Adult Care Currents (a St. Ann Center publication)
You may already be aware that older people—especially those with certain medical conditions or taking certain medications—are at higher risk of falling, and that those falls can cause serious injury or even death. Research shows that even younger adults with cognitive impairment or physical disability are also at higher risk.
Falls and their resulting injuries occur more often than strokes. More than a third of people 65 or older fall each year, and half of those people experience recurring falls. Even younger adults can be at risk of losing mobility and independence. Falls are a big reason that people end up in nursing homes, which is especially sad because some older people, fearing loss of independence, will deny or minimize their falls, even to family.
Falls are of special concern here in Wisconsin. We have, unfortunately, the highest rate of fatal falls among older adults. In 2019, our death rate from falls was three times the national average.
The good news is, most falls can be prevented.
In September, as National Falls Awareness Week draws near, you’ll see a flurry of info about falls prevention—tips on frequent vision screening, exercises to improve muscle strength and balance, safer flooring surfaces and footwear, adequate lighting and medication evaluation.
Those are all important in preventing falls, says Carol Dickert, an occupational therapist who wrote her doctoral thesis about taking a holistic approach to falls prevention. Dickert, vice president of outpatient therapy services here at St. Ann Center for Intergenerational Care, also is a licensed physical therapy assistant, with a master’s degree in administration and patient education, and has run a falls prevention clinic at St. Ann Center for about 15 years.
The key factor in falls prevention, Dickert believes, is getting a person’s buy-in, raising their safety awareness and judgment in their everyday lives.
Without that, she says, the exercises and safety modifications are “like a Band-Aid on the wrong spot.” You can take all those steps, she says, but unless the person really absorbs the information about her risk, she won’t hesitate to climb atop a kitchen stool to swat at a spider on the ceiling. Or maybe she’ll unthinkingly rush across ice on a sidewalk.
Seeing the Big Picture
Occupational and physical therapists often view clients through the lens of their diagnosis, Dickert says, but she believes falls prevention is best approached as a larger issue, one that evaluates each individual beyond their diagnosis. A multi-disciplinary team—with an occupational therapist, a physical therapist, a doctor, perhaps a case manager or caregiver—can help see a person’s situation and get to the root of their problem in preventing those falls.
The cause could be environmental. A person falling only while making her bed might be stepping on the bedspread, trying to maneuver tightly packed furniture without her walker, or wearing socks on slippery bedroom flooring. But another person, falling more often and in more places, might need vision correction, muscle strengthening or an evaluation to see if multiple medications are making them dizzy or fatigued.
“There are so many factors,” Dickert says, and it really helps to have a team to work together with that person to put together the puzzle of what’s causing their problem.
Research shows, too, that once you get people at risk aware of the need to think first about how they’re going to do something, it helps keep them mindful of safety, and more likely to practice safer behaviors.
“I did falls prevention clinics with some of our day program clients here, as well as community members,” Dickert recalls, adding that the process included a home visit as part of the comprehensive assessment and treatment plan. Then, she’d check in afterward with them periodically.
“Just knowing they would be seeing me afterward, and that I’d be asking them how they were doing helped keep them aware that they should think about how to move safely,” she says.
Ideally, doctors would identify patients at risk by asking at each exam: “Have you fallen since you were last here?” But often, that doesn’t happen, Dickert notes — both doctor and patient may focus more on another problem that brought them in.
What will help, she says, is if anyone involved in caring for an adult remains aware of the risk and stays alert to their mentions of dizziness, light-headedness, fatigue or falls.
When you become aware someone is falling or fear that they may, she says, the best course is to get the person’s doctor to refer them to a good falls prevention clinic for a full evaluation.
That, she says, can help keep your loved ones steady as they go.
More Local Resources
Milwaukee County Falls Prevention Coalition https://www.mcfpc.net/ is an interprofessional group of community members, health systems, and government agencies collaborating to establish a framework promoting fall screening and prevention in Milwaukee County. Their website https://www.mcfpc.net/ offers toolkits, events, classes and a quarterly e-mailed newsletter with timely, practical information.
Several local healthcare organizations offer falls prevention clinics. For information about the one at St. Ann Center, which is open to community members as well as to the day program clients, contact Carol Dickert at414/977-5005 or email email@example.com.