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Staying put at home? Do a safety check

WASHINGTON — Helen Sellevaag knows her next fall could be fatal. At 97, she also understands her chances of falling have increased as she has grown older.

So Sellevaag listened carefully during a recent visit from a social worker. Then, with the help of a walker, Sellevaag followed the visitor on a room-by-room tour of her home in suburban Annandale, Va., to see for herself the possible dangers posed by ordinary objects: Throw rugs. Low-watt light bulbs. Electrical cords on the floor. Medications.

Jennifer Edge, a social worker, lifted each rug in the kitchen to see whether it had an anti-skid bottom. She flicked switches and discussed handrails. She cataloged Sellevaag's medicines and vitamins — 24 in all — while explaining that, generally, taking four drugs or more can affect your sense of balance.

Experts estimate that more than a third of Americans 65 and older will fall, every year. For those 85 and over, the odds are four to five times worse.

And falls — with the resulting injuries and snowballing complications — are the leading cause of accidental death in the elderly.

The dangers of home

With the first boomers hitting 65 in three years — and generally expected to live 18 years beyond that — officials in the Washington suburb of Fairfax County, Va., are taking urgent steps now: They're helping residents "age-proof'' their homes so these older adults can stay put.

"People want to stay in their own homes and take care of each other. This is a way of doing it," said Cathy Cole, director of ElderLink, a cooperative program created by Inova Health System, the National Capital Area Chapter of the Alzheimer's Association and the Fairfax Area Agency on Aging.

As people age, arthritis can inflame joints and hinder movement. Muscle mass and strength diminish, reducing the ability to retain balance and coordination. Because women have less muscle mass than men to begin with, older women are more likely to fall than men, at least until both reach 85, when the rate of falls becomes more equal.

Eyes also falter, reducing depth perception. Older people need more light to distinguish objects in detail, said Edge, the ElderCare social worker.

Medical conditions sometimes cause momentary dizziness, such as when a sudden drop in blood pressure occurs as a person stands up abruptly.

Researchers also have found that balance can be hindered by the side effects of certain medications and combinations of drugs.

Preventing falls

"We really need to have public campaigns about fall-safety awareness. It's a top public health concern," said Jean Wyman, director of the Center for Gerontological Nursing at the University of Minnesota.

"It's going to be a major cost to society if we don't do better in our prevention efforts. And I think the important issue to get across to people is falls are preventable."

Research, including Wyman's 2002-05 study of women ages 70 to 101 in Minnesota's Twin Cities, has found that relatively simple and inexpensive measures could prevent many falls.

The preventives include moderate exercise, education and one-on-one home visits. Wyman's study found that such measures reduced the number of falls by 35 percent.

But experts say one of the biggest obstacles is the older residents' complacency. Falling has long been the stuff of slapstick comedy, so it does not seem serious. Older Americans sometimes shy away from using a cane or walker, and they can be reluctant to admit having fallen, for fear their adult children might reduce their independence.

"There is a big taboo about falling, and that's why we'd like it to be talked about more," said Dorothy Baker, a research scientist in geriatrics at Yale University School of Medicine.

So social worker Edge, through seminars in churches and senior centers, has been offering home visits as part of an initiative to help people stay in their homes as long as possible.

Easing the routine

Although her focus is mostly on preventing falls and fires, Edge also gets down to the nitty-gritty of her clients' daily routines, suggesting devices to make life easier: tableware with special handles that make them easier to grip, telephones with amplifiers and captioning screens, and portable food warmers that allow people to take their time eating without having to get up and reheat their food.

She also advises older residents about free exercise programs, along with free consultations with pharmacists.

And although many tips are common sense, advocates said people need to be told, and often told more than once, to take even simple steps to prevent falls.

Before touring Sellevaag's home, Edge went over a list of questions about Sellevaag's history, medical condition and daily habits.

"I'm aware that I have to be careful," said Sellevaag, who lived for 77 years in Connecticut in the house her husband built until a nonmalignant brain tumor forced her to move in with her daughter, Linda.

"My big concern is, I don't like to be alone. I guess that's because I'm aware I might fall."

Unexpectedly, Edge discovered something else: Linda Sellevaag, 60, also took a fall that could have seriously injured her. It occurred when her mother awoke in the night and called for help. In her haste, the daughter bolted toward the stairs without turning on a light — and fell down a few of them before catching her balance.


The danger of falls

• Falls are the leading cause of death by accidental injury among people are older than 65.

• Falls are the most common cause of hospital admissions for trauma among older Americans.

• The direct and indirect costs of fall injuries are expected to reach $43.8 billion a year by 2020.

• The risk of serious injury increases with age. In 2001, people 85 or older were four to five times more likely to be injured in a fall than people 65 to 74.

• More than a third of adults 65 and older fall annually.

• Six in 10 falls occur in the home.

• Women are 67 percent more likely to suffer a nonfatal injury from a fall than men, and the odds of fall-related fractures are more than twice as high for women.

• Men are more likely to die from a fall. Adjusted for age, the fall fatality rate in 2004 was 49 percent higher for men than women.

Sources: New England Journal of Medicine; U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; American Academy of Orthopaedic Surgeons; National Institute on Aging

Staying put at home? Do a safety check 02/25/08 [Last modified: Thursday, October 28, 2010 8:54am]
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