“I’ve fallen and I can’t get up!” How many times have we heard comics deliver that line from a now-famous 1980s TV commercial?

The truth is that a dangerous fall is no laughing matter.  It’s a real worry — for those who suffer from balance dysfunction and for the family caregiver. 

Just the fear of a parent, spouse or other loved one falling  is enough to give a caregiver chills.  And the statistics bear that out.  The National Institutes of Health says that falls are the leading cause of fatal and non-fatal injuries in people 65 and older.  And The New England Journal of Medicine reports that if you’re elderly and are injured by a fall, there’s a good chance you’ll end up in a skilled nursing facility, such as a nursing home.

Hip fractures alone are a serious problem.  The American Academy of Orthopaedic Surgeons has estimated that 90 percent of the 352,000 hip fractures recorded in the U.S. each year are the result of a fall.  Only a quarter of hip fracture patients make a full recovery.  About 40 percent will require nursing home care, half will need a cane or walker and another quarter over age 50 will die within a year of the injury.  In fact, the rate of hip fractures begins to increase at age 50 and doubles every five to six years.  Women over 50 suffer such fractures at two to three times the rate of men.

Fortunately, there are a series of steps that the caregiver and patient can take to reduce the risk of dangerous falls and increase the safety of maneuvering at home.  If balance dysfunction appears to be an issue, both should visit the family doctor for a discussion of the symptoms and possible treatments. 

A typical solution will be for the doctor to refer patients to a fall prevention program. Today, there are both traditional and advanced programs available on an outpatient basis and at home.  Home therapy programs can offer some distinct advantages over treatment at an institution:

• Patients who have balance problems or who have already fallen may not be able to travel to a rehab facility, and it may be inconvenient or impossible for the caregiver to provide transportation. 
• Home treatment allows the patient to progress in a familiar environment, while institutional therapy can sometimes require a patient to learn movements all over again when he or she gets back to the house. 
• Home therapy allows a patient to remain among family and friends.
• Home programs typically involve individual one-on-one therapy focused on a speedy recovery, while institutional rehab may treat patients in a group setting.
• Those patients who still have an active career find it easier to work at home and keep in touch with the office while they’re recovering.

Traditional home fall prevention methods have typically involved “gait training,” which is essentially teaching someone to walk.  The patient also gets general strengthening exercises and instruction on how to use an assistive device, such as a cane or walker.  The challenge with these basic programs is that they sometimes leave the patient coping with certain limitations when they could actually achieve a higher level of mobility through more advanced treatments.

To guide patients toward the most successful recovery, newer, more advanced therapy programs have emerged to deal proactively with the root causes of balance problems.  The causes might involve vision, inner ear or other balance-related issues.  Sensation and coordination problems could be factors.  There might be pain or numbness in the feet.  A patient’s lack of strength or flexibility could be the cause.  Or a person’s living area and environment could reveal hazards which increase the likelihood of falls.

These newer programs examine the potential causes through a detailed evaluation.  Working with the physician, specially trained therapists then develop and launch treatment plans that are customized for each patient.  The success rate is high.  Sponsoring home health organizations have begun to document patient outcomes demonstrating the ability of such programs to relieve pain, increase sensation and reduce the risk of dangerous falls.

As part of any fall prevention program, a therapist can make recommendations to the patient and caregiver about improving safety in a home environment.  The caregiver can follow through on these and other possible recommendations:

• Keep floors clear and reduce clutter.
• Ensure that floors are clean and not waxed.
• Use non-skid throw rugs.
• Install handrails or grab bars in stairways or bathrooms.
• Make sure the home is well lit.
• Use a sturdy step stool or ladder to reach high places.
• Excellent do-it-yourself fall prevention information can often be found on Web sites of state or local health departments, and through local or regional fall prevention coalitions.

Balance programs can help to change the lives of patients and allow them to live more independently at home.  A Florida woman resumed her walking regimen and said that her life was worth living again.  An 87-year-old pharmacist was able to return to work.  Even a 100-year-old Hurricane Katrina survivor was made mobile enough to return to relatives in New Orleans. These new balance therapies can also help to reduce stress for caregivers and help them sleep at night, knowing that an older relative is safe from fall injuries that could send them to the hospital – or worse.

The message is clear:  there’s no reason for patients or their caregivers to suffer from a fear of falling when solutions are just a phone call away.

 

Steven Allred, MS,PT, is Assistant Vice President, Neurological Specialties, for Gentiva Health Services, Inc.  Jennifer Ellis, MS,PT, is National Specialist for Gentiva Safe Strides, a home-based balance therapy program.

 

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