Can Exercise and Cleaning Save 30 Billion in Eldercare?

Preventing falls could save 30 billion dollars a year–and keep elders at home

Posted Jul 14, 2014

I read Jennifer Conlin's NY Times piece on living with her elderly parents this morning and started to cry.  It's one of a series in her blog about living with her parents and children in their home in the midwest.  This week she talks about "curling"–- that quirky sport of the Northern ice where skaters carefully sweep the ice clear to smooth the path of a stone sliding across the ice.

Here she was talking about 'curling' her parents.  Clearing the path in front of their feet to make it safe for them to walk without falling.

I can so relate.  After 33 years of living many hours away, my in-laws moved to our home town to take advantage of the easy driving, flat slopes, ubiquitous sidewalks, and inexpensive real estate of rural Ohio.  I had always thought of our town as accessible. Its current goal is to become universally accessible. ("Universal" accessibility is a term used instead of 'handicapped accessible to more accurately describe the fact that it's not just those with physical disabilities that are aided by wider doors and ramps, but parents with strollers, teens with sprained ankles, delivery-men wheeling boxes, and kids riding bikes as well.)  Sidewalks throughout town are ramped up and down. Our stoplights ding. There are spaces designated for handicapped plates and children seemingly everywhere. Almost all the restaurants in town could be rolled into with carriage, walker, or wheelchair. There are apartments in multi-use apartment/retail building in walking distance to banks, restaurants, and shopping.  There is a wonderful, albeit expensive, senior living center that shuttles people to the walkable downtown.  

And you can see that it helps. You often see sight impaired people out strolling with canes or dogs, many people with walkers out with oxygen bottles, and folks on scooters, canes, and wheelchairs of various ilk. Not only that, but you see people walking and biking everywhere.  Even very young kids can navigate from one end of town to the other on their bikes on the safety of a sidewalk. The biggest problem is downtown, where kids moan as the police rigorously enforce the "no bikes" rule around the library. All those articles bemoaning kids not allowed off on their own?  They don't make sense here–the streets look like those of my childhood–filled, with small groups of chatting, biking kids.

Communities creating barrier-less spaces are important, but what really resonated with me about Ms. Conlin's piece was her description of the thousands of small barriers we don't notice, and how dangerous they can make the lives of people who are frail.   

A Thousand Places To Fall

A lot has been written about physical barriers for people with difficulty climbing steps. I won't discuss them here (a link to resources is provided below). However, as the aunt of a wheelchair bound teenager, daughter of a man who spent years in walker and wheelchair, and daughter-in-law of two cane users, I must tell you that there's more to accessibility than a ramp. Door width and aisle spacing are equally important, as are other features as well.

I do want to talk about falling. According to the Center for Disease Control, 1 in 3 people over 65 has a fall every year. Hip fractures are the most commonly heard about outcome, as bones become more fragile with age.  I remember a colleague of mine walking across the lobby of a fabulous old hotel a few years back, slipping on a rug, and being unable to stand because he had fractured his pelvis. Falls are the leading cause of injury for older people. Many do not tell their caregivers.  Falls–even minor ones–can lead to long term hospitalization or institutional care.  They can also lead to death–both because of immediate injuries but also, more horrifyingly–because the person falls and doesn't get help.

I can relate to that last one personally. My own grandmother lived in an apartment with a very narrow bedroom. She slipped while making the bed and found herself wedged between bed and wall. She was there overnight–and I'm sure she thought she'd die there, because no one in her apartment building heard her calling for help. When my mother called in the morning and no one answered, we found her and got her unstuck. Although she hadn't broken anything, in her attempts to free herself, she had rubbed that skin off the back of her heel, which resulted in a surprisingly virulent infection that resulted in her being unable to walk or care for herself for months. Many other people aren't as lucky.

The CDC says that falls in the elderly cost 30 billion dollars in 2010.  

This is directly from the CDC website:

  • Twenty to thirty percent of people who fall suffer moderate to severe injuries such as lacerations, hip fractures, or head traumas.  These injuries can make it hard to get around or live independently, and increase the risk of early death.
  • Falls are the most common cause of traumatic brain injuries 
  • In 2000, 46 percent of fatal falls among older adults were due to traumatic brain injuries.  
  • Most fractures among older adults are caused by falls. The most common are fractures of the spine, hip, forearm, leg, ankle, pelvis, upper arm, and hand.
  • Many people who fall, even if they are not injured, develop a fear of falling.This fear may cause them to limit their activities, which leads to reduced mobility and loss of physical fitness, and in turn increases their actual risk of falling.

