Friday, September 28, 2007

Falling Down

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A significant portion of my business lately has come from Falling Down. No, not the old Michael Douglas movie, but rather the actual falling down of patients, mainly the elderly. I cannot tell you how many dozen examinations I have read over the past several weeks that were prompted by an old person falling. The average age for this particular problem is creeping up, although the range is widening overall. I'm seeing more and more exams on those in their late 80's and early 90's, although I haven't seen any on those 100 and over for a while.

According to the CDC as quoted by, falling down is "the leading cause of injury-related death in people over 65, primarily the result of hip fracture complications. (B)y by 2020, medical costs from hip fractures alone—resulting from falling accidents—are expected to cost the healthcare system between 20 and 50 billion dollars." Big problem. Really big problem.

It may be a stupid question, but why do old people fall down? And how can we prevent this from happening? There are several answers out there....

From, we find this:

Scientists at the University of Birmingham have been investigating this troubling phenomenon, and they’ve found that vision plays a part.

It seems that the normal thing to do, when walking through cluttered environments, is to look ahead to locate safe places to put one’s feet. But older people need to look much sooner to these targets, possibly through a slow-down of reflexes or a need to make sure that the way is clear.

Result is, they are in danger of looking ahead before they have sufficient visual information to negotiate the step immediately in front of them. And this makes for a higher risk of tripping and falling.

The article adds:

There are intrinsic changes associated with the aging process. The changes that increase the risk of falling are a degrading musculoskeletal system, sensory function, and gait changes associated with aging.

There are actually many factors that contribute to slip-and-fall accidents in the elderly. Medication side-effects can cause balance problems or dizziness, which can lead to falling. Elderly people have more chronic illnesses. Arthritis, for instance, is one of the major factors in falling. Pain associated with joints can cause falling. Fatigue, osteoporosis, dementia, and all sorts of things that more commonly strike the elderly, can lead to falls.

As my wife's grandfather, who passed away at age 93, used to say, "Getting old isn't for sissies."

So, what can be done about this? There is a long list of precautions to consider, such as these exerpted from the article:

Minimize changes in walking surfaces, and use slip-resistant coverings

Use lighter-colored floor surfaces to create color contrasts between walls and floors

Increase lighting and reduce the contrasts in lighted areas

Securely install grab-bars positioned for support

Don't wax floors

Avoid climbing and reaching to high cabinets

Always keep a night-light on in your bathroom

Use bathroom rugs with nonskid backing

Install light switches at the top and bottom of stairs

Be sure carpeting is tightly woven and installed so it doesn't move or slide

And so on. Perhaps the most important recommendation for the older generation is to maintain good health, and not to let the fear of falling get in the way of exercising, and enjoying life. You see, there's a lot more to look forward to as we get older than having some cranky radiologist read your hip radiograph!

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