ELDER MUSIC: Bullfrogs on my Mind
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How to Prevent Falling

On last week's post about loneliness versus solitude, long-time TGB reader Darlene Costner left a comment about how quickly a fall can occur and one way for old people living alone (unrelated to loneliness) to be prepared for them.

It is a powerful statement and I am repeating it here almost in its entirety. Emphasis is my own:

"I do want to tell those people who say they are going to die anyhow so why have a panic button that unless they are much braver than I am,” writes Darlene. “I would have given all I possessed to have had one when I fell the first time and broke my hip.

"Before I realized I had to get to a phone I sat there wondering how long it takes to die without water. I was in shock at first and must have passed out because when I realized my predicament I was sitting with my back against a cabinet wondering how in the bloody hell I got there.

"I have had worse pain, but it still wasn't fun when I had to move my body so I could roll over on my stomach and crawl to the other side of the room to get a telephone. From the time I fell until help arrived it had taken me 10 hours to get help...

"Another time I fell and to break my fall I instinctively reached for a heavy coffee table made of Belgian glass and it fell on my arm trapping me. I would not have been able to crawl to a phone that time and was soooo glad I could press the panic button around my neck (with the other hand) and help would arrive.

"I do not understand why others have had trouble with them. I have had Alert 1 for years and the only problem I have had was when I accidentally pressed the button and the firemen came and I was surprised to see them. That would not happen with someone who is not hearing impaired because they try to reach you on the phone when you don't answer them asking if you are all right."
The first day of autumn each year is the official Falls Prevention Day of the U.S. National Council on Aging (NCOA). For many years on that day, I have posted information about how to keep ourselves as safe as possible from falling, and here are three good reasons to do that:

Every 11 seconds, an older adult is treated in the emergency room for a fall; every 19 minutes, an older adult dies from a fall

Falls result in more than 2.8 million injuries treated in emergency departments annually, including over 800,000 hospitalizations and more than 27,000 deaths

Falls are the leading cause of fatal injury and the most common cause of nonfatal trauma-related hospital admissions among older adults

Since my Whipple surgery last June and for the first time in my life I have a dizziness, or vertigo, problem. It occurs most commonly when I get out of bed so I now sit on the edge of the mattress until the room stops spinning.

Sometimes the vertigo turns up for no good reason when I'm walking around the house and I've taught myself to touch a nearby wall, door or piece of furniture until the sensation subsides. It usually takes only a few seconds until I feel steady again.

With one or two exceptions, it is we ourselves who can prevent our own falling. The NCOA has produced a video that, for all its brevity, covers almost everything you need to know about keeping yourself safe at home from falls:

The video makes a visual point of warning against ladders. About 10 days ago, two sets of fluorescent tubes above my kitchen cupboards burnt out. I dragged the ladder from the storage room, climbed up and retrieved the dead bulbs to know what replacements to buy.

Then, THEN it occurred to me that I might be in big-time falling trouble if the vertigo hit me when I was on the ladder. So I saved the new tubes for a 40-something friend who, a few days later, arrived for a visit and installed the tubes for me. It is undoubtedly time, at nearly 77 years, that I turn over ladder climbing to younger people.

Usually on Falls Prevention Day in September, I publish either a long checklist of how to falls-proof your home and/or link to other good information to keep us safe from falling. Here is one of those posts.

Since last autumn I have found another important prevention item I have never seen listed and I have discovered is important.

In addition to and separate from vertigo since the surgery, I am less certain of being steady on my feet. The difficulty in this case is getting my pants on. All my life, I've just stood there wherever I was in the room and pulled them on - one leg at a time, as they say.

You might call it free-styling with nothing to support myself when I'm on one leg. I considered it a daily exercise to improve my balance, but no more. The mild unsteadiness I feel sometimes in general, multiplies when I'm on one leg.

So now, I sit down to pull on my pants or, at the very least, lean against a wall or counter. This, I believe is an important addition that has been overlooked in the lists of falls prevention items.

Darlene's powerful testament reminded me that given the statistics, twice a year is not too frequent to remind ourselves about falls prevention. The life you save may be your own.


Comments

Thanks for the reminder. I felt if I could still get my slacks on while standing I was doing well balance-wise. Fortunately for me I was standing by my bed when I fell over to a soft landing. Also watch out for your bath mat in the tub. I hang mine to dry after use. They can get slick with soap residue or even hair conditioner and lose their suction. Mine did and I slipped. I managed not to fall hard but the abrupt twisting has left me with a c-shaped curve in my lower spine, acquired scoliosis by name. Mostly it means anything I do standing can only go on for about 10 minutes before I have to sit or lie down for a bit.

