Fall-prevention efforts offer simple steps for older adults

Ballard resident Mary Flodquist leans on a cane to steady each step she takes into Harborview Medical Center.

At 94, she has come to the fall-prevention clinic to relearn how to stay on her feet so she can still get out to the bank, the hairdresser and the corner restaurant to have lunch with her neighbor.

Flodquist has fallen several times in the past decade, thanks to a small rock, a weedy parking strip and a tiny side yard, where she was washing windows with a hose while looking up and walking backward. Usually, she broke something — an ankle, elbow, wrist, leg.

Then, in December, Flodquist was headed to the bus stop, carefully avoiding cracks in the street, when she failed to step high enough to clear a curb. She only bruised a thumb, but it scared her.

"I have learned to look at the ground all the time," she said.

Flodquist is among millions of people age 65 and older who fall every year in the U.S. In Washington, falls by older adults are the leading cause of all injury-related hospitalizations — 12,200 in 2005, about four times more than hospitalizations of motor-vehicle occupants injured in accidents.

"It can be the kiss of death for these older people," said Sally Ragsdale, a nurse practitioner at Harborview's fall-prevention clinic. "They break a hip, go in the hospital, get septic or pneumonia and die."

Or they end up permanently in a nursing home.

The growing numbers of older adults and their desire for independence, combined with the high medical costs of their falls — $19 billion nationwide every year — are creating a push for prevention across the nation.

Calling senior falls a top public-health issue, the Centers for Disease Control and Prevention is launching a national education initiative on the issue in March.

At least a dozen states have started fall-prevention efforts, with Washington considered among the most committed.

"Falling is not a natural part of aging," said Ilene Silver, a program manager and expert on fall prevention in the state Department of Health. "People need to understand there are simple things you can do."

Taking that message to heart, some lawmakers, health officials and Gov. Christine Gregoire want to start a new statewide fall-prevention program. The governor's supplemental budget includes nearly $600,000 for the program, to start initially in six counties in July. It would help communities reduce falls with education, exercise programs and referral networks.

Already, the county's Medic One/Emergency Medical Services Division tries to contact many of the older adults who call 911 after a fall. In 2006, fire departments in the county responded to 8,000 such calls.

If the person agrees and meets the criteria, an injury-prevention specialist sets up a meeting to assess whether the person has poor vision or weak muscles or is taking medication that causes dizziness.

The specialist also looks for such hazards in the home as scatter rugs, dim lighting and inappropriate footwear, and makes recommendations.

Many seniors don't take advantage of the service, fearing they'll be sent to a nursing home. Actually, the opposite is true.

"We're trying to make it so they can stay independent as long as possible," said Alan Abe, manager of injury prevention and education with Emergency Medical Services.

Harborview's half-day-a-week fall-prevention clinic is one of a handful in the nation.

"We want to prevent the injurious falls. It's really the injury that we're worried about," said the clinic's director Dr. Elizabeth Phelan. The most common are hip and long-bone fractures and brain hemorrhages.

Clinic staff members assess the patient's history and home situation to learn what may be contributing to their falls, then make recommendations to help them keep moving as safely as possible.

Mary Flodquist, who used to be a retail clerk at the old Kress variety store downtown, was given a "Get Up and Go" test. From a sitting position, she was asked to stand up and walk up and down a hall. The steadiness of her gait and the time it took gave a preview of her risk for falls.

Ragsdale, the nurse practitioner, gently prodded: Does she have steps to the front door? Handrails on the porch? Furniture to navigate? Does she often use the bathroom in the middle of the night. Is she bothered by headaches, chest pains, shortness of breath?

The nurse pricked the bottom of Flodquist's feet to check for nerve sensation and asked her to stand with her feet together, then one foot in front of the other.

Not as easy as it looked.

Flodquist admitted she seldom walks for exercise, partly out of worry and also because of knee pain.

Ragsdale sympathized but insisted, "We need to find ways to keep you strong so you can stay on your feet."

At the visit's end, the nurse suggested Flodquist get physical therapy and take vitamin D to improve muscle strength and balance. She should drink plenty of water to prevent dizziness from dehydration and try a chair-exercise class on TV.

"My wish for you," Ragsdale said, "is that you're more confident on your feet and you will lose your fear of falling."

Maybe then, Flodquist quipped, "I can go downstairs and clean my basement."

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