When we are young, falling is a fact of life, a normal rite of passage.   It’s something that happens the moment we start toddling and continues through the new bike years of childhood.  By the teenage years, our falls are pretty much limited to the “head over heals” kind or those caused by sports.  As young people, we only think of really violent falls as serious, the ones where our heads hit concrete or when we fall off something from a high distance.

The young boy with the broken arm loves the attention he gets from his classmates for a fall that caused damage that is temporary.  It will likely heal in six weeks.

Seniors, on the other hand, want no attention for falling.  Many fear the consequences not just to their bodies, but to their way of life.   A fall might mean a loss of independence, a sign of growing physical weakness, an “excuse” for the “kids” to start talking about nursing homes.

It’s true, falls are far more devastating, on average, for older people.  Falls are the number 1 reason for admission to skilled nursing facilities and they are a major factor in 40 % of all admissions for any reason.   1 in 3 seniors fall each year.

In San Diego County, in 2008, there were 12, 535 seniors treated in the emergency department for falls.  In 2007, falls were the cause of 186 deaths.

Why so many falls?  First, let’s look at how our balance system works.  We have our sense of vision, or sence of touch, and our vestibular/inner ear.   Our eyesight and our inner ear help keep us stable.  Information from our eyesight, inner ear, and our sense of touch is coordinated in our brain to give us balance.    The problem is, as we age, our vision and our ability to sense the ground through our shoes are diminished.   Also, changes in our strength and flexibility affect our ability to quickly “right ourselves” if we start to fall.

Factors that may hinder our balance and make us more likely to fall include medical issues, physical issues, and cognitive issues.

From a medical standpoint, here are some common reasons a person’s balance is compromised.  Arthritis can make it difficult or painful to move around.   High or low blood pressure may lead to dizziness.   Diabetes can lead to nerve damage and numbness in the feet.  Osteoporosis, or brittle bones, makes injury from a fall more likely.  Parkinson’s causes a person to have diminishing control over their movements.  Stroke or brain injuries affect balance.  Even incontinence can cause falls, because the senior may rush to get to a restroom and move too quickly.

Medications are another big issue, with side-effects and interactions.  Blood thinners like Coumadin make even the slightest of falls very serious.  Sedatives, pain meds and antidepressants can also lead to falls.  One way to deal with this issue is to talk to your doctor or pharmacist, keep an updated list of all your medications and post a Vial of Life on the fridge.

Some physical causes of falls include generalized weakness, a simple loss of muscle over time.  This causes people to have difficulty walking and balancing.  A lack of physical activity makes falls more likely.   This can be hard because many seniors who fall are told, “stop trying to do so much or go so many places, take it easier.”   The senior may become even more inactive, when the opposite is often more beneficial.  Dehydration is another physical cause for falls.

Then there are the cognitive issues.  Dementia poses a higher risk of falls, especially when the senior is no longer familiar with his or her surroundings or can’t remember the purpose of items, such as a walker or cane.   Some falls are linked to denial, a person not accepting that they are aging.  This is the same reason many seniors drive for many more years than they should.   Depression may cause a senior to not take medications correctly.  Also, distractions can lead to falls.  Some seniors are not able to focus on several things at once, so if they are walking while reading a card or talking on a phone they may be more likely to trip. (This is not limited to seniors, of course, multi-tasking can lead to falls for people of any age!)

Finally, fear can cause falls.  Fear of falling again may make the senior less active, less strong and flexible.  Fear may even cause a senior to change how they would normally walk.

If aging is a privilege, and most of us prefer it to the alternative, what can we do? How can we prevent falls?  The answer is actually very basic.  Number one, talk about falls or your fear of a fall.  Talk to your doctor about any falls you’ve had, request a fall risk assessment, ask for referrals to physical therapy or occupational therapy, or vision.

Next, do the opposite of “taking it easy” –  exercise.  Get involved with balance exercises with a group.  Try Tai Chi, Feeling Fit, Silver Age Yoga, Silver sneakers, etc.  Try to get 30 minutes of exercise most days of the week.  (That’s 2 miles of brisk walking or dancing.)

