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Thursday, August 18, 2016

Standing Strong

Posted By: Advancing Care

One in three adults over 65 will sustain a traumatic injury from a fall this year. Here’s how to avoid becoming a statistic.

By Ali Jackson-Jolley

Step into Westchester Medical Center’s Level 1 Trauma Center, where some of the most critically injured patients are treated daily, and you might be surprised to find that a majority of the patients are here because of a fall, says Lynn Kemp, RN, the Regional Trauma Administrator for the Westchester Medical Center Health Network (WMCHealth).

“Falls are dangerous at every age, but for the elderly, falls are the leading cause of fatal and nonfatal injuries,” Kemp reveals. In fact, of more than 156,000 seniors aged 65 and above living in Westchester County, one-third will fall this year. According to the U.S. Centers for Disease Control and Prevention, falls account for 25 percent of all hospital admissions and 40 percent of all nursing home admissions. Almost half of those admitted to the hospital or nursing home do not return to independent living and 25 percent will die within a year of a fall. But with a greater awareness of your fall risk, and with a mind toward prevention, you don’t have to become one of them.

With the oversight of WMCHealth’s three trauma centers (Maria Fareri Children’s Hospital, Westchester Medical Center and MidHudson Regional Hospital), Kemp has witnessed her fair share of devastating falls. Falls hit seniors harder than the rest of the population because seniors are often more frail and slower to recover. Add to the mix pre-existing conditions and medications that can mask or exacerbate an injury, and you have a recipe for disaster.

“A fall that may have been very trivial in another patient can turn into something severe when you are taking blood thinners, especially if you hit your head in the fall,” says Kemp. “Or, if your body goes into shock as a result of an accident, and you happen to be taking beta blockers, your heart rate cannot increase, making it harder for us to see that you’re in trouble.”

Know Your Risk

To combat this epidemic of traumatic falls by seniors, the medical community has shifted its focus more heavily to educating the public on fall-prevention strategies. The program’s outreach coordinator, Mary McCarthy, is the Trauma Injury Prevention Coordinator at WMCHealth. “I hear from older adults all the time that they expect to fall because they are old. Our seniors need to better understand that falls are not a natural part of aging.” As such, falls are not “accidents” but are “predictable and preventable.” Older adults need to better recognize the medical, behavioral and environmental factors that can increase the likelihood of falling.

In her role, McCarthy collaborates with other healthcare advocates, disseminates information on fall prevention and educates people on reducing the likelihood of a fall. Knowing what factors put you at risk is the first step, so McCarthy facilitates biannual community-wide screening events aimed at helping seniors identify and reduce their risk. These screening events include stations dedicated to areas where modifications can reduce the risk of a fall. These include vision and hearing, balance and mobility, medication, diet, exercise and safety of the home environment.

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Angela Katz, of the YWCA and a Falls Collaborative Partner, leads a class for seniors. WMCHealth has teamed with YWCA White Plains & Central Westchester to offer courses geared toward balance improvement.

The idea of providing free, community-wide fall screening is a relatively novel practice, but fall-risk assessments have long been standard practice in senior-care facilities, like the Bon Secours Schervier Pavilion nursing facility, also a Member of WMCHealth. Here, residents are screened upon admission, every three months thereafter and when a change in functional ability is identified. As Schervier Pavilion Administrator Lisa Brocky explains, “We have incorporated interactive Wii video games for some of our residents, to help assess their balance and mobility. Our therapists use different programs, like bowling or downhill skiing, to assess mobility and balance. Then, once we’ve done the assessment, we incorporate the Wii into their therapy.” Brocky is clear that this creative use of technology is only a small piece of the puzzle: “Fall-risk assessments need to be considered with a holistic approach. It’s environmental; it’s recreation; it’s diet.”

An Ounce of Prevention Is Worth a Pound of Cure

In Kingston, at HealthAlliance Hospital: Mary’s Avenue Campus, another Member of WMCHealth, Occupational Therapist Bill Shashaty addresses the Seniors Health & Wellness Breakfast Club to educate older adults on fall prevention.  At the event, he stresses that home safety is a key to fall prevention [see sidebar], but so is adopting an exercise program that includes stretching, strengthening and balance training. He suggests finding a community dance, yoga or t’ai chi class.

For seniors who don’t have the ability to participate in community classes, it’s still important to work on balance. In this case, an occupational therapist can work with someone to create a home-exercise program. “Sometimes people get anxious about falling. The problem with this is that when they limit their activity, it makes them weaker. Since most falls happen at home, people who limit their activities don’t go out into their communities but still probably fall at home,” Shashaty warns. “I tell people to stay safe — and active.”

In White Plains, WMCHealth recently joined forces with County Executive Rob Astorino and the YWCA White Plains & Central Westchester, to launch a comprehensive balance-training and fall-prevention program. Since April, YWCA White Plains has begun offering courses specifically geared toward balance improvement and fall prevention in older adults. For example, there is the Matter of Balance Program: Managing Concerns About Falls, and the more active class, including Tai Ji Quan: Moving for Better Balance.

Never Underestimate Your Injury

If you do get hurt because of a fall, never downplay your injury. “Too often the elderly fall and do not seek treatment. Or, as is sometimes the case, an injury is undiagnosed,” says Kemp. Falls in older adults pose unique problems, such as the possibility of multi-system body injury or symptoms that are obscured because of multiple medications. That’s why trauma clinicians are trained to have a heightened awareness of potential injuries in seniors and why seniors themselves need to be extra vigilant.


How to Make Your Home A Safer Place

  1. Make sure all pathways through your home are clutter-free, such as from bed to bathroom.
  2. Remove all rugs that are not properly secured with non-skid backing, especially at the top of stairs.
  3. Remove or repair all wobbly furniture.
  4. Keep wires and cords secure and out of pathways.
  5. Have proper lighting throughout the home, especially in stairwells.
  6. Use nightlights in bedrooms and bathrooms or any area routinely accessed during the nighttime.
  7. Install permanent grab bars near the tub and toilet.
  8. Keep all routinely used products in reach
  9. Be aware of small pets and small children.
  10. Wear properly fitting shoes and clothing.

For more tips, request a copy of the WMCHealth Fall Prevention Tool Kit for Older Adults by e-mailing [email protected]