Seniors and Falls – A Critical Combination
A recent New York Times article illustrates the point that falls, once seen as an inevitable sign of aging, are now considered complex events. Falls have multiple causes and consequences, and require a wide range of interventions that many patients never receive.
Dr. R. Sean Morrison, a professor of geriatrics and adult development at Mount Sinai School of Medicine in New York, says that even falls that cause only minor injury “need to be taken as seriously as diabetes” because “they can be a real warning sign that something serious is wrong. Dr. Mary E. Tinetti, a falls expert at Yale University Medical School, says that falls can be as harmful as stokes, and that may people do not report them or ask for help for fear that their families may try to move them out of their homes to assisted living facilities or nursing homes. Some people feel that admitting that they fall is the same as admitting that they can no longer take care of themselves.
The Centers for Disease Control and Prevention (CDC) reports that each year, over 1.8 million Americans over age 65 are injured in falls. Some people recover and rebound as if the injury never happened. For many people, however, the fall starts a downward spiral that their bodies can no longer withstand. Depression, pneumonia, social isolation, infection and muscle loss are some of the potential consequences of falls. In 2005 (the last year for which statistics are available), 433,000 people over age 65 were admitted to hospitals after falling, whereas 15,800 died as a direct result of the fall. Many others survive falls, but have indirect consequences. According to the CDC, one in five hip-fracture patients over age 65 dies within a year after surgery, while one in four spends a year or more in a nursing home. Older persons with slower reactions and less upper-body strength are unable to break falls with their wrists, and their weight can fall on their hips or heads. Existing respiratory or heart problems can increase the possibility of a downward spiral.
Dr. Deanna Gray-Miceli, adjunct professor of nursing at the University of Pennsylvania, is an expert in geriatric falls. Her research indicates that the period of immobility after a fall is particularly dangerous. “Being immobile, you’re not taking deep breaths, you’re more prone to orthostatic pneumonia, or older people can develop urinary incontinence. And that can have a whole cascade of emotional consequences as well as the physical consequences, such as skin breakdown, pressure sores, bladder infection, and lung infection.” Infection can also cause confusion.
Dr. Gray-Miceli says that after a fall, it is important for medical staff to keep the patient focused on signs of progress so the patient can say, “Today I got up by the side of the chair and took five steps. Yesterday I only took four steps.” These signs of progress are important so the patient can gain a sense of optimism and control and help prevent depression from setting in.
Dr. Gray-Miceli has identified treatable causes of falls, such as low blood pressure, declining vision, changes in gait and heart arrhythmias, as well as conditions in the home. The CDC also offers tips to reduce falls at home, such as removing loose rugs, and ensuring that stairway handrails are installed. The CDC website atwww.cdc.gov/ncipc/duip/preventadultfalls.htm includes many other tips. Physical therapy and changes in medication reduced falls by 11%, according to a study by Dr. Tinetti. Families and doctors should be alert for circumstances and conditions that can cause falls and do their best to prevent them.
O&H: Allie, we’ve heard that there is new study that animals can actually feel the beat of music that they hear. Please tell us about it.
Allie: Sure! The Neurosciences Institute in San Diego recently released results of a study that was published online last week by the journal Current Biology. Aniruddh Patel of the Institute conducted the study that showed that some parrots and an occasional elephant actually felt the beat of the music they heard. Unfortunately dogs, cats and chimps did not demonstrate that same ability. The research initially included studying YouTube videos of Snowball, a medium sulfur-crested Eleonora cockatoo, dancing to the beat of his favorite Backstrert Boys song, among other songs. (My favorite video of Snowball has him dancing to “Another One Bites the Dust” by Queen; that one gets Oast & Hook’s staff dancing along with him!) Mr. Patel then collaborated with Snowball’s owner for more extensive research. Other scientists studied Snowball, an African gray parrot named Alex, and other animals on YouTube. The research shows that some animals share with people some ability to mimic sounds that they hear, and that same brain circuitry also lets people learn to talk, and sometimes also dance or tap their toes to music. The scientists say that the research has given them some insight into why humans became able to dance.
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