Finally, maintain good overall health.  Strive for good general nutrition, including enough water, plenty of calcium and vitamin D,  and not too much alcohol consumption.

If you would like more information, the County of San Diego has a fall prevention task force.  Visit their website at www.sandiegofallprevention.org.    You can also get a directory of PT and OT providers at www.vestibular.org.

The Fall Prevention Task Force also hosts fall prevention seminars and trains speakers to present to community groups.  I’ll be presenting this Friday at the 24 hour fitness in Rancho Bernardo to the Silver Sneakers.  There are seminars throughout the year.

At Home Care Solutions is a Certified Provider of non medical in home care for the elderly or those facing a loss of independence due to health related factors.  Call 1-888-634-8004 for a no-cost, in-home assessment. Visit us online at www.thecaresolution.com to learn more.

Jewelry theft and financial abuse are most common problems

Deputy District Attorney Greenwood, head of the elder abuse prosecution unit in San Diego County, has never been busier.  He credits the testimony on March 2^nd of 90 year old actor Mickey Rooney.

“Within two days of Mickey Rooney testifying before Congress on March 2^nd, my phone was ringing,” Greenwood said to a crowd of investigators, attorneys, and elder care professionals attending an educational seminar at Somerford Place Alzheimer’s Assisted Living.  The seminar was sponsored by Somerford Place and At Home Care Solutions, owned by RSF resident Lauren Reynolds.

Jaime Cianciolo, Lauren Reynolds, Paul Greenwood, Mara Karney, Terry Records

Rooney’s testimony about being deprived of food and medicine, allegedly by his step-children, brought elder abuse into the national spotlight, Greenwood said, illustrating that it’s a growing national problem.

“You are going to see many more people who are potential victims,” Greenwood explained, based on demographics.  In San Diego County, about 16 % of the population is over 65, roughly half a million people.

“The problem is that people are being looted in San Diego County every day,” he said.

He explained that jewelry is the number one item being stolen from seniors in San Diego.  One recent case involved a housecleaner/caregiver in Poway.  When a homeowner reported the jewelry missing, sheriff deputies installed a video camera in the bedroom and actually caught the housekeeper on tape taking items from a drawer.

“Turned out that housekeeper worked for 12 other people,” Greenwood said, “and 9 of the 12 had jewelry missing.”

His advice is that seniors keep an inventory of jewelry including pictures.  Valuables should be kept in a locked drawer or safe.   And he said there is a pattern for whom is doing the stealing.

“The #1 culprit is a convicted felon turned caregiver,” he explained.

There is no law requiring background checks on caregivers and some unscrupulous agencies hire them based only on “self-reporting” of any past criminal history. (At Home Care Solution, a fully certified home care agency, runs local, state and federal background checks on all of their employees.)

Secondly, Greenwood said, adult sons who are lazy, unemployed and addicted to drugs or alcohol tend to be the thieves, followed by tradesmen who are in the home to provide a service.

“In one case, a carpet cleaner used his high powered hose to actually vacuum the jewelry out of the drawer and into his van,” Greenwood said.

The criminals prey on confusion and fear.  One local man called up an elderly woman, claimed to be her grandson and convinced her that he needed $100,000 to be wired to China.  The fake grandson told the woman he desperately needed the money for a legal settlement.  Greenwood blamed the bank for allowing the suspect transaction to go through.

There is an Adult Protective Services hotline to call for those who suspect elder abuse, 1-800-510-2020.  However, Greenwood admitted the strapped state budget has left the hotline understaffed and the wait can be up to an hour. He hopes the state legislature will soon pass a pending bill that would allow reports of elder abuse to be made online.

Somerford Place, located in Encinitas, provides licensed dementia and Alzheimer’s residential care and can be reached at 760-479-1818.

At Home Care Solution provides certified in-home caregivers to those facing a loss of independence due to age or health related factors and can be reached at 760-634-8000.