What you said, about vertigo -- and about pants! My vertigo may be medication-related, or maybe it's to do with my vision. It comes and goes. At its worst it's been like the careful-walking stage of being drunk; I may be liable to wobble and swerve a bit if I don't pay attention, but it's not going to make me fall down unless something else happens.

I've had two falls in the last year. Luckily they did not have serious consequences, just some bruising on my poor swollen legs (my bone density is still pretty good), but I have forced myself to admit that I am now an "old woman at risk of falling."

Both times I fell, it was caused by trying to do more than one thing at a time.

I am trying to beat into my head that it is dangerous for me to multitask. If there's a step or obstacle in front of me, and I can't just walk around it, I need to consciously remember that my left foot no longer lifts quite as high as I tell it to. I have to stop, concentrate, and make sure I have something near to hand to keep my balance -- or if that's not possible, at least pay full attention to getting my feet past that ground-level barrier, one thought-out step at a time.

And I must always use the safety clothing clip when walking on the treadmill! I had come to neglect that precaution, because hey, I was holding on to the bar anyway, wasn't I? But then I tried to take pulse oximeter readings while walking, and that meant using my hands, which meant I didn't have a good grip on the bar. So of course sooner or later something went wrong.

I have mentioned in other comments here in recent weeks that my mother and stepfather's life (as well as those of their children in the area) changed a couple of months ago, due to something like a fall. My mother apparently tripped (over what it's unclear) and in trying to break her fall, landed on her arm on a piece of furniture and dislocated her shoulder. Following a few days in the hospital, she was sent to a rehab facility. Unfortunately, a month of rehab was not very effective for either upper or lower body.

Now confined to a wheelchair, and with deepened dementia, she has been in this same facility beyond her Medicare covered month, paying costs out-of-pocket, while we've been trying to find a permanent home in a more appropriate long-term facility. The dementia that had been coming on for more than a year has worsened and it does not seem likely that she'll ever walk on her own again.
I've seen this before. Between hospital psychosis, or just removing someone with cognitive difficulties, quickly and unexpectedly, from their familiar surroundings, routine and partner, a person can be quickly disoriented, their confusion quickly ratcheted up and everything changes.

Due largely to the dependency on the wheelchair, and worsened dementia, she has now been denied at three facilities, and we have had to expand the search beyond the small city in which she lives. We are now looking at a facility nearly thirty miles away, not only out of her town, but across the Wisconsin border, so out of state as well. Her 91 year old husband has been visiting her for an hour or two every morning where she has been, which has been feasible because it's an easy drive, and less than five minutes for him. When he did not show up one morning as usual, Mom was very disoriented and anxious. I suspect that she will be facing that on an almost daily basis now, and I anticipate that medication will have to be used to help her deal with this, yet another factor that can quickly increase adverse events. And who knows how her husband will fare now with her continued absence from their home. Until three months ago, they had never even been away from each other overnight since joining their lives together nearly 30 years ago.

All the checklist items are helpful for fall prevention, as are exercises to help with balance and strength, but at some point, a fall or trip and its consequences will probably happen to most of us, regardless of how careful or fit we are. The real bogeyman that I see as the outcome, is the lack of options for what happens after that. Whether there are adequate number of spaces in long-term care facilities, I do not really know. What I do know is that a person can be denied admission to them for any reason (which the facility is not obligated to disclose). They are apparently also free to calculate how long, based on your income and assets, you would be able to remain, and rather than eject someone after however many months it takes to exhaust their resources, it's often easier to cherry pick and accept only those who seem unlikely to outlive their financial resources. Other than dementia and bum legs now, my mother, at 87, is still pretty healthy, as she always has been. Unfortunately, you don't necessarily get any points for that at this stage of the game.

To further illustrate my point of falling without being able to get help I want to add this story. When I broke my hip my roommate in rehab had broken her back and she had never worried about getting help if she needed it because her son lived nearby and her sister called her every day. It so happens that on the day she fell her sister had been gone all day and didn't call as she usually did. The poor woman laid there for 21 hours before her son found her on the floor.

Unless you have someone living with you who will come to your rescue I urge you to make some arrangements to get help if an accident should occur. None of us think we won't fall and our balance is great. It never occurred to me that I would lose my balance and fall before I did.

It can happen in a second and, if it does, it's too late to make arrangements for that unhappy event. You should be proactive with this like you are with other things.

