More boomers at risk for falls; ER rates increase

Nov. 21--Falling down is going up.

Across California, more seniors are winding up in hospital emergency rooms after taking a tumble, hitting a high of more than 232,000 last year, according to new statewide data.

That's no surprise to Wendi Skala, trauma injury prevention coordinator for Kaiser Permanente South Sacramento.

"The numbers are going up and up because our population is aging," she said. "As baby boomers go into their older adult years, the things that make them susceptible to falls just multiply. It's a huge problem."

Statewide, there's been a 38 percent jump in the number of Californians 65 and older taken to emergency rooms because of falling between 2010 and 2015, according to the Office of Statewide Health Planning and Development. Through June this year, that number has already reached nearly 118,000, meaning the upward trajectory isn't slowing down.

For some seniors, a fall means they can't return home. For others, it shatters their confidence about staying active.

"One bad fall can lead to hospitalization, rehab and never being able to go home again," said Linda Revilla, program director at ACC Senior Services, which operates the Greenhaven Terrace senior living community in Sacramento.

According to the federal Centers for Disease Control and Prevention, one in every five falls by an older adult results in serious injury, such as broken bones, a hip fracture or head trauma. Or worse. Nationally, more than half -- 55 percent -- of all unintentional deaths among American adults in 2012-13 were due to falls, according to the CDC.

That's why senior centers, hospitals and health centers offer regular "fall prevention" classes that focus on building strength and balance, as well as tips to reduce risks around the house and while walking.

On a recent morning, Siok Oen and Virginia Davvison were twirling their arms and bending knees at a Sit and Fit class, held twice a week at Greenhaven Terrace, a predominantly Asian American seniors community in Sacramento. "It's great for your health and keeps your muscles in tone so you don't stiffen up," said Davvison, who just turned 95. "As you get arthritis and stiffer joints, this helps you to keep limber."

But many boomers don't see themselves as at risk for a fall.

"Older adults do not really want to hear they're at risk," said Kaiser's Skala. "They want to be viewed as aging gracefully, going to the gym or riding their bike on the American River Trail. It's difficult to get interest from 55- to 75-year-olds who see themselves in that active-aging group."

Too often, there's a disconnect between a still-youthful mind and an aging body. For instance, the senior climbing up on a ladder this time of year to clean gutters or trim tree limbs may not have the same agility, balance, strength or vision as just a few years ago.

"Our mental age isn't always keeping up with our physical age. People aren't realizing how age has affected their body in subtle ways," said Christy Adams, trauma prevention coordinator for the UC Davis Health System. Those subtle changes can include weaker muscles, stiffer joints, poorer vision and lack of balance, all of which can be ingredients for falling.

According to the CDC, the most common risk factors include: lower body weakness; vision problems; vitamin D deficiency; balance and walking difficulties; feet pain and poor footwear; and household hazards such as broken steps, rugs and clutter that can be tripped over.

As part of a national campaign to reduce elderly falls, the CDC urges doctors to ask their older adult patients three questions: Have you fallen in the past year? Do you feel unsteady when standing or walking? Are you worried about falling?

If patients say yes, they should be screened for potential risk, including medications that might create a tendency to fall.

According to the American Geriatrics Society, dozens of medications commonly prescribed for seniors can cause side effects -- dizziness, confusion, sleepiness -- that could contribute to being unsteady on their feet. The society's Beers Criteria list includes "potentially inappropriate" drugs for those 65 and older, including medications for high blood pressure, Parkinson's disease, depression and cardiac problems.

"We recommend all seniors talk to their pharmacist or primary care physician," said UC Davis' Adams. "Take your entire list of medications and sit down with your doctor to understand what that medicine does, how it interacts (with other medications) and if there's one that puts you at risk for falls."

It may be possible to modify, reduce or switch to another medication that doesn't have the same side effects, she said.

At home, older adults or their caregivers can reduce risk by keeping floors free of clutter, removing small rugs or taping them down, adding grab bars in the bathroom, ensuring there's plenty of light in all rooms, and never wearing socks or stockings on slippery hardwood floors.

Another hurdle is fear. If someone has fallen once, they're twice as likely to fall again -- and more likely to worry about it, according to studies. Fear of falling often leads to less mobility, which causes weakness and loss of muscle strength, further boosting the risk of another fall.

Sometimes prevention is as simple as better-fitting shoes, said ACC program director Revilla. Some seniors, she said, buy shoes that are slightly too big to make it easier to slip them on and off, but a sloppy fit can make them more prone to trip or slide. Same for slippers.

Strength and balance exercises, everything from chair yoga to Tai chi, also are recommended to help prevent falls.

"Falls are not an inevitable part of aging," said UC Davis' Adams. "You can't slow aging but you can slow the muscle loss that comes faster with inactivity. You can rebuild muscle no matter how old you are."

Building muscle, she said, provides the leg and ankle strength that can keep someone upright if they trip or lose their balance.

UC Davis sponsors a series of eight-week classes -- Matter of Balance and Stepping On -- taught at various health care facilities and seniors residences throughout the region. The classes emphasize fitness but also prevention such as how to avoid everyday risks, such as taking time when getting out of bed and not rushing to answer the phone or doorbell.

"As we grow older, this awareness is important for graceful aging," said Wayne Shimizu, a retired state Department of Education employee who co-teaches the Matter of Balance class at Greenhave Terrace. "We can't prevent falls, but we can reduce the risk of falls."

Claudia Buck: 916-321-1968, @Claudia_Buck

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