Falls can pose serious health hazards for elderly

The bruises are still visible on Ann Drake’s left arm and hip.

The slightest movement causes intense pain from a dislocated shoulder, and a 2-inch gash, with dark blood caked along its edges, serves as an unintentional part in her gray hair.

The physical wounds, of course, will heal in time.

Etched in her mind, however, is the tumble she took down a set of concrete steps outside her southwest Atlanta home as she headed to a dental appointment.

“I went down like a ton of bricks,” said Drake, 80, a retired teacher. A neighbor driving by saw her sprawled at the bottom of the steps and stopped to help. “Blood was everywhere. I got my first ambulance ride and it was nice, but I don’t want to do it again.”

A fall like Drake’s is a nagging concern for many seniors. One slip can mean a trip to the emergency room or worse.

Drake usually uses a cane or walker to get around. That day, as she headed down her front steps, she turned to grab a tote with an extra oxygen container, and the momentum propelled her down the steps.

She thinks medication she takes daily to control her diabetes and high blood pressure also might have played a role. “They make me unsteady,” Drake said.

Falls are among the leading causes of injury in people age 65 and older. They can cause everything from minor cuts and bruises, to fractured or broken bones to serious — and potentially fatal — head injuries.

“There’s no question, falls have gotten to be a very common issue in the elderly population, especially,” said Dr. Jim Sloderbeck, an emergency medicine physician at Piedmont Atlanta Hospital. “In older people — those in their 80s — a fall can really be life-changing. For someone who has managed to live on their own independently, a major fall can take you out of that situation and put you in assisted living or a skilled nursing home. It’s a real problem.”

According to Piedmont’s Sixty Plus Services’ fall prevention guide, at least one-third to one-half of the population over 65 years of age will experience a fall, which accounts for more than 90 percent of the hip fractures suffered by older adults.

In 2013, 2.5 million nonfatal falls among older adults were treated in emergency departments in the U.S., and more than 734,000 of those patients required hospitalization, according to the Centers for Disease Control and Prevention.

It’s fortunate that Drake’s fall did not result in more serious injuries.

“I’m so glad, because it could have been much worse,” said her daughter, Crystal, who rushed to her mother’s side. “It was a terrible car ride over, not knowing.”

In Georgia, medical personnel expect to see more cases as the state’s general population ages. There’s reason to worry.

By 2020, the number of people age 60 and older living in the 10-county Atlanta region is expected to exceed 855,000, according to the Atlanta Regional Commission.

In 2007, the state’s death rate for falls for older adults was higher than the U.S. rate, said Elizabeth Head, co-chairwoman of the Georgia Falls Prevention Coalition, which was formed in 2008 to promote strategies to prevent falls and reduce fall-related injuries among at-risk populations. Georgia was ranked 29th in the U.S. for fall deaths in 2012, compared to 16th in the nation in 2007, an improvement.

And once an elderly person falls, that person is two to three times more likely to fall again.

“So many falls happen when people are doing routine activities in the home such as when they have to get up and go to the bathroom,” said Head, program coordinator for the Georgia Department of Public Health, Injury Prevention Section.

Hospitals and nursing homes are paying attention and trying to institute policies and programs to limit the risk of falls.

Jackie Summerlin, director of clinical services for A.G. Rhodes Health & Rehab, which operates three nursing homes in metro Atlanta, said residents go through a routine assessment to determine what, if any, measures need to be in place to reduce the risk of falls. The assessment looks at vision, mobility and daily activities.

Procedures may include putting a mat next to the bed, installing nightlights and making sure socks have no-skids grips on the soles.

“People are going to fall,” she said. “We don’t want them to have a major injury. We want to keep them as safe as possible while at the same time let them maintain their highest level of functionability.”

Overall, motor vehicle accidents are the main injuries seen for trauma patients at Grady Memorial Hospital, followed by falls and gunshot wounds. But among people 65 and above, falls are the main injury for trauma patients.

The problem, says Dr. Jeffrey M. Nicholas, Grady’s chief of trauma and director of the Marcus Trauma Center, is that it doesn’t take much of a fall to cause injury to an elderly person, who might not recover as quickly as someone who’s younger. As a person ages, bones become more brittle, and the body becomes more fragile. Additionally, many older people are on blood thinners, which can make an injury that much more devastating and puts them at greater risk of bleeding complications.

He said many older adults have balance issues and have lost much of the core strength. Additionally, some medications or combinations may cause dizziness or cause them to black out.

Many falls, especially if the injuries are slight, may not ever come to the attention of a doctor.

Older people may fear if their families became aware of a fall, they might insist on them moving out of their home into senior housing. Or, in the case of a devastating injury, into assisted living or a nursing home.

“They fear their independence being taken away,” said Emma Harrington, director of injury prevention and education services at the Shepherd Center. And it’s not just physical. “The worse part of this is that a fear of falling sends you into a vicious cycle. You start limiting your activities. You stop exercising or going out with friends. And that may make you more apt to fall because you’re weaker. Staying active is the No. 1 way to prevent falls.”

Head thinks prevention is the key.

Contrary to popular belief, “falls are not a natural part of aging,” she said. “They’re highly preventable. We can really make a difference and improve the health of Georgians by reducing their risk of falling.”

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