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Falls Risk & Prevention

By: Tara Lee Woodside, RN BSN CALA

I am told it is a good story.  I am also told that it is five o’clock somewhere.  At five o’clock on April 26th, 2019, my life changed, if not forever, at least for the lion’s share of the upcoming summer.  Moments before pulling into my driveway, heavy droplets of rain pelted down from the heavens, angrily assaulting my windshield.  I then engaged in a mindless task I had performed numerous times.  I turned off my car, raised the garage door, and with a gesture of bravery, flipped up the hood of my raincoat.  I distinctly remember taking a deep breath, as if about to submerge myself underwater.  I then opened my car door, clutched my purse to my body, and made a mad dash into the garage.  Little did I know, those four feet between my car and the not-yet-open garage door would be the last I would bear weight on my right leg in over two months.

I literally ran into my garage.  More specifically, the top of my head smacked the garage door, the upper half of my body twisting, glancing off the hood of my car, and rolling onto the asphalt of my driveway.  Blinking in disbelief, I quickly determined it was useless to support myself using my legs. I drug my body across the concrete to my purse and cell phone, both of which had mercifully landed in the dry garage and called for help.  As if mocking my foolish hurry, the rain stopped just as quickly as it started.

I suppose the same could be said for me.  My schedule was routine.  Rise.  Run.  Work.  Return Home.  Repeat.  Then it stopped just as quickly as it started.  Hours later in the Emergency Department, I would gift the physician’s assistant whose fate it was to deliver my diagnosis, with the most incredulous look and adamant exclamation of denial.  He patiently repeated himself, “Miss Woodside, your ankle is fractured.”

Less than a week later I was in surgery to repair a displaced spiral fracture to my right fibula.  Apparently, when the bone in the leg is displaced from everything it is supposed to be attached to by three millimeters, it is a big deal.

My prognosis is positive.  After two weeks of strict bed rest and elevating my right leg on seven pillows, four weeks of non-weight bearing activity, and two weeks of partial weight bearing, I am hopeful to graduate to a weight bearing boot in the next several days.  I can reasonably expect to return to running by the early days of autumn after learning to walk again.

What astounds me is the sheer difficulty and hardship this “broken ankle” has imposed upon my body.  What is even more staggering is that I am a healthy, fit, woman in her early thirties.  Prior to April 26th, I ran one to one and a half miles a day, did yoga, dabbled in Pilates and chased my toddler through the house.  How much more severe my prognosis would be if I were a woman twice my age.

According to the American Academy of Orthopedic Surgeons (2018), as an individual ages, the likelihood of falling and the severity of injury as a result of falling, increases.  A fall by definition is an “event which results in a person coming to rest inadvertently on the ground or floor or other lower level” (“Falls,” 2019).

The statistics are staggering. Just five years ago in 2014, an estimated 29 million falls occurred in the “older adult” population of individuals over the age of 65 in the United States.  Of those 29 million, 7 million resulted in injury. In 2016, falls triggered 3.2 million Emergency Department visits, 963,000 of which were hospitalized and 29,000 of which were fatal (Johnston et al., 2018).  The Center for Disease Control [CDC] (2017) estimates that one out of five falls will result in fractures or head trauma with approximately 300,000 individuals per year being diagnosed with a fractured hip.

Even more disheartening is that after falling, your likelihood of falling again, doubles (CDC, 2017).

Simply put, falling is a major health risk.  It is the second leading cause of accidental death worldwide with the most vulnerable population being those over the age of 65 (World Health Organization [WHO] 2019).

While some risk factors, such as age and gender, can only be acknowledged and not changed, there are fortunately, other risk factors that can be modified.  Moreover, the path to fall prevention is one paved with a multi-faceted approach, unique to everyone, making it important to have an open and honest conversation with your healthcare provider. Risk factors and action items recommended by the CDC (2017) and WHO (2019) include:

Risk Factors

– Difficulty Walking

– Poor Balance

– Foot Pain

– Inappropriate/Poor Fitting Footwear

– Poor Vision

– Environmental Hazards (i.e. throw rugs)

– Weakness

– Vitamin D Deficiency

– Medication that Causes Drowsiness (i.e. tranquilizers, sedatives, antidepressants)

Take Action

– Have a conversation with your Primary Care Physician

– Be open and honest about difficulties you are experiencing or falls you have had.

– Review your medications.

– Ask if a Vitamin D or Calcium supplement would be appropriate.

– With the approval of your physician, do balance and strength exercises and participate in exercise classes.

– Ask about pursuing physical and occupational therapy.

– See your eye doctor.

– Ensure your glasses/contacts are your most current prescription.

– Review your environment.

– Remove tripping hazards such as throw rugs.

– Clear the stairs and pathways in your home.

– Ensure enough lighting and consider adding additional lamps or nightlights.

– Add properly installed grab bars and rails near the shower and toilet.

– Tuck cords out of the way.

– Store items you use often within easy reach.

– Place a lamp close to your bed for easy access.

– Ask for assistance if you cannot reach an item in a higher or lower location.

– Wear appropriate footwear:

– Shoes should fit well.

– The heel should be enclosed for stability.

– The shoe should have a textured sole to reduce slipping.

– Do not attempt to walk in socks or bare feet.

This checklist of items may seem daunting, but, the majority of these suggestions can be put in place with little disruption to your current lifestyle.  What is more, you do not have to do it alone!  If you live in one of our Assisted Living or Healthcare neighborhoods at Friends Village at Woodstown, your nursing staff will more than happy to provide you with a list of your medications so you can review them with your physician.  Our friendly social workers can also provide you with guidance and information on pursuing physical and occupational therapy while our Life Enrichment staff will be more than happy for you to join one of our many exercise classes offered weekly throughout our community.  In addition to our therapists, our Building Services department can work with you to provide environmental reviews of your room(s).

These interventions alone will not guarantee that you will never fall, but they will help to reduce your risk of falling.  Perhaps most importantly, take the time to slow down and when in doubt, press your life alert button or call bell and ask for help!  We are here to serve you!

 

References

Falls. (2019). Retrieved June 17, 2019 from https://www.who.int/news-room/fact-sheets/detail/falls

Important Facts about Falls. (2017). Retrieved June 17, 2019  from https://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html

Preventing Falls Among the Elderly. (2018).  Retrieved June 17, 2019 from https://orthoinfo.aaos.org/falls/

Yvonne A. Johnston, DrPH, MPH, MS, Gwen Bergen, MC MPH, PhD, Michael Bauer, MS, Erin M. Parker, PhD, Leah Wentworth, PhD, MPH, Mary McFadden, BS, CPH, Chelsea Reome, MPA, and Matthew Garnett, MPH (2018). Implementation of the stopping elderly accidents, deaths, and injuries initiative in primary care:  An outcome evaluation.  The Gerontological Society of America, 20(20), 1-10.