Preventing falls key to independent living

Millions of Baby Boomers are marching into old age, and it turns out many are unsteady on their feet.

Each year, one in three Americans age 65 and older takes a fall, and 64-year-old Philadelphia resident Alice Foley can have trouble staying upright.

This story is part of a series on aging in the Delaware Valley called “Gray Matters: New Tools for Growing Older” from the WHYY Health and Science Desk. The six-week series features audio and video stories as well as personal essays.

Millions of Baby Boomers are marching into old age, and it turns out many are unsteady on their feet.

Each year, one in three Americans age 65 and older takes a fall, and 64-year-old Philadelphia resident Alice Foley can have trouble staying upright.

“I had short periods where I would get dizzy, but they would only last a minute or two. I’d just lean on the wall. Maybe take a drink of water and feel fine,” Foley said.

It’s easy to dismiss an occasional misstep, even an unsettling stumble, but sometimes a fall is more serious.

Falls send two million older Americans to the emergency room each year. Rehabbing a broken hip can cost $37,000, and 25 percent of older people who suffer a hip fracture are dead a year later.

“Each fall comes so quickly,” Foley said.

Her biggest scare was a year ago, but it wasn’t her first.

“I had my shower, turned around, took two steps and flew into the living room and hit my head on a box and fractured my hip,” Foley said.

“In the span of four years I had 12 falls, including three concussions, and they really take a long time until you feel back to whatever normal is,” Foley said.

Foley is an occasional neighborhood tutor, serves as a lector at church, and walks to the grocery store. She says her biggest wish is to stay active in her neighborhood and to continue to live on her own. In part, that means being extra careful when her 19-year-old tan-and-white calico is underfoot.

“Sometimes the cat will stop and see something that people don’t always see,” Foley said. “He can be right in front of my feet when I’m trying to get from the refrigerator to the sink to the cat dish.”

A new nightlight makes those early morning excursions a little safer. These days, the area rug in the living room is tacked down tightly. Also, Foley’s a big believer in sensible footwear.

“My Aunt Helen used to say that a person’s shoes and teeth need to be comfortable,” Foley said. “Once my feet are comfortable in shoes that are fitted I feel more stable.”

She learned some of those tips during a fall prevention workshop at Germantown’s Center in Park, Foley’s neighborhood senior center. Since then, she hasn’t fallen once.

During the Healthy Steps program, the class identifies a litany of home hazards including tangled electrical cords and years of household clutter.

Many at-home falls happen on slippery bathroom surfaces. So one of the top workshop tips is to install — and use — grab bars. Instructors say many people use a towel rack or soap dish to steady themselves in the shower, but those handholds aren’t sturdy enough or made to prevent a fall.

The workshop also includes a quick assessment of leg strength, balance and walking ability. Participants go home with a falls-risk score which they can use to begin a conversation with their doctors. Experts say if you’re worried about a fall — actually before you’re worried about a fall — talk with your primary care physician about drug interactions or medical conditions that can cause balance problems.

They also recommend exercise.

In Cherry Hill, N.J., Fox Rehabilitation is testing a 12-week group class to help older adults build strength. Fourteen years ago, physical therapist Tim Fox founded the rehab practice and decided to focus on house calls for seniors. Today the business has 600 employees and offices in seven states, but Fox says geriatrics wasn’t cool in 1998.

A lot of my colleagues went into professions that were more sexy, so to speak,” Fox said. “Orthopedics, sports medicine. I was criticized by my colleagues: ‘Why would you want to do that?'”

Maybe Tim Fox saw the future. Every day — for the next 18 years — 10,000 Baby Boomers will turn 65, and many of them will experience a fall.

“It doesn’t have to be that way,” Fox said. “The best thing we can do as a society is throw out grandma’s couch.”

Many older people curb their activities and stay home a little more after a fall, but Fox says seniors who sit around lose confidence and become weaker over time. So, often, his advice is to keep moving.

“People think, ‘Oh, I’ll exercise one day a week, two days a week, for three weeks,’ and think, ‘That’s good I got physical therapy.’ Well really that’s not it,” Fox said. “It needs to be prescribed just like a medication. So it needs to be prescribed at the right frequency, duration and intensity over time for it to be effective, for it actually to work.”

A serious fall injury can speed the progression from home to assisted living to long-term care, and each of those steps leads to costlier health care. Fox says people too often keep quiet about near falls, even when those scares keep them from doing what they want to do.

“‘I can’t go to church anymore, I can’t get down my steps anymore,’ but they are not typically reporting that to the physician,” Fox said.

He says many physicians are not trained to assess — or not in the practice of assessing — their patients’ ability to take care of everyday tasks.

“We need to start looking at both aspects of aging, the medical aspect and the functional aspect,” Fox said.

In 2000, medical expenses for falls cost the U.S. health system about $19 billion. That equals about $28 billion in 2010 dollars, according an estimate from the Centers for Disease Control and Prevention.

In Philadelphia, Alice Foley gets her health care through the Medicaid and Medicare programs. She was in the hospital for three weeks after her hip fracture and needed another six weeks of rehab at home. A year later, she’s stronger and little more cautious.

“Whether I’m in my home here or out in the neighborhood a little bit I have a sense of presence that I don’t need to fall, that I’m not going to fall,” Foley said. “I can handle myself.”