It is my zechus to address our kehila on the important topic of fall prevention in the elderly. As a physical medicine and rehabilitation (PM&R) physician, I would like to share with you some facts and ideas about fall prevention that may save you or your loved ones’ lives. While we know that everything is in Hashem’s hands, we also have the mitzva of “V’nishmartem meod l’nafshoseichem,” to take appropriate precautions to guard our health, which is the background to this article and to the approach I take with my patients.
Are you or someone you know at high risk of falling? According to the Centers for Disease Control (CDC), a person who has fallen once or twice over the past 12 months with a resulting traumatic injury (for example, a broken hip) is likely to be at high risk of falls. If you or one of your loved ones is in this category, preventing further falls is crucial. Some people believe themselves impervious to future falls, despite having fallen “only” a few times and suffering “only” a few broken bones. If you or someone you know is in this category, here are some more facts that may put things into perspective:
- Some 95 percent of hip fractures are caused by falls, with a subsequent approximately 30 percent mortality rate and 50 percent resulting necessity of nursing home care for a year after the injury.
- Falls are the most common cause of brain injury in elderly adults.
If you or someone you know is high risk, don’t wait – get help. Even if you haven’t had a traumatic fall but you have concerns about your balance, contact us; we can help you stay stable.
For lower risk older adults, here are some recommendations for keeping your balance steady. (Please note: I urge you to discuss these details with your primary care doctor, who knows you and your body. As with most things, these suggestions will be more appropriate to some people than others.)
- Get your vision checked and attend to any vision problems, such as cataracts, promptly. Avoid bi-focal lenses. If you are at risk of falling, you should own two different pairs of glasses.
- Maintain an active lifestyle, for example by walking at least 30 minutes a day, 5 days a week. (Of course, if you haven’t been active until now, start slowly and build up to it.)
- Exercise to strengthen your legs (you may need a personal trainer for this). Weight-bearing exercise (e.g., walking, running) is good for strengthening bones and preventing bone fractures.
- Sign up for a Tai Chi class at your local senior center to help improve your balance. This will teach you to stand and move with mindfulness.
- Get rid of tripping hazards such as throw rugs or clutter in your home. Pets like dogs and cats are a common tripping hazard, so take precautions.
- Install night-lights to illuminate your path to the bathroom at night. If you wake up more than three times at night to urinate or you have bladder incontinence, it may be wise to see a urologist.
- Don’t wear flip-flops or other slippery footgear.
- See a podiatrist if you suffer from foot problems, e.g., numbness, skin ulceration, or circulation issues caused by diabetes or peripheral vascular disease.
- Monthly or weekly vitamin D supplementation (e.g., 50,000 units) increases risk of falls and fractures (perhaps because high doses make muscles less responsive to the circulating vitamin D). If you’re taking such supplements, discuss this with your doctor.
- Avoid calcium supplements, which recent studies have shown are associated with risk of strokes and heart attacks. Instead, eat calcium-rich foods to meet your daily calcium requirements, e.g., a fist-size serving of cheese or yogurt three times a day. Similarly, consume protein to keep your muscles strong.
- Sign up for Stepping On Fall Prevention Class.
Again, please speak to your doctor before implementing these ideas, as some of them may not be right for you!
So, you may be wondering, what is a “falls doctor” and why would you need one? Although physical therapy is often helpful for people who fall, new evidence backed by the CDC recommends that falls be managed by doctors. Some medical specialists focus on specific issues that lead to falls – for example, otolaryngologists specialize in falls due to inner ear problems. Working at Johns Hopkins, however, I had the luxury to learn from other specialists and to develop a “one-stop shop” model to falling to help avoid multiple physician visits.
Using training in biomechanics and a whole-person approach, the Johns Hopkins Falls Prevention Clinic, where I serve as the medical director, accurately diagnoses the specific conditions causing falls and creates an individualized, comprehensive, goal-driven, evidence-backed management plan for each of its patients.
Recently, I decided to bring the science of fall prevention to the community and started Steady Strides: Fall Prevention and Stroke Rehabilitation Medical Institute in Owings Mills. For more information, or to have any questions answered, you can contact our office at (443) 898-8160, firstname.lastname@example.org, or through our website at www.steadystridesmd.com.