By JUDD MATSUNAGA, Esq.
I had a client in the office the other day who told me a very funny story. She was her husband’s primary caregiver for many years. She said, “In the beginning, I helped my husband at home. As he grew weaker, I supported his weight more and more. Until the day I couldn’t support all of his weight and we both fell.
She exclaimed, “Daddy, daddy, are you ok???” The husband looked up and said, “I don’t know, mom. When I touch my leg, it hurts. When I touch my back, it hurts. When I touch by the neck, it hurts. The woman calls the doctor, and the doctor says, “That doesn’t sound good. You better take him to the ER. Turns out he tried to break the fall with his hand and broke his finger.
Although it’s one of my favorite jokes, falls are no laughing matter, especially if you’re an elderly person. According to the CDC website (www.cdc.gov), millions of people age 65 and older fall each year. In fact, every second of every day, an older person (age 65 and older) falls in the United States, making falls the leading cause of injury and death from injury in this age group. Falls are a threat to the health of older people and can reduce their ability to remain independent.
Although many falls do not result in injury, one in five falls results in a serious injury such as fractures, for example wrist, arm, ankle and hip fractures. Falls can also cause head injuries. Each year, 3 million older adults are treated in emergency departments for injuries from falls, making falls a public health issue, especially among the aging population.
Falls are the most common cause of traumatic brain injury. These can be very serious, especially if the person is taking certain medications (such as blood thinners). An older person who falls and hits their head should see their doctor right away to make sure they don’t have a brain injury.
However, falls don’t have to be inevitable with age. You can reduce your risk of falling or help a loved one prevent falls. How? After a fall, ask your doctor or health care professional to assess your risk of falling and discuss specific steps you can take. Even if you’re pretty sure your loved one has just tripped and tripped, a good assessment from your doctor can reveal the issues that made tripping and tripping more likely.
Less than half of seniors who fall tell their doctor. However, falling once doubles your chance of falling again. Many people who fall, even if they are not injured, are afraid of falling. This fear can cause a person to reduce their daily activities. When a person is less active, they become weaker and this increases their risk of falling.
IT IS IMPORTANT! Busy doctors may not be thorough unless the caregivers, i.e. you, the family member, are proactive in asking questions. Most doctors have the best of intentions, but too often a medical visit after a fall is all about treating any injuries the older person may have sustained. Studies have shown that elderly patients often do not receive recommended care.
If you want to help prevent future falls, it’s also important to make sure doctors have checked for anything that could have contributed to the fall. A fall can be a sign of a new and serious medical problem that needs treatment. By being politely proactive, you can ensure certain things aren’t overlooked (like medications that worsen balance).
To give you an idea of what to ask the doctor to look at, here is a list of several key things you can make sure doctors check for after a fall. This list is based on the American Geriatrics Society clinical practice guidelines on fall prevention. (Source: www.betterhealthwhileaging.net) Although this is not a complete list, the following will help ensure that your loved one has been thoroughly assessed and can reduce risk serious falls in the future.
(1) Drug review. The Centers for Disease Control recommends that older adults concerned about falls seek a medication review. Many older people take medications that increase the risk of falling. These drugs can often be reduced or even eliminated. Be sure to ask the doctor about the following types of medications:
● Any sedative, tranquilizer or sleep aid. Common examples include Zolpidem (Ambien) for sleep or Lorazepam (Ativan) for anxiety. Antipsychotic drugs for agitated dementia behaviors, such as risperidone or quetiapine, may also increase sedation and risk of falling.
● Medicines for high blood pressure and diabetes. As noted above, it is not uncommon for older people to be “overtreated” for these conditions, meaning they are taking a level of medication that lowers blood pressure (or blood sugar) compared to what which is really necessary for ideal health.
● “Anticholinergic” drugs. These drugs are commonly taken by older people, who often have no idea that these drugs worsen balance and thinking! They include medications for allergies, overactive bladder, dizziness, nausea, and certain types of antidepressants that may also be given for nerve pain.
● Opioid analgesics, especially if they are new.
(2) A seated and standing blood pressure and pulse reading. This is especially important if you’re worried about falls — or near falls — associated with dizziness or fainting. If your elderly relative is taking blood pressure medication, you should make sure the doctor confirms that he does not experience a drop in blood pressure while standing.
A 2009 study of Medicare patients presenting to the emergency room after fainting found that checking blood pressure while sitting and standing was the most helpful test. However, this was only done by doctors a third of the time. (Note that tamsulosin — brand name Flomax — is a popular prostate medication that also causes a drop in blood pressure.)
(3) Gait and balance. At a minimum, a gait assessment means the doctor carefully monitors how the older person walks. There are also easy ways to check the balance.
Simple things to do, if gait and balance don’t seem quite right, are:
● Treat any pain or discomfort, if it seems to be causing problems. Many older people react to foot, joint or back pain.
● Consider physiotherapy referral for gait and balance assessment. A physical therapist can often recommend appropriate strengthening exercises and can also help fit the older person with an assistive device (eg, a walker) if needed.
(4) Vitamin D level. If your older loved one spends a lot of time indoors and doesn’t take a daily vitamin D supplement, chances are they have low vitamin D levels. Studies suggest that treating low levels of vitamin D (eg, less than 20 ng/ml) may help reduce falls in older people. Low levels of vitamin D can also contribute to brittle bones.
When vitamin D levels are very low, doctors sometimes treat with higher doses of vitamin D for a few months. Taking a daily supplement of 800-1,000 IU will eventually keep vitamin D levels normal in most people, but if you’re very concerned about falls or vitamin D, talk to your doctor about getting a checkup. level.
(5) View. Have your eyes checked by an ophthalmologist at least once a year and be sure to update your glasses if necessary. If you have bifocal or progressive lenses, you may want to get a pair of glasses with only your distance prescription for outdoor activities, such as walking. Sometimes these types of lenses can make things appear closer or farther away than they actually are.
(6) An evaluation for a new underlying disease. Doctors almost always do this if an older person has had generalized weakness, delirium, or other signs of discomfort. Be sure to bring up any symptoms you’ve noticed and let the doctor know how quickly the changes happened. Just about any new health condition that weakens an older person can lead to a fall. Some currents include:
● Urinary tract infection
● Anemia (low number of red blood cells), which can be caused by bleeding in the gut or other causes
● Heart problems such as atrial fibrillation
● Hits, including mini-hits that do not cause weakness on one side
In conclusion, if your aging loved one falls and breaks a hip, life may never be the same. After a fall (or near-fall), it is important that you, the caregiver, be “proactive” in the doctor’s office. Learn about ways to reduce the risk of falling back. Plus, here are some simple things experts say you can do to keep your loved one from falling:
● Do strength and balance exercises. Do exercises that strengthen your legs and improve your balance. Tai Chi is a good example of this kind of exercise.
● Make your home safer
– Get rid of things you could trip over.
– Add grab bars inside and outside your tub or shower and next to the toilet.
– Put guardrails on both sides of the stairs.
– Make sure your home has plenty of light by adding more or brighter bulbs.
– Keep items you use often in cupboards that you can easily access without using a stepladder.
– Use non-slip mats in the tub and on the shower floor.
Judd Matsunaga, Esq. is the founding partner of the law firms of Matsunaga & Associates, specializing in estate/medical planning, probate, personal injury and real estate law. With offices in Torrance, Hollywood, Sherman Oaks, Pasadena and Fountain Valley, he can be reached at (800) 411-0546. The opinions expressed in this column are not necessarily those of The Rafu Shimpo.