Slipping, sliding and stumbling

I fell the other day. I tripped over my very large, plump Doberman while taking her for a walk in the neighbourhood. Not only did I bruise my knee and instep, but I was also the afternoon’s entertainment for my neighbours and their children who were playing outside. After initially being frozen from shock, I managed to drag myself, embarrassed, into standing, in time to receive words of “encouragement” from a man in a passing car. “Doh study it baby!” he urged, as my Doberman burst into a run and jerked me forward. I returned home to nurse my wounds and bruised ego. We have all fallen. It is not just something that happens to the elderly. According to the Centre for Disease Control in the USA, falls are the leading cause of non-fatal injuries in children aged 0-19 years. Every day, 8,000 children are treated in emergency rooms for fall-related injuries and this adds up to 2.8 million children and adolescents per year. We have all heard of the recent fall-related accidents and deaths on construction sites. These highlight the fall risks that are present in many jobs. Building cleaning maintenance, transport and material moving, construction and extraction jobs are particularly high-risk jobs for falls. At Total Rehab, we see a lot of younger people with fall-related injuries. Broken ankles and back pain are common conditions resulting from falls in this population. I also see a lot of wrist fractures from falling on an outstretched arm.

 

However, these fractures are usually of a wrist bone called the scaphoid in younger individuals, whereas older people tend to break the bones of their lower arm instead because of the weakening of these bones with age. A bruised ego and knee were all I received from the fall over my dog. However, in the elderly, the repercussions are much greater because their bones and muscles are weaker, balance is poorer and the injuries are more severe. One out of three adults falls in the USA each year. Falls are the leading cause of death in adults older than 65 years, and are also the most common cause of non-fatal injuries treated at hospitals. Falls in older adults often result in brain injuries and life threatening fractures of the hip. In fact between 15-30 per cent of elderly who suffer a hip fracture die within the first year after the injury. This is because such an injury can lead to severe debilitation and loss of function. Falls are also not limited to the female population. Actually, men are more likely to die from a fall. In 2007, after accounting for age, the death rate from falls in the USA was 46 per cent higher in men than in women. How on earth could I have tripped over my dog? In school we were taught that pets are often the cause of falls in the elderly. Never would I (a far cry from being elderly) have expected to trip over my dog! I have no recollection of how it occurred. It just did, and even in hindsight, I could not have prevented it. These kinds of falls happen to most of us, but others we can most certainly prevent. 

Be smart. Avoiding carelessness will go a long way, but I admit that this is difficult to execute all the time! A family member was given some great advice the other day. She was out of breath when she answered the phone and the caller asked if she had been exercising.When she replied that she was just rushing for the phone, the caller said, “Don’t ever rush. You can fall.”

 

And the risks are increased if one is wearing flip flops on wet tile. Thank goodness terrazzo is a thing of the past, because that flooring was disastrous! My strong advice when choosing a floor is to get a non-skid surface. And keep that surface clean and free from obstacles such as children’s toys, which are significant hazards for young parents and grandparents! Train your animals. Little dogs (and large ones) should be taught to walk at your side, not run between your legs and in front of you. Large dogs like mine love to run at full pace and barrel into you (their interpretation of a very warm greeting!), step on your feet and jump up for attention. Let Poochie understand that this is unacceptable. For the elderly, safety in the home is paramount. As physical therapists doing home visits, part of our responsibility is ensuring that the home is safe for the patient. But don’t wait to become a patient. Be proactive by making your home hazard free. Throw rugs and extension cords and cables should be removed from thoroughfares and the home should be well lit. Nightlights are a great way to light the path to the bathroom at night. Age-related decreases in vision also put the elderly at risk for falls, which often occur at night while going to the bathroom. Annual eye exams should be done to monitor changes in vision. Most falls occur in the bathroom, so it is important to make this place as safe as possible. Grab bars to hold onto and non-skid mats in the bathtub/shower are necessary to prevent falls. Grab bars by the toilet seat can also assist the person in getting up off the toilet seat which is another common area in which falls occur. Railings in stairways are very useful as well to assist with balance and compensate for decreases in strength that make negotiating stairs treacherous. It is also vital that the elderly get regular physical exercise that helps to improve strength and balance. Tai Chi has been shown to be very effective for such goals. Medications must also be monitored for side effects and interactions that may cause dizziness and drowsiness that can lead to falls and their repercussions. There is a lot we can do to help prevent falls and limit their repercussions, should we have one. According to American football coach Vince Lombardi, “greatest accomplishment is not in never falling, but in rising again after you fall.” While he is referring metaphorically and literally to his athletes, this is true for all of us, particularly the elderly.