“I’ve fallen and I can’t get up” has long been part of the American lexicon, a staple of late-night comedians for generations.
But for older adults – and California’s fragile healthcare system – falling is no laughing matter.
One in three adults 65 and older falls every year. Falls are the number one cause of injury – and death – for seniors in California and across the nation. They are also the largest single contributor to nursing home admissions – a staggering financial burden for both families and governments who shoulder the high costs of assisted living.
Yet a number of experts and programs around the state are helping California become a leader in fall prevention awareness and training. In a state whose over-65 population is expected to be more than 10 million by 2040 – nearly one in five citizens – this is welcome news.
“Fall is a dirty word,” says Debra Rose, co-director of the Center for Successful Aging at California State University, Fullerton. “Nobody wants to address falls.”
Rose and her colleagues have trained more than 500 instructors under the center’s FallProof certification program using a wide-ranging curriculum that combats the common stereotype that falls are caused simply by physical frailty.
In truth, falls are caused by a combination of risk factors: medications, the surrounding physical environment, poor footwear and age-related decay – which includes vision and hearing.
“People want to find a quick fix for falling, and it’s just not that simple,” says Rose.
Many of Rose’s students are physical therapists or fitness instructors.
“This just adds one more element of expertise to their burgeoning bag of tricks,” she says.
FallProof graduate Kelly Ward, who has trademarked the name “The Fall Prevention Lady,” was once a personal trainer to high-tech firms like Intel. Over six feet tall, lean and muscular, Ward is a striking contrast to seniors nearly a foot shorter in her elder mobility class at a Sacramento Presbyterian church.
Ward steps the 60 and 70 year-olds through a rigorous series of toe lifts, marches, step-ups, and heel-to-toe walks to improve balance and strength. Students use resistance bands for upper body strength, then face a challenging obstacle course.
“They’re not going to get this at senior centers,” jokes Ward, who typically sees improvements in the third week of her six-week program. “The choices you make in your 60’s will determine your vitality and independence of your 70’s.”
Aileen Nitta has taken Ward’s beginner class, and is now in the intermediate course.
“I went hiking in Sedona and hiked two times a day and am glad I had that prep,” she says. “My legs didn’t buckle. And I watched where I was going.”
Low-risk seniors who’ve never fallen can pursue several health-promoting physical activities: walking, biking, tennis, yoga, pilates, and tai chi.
But adults who have already taken a tumble “need a program that specifically targets balance and strength,” says Rose. “You can’t refer them to an aerobics or yoga class.”
In 2009, there were 1,851 deaths and more than 81,000 California seniors over 60 hospitalized due to falls, says Barbara Alberson, chief of the State and Local Injury Control Section. About one-quarter of seniors who suffer hip fractures die in the year following a fall.
The nation’s pioneer in fall prevention is Mary Tinetti, director of the Program on Aging at Yale University, whose early work paved the way for California’s two-day “Targeting Falls in Older Californians” conference nearly a decade ago.
That event spawned creation of the Fall Prevention Center of Excellence, a comprehensive resource both nationally and internationally headquartered at the University of Southern California’s Andrus Gerontology Center.
Center co-director John Pynoos says that that physical environments – both indoors and out – are implicated in nearly 40% of falls.
Pynoos describes most contemporary homes as “Peter Pan housing” – built for families who never grow old.
“What I really hate are the modern houses in Architectural Digest with floating staircases, and no hand rails,” says Pynoos. “They’re beautiful designs but disastrous for anybody with disabilities.”
Many falls occur on stairways, which often suffer from dim lighting, worn carpets and single-side hand rails. Pynoos says the best indoor improvements include bathrooms located in the ground floor, walk-in bathtubs, grab bars, non-slip tiles, raised toilet seats, and glare reduction. Older adults need up to three times as much lighting as their counterparts.
Outdoors, Pynoos says cities can do plenty: fix uneven sidewalks, add hand rails, or improve lighting by replacing bulbs or adding new LED or halogen lights. Timed walkways also help seniors cross safely.
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