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Simple falls, serious consequences

Many life-changing injuries to the elderly can be prevented through exercise and changes in the home, says a CDC report.

By WES ALLISON

© St. Petersburg Times, published April 11, 2000


Eleanor Anderson took her first tumble almost two decades ago, just three weeks after she retired from Florida Power. She had planned to spend her retirement traveling; instead, after two more falls and a broken hip, she has spent much of it in a wheelchair.

"I was all set to go on trips and everything else. I was ready to go out and enjoy myself," Anderson, 80, said Monday after finishing physical therapy at Bon Secours-Maria Manor Nursing and Rehabilitation Center in St. Petersburg, where she lives.

"It stripped me of ever, ever being able to take a trip. I'd always been very independent, and to strip me of my independence was the worst thing."

Hundreds of thousands of elderly Americans, including 20,000 Floridians, will suffer a bad fall this year and spend years trying, often in vain, to recover.

Too often those life-changing injuries could have been prevented through exercise and simple changes within the home, according to a recent report by the Centers for Disease Control and Prevention.

The CDC has provided its first count of how common falls are among the elderly and how the numbers may be reduced. The recommendations, designed for caregivers, doctors and senior citizens, were part of the CDC's first report on women's health. It was mailed last week to thousands of doctors, hospitals, researchers, and state and local health departments.

"These are measures that don't necessarily take a lot of time, energy or effort, but they take someone paying attention, and folks being responsible and aware of their surroundings, their environment, their medications," said Yvonne Green, director of the CDC's office of women's health in Atlanta.

People lose bone mass as they age, making them susceptible to fractures. Hip fractures are by far the most troublesome, and physical therapists who work with seniors say a broken hip often marks the beginning of the end.

In its reporting, the CDC found staggering figures: At least 340,000 people age 65 or older, including 20,000 in Florida, are hospitalized for hip fractures each year, and 80 percent are women.

Only half are able to return home or live independently.

According to the CDC, 50 percent to 60 percent of falls occur at home, but they also are common in assisted-living facilities. Half of the nation's 1.7-million nursing-home residents will fall at least once, and one in 10 will suffer a serious injury.

The CDC's recommendations are routine measures at many hospitals and nursing homes, but physical therapists and seniors acknowledge that laypersons do not always think of them. They include installing grab bars in bathrooms, getting rid of throw rugs, and installing non-skid flooring in bathrooms or kitchens.

Doctors should ensure their elderly patients are not overly medicated. Padded undergarments also can help cushion a fall, and several companies are testing a flooring that is designed to have the same effect.

Exercise can make the biggest difference, the CDC says. According to clinical studies cited in its report, increasing physical activity can cut the likelihood of falling and suffering a hip fracture by 40 percent to 60 percent. Exercise can help maintain balance and coordination, as well as rebuild bone mass.

"Balance and strength go hand-in-hand," said Nova Villanueva, a physical therapist at Bon Secours-Maria Manor. "If they get stronger, they can balance themselves better."

Liliana Vidal, therapy director at Westminster Shores, a retirement center in St. Petersburg, said it is not as difficult to get the benefits as many seniors fear.

"If you do a strength and exercise program, you can really see the difference after a couple of sessions," Vidal said.

Peggy Lassanske, executive director of the Elder Floridians Foundation in Tallahassee, said the CDC's education campaign may be helpful, but more must be done to prevent the root cause of most bad breaks: The majority of people who fracture their hips or other bones suffer from osteoporosis, a significant weakening of the bone that worsens with age.

One of two women over age 50 are at risk for osteoporosis, as is one out of three men over age 75. The disease can be slowed through exercise, diet and, for women, estrogen therapy.

"If we did not have brittle bones as we aged, hip fractures as a result of falls wouldn't be the problem," Lassanske said. "What we need to do is help people learn how to keep their bones healthy."

Since January, the foundation has been working with the state Department of Health and the Florida Medical Association to develop a course that will teach physicians how better to counsel their patients about osteoporosis. In a survey of 6,000 Florida seniors, the foundation found that more than two-thirds had not discussed the disease with their doctors.

"Doctors need to be talking to their patients about bone health, and we're not doing that in the state of Florida," Lassanske said. "If we had done that, we would not be having to address the issues of falls when they're 80 or 85."

Anderson said she never considered how a simple fall could change her life until she actually fell.

Her first, down the stairs at her daughter's home, was fairly uneventful, but it was soon followed by a fall down some stairs at a restaurant that broke her foot. Then she fell in her bedroom, breaking her hip and badly twisting her right knee.

"I caught my heel in the carpeting," she said. "You don't think of something like that."

Then she admonished, "Stay active, and I don't mean recreationally active. I mean physically active. I worked in my yard every Saturday, but it wasn't enough to keep my body in the shape it needed to be in."

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