By Thomas Goldsmith
The family tragedy often unfolds something like this — Cousin Lily, who’s 88, falls at home in August and enters the hospital with a broken hip. By Thanksgiving, Lily is gone; dead following complications.
People sometimes don’t realize that Lily could still be living and that older people, in general, can increase their odds of avoiding a hip fracture with some targeted exercise and changes to their homes. That knowledge becomes even more crucial in light of a 30 percent national increase in the rate of falls among older people during a nine-year period ending in 2016, according to the Centers for Disease Control and Prevention.
Precautions are necessary because older people who break their hips face outsize risks: They are five to eight times more likely to die in the first three months after a fracture than otherwise. That increased likelihood of death continues for at least 10 years.
That’s according to researchers including geriatrician Dr. Cathleen S. Colón-Emeric, of Duke University School of Medicine, one of the authors of a widely cited 2010 paper on the relationship between falls and hastened death.
“I think many people have experienced this with older family or friends,” Colón-Emeric said in a phone interview last week. “They’ve seen somebody with this downward spiral after a fracture. A lot of families that I interact with are very aware of this, but it certainly does come as a surprise to others how quickly they see people go downhill.
“Unfortunately, we’re not as good at reversing that once it starts. It‘s much better to prevent the hip fracture from happening in the first place.“
The continuing toll of fall-related deaths means that lives can literally be saved by efforts such as home visits and education efforts for older people by a group of Meredith University students. The same holds true for Tai Chi-based classes at North Carolina YMCAs in Wilmington and elsewhere.
Meredith student Paige Lawrence and classmates have worked for two years with the Cary-based Center for Volunteer Caregiving on a project called Stronger Together, designed to help older people reduce their risks of falls. She talked last week at a Wake County senior center about the student-led home modifications and evidence-based exercises promoted during visits to a group of low-income people in Wake County.
“They are cool exercises,“ Lawrence told several dozen professionals and caregivers at the workshop at a Wake County senior center. “They seem very simple, but for people who don’t get much exercise, it helps them improve their balance.“
The roomful of people kept up with Lawrence and a video as they followed along on a 10-minute, low-impact exercise routine with special attention to balance and to the neck, spine, arms and shoulders. Some used principles of Steadi, a program developed by the CDC to promote the idea that falls among older people are not inevitable.
‘A negative cascade’
People’s medical conditions before a hip fracture and the effects of the injury can both have potentially devastating results, Colón-Emeric said.
“There are a number of chronic conditions of aging that increase your risk of a hip fracture, either through decreasing your bone density, and therefore your bone strength, to make it more likely that if you fall you’re going to break a bone, or by increasing your risk of falls, or both,“ she said.
Countdown on hip fractures
A brochure from the Centers for Disease Control and Prevention lays out information about the realities of hip fractures, which can mean the end of independent living for older people.
CDC statistics and background show that:
- Nationally, more than 300,000 people older than 65 are admitted to hospitals because they have had hip fractures, with almost all resulting from falls.
- About three of four hip fractures happen to women, who are more prone to falls than men and who often have more brittle bones as a result of osteoporosis.
- The older people get, the greater their chance of sustaining a hip fracture.
People with dementia, for example, have a low bone density as well as an abnormal gait that goes along with their brain issues. Among other groups with low bone density are people with Parkinson’s disease, chronic lung disease, congestive heart failure and kidney disease.
“People with diabetes have actually paradoxically higher bone density, but a higher fracture risk because they have a greater risk for falling,“ Colón-Emeric said.
In addition, people caught in the “negative cascade“ that can follow falls may experience depression, broad inflammation and loss of mobility.
*Two-thirds of people will never regain the same level of mobility after hip fracture,* she said.
How to stay strong
Encouraging people to stay strong and prevent falls becomes the role of people like Bridget Carroll, a community health program coordinator at the YMCA of Southeastern North Carolina.
The facility in Wilmington keeps two 24-week balance classes going at once, with participants working on exercise day to day at home.
“We do an assessment in what we call the welcome class and we do the same assessment at the very last class,’’ Carroll said. “The biggest take-home has been that the class has been shown to reduce the risk of falls by 65 percent.”
Participants in classes at the Wilmington Y range in age from about 50 to 90, with an average of 65. The Moving for Better Balance program is based on proven methods and uses Tai Chi moves as well as more conventional exercises.
In Wake County, the two-year Meredith program has concluded, but participants won’t be abandoned.
“We left them with an exercise packet, encouraging them to exercise once we left,” Lawrence said, noting that participants will also have continuing reinforcement through visitors from the sponsoring Center for Volunteer Caregiving.
Fall-proofing the home
Another key means of preventing falls involves taking a close look at an older person’s living quarters for hazards such as scatter rugs and slippery bathtub accessories. John Abernethy, 76, attended the Raleigh workshop looking for tips on safekeeping for his wife, Judy, 77, who had a stroke years ago. Recently, she had a fall, only from the height of a sofa, that produced a compressed vertebra, he said.
Abernethy and other caregivers each mentioned particular scenarios, not necessarily foreseeable, that could cause problems.
“The shower mat that I bought was OK, but a better one had a lot more suction cups on the bottom,“ he said. “It doesn’t move.“
Workshop attendee Carolyn Casey, 50, of Raleigh, keeps up with her dad, Bill, who lives by himself. Their problem: Bill takes his hearing aids out at night and can’t hear or find the phone, even if he falls out of bed, Casey said. What could she do?
“Alexa!“ came a chorus of voices. “He can say, ’Alexa, call my daughter!’“
Finally, caregivers and physicians both should take an older person‘s medications in account when trying to ensure her safety.
“Older adults are on a number of medications and some of those can increase your
chances of falling,“ Colón-Emeric said. “And some of those can affect your bone density. So it’s a good idea to have your physician review your medication list with an eye toward minimizing medications that might make you more prone to fall.’’