Staying strong is key to avoiding falls

By Marsha King
Seattle Times staff reporter

THOMAS JAMES HURST / THE SEATTLE TIMES Harriett Neal, 76, does arm lifts with wrist-weights in a statewide study by the Centers for Disease Control and Prevention on how older adults may be able to prevent falls by using exercise to build strength, aerobic capacity and balance.

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"Many seniors never recover from that. They just wither away."

Her mom's last big fall came five years ago while she was recovering from back surgery.

Frances Nielsen got up to go to the bathroom in the middle of the night. For no apparent reason, she lost her balance, literally tipped over and fell hard on her back on the bedroom floor. It knocked the wind out of her and bruised several vertebrae.

"It took a long time for her to come back from that pain. It was discouraging for her," said Doemland.

The daughter's fear about another fall is realistic and widely shared.

Falls are so devastating to millions of older people's lives and so astronomically expensive to the health-care system that preventing them has emerged as a major public-health challenge.

	THOMAS JAMES HURST / THE SEATTLE TIMES Harriett Neal, 76, does arm lifts with wrist-weights in a statewide study by the Centers for Disease Control and Prevention on how older adults may be able to prevent falls by using exercise to build strength, aerobic capacity and balance.

A really bad fall can steal self-confidence and mobility. Elderly people who are frail and get seriously injured in a fall often never fully recover. Disappointment and anxiety set in. The person commonly ends up restricting physical activity to keep from falling again. That leads to greater weakness — and a higher likelihood of falling again.

"It's a huge, huge problem," said Judy Stevens, an epidemiologist in the injury center at the Centers for Disease Control and Prevention in Atlanta.

So huge, the federal agency is dedicating several million dollars to study, in real community settings, which fall-prevention strategies work best with older people. Washington through its Department of Health — is one of four participating states, along with California, Michigan and Wisconsin.

Falls are not inevitable

Falls among the elderly will never be eliminated, but much can be done to reduce their numbers.

"Falls are not an inevitable consequence of aging," says Anne Shumway-Cook, a senior consultant on the CDC project and a University of Washington professor of physical therapy. "Falls are often both predictable and preventable."

Exercise resources • Strong and Steady Program, University of Washington Medical Center, doctor's prescription needed, 206-598-2888 • S.A.G.E. (Safety and Gait Enhancement), Northwest Hospital and Medical Center, requires doctor's prescription, 206-368-1769 • Lifetime Fitness Program, classes available primarily at senior centers, to locate a class go to www.seniorservices.org or call 888-435-3377 • Exercise: A Guide from the National Institute on Aging, book alone is free; book with video costs $7, available in both English and Spanish. Order online at: www.nia.nih.gov/exercisebook/ or call: 800-222-2225 (Sample exercises from the book are at left.)

You wouldn't know it from statistics cited by the CDC:

Nationally, more than a third of adults 65 and older fall every year. In 2001, at least 1.6 million older adults were seen for fall-related injuries in emergency rooms. Also, more than 11,600 people 65 and older died from fall-related injuries.

People 75 plus who fall are four to five times more likely to be admitted to a long-term care facility for a year or more.

In 2002 in Washington state, 11,516 falls among older adults accounted for 30 percent of hospitalizations for people of all ages for non-fatal injuries, which include car crashes, shootings, suicide attempts, bites and stings, poisonings and falls. More than 400 older people died from falls.

A state analysis on ways to prevent falls among the elderly reports Medicare paid $68.6 million to treat fractures among state residents 65 and older in 1999, the most current year for which statistics are available. Falls caused most of those fractures.

Frances Nielsen's fall five years ago scared her middle-aged children. Nobody wanted Mom to become so disabled that she had to move permanently to a nursing home. Neither did they want to try to carry and lift her around the house.

"My sisters and brothers and I decided we had to do something to keep her strong," says Doemland.

They were exactly right.

Keeping legs strong

A key to keeping older adults on their feet is exercise that emphasizes building strength in the legs, as well as balance and gait training.

That formula has improved life in only a few months for David McNeir, a participant in the CDC's study.

A few years ago, McNeir was hit by a car coming out of a shopping mall. Soon afterward, he had a stroke. Then one day he got dizzy in the grocery store and knocked over a display of soup cans before hitting the floor.

After that he started using a walker.

But even with the walker, "if you just run over a little pebble the size of a pea you fall down," he says.

So many mishaps left him sticking close to home in front of the TV. His son even moved in to help out and fit the house with safety devices.

"I was getting pretty dismal. I could read the paper and see all the fun other people were having," said McNeir, who in younger days raced sailboats.

One day, the retiree saw an ad in the paper seeking participants for the CDC falls-prevention study.

"I want to be more active. I want to live more than I am now," McNeir said to himself. So he signed up along with 452 other older people statewide.