Darlene is right.

Barb, mom's former neighbour lived alone in a small bungalow.

Barb's niece lived a few streets away and would check on B a couple times a week. Barb was still driving age 94 I kid you not.

Barb tripped, fell down her basement stairs and lay there for 24 hours before her niece even knew she was down.

That episode, plus B's falling face down in a grocery store promoted the niece to move B to an ALR.

My senior friend in the ILR has a medic alert necklace.

It works for her.

----

Overheard at the ILR where I volunteer..

One 92 year old to his 98 year old female table mate..

"Gill I want you to bump off my ex- wife. I'll drive the getaway car."

Every time I check in at the cancer center for a routine follow-up, the first and only questions I'm asked are "Have you fallen?" and "Have you been out of the country?" I've chided them for making me paranoid about falling, but it may not be a bad thing.

I've learned that I can go up a ladder, carefully, but going down requires a certain flexibility in knees and/or ankles that I seem to be losing, so no more ladders. I routinely lean against the bed when putting on pants. I try to always have my cellphone within reach, especially in the bathroom. And I now have Google home speakers that I can call out to, if necessary, and have them dial my son. I'd consider a call button at some point, but don't want to pay a monthly monitoring fee.

My gait is a bit slower, with a lot more attention to the ground in front of me. And I've considered carrying a walking stick when I go for walks, because I've discovered I can't get off the ground without something to pull up on. I've wondered if my dog would stand still and let me push up off her shoulders.

I no longer have to worry about orthostatic hypotension (dizziness when standing up quickly) because I can't get up that fast, but I did learn during chemo that dehydration can have the same effect, so I try to stay hydrated.

Another worthy topic. Also important for us elders to remember is that sometimes things like dizziness, wooziness and other impediments are not forever. I had issues like these several years ago...........impossible to stand on one leg, balance was iffy. With time these difficulties subsided completely.
Keeping ourselves safe, yes. I tripped once over a beloved area rug, and it's gone. I hounded my mother for years to no avail. At least I can do it for myself.

I have a medic alert necklace and wear it in the shower! Many people who have them do not realize you can wear them in the shower!

Better to be found naked then not to be found at all!

Do a search for “Elliot Royce fall” for links to his YouTube videos on how to fall. Elliot was doing classes on this for seniors when he was in his 90s. He encouraged falling the correct way, multiple times per day so that muscle memory would kick in when accidents happen.

He died a year or two ago at an advanced age. NOT from falling.

In general, I continue to oppose "spy gadgetry". However, if my husband predeceases me and I end up living alone, I concede that in time a medical alert button might be a good idea. I try to use due caution and haven't fallen recently (in fact, not for years) but it's always a possibility, especially since I've been more or less of a klutz all my life. A few years ago, then in my mid-70s, I began to realize that I also need to be more conscious of the terrain and where it is in relation to my feet. Our home is on one level which eliminates the issue of stairs to fall down. If I must use a ladder, I do so v-e-r-y carefully.

It's definitely scary to contemplate that care facilities can apparently deny admission pretty much "at will" and that money plays such a large role.

However, I still stop at being electronically monitored in my home.

I got vertigo for the first time shortly after my mastectomy. It comes back now and then. I learned to do the half somersault -- very easy -- and the vertigo goes away. Sometimes I have to do it every day for a week or so, but just this week, I only had to do it once and the vertigo disappeared. You can Google it -- there are videos that show you how.

You provide always good reminders for avoiding or coping with falls. A few years ago when I felt hesitant about moving to one more higher ladder step to change ceiling light bulb, I listened to my body and left the bulb for another to replace. I concluded, like you — might be wise to stop climbing around, in concession to my aging body imposing a few restrictions.

As for balance, I’m always reminded of family friend who died years ago at 103+ “living in place” quite a few years after her husband’s death. During those years she experienced vertigo, went through balance/ear retraining that was unable to correct her problem (aging consequence in ear mechanism). When I visited she talked of how she had to frequently remind herself to maintain position a few seconds before moving into a new one. That meant when she sat up bedside before getting up, that once she stood she needed to stand there a few seconds before walking, no fast movements including, and especially, head turns. She was used to standing, then quickly walking forward, or turning to move elsewhere. Bottom line is no fast turns and moves with body including head turns.

