Will Denial Be Your Downfall?
Each year in the U. S., one out of every three adults over the age of 65 is injured in a fall. Yes, that’s one-third. And falls cause the most nonfatal injuries and hospital admissions in this age group. Under the best of circumstances, a healthy person who takes a bad spill can have broken bones, need surgery and/or rehab, and extensive physical therapy. People who are older, frailer, demented, or otherwise ill can sometimes face more dire consequences, including death.
Now, we all know that 65 is not necessarily “old” these days and it can be hard to accept being a member of the “older adult” cohort. Many of you are still actively pursuing the sports and hobbies you’ve enjoyed all your lives like skiing, running, and cycling. What I’ve witnessed with my patients is that, at any age, denial can be a powerful thing. They are sometimes not ready to deal with the physical changes associated with aging and, as a result, may experience a fall or an accident. Recognizing and honoring these changes, and making accommodations for them, can represent an investment in your independence for years to come.
I’d like to encourage you to take a good look at what’s going on with you, personally, and give some thought to your potential fall risk. There are many things you can do, ranging from subtle to more extreme, to diminish the possibility that you will take a life-altering tumble.
First, develop a good, open relationship with a primary healthcare provider who you trust. Then be completely honest with that person. We know that many people don’t report falls to their physicians. I’m guessing that may be because they are afraid their independence will be taken away if others know they are falling. On the contrary, asking for help means that you will get the kind of assistance you need to reduce the likelihood of subsequent falls and make it safer to stay in your own home as long as possible.
Your primary care physician can do a number of things:
- Review your medications. Sedating drugs are often to blame for falls, especially when narcotics such as pain relievers are combined with antidepressants or other drugs. When you have prescriptions written by different physicians, be sure that your primary care provider knows about everything you’re taking. And if you have any questions or concerns about the effects your medications are having, please, do not hesitate to ask your provider! It is very important that you take the initiative for your own well-being in this way.
- Screen for osteoporosis. This is a common condition, especially in women, in which the bones lose calcium and minerals, thus becoming weaker and more likely to fracture or break. Everyone (men and women) should have a routine screening at age 65 (and those with certain risk factors may be screened even younger). There is a simple imaging test called a “DEXA scan,” commonly used to measure bone density, that will tell your physician whether you need to take preventive measures to address osteoporosis. Medications, Vitamin D, calcium supplements, and hormone supplements are the most common forms of treatment. Exercise is also likely to be recommended (more to follow on that).
- Make a referral for a home environmental assessment. When I am concerned about a patient falling, I will sometimes ask them to have a home health agency come out and take a look at their living environment. The agency will make specific recommendations about how to make the home a safer place.
- Evaluate your gait. The term, “gait” refers to the way you walk. While walking may seem like a simple idea, your gait is actually a complex, coordinated action that involves your nervous system, musculoskeletal system, sensory function, balance, vision, and more. As we age, our gait naturally changes. Your physician can observe your gait initially and over time, watching for particular cautionary signs.
- Assess your cognitive function and look for other health risks. Being alert and aware of your surroundings is essential; dementia and cognitive decline can prevent this from happening. Tell your physician about any dizziness, numbness, joint pain, vision, hearing, or other problems you may be having.
Other proactive steps you can take include:
- Have your eyes screened regularly. Cataracts are a common problem that is easily remedied. Obviously, if you can’t see well, you are more likely to trip over something, run into something, or miss a stair. So keep an eye on your vision.
- Wear good, reasonable footwear. Our shoes create an important foundation for moving through the world. Beware of high heels, slippery soles, thick rubbery soles, and big slippers. Choose shoes that fit and support your feet well. Consider seeing a podiatrist if you have specific foot issues or trouble finding comfortable shoes.
- Exercise! Moving the body, within your appropriate level of ability, is good for everyone. You may be that avid cyclist I referred to earlier, or someone who practices seated chair exercises, or, more likely, somewhere in between. Activities like light weightlifting, yoga, tai chi, and water aerobics are fantastic for building the body awareness, balance and strength that will keep you grounded and steady as you navigate your life. If you are afraid that exercising will increase your risk of falling, consider consulting with a physical therapist who could design a safe and effective program just for you.
- Eat a nutritious, healthy diet. Your food choices are critical to maintaining your overall health and well-being, thus preventing falls. Stick primarily to fresh vegetables, fruits, whole grains, low-fat dairy products, and lean protein (like fish and chicken). Limit salt, caffeine, soda pop, and highly-processed junk foods. You may want to consider supplementing with fish oil, Vitamin D, and calcium (ask your physician).
- Use a device to assist you. At some point, it may be helpful for you to lean on a cane or walker. Please don’t feel embarrassed or too proud for this—it is simply a tool to help you get safely up and about.
- Fall-proof your home. Referred to as “environmental modification,” look for the things you can do to make your home a safer place.
- Lighting. Be sure there is sufficient lighting to see well in every room. Add lamps and night-lights where necessary.
- Rugs. Remove loose rugs that can easily be tripped over. They don’t call them “throw rugs” for nothing—they can throw you right across the room!
- Furniture. You know that ottoman or coffee table that you’re always stubbing your toe on? Get it out of the way before it takes you down.
- Stairs. If you must walk stairs, ensure there are good handrails in place. Don’t stack objects that you intend to take upstairs or downstairs on the steps.
- Bathtubs and showers. A walk-in tub is a wonderful luxury if you can have one installed. If not, work with grab bars, non-slip mats or decals, or perhaps a non-slip stool designed for the tub or shower.
- Pets. While our furry friends provide love and companionship, they are also notorious for getting under-foot and leaving their playthings in the middle of the floor. Be alert to their presence and know where they are.
Accepting and embracing the process of aging doesn’t mean “giving up” or “giving in” to the inevitable. Instead, it is a conscious, proactive way to modify your environments and habits to adequately suit your changing lifestyle. Don’t let denial be your downfall! Start taking the right steps to prevent falls today.