January 28, 2013

Deadly falls on the rise among seniors

Mas Hatano knows he was lucky. When the 84-year-old retired civil engineer took a bad fall a couple of years ago, the only thing hurt was his pride.

Mas Hatano knows he was lucky. When the 84-year-old retired civil engineer took a bad fall a couple of years ago, the only thing hurt was his pride.

"I tripped and crashed on the sidewalk," said Hatano, who recently signed up for a UC Davis Health System fall prevention workshop. "As I sat there, a passing car stopped and the people asked if I was all right. Yes, except for my dignity."

He is an exception to a deadly trend.

In recent years, California hospital emergency rooms have been flooded with older adults injured after falling, and deaths related to falls among seniors are rising, too.

From 2000 to 2010, the number of Californians age 85 or older killed during falls more than doubled from 415 to 860, according to the state Department of Public Health. The rate of deaths related to falls among that age group rose about 50 percent during that period.

"The reasons are still being studied, but we can surmise what the data indicate," said Barb Alberson, the department's state and local injury control chief. "Seniors are living longer. They're living with multiple chronic conditions that raise the risk of a fall."

And, she said, the medications for many of those illnesses – heart disease, high blood pressure, diabetes, benign prostate problems – can increase the possibility of falling, as well.

For example, powerful heart medications can cause dizziness. Combine that with commonly prescribed prostate drugs, which can cause fainting, as well as fragile bones prone to breaking, and it's not hard to see how an elderly man can end up in the emergency room with a fractured hip.

In the four-county Sacramento region, 67 people age 85 and over died from falls during 2010, up from 33 in 2001.

The same trends are occurring nationally. From 2001 to 2010, the number of deadly falls involving Americans 85 and over jumped from 5,350 to 11,412, according to the Centers for Disease Control and Prevention, and the death rate for falls in that age bracket jumped 65 percent.

Hospitalization statistics are equally alarming.

In California, 59,000 people age 85 or older visited the emergency room after a fall during 2011 – about one of every 10 California seniors, according to the Office of Statewide Health Planning and Development – and another 31,000 were hospitalized as a result of falls.

The number of older adults admitted to UC Davis Medical Center for fall-related injuries increased from 292 in 2010 to 402 last year, hospital figures indicate – and the average length of stay rose from four days to 6.35.

"And the baby boom is coming," said Rachel Zerbo, who manages the Safe and Active Communities fall prevention program at the Department of Public Health. "The need will only increase. We have our work cut out for us."

With 76 million baby boomers edging into their senior years – many of them with the mindset that they're eternally immune to growing older – the likelihood is that statistics related to falls will rise exponentially in coming decades.

Already, one-third of Americans 65 and older suffer falls each year, according to the CDC: For older adults, falls are the leading cause of injury-related death.

"My sense is there's a perception among older adults and even health care providers that falls are an inevitable part of aging," said Zerbo. "You fall, and you have to live with that.

"But the fact is, falls are preventable. We have evidence that we can prevent falls and the disabilities and decreased quality of life they cause."

At a recent meeting of the seven-week Stepping On fall prevention workshop at the Kiwanis Family House on the sprawling UC Davis Medical Center campus, 16 older adults practiced exercises designed to improve their balance, flexibility and strength.

"You can include exercise in your daily life," Kim Wong, a physical therapist, told them. "Sidestep away from the bathroom, with your hand to the wall to guide yourselves."

Retired broadcaster Lou Coppola, 85, has no trouble keeping track of his recent falls: twice going down the short flight of steps separating his kitchen from the den; once while standing on a stool to change a light bulb.

"I have balance problems," he said. "You lose your muscles if you don't do some exercise every day."

Fear of falling keeps many older adults off their feet, but failing to get up and move raises their risk of taking a potentially deadly tumble.

Some shuffle rather than picking up their feet, making them more vulnerable to falls. Some try to avoid the stereotypical stooped-over posture of old age – shoulders slumped, chin jutting forward, eyes to the ground – but when they throw their shoulders back, the shift in their center of gravity can tip them into falling backward.

The Stepping On program, formulated in Australia and recommended by the CDC because its effectiveness is backed by research, is in a pilot phase with its UC Davis sessions.

Fall prevention has become a hot topic for older adults.

"The interest has been out there all along," said UC Davis Trauma Prevention Program coordinator Christy Adams. "There's an inadequate supply of fall prevention education in the community. We have not as a society kept up with seniors' needs.

"These workshops are a drop of water in the desert. But ultimately, we'll have more classes."

In another effort to stem the tide of fall-related mortality, California State University, Sacramento, biomechanics professor David Mandeville has created a prototype device that he hopes will one day monitor older adults' body position and alert medical professionals when seniors are in danger of falling.

"It's very new research," he said. "The context is remote monitoring through telemedicine. That's the beauty of it."

For now, Mas Hatano takes daily three-mile walks, and he attends the Stepping On classes to see if he needs to learn more.

"You should always learn something," he said. "But the problem with coming to a class like this is that you can get paranoid.

"All they talk about is falling."


People interested in taking part in the Stepping On fall prevention workshop at UC Davis Medical Center are required to register. Call (916) 734-9794.

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