, but that's very important because the less motivated, the less activity, the greater the risk of falling.

Host: Can you give us any examples of how relatives have made a difference in fall prevention for their loved ones?

David Summers: Works out well. And one of my main targets, instead of necessarily at a senior events, you're trying to encourage that person to look at their place and are your grab bars in the best spot? Do you need a lift on your commode? Checkout how much clutter you have in your pathways? I like to target the children, which actually would be my age that we're still working, but we're, you know, looking at retirement kind of thing, but what that does, I'm better off to walk into my parents' house and say, you know, I'm watching you walk and that hallway is a little bit too narrow for your walker or your getting in and out of the shower or the bathroom. And I see that you have some structural issues. So people have either take it upon themselves to make some modifications at their parents' house, or they hire a contractor. And there's some contractors that are certified in the geriatric modifications. So install, grab bars, railings, building ramps. So they don't have to step up going from the driveway into the doorstep to get into the house. And looking at lighting is extremely important and also spend time with your elders and try to reduce their clutter. And instead of walking in and telling them Atlas, roll everything out, go through that stuff. That's in there with them that gives them value that you care. And there'll be more apt to maybe thin out some stuff that might be causing them some issues.

Host: Or even throw rugs. Those could present a trip hazard as well. Things that are so simple and may prevent a fall and not only save a life, but help your loved one live longer.

David Summers: Absolutely. Our parent to grandparent generation loved those throw rugs and they are just a nuisance. They look great. They might serve a function, but they're also a major hazard. We know some of them serve a function, but it's a much known fact that throw rugs are huge trip hazards. So we have to work on coming up with alternatives or making no stick padding underneath working in a way that you can make your environment bigger, better and safer

Host: Are falls more common among men or women?

David Summers: Well, it seems that falls affect women and more women go to the emergency department because of the fall and more women die because of the fall. However, according to the CDC, the rate of fall deaths is more common among men than women. What that means is out of a hundred thousand men more will die. Then a fall out of a hundred thousand women.

Host: Hmm. Interesting. More will lose her life from a fall out of 100,000 women.

David Summers: Yep. So more men will die, even though the women will survive the fall and have a hospitalization with maybe hip fracture that needs fixing or something like that.

Host: And typically, as you age, the time of recovery lengthens as well. On a personal note, I've seen the advantages of following these tips that you're outlining when it comes to my own mother, she's 85 has recovered from several falls and hip surgery. She's using a walker. Physical therapy has been extremely helpful after each of her falls, along with regular exercises, as you recommended. How do you keep them motivated to stay active, but cautious enough that they don't move too quickly or overdo it?

David Summers: Well, encourage them to be slow, but steady. Keep moving, keep exercising and just do it at a steady pace and practice. Those physical therapy exercises is very important. If your physical therapist, gives you a practice summary, a little patches sheet that you can put up on the wall, do it. That'll be a motivational factor with my own parents. I recommend while they're watching TV, every time a commercial comes on, get up, stretch, move, you know, practice sitting, you know, sitting out of the chair up and down a few times and just use the commercials as your cue. But the most important thing is if you've benefited from having a physical therapy evaluation and their specific exercises, which they work on core strengthening. And what I mean by that is central strengthening. How to stand up from a sitting position, multiple times. Arm strength to help compensate for leg weakness. Those are very important. And that's your best friend right there.

Host: David, as a trauma nurse, you've seen more than your share of traumatic injuries caused not only by falls, but by automobile crashes, as students resume in classroom learning and school buses returned to the roads. Do you have any thoughts you'd like to share for drivers and pedestrians?

David Summers: Absolutely. So what we have going on here in Florida, I believe the numbers are from 2019 because we're still working on 2020. There's about 400,000 crashes on our roads in Florida every year, this past year, 26,000 of those happened in Palm Beach County. And since I concentrate on a lot of youth drivers stuff, 2,600 were youth drivers, whether it was their fault or not. So my recommendation is everyone just be aware, realize that a lot of people are back on the roads or trying to get back into a normalcy, but we can't let our guard down.

Host: In addition to falls prevention. What's one top tip you'd like to share that helps keep everyone healthy?

David Summers: That's easy, buckle up everyone. Every trip, every time. A seatbelt can reduce the chance of death by about 45%. It can reduce injury by about 50%. From the people that die in a car crash, 41% might've been saved if they were wearing their seatbelt. So buckle up.

Host: Well, David, thank you so much for your time and expertise as a trauma nurse outreach coordinator, we really appreciate your incite and advice.

David Summers: I appreciate the method on getting the word out and it's great to be here.

Host: You like to say about playing out there?

David Summers: Play hard, but play safe.

Host: All right, David, thanks to you. Thanks to all of our listeners. If you find this podcast helpful, share it on your social channel and check out our full podcast library for topics of interest to you at healthcaredistrictpodcasts.org. Let us know what you think, your review helps us reach more people just like you. And if you have a suggestion about a future podcast topic, have some questions or any feedback you can call us at (561) 804-4111. Today's podcast is brought to you by the Healthcare District of Palm Beach County's Trauma Agency, which is a key component in the county's lifesaving trauma system. For more information on preventing falls, visit www.traumahawk.org and click the education and prevention tab on the left side of the page, where you will find the link to the falls awareness page. There we offer our printable flyer six steps to prevent a fall, as well as a home falls prevention checklist. You can also find helpful information on the CDC website at cdc.gov/steadi. And that's spelled S T E A D I today's podcast is also brought to you by the Healthcare Districts Federally qualified health centers, the CL Brumback Primary Care Clinics. If you or someone you know, could benefit from having a medical home, please call the Brumback Clinics at (561) 642-1000 to make an appointment for an in personin-person or telemedicine visit, COVID-19 testing, school physicals, medication assisted treatment and other services…or you can visit brumback clinics dot org.