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Podcast Transcript

Topic: Fall Prevention and Home Safety for Seniors

Melanie Cole (Host): Falls are one of the most serious health risks for older adults, and they're also a significant cause of disability. Welcome to Checkup Chat with EvergreenHealth. I'm Melanie Cole and today we're discussing fall prevention, home safety, and when to talk to your doctor about falls.

Joining me is Dr. Marissa Black. She's a physician at EvergreenHealth Geriatric Care. Dr. Black first, before we get into some fall prevention, tell us what you've seen as far as the prevalence of falls and what the complications, what they do to older individuals that suffer falls?

Dr. Marissa Black: So before we get started, I just want to make sure we're using the same definition of fall. So a fall is any action when a person inadvertently comes to the ground or a lower level, not due to a loss of consciousness, seizure stroke, or overwhelming environmental hazard.

And as you described, we know that falls are common. A third of adults over the age of 65 fall every year, and about half of adults, community dwelling adults over the age of 80 fall every year. And we know that falls are almost always due to multiple risk factors and almost never a singular cause. And every fall create sort of a cascade of events where if the person ends up in the emergency room or in the hospital, their function and ability to live independently declines.

Host: So let's discuss a few of the risk factors that can increase a person's risk of falling, whether it's medications that they are on, or whether it's carpet things in the way or they're sedentary. So they're not used to walking around very much. Tell us about some of these risk factors.

Dr. Black: There are different types of risk factors. Some are intrinsic to the person and others are environmental or external like carpet like you described. And some of these risk factors are modifiable and others are non-modifiable. And we try to identify the modifiable risk factors and work on those.

So an example of non-modifiable risk factor that increases the risk of fall would be age or female sex. And those we can't change, but other sort of modifiable risk factors would be medications. So certain medications can increase the risk of falls or environmental hazards or just weakness are risk factors that we work on and try to get to the bottom to.

So anybody on more than four medications is at increased risk of falling and then different types of medications can obviously increase the risk of falling such as antipsychotics, antidepressants, any medicine that has anticholinergic side effects.

Host: Well, that's so important to be able to identify these things. So when you are meeting with someone, what sort of questions do you ask? How do you determine a person's risk of falling? Can you estimate their risk? Do you assess their balance? How does all of that work?

Dr. Black: We do, the bottom line is anybody who feels unsteady when they're walking worries about falling or has gait, balance, or strength impairment on exam is unfortunately more likely to fall. We tend to risk categorize people into low risk or high risk. Any person with the characteristics I just described or who's fallen twice in the past year or twice or more times, or has had an injurious fall, is considered high risk and should be evaluated more thoroughly.

And we tend to take a fall related history and that will include past medical history. Does the person have conditions such as osteoarthritis or osteoporosis, vision loss, motor weakness, cognitive impairment, urinary incontinence, the list goes on diabetes, for example, or other neurologic disorders such as neuropathy or Parkinson's disease.

Then we look at medication lists, you know, is the person on antiseizure meds? Are they on diuretics? Are they on insulin or other oral hypoglycemics?

And then we do a balance and strength assessment, particularly of the lower extremities, and a comprehensive physical exam. So that will include cardiovascular exam and neurologic exam. And then of course assessing gait and balance.

Host: Well, that's a very comprehensive assessment. So what about things like sedentary lifestyle Dr. Black, the pervasive fear of falling sometimes keeps older citizens from being able to exercise because they're afraid to fall. So they don't get up and move around, speak about this sort of vicious cycle that can help contribute to these falls and what you recommend they do about that.

Dr. Black: So in the past, pre COVID-19, we often referred in clinic to community exercise programs at senior centers or at our hospital. There's a fall prevention class and those are based on evidence based programs that reduce the risk of falling. There are different types of exercise. So often people think that if they just walk, that will help their fall prevention risk, but there are really kind of three types of exercise. So cardiovascular balance and strength, and there are exercises that seniors can do at home to reduce their risk. And the National Institute of Aging and the CDC have some nice kind of simple exercises on their websites to help guide seniors and provide some structured exercise at home. Often we end up referring to physical therapy or occupational therapy for an in home falls assessment and home safety assessment. But what can seniors do?

So minimizing medications, monitoring response to the medications that they're on to make sure that they're actually getting a benefit from the med. And of course the risk of fall must be weighed against the benefit of the med. Optimizing the treatment of their underlying medical conditions. Vitamin D has mixed evidence, but if one is deficient, it is important to replete Vitamin D to at least have a normal amount.

Make sure that they're getting regular visual assessments and exams and treating visual impairment.

If they're light headed, when they stand up, making sure that they're sitting before standing after lying down, and allowing time for the blood to get to the brain, if they're prescribed pressure stockings, wearing them, that sort of thing. And then working with their physician to, or physicians and team to individually tailor an exercise program. And then of course, things like managing footwear or podiatry issues and the cardiac issues that I mentioned.

Host: So Dr. Black, as you've given us some tips to stay safe at home, what can a family member or a loved one do to help someone of high risk can technology like the Apple watch with fall detection? Do some of these things really help seniors? What do you think about them?

Dr. Black: So I think making sure the home environment is really safe is definitely one of the number one things. So that's things like making sure railings and steps are in good condition, making sure rugs are secured or removed, making sure there are no electrical cords going across the room, making sure the bathroom is safe. And if there are grab bars needed, that they're there. Minimizing clutter in hallways, that sort of thing. Making sure there's great lighting in the house and nightlights in the hallways, and then making sure that potential medical equipment is there like a toilet riser to make sure the toilet seat is higher or a shower chair, things like that.

And then as you have sort of referenced with the Apple watch, making sure that there is some fall alert system, so that can be a watch or just some sort of safety alert system where if there is a fall that patient can press a button and notify or there's an automatic kind of notification system to the family and medics.

The family member can encourage active inactive lifestyle. So making sure that the strength and balance exercises, which are often the things that get neglected, that type of exercise that gets neglected are actually being encouraged and supported. And then again, the optimization of hearing and vision and medicine management is really key. There is a CDC 12 item questionnaire called Stay Independent, and it is a validated self assessment that can be completed by the older adult or family member. And a score of four or more basically means that the patient needs further clinical evaluation. So that can be done by a family member.

Host: Dr. Black, as we wrap up, at what point should someone speak to their doctor about this fall risk, some things that you want, family members and loved ones to notice, and how do they prepare for the visit. And while you're telling us that, give us your best advice for preventing falls in the home for our seniors.

Dr. Black: If the person has fallen or they feel unsteady on their feet, or they're having a fear of falling that is enough of a warning sign that the family should have the loved one evaluated. And just in terms of how to prevent falls at home, the environmental modifications that we just talked about, there's a checklist on the CDC website that can be reviewed and gone through in the home and then really can guide you to make adjustments to lighting or different furniture in the home and rearranging things. And really just being in touch with the patient's doctor and making sure that these modifications are taking place and encouraging a healthy lifestyle are really important ways to prevent falls.

Host: Thank you so much, Dr. Black for such important information and to make an appointment or to learn more about the services at Evergreen Health Geriatric Care, please visit evergreenhealth.com/geriatric-medicine. And that concludes this episode of Checkup Chat with EvergreenHealth. Please remember to subscribe, rate, and review this podcast and all the other EvergreenHealth podcasts for more health tips and updates. Follow us on your social channels. I'm Melanie Cole.

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