The study is measuring the effectiveness of a multi-part program to prevent falls. Participants receive a falls risk assessment which is sent to their doctors. They also attend educational sessions and an award-winning senior-exercise program: Lifetime Fitness, which was named one of the top 10 exercise programs in the nation by the National Council on the Aging and is managed by Senior Services of Seattle/King County along with Group Health Cooperative.

Study participants go to exercise class three times a week and keep track on a calendar of how many times during the month they fall. Their records will be compared against that of a control group — people who don't take the class, but receive printed educational materials.

Lifetime Fitness uses exercise to build leg strength, aerobic capacity and balance.

"We need to ignite those balance receptors. If we don't use them we lose them," says instructor Patty Dickinson to a roomful of white-haired students in sweat pants.

McNeir gamely participates at his own pace using the walker. "The class has taught me to be more alert and look around and see what's going on instead of looking at my feet."

When walking, he keeps an eye on what's ahead figuring out what to grab for balance, if necessary. And he's more aware of the importance of posture — "I'm a geezer. I kind of slump over." And his legs are getting stronger. Before he needed help getting up from his deep-seated TV chair — "Now I jump out of it."

But he tries not to watch TV so much anymore.

"It's bad news especially for older people. You should move around, exercise or something even if it's just going out in your front yard," McNeir said.

Risk factors and prevention

People who have already fallen or who sense their balance is getting worse should get their doctors involved.

An assessment can determine an older patient's risk of falling. People with poor vision and hearing or other sensory deficiencies such as numbness in the feet are much more likely to topple. Certain medications such as tranquilizers and anti-depressants — especially taken in combination — may promote dizziness and grogginess. Confusion doesn't help. It sounds obvious, but shoes should be sturdy.

Homes, inside and out, should be free of hazards such as loose rugs, lamp cords that can trip and poorly lit stairs. They should be fitted with devices such as grab bars near the toilet and bathtub.

When a person does fall, usually several factors have converged — for example, balance problems, leg weakness and a bumpy driveway on a rainy night.

Older people also can learn how to lessen the impact of a fall and the best ways to get up.

People who want to stay on their feet can find this information numerous ways including senior-center exercise classes, hospital-rehabilitation programs and in-home personal training and physical therapy.

The tough part is getting them to change their lives.

Navigation training

Former hairdresser Bonnie Lutcavich didn't have a choice. Diagnosed with multiple sclerosis a decade ago at age 50 after falling in her back yard, her balance gradually grew so iffy that she started to crawl to reach certain things around the house.

"You've got to do something," her doctor recently advised.

Lutcavich enrolled in Northwest Hospital and Medical Center's Safety and Gait Enhancement program or S.A.G.E. The program, which requires a prescription, teaches the classic components of a good falls-prevention program, plus patients get to practice what they've learned on Easy Street.

Easy Street is a mock-up of a life-size city street with a car, grocery store, movie theater, restaurant and furnished home. Patients — often with canes and walkers — must step up and down real curbs, find a seat down an aisle in a darkened theater, keep from tripping on a bedspread.

Lutcavich, who just bought her first cane — one decorated with cat pictures to match the cats on her socks, is learning how to get out of a chair carefully.

Scoot forward to the edge. Feet back, but not underneath the seat. Lean out, nose past toes. Push lightly.

"It's amazing how you take so many things for granted," she says. "Then something happens."

One of the hardest tasks at home is picking up the cat's litter box and dumping it outside.

"I have to go down one step. Oh boy. I pray a lot."

So an important part of her therapy at Northwest is practicing going up and down steps.

"Now I can balance myself a lot better," she says.

Not everyone who could use ongoing help to prevent falls is able to leave home.

They may feel self-conscious about being out of shape. Transportation may be difficult. Or they may be too confused or frail to participate in a class of able-minded peers.

Nielsen lives with her daughter, Katie Doemland, and son-in-law in Ballard, so her day-by-day decline because of the big fall and other setbacks was obvious.

"She was getting progressively weaker and weaker and more incapable of walking," recalls Doemland.

Despite the expense, Doemland hired physical therapist Chuck Kinsey to evaluate her mother and get her started on easy strength and balance training.

"Within a week the difference was phenomenal," says Doemland. "She just got stronger and it made it her more self assured."

The therapist still comes three days a week at $65 a session, a financial sacrifice for the family, but well worth it.

Today, Frances Nielsen can walk up a few stairs, fix her own breakfast and take care of herself in the bathroom.

"The more independent she is, the happier she is," says her daughter.

The therapy hasn't stopped the falls.

"But if she loses her balance a little bit, she's able to grab something, steady herself and lower herself to the ground. She's learning to keep her balance, and her wits about her," says Doemland.

Has the experience with her mother made an impression?

"Oh yes. You bet."

The 60-year-old daughter intends to lead a productive, full life for as long as possible. To prepare, she's joined an exercise class to stay mobile and strong.

"I don't want to become dependent and weak because I didn't do something earlier in my life."

Marsha King: 206-464-2232 or mking@seattletimes.com

Copyright © 2004 The Seattle Times Company

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