Originally published in SFGate.
By Victoria Colliver
July 25, 2012
Henrietta Petty has taken a few tumbles in her home but never had to be hospitalized for injuries related to those mishaps – and the 70-year-old Oakland woman intends to keep it that way.
Petty, on the advice of her primary-care physician, attended a fall prevention clinic at Oakland’s Highland Hospital earlier this week designed to help patients who ended up in the emergency room due to a fall as well as those considered at risk of falling.
The idea is to help people like Petty avoid the possibility of injury, hospitalization or even death.
“I’m older now and I know I have to do more things to keep myself safe,” said Petty, who learned how falls affect the elderly during her more than 40 years as a home-health worker. “I want to live to 100, and I want to be healthy.”
Falls are the leading cause of nonfatal hospitalizations for all ages, but older adults are at much higher risk of falling. Falls are the fifth leading cause of death among people over the age of 65. More than 92,000 Californians over the age of 50 were admitted to hospitals for injuries related to a fall in 2010, according to the California Office of Statewide Health Planning and Development. Those numbers are expected to increase as the Baby Boomer population ages.
The price of falls
Health costs associated with falling also add up. Falls among those over age 65 cost the U.S. health system more than $19 billion in 2000 – a figure estimated at $28.2 billion in 2010 dollars, according to the U.S. Centers for Disease Control and Prevention. Curbing health costs by reducing preventable emergency room visits is a component of the federal health legislation.
For Stefania Kaplanes, community injury prevention coordinator for Alameda County Medical Center’s trauma department, the motivation to create a program aimed at reducing this potentially avoidable hazard was triggered by seeing patients repeatedly being brought to the hospital for falls.
“The biggest risk for the second fall is the first fall, but we also want to prevent falls altogether,” said Kaplanes, a medical social worker who developed the program in 2009.
Many hospitals offer fall prevention services to their patients, but Highland Hospital’s program takes an unusual approach by concentrating on identifying patients in advance of any falls and involving various specialties in a one-stop clinic.
Primary-care physicians are versed in how to identify patients who could benefit from the fall prevention clinic. Patients considered at high risk include those who are over 60, have had a history of falls, or experienced dizziness, weight loss or problems with vision, balance or gait. Certain medical conditions or medications may increase a patient’s risk of falling.
Dr. Claudia Landau, chief of geriatrics and palliative care, said the program has recently added another element – simply a patient’s fear of falling – to its criteria for assessing risk. “If everything is normal but you’re afraid of falling, you’re at higher risk,” she said.
Referred to the clinic
Once identified, a patient is given the opportunity to be assessed by a physical therapist as well as an occupational therapist. An educational session comes next, followed by a conversation with a pharmacist about medications before a patient is sent home with educational materials that include a home-safety checklist and a deck of cards with injury prevention messages. The clinic takes place in one two- to three-hour session.
The approach shows promise. Since September 2011, when the service moved out its pilot phase and became a full-fledged clinic, none of the 45 patients who have attended the clinic has been seen in Highland Hospital’s emergency department for a fall.
Pamela Hooks-Simmons received a new walker after her evaluation. The 58-year-old Oakland woman, who was diagnosed at age 27 with rheumatoid arthritis and also suffers from osteoarthritis, said she was referred to the clinic after she told her doctor she experienced a few falls when she got up at night and complained that she felt her knees “giving out.”
“Now when I wake up, I’m first going to sit up, move stuff around and make sure I’m totally present,” she said.
Henrietta Petty said she learned a lot through the program, particularly the need to walk in a heel-toe fashion and to wear shoes that have thin rubber soles and that are either fully encased or at least have a strap in the back.
But that advice caused her a bit of dismay. Petty, who refuses to wear “old lady” shoes, said she would have a hard time completely giving up her beloved open-back sandals and flip-flops.
“I’m just going to be extra careful when I do wear my flip-flops,” she said.
— Wear low-heeled, enclosed shoes with thin rubber soles. Avoid flip-flops, open-backed shoes and high heels.
— Know that being tired, hungry, dehydrated or in a hurry can greatly increase the risk of falling.
— Tell your doctors about all the medicines you are taking – including vitamins, herbal remedies and over-the-counter drugs. Some health conditions and medications may increase your risk of falling.
— Do not shuffle your feet. Picking up your feet and walking heel-to-toe will reduce the chance of trips and falls.
— Always leave one hand free to hold on to handrails, even if you don’t think you need handrails.
— Make sure to use bedside lamps and nightlights and remove obstacles to reduce the chance of falling if you have to get up in the middle of the night.
— Take a moment to “get your bearings” when getting up in the morning or moving from sitting to standing to avoid dizziness.
Edited on June 11, 2018.