I want to focus on that last point, because it is so important.  Although older people are more prone to falls and fall injuries, there are things that can be done to prevent them.  

Why Do Older People Fall?

Some people are at greater risk for falls than others.  Risk factors include:

  • Muscle weakness, particularly in the legs.
  • Poor balance. This can be due to issues with muscle weakness or arthritis or to inner ear problems.
  • Unsteadiness after standing up. Lots of us get dizzy when we stand up. This is worsened by some medications, like those for blood pressure or Parkinsons.
  • Slower reflexes.  Slowing is one of the universals of aging. Younger people have an easier time catching themselves after they trip than older people do. Older people also tend to react more slowly to hazards such as pets underfoot–a very common cause for falls.
  • Unsafe footware. Those open-backed slippers? Lose them! People who wear footwear that is too loose or too tight or too high heeled tend to slip, trip, and fall.  
  • Sensory problems. Just as it's easier to trip in the dark than during the day, it's easier to trip when you don't see well. It's not just sight though, it's also noticing small changes in the floor or wires crossing floors you would have noticed and adjusted for when younger that you don't notice now until it's too late.

Fall Prevention

There are two types of fall prevention: Fall proofing the person and fall proofing the environment.

For the person, the most important factor is exercise.  The stronger people are and the better their balance, the less prone they are to falls.  According to the CDC, exercise is the only person-based intervention that makes a consistent difference in preventing falls. Medicine won't help–you have to work.

  • Slow exercises that emphasize strength and balance are particularly important. These include walking and programs like tai chi. Water aerobics can be very helpful because the water provides resistance, building muscle and strengthening bones, while cushioning your body from falls and injury. Strength training can be done with very light weights.  
  • Exercise OFTEN. 30 minutes a day, 5 days a week are recommended.  But even walking to the far bathroom instead of the near one can be helpful.
  • A doctor can prescribe a short course with a physical therapist to teach simple exercises using stretchy bands and home equipment like a kitchen counter.

Finally, USE CANES, WALKERS, OR WALKING POLES.  Often, people will avoid exercising because they're afraid of falling. Ironically, this makes them more vulnerable to falls. It is better to use tools to help make you more stable. Using a walker can build up strength so you're comfortable with a cane or walking stick. My dad had a walker with a seat. He'd walk a while, stop and sit, then walk some more. He could go much further–and get much more exercise–that way than with just a cane, and certainly on his own. He found a footed cane much more stable than a traditional one. When navigating places where a walker was awkward, he'd take two four-footed canes. ALL activity is good. Get there any way you can.

For the environment

The CDC has some good guidelines for preventing falls.

In the home:

  • Get ride of clutter!  The most important thing on every list for fall prevention is getting rid of things to trip over. Magazines. Clothes. Shoes. Little area rugs. Put them away.  
  • Watch for pets. Pets can be a huge source of comfort, but are one of the most common things for people to trip over. Can you train your dog or cat to walk besides you rather than in front? Think hard about how to make their presence a comfort and not a danger.
  • Make a clean sweep. Cat and dog food slip like marbles. Any small object on the floor can be a hazard.
  • Clean up cords. Charging phones, tv cables, oxygen lines…floors get covered with cords.  A fast trip to the hardware store will produce some great cord organizers that will keep them tucked safely along the wall and way from your feet.
  • Arrange the furniture so you have a good traffic pattern.  
  • Avoid wet floors.
  • Put in safety grips, non-skid pads, and grab rails 

Outside the home:

Choose places that are easy to navigate. Many people like malls because they are often barrier free, in that they have no steps. However, they can be HUGE and require more energy than people may have to navigate. One option is to use wheelchairs or carts to move around. Another is to shop in smaller places where you can go in and out easily. In our area, I have noticed that many large drug store chains not only have prescription services and the normal cosmetics and first aid equipment, but lots of daily necessities like milk and pet food. One reason is that they are small enough to navigate but can serve many needs. Keep a sharp eye out for other stores that make shopping easier for you. In our town, one reason that the downtown thrives is because of the many elderly, as well as the many students, who shop the small stores.

The added benefit of all these small changes is that they aren't just good for the elderly, they're good for all of us. Barrier free living makes it easier for all of us to exercise more and remain healthy. We're all just a slip away from an accident.

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