Balance adjutments of body are in ears, with input integrated from what eyes perceive which can evolve into vertigo under certain circumstances. Also, colds, allergies, middle ear and/or sinus infections, as I sometimes experience, can create stuffiness to the degree the eustation tubes in ears swell or become stopped-up — prevents inner ear fluids from adjusting to air pressure (like when we change altitudes driving mountain roads, or fly in a plane). This can result in dizziness or vertigo increasing fall potential.

A person’s system can be sensitive to different odors, including some flower fragrances, perfumes sometimes that will set-off the stuffiness and then the process is triggered to occasionally reach a dizziness stage. Such sensitivity may not always occur, so is an inconsistent unpredictable reaction. That’s another whole issue.

Years past when I was considerably younger and fell a couple times, I simply allowed myself to collapse by relaxing, folding up naturally as I went down — what we called a stage fall we learned in our acting classes. I did need to protect/cushion head from striking hard surface to avoid brain damage (closed head trauma). Did cause deep body tissue bruising — my first experience with that and sure seemed to take forever to heal. I decided I must be getting old even then, decade and more ago, when I thought of all the tumbling around I did when much younger, including even when my children were young and didn’t recall any such bruising.

When my adult children proposed an alert button for me after my husband’s death my reason for declining is that I carry my portable phone with me throughout house — have several in other rooms, too. This is landline, giving me a direct connection to emergency help that can identify my location if I can’t speak (unlike cell phone systems where I live and many other places that have to ask you where you are — they can’t tell), then transfer your call to that city, usually just a short delay

Should my situation change, I think the ideal button subscription system would be one that provides an alert for a person who is unable to press a button, dial a number, or speak a word/make a sound. Does that mean a video monitoring system?

Having bathroom needs during the night, I cleared a way from the bed to it, removing rugs, furniture, anything obstructive. Did the same for going to the kitchen.

TaiChi instructor also said, when in darkness, to join hands, extend them in front and walk, thereby no frontal surprises. This helps especially when not home in familiar surroundings.

I also got rid of all high heels save 2 pair of low heels. A fall is not worth the sake of appearance. There are great selections of safe, attractive shoes these days.

Multitasking was something I prided myself in forever, but not since a friend, carrying a teacup, stepped on her bathrobe while going up stairs. It can be something so simple and ordinary.

Lastly, TaiChi , pilates, yoga or some form of balance and strengthening exercising. This includes mindfulness which is possibly the biggest benefit.

When arising from anywhere to move, I consider safety-planning first these days by taking a quick scan of the surroundings. It only takes ~3-20 seconds.

I wonder how many falls can be traced to pure vanity. That is, not wanting to use a cane or Rollator or walker for fear of having people think of you as an invalid or, heaven forbid, elderly?

Bruce, it might be more, not thinking of yourself as an invalid, or elderly. In your self-image, part of you is still young and healthy. And that's not wrong. Sometimes parts of your body want to do something that other parts can't handle -- in my own case, it's leg muscles that would still love to walk at a normal-to-fast pace, and lungs that can't keep up.

It's not a one-time thing, I'm learning. There's an ongoing adjustment process. I expect a lot of people are caught off guard by some new change.

When I tripped and fell on a hike 5 1/2 years ago I was crippled up for a long time...went to ER for stitches and X rays of hand, - one week later unable to walk from pain, had to use a wheelchair at my 55th H.S. reunion!! Went back and insisted on Xray of hip - Ortho doc told me "get out of that wheelchair and use a walker"... nothing broken.

The walker threw off my right side, as I didn't know to adjust the damn thing....finally, 2 months later, a nurse practitioner RX physical therapy...the young male therapist told me to get rid of the walker which I did that day...even tho painful, had to walk in spite of my brain telling me "it hurts too much" ....I am now 78 and OK but for the arthritis in my pelvis, knees from that fateful fall....I am VERY careful now when I walk which is about 4 X times a week, plus Yoga 2 X weekly. It took more than a year for the pain to subside, and also for my brain to adjust that I wasn't going to topple over when I went down the 2 steps to my garage, and back and front porches.

In yoga we practice a stance if threatened with a fall....but usually one cannot be avoided as I have had several unplanned "trips" but able to catch myself with my hands so no harm done.

The video states falls are not a normal part of aging. In the next sentence, it states every 11 seconds an older adult visits an emergency room for a fall related injury. It seems to me falls are a part of aging.

I have beginning arthritis in my right hip and right foot. I don't do balance poses on my right side as well as my left and I think it's because of this.

My Pilates instructor, who is in her 80s, fell in her condo last year. She was in the hospital for over 3 weeks. She had internal injuries due to the fall including broken ribs.

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