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Guarding Health, And Independence: As Populations Age, Localities Tailor
By Fredrick Kunkle, Washington Post
January 27, 2008
Helen Sellevaag knows her next fall could be fatal. At 97, she also understands her chances of falling have increased as she has gotten older, and the slightest misstep could lead to a life-threatening injury.
So Sellevaag listened carefully during a recent visit from a social worker. Then, with the help of a walker, Sellevaag took a room-by-room tour of her home in Annandale to see for herself the possible dangers posed by ordinary objects. Throw rugs. Low-watt light bulbs. Electrical cords on the floor. Medications.
Jennifer Edge, a social worker from ElderLink, lifted each rug in the kitchen to see whether it had an anti-skid bottom. She flicked switches and discussed handrails. She catalogued Sellevaag's medicines and vitamins -- 24 in all -- while explaining that taking four drugs or more affects your sense of balance.
More than a third of people 65 and over fall every year. For those 85 and over, the odds are four to five times worse. Falls are the leading cause of accidental death in the elderly, surpassing vehicle crashes.
All it takes is a single fall for an older person to lose his or her home. And with the first baby boomers hitting 65 in three years -- and expected to live another 18 -- Fairfax County officials are taking urgent steps now: They're helping residents age-proof their homes so they can stay put.
Home visits are the latest sign that Fairfax, like many other local governments, insurers and health-care providers, is preparing for a vast demographic shift toward a grayer America. With the nation's aging population projected to double by 2020, the county has put together the "Fairfax 50+ Action Plan" for new transportation, building codes and other measures.
Montgomery County offers similar fall-prevention programs as part of several services for older residents. Home visits are usually in response to a call for acute needs, said John J. Kenney, chief of aging and disability services in Montgomery. Prince George's County also offers educational sessions on preventing falls.
"People want to stay in their own homes and take care of each other. This is a way of doing it," said Cathy Cole, director of ElderLink, a cooperative program among Inova Health System, the National Capital Area Chapter of the Alzheimer's Association and the Fairfax Area Agency on Aging.
As people age, arthritis can inflame joints and hinder movement. Muscle mass and strength diminish, reducing the ability to retain balance and coordination. Because women have less muscle mass than men to begin with, older women are more likely to fall than men, at least until both reach 85 and the rate of falls becomes more equal.
Eyes also falter, reducing depth perception. Older people need more light to distinguish objects in detail, Edge said.
Medical conditions sometimes cause momentary dizziness, such as when a sudden drop in blood pressure occurs when a person stands up abruptly. Researchers also have found that balance can be hindered by the side effects of certain medications and combinations of drugs. Depression, for reasons that are not clear, can contribute to falling, perhaps because a person's low mental state might distract them.
Studies have found that about half of those who are hospitalized for serious injuries after a fall are able to return to their homes and live independently. One found that, in 1998, the average cost to treat the injuries of a 72-year-old person's fall was $19,440.
"We really need to have public campaigns about fall-safety awareness. It's a top public health concern," said Jean Wyman, director of the Center for Gerontological Nursing at the University of Minnesota. "It's going to be a major cost to society if we don't do better in our prevention efforts. And I think the important issue to get across to people is falls are preventable."
Research, including Wyman's 2002-05 study of women ages 70 to 101 in Minnesota's Twin Cities, has found that relatively simple and inexpensive measures could prevent many falls, including moderate exercise, education and one-on-one home visits such as those Fairfax has started. Wyman's study found that such measures reduced the number of falls by 35 percent.
But experts say one of the biggest obstacles is complacency. Falling has long been the stuff of slapstick comedy, a fact of life so ordinary that it does not seem serious. Older Americans sometimes shy away from using a cane or walker, and they can be reluctant to admit falling for fear their adult children might reduce their independence.
"There is a big taboo about falling, and that's why we'd like it to be talked about more," said Dorothy Baker, a research scientist in geriatrics at Yale University School of Medicine.
So Edge, through seminars in churches and senior centers, has been offering home visits as part of an initiative to help people stay in their homes as long as possible.
Although her focus is mostly on preventing falls and fires, Edge also gets down to the nitty-gritty of her clients' daily routines, suggesting devices to make life easier: tableware with special handles that make it easier to grip, telephones with amplifiers and captioning screens, and portable food warmers that allow people to take their time eating without having to get up and reheat their food.
She also advises older residents about free exercise programs at houses of worship, along with free consultations with pharmacists at CVS.
Since its launch in January 2007, ElderLink's program has targeted parts of the county with high proportions of older residents, such as Rosehill and Franconia, while also spreading the word through homeowners associations.
Schools have allowed Edge to reach caregivers in the "sandwich generation" who are raising children and looking after aging parents at the same time. And although many tips are common sense, advocates said people need to be told, and often told more than once, to take even simple steps to prevent falls.
Before touring Sellevaag's home, Edge went over a list of questions about Sellevaag's history, medical condition and daily habits.
"I'm aware that I have to be careful," said Sellevaag, who lived for 77 years in Connecticut in the house her husband built until a nonmalignant brain tumor forced her to move in with her daughter, Linda, in Annandale. "My big concern is, I don't like to be alone. I guess that's because I'm aware I might fall."
Unexpectedly, Edge discovered something else: Linda Sellevaag, 60, also took a fall that could have seriously injured her. It occurred when her mother awoke in the night and called for help. In her haste, Linda bolted toward the stairs without turning on a light and fell down a few of them before catching her balance.
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