Hold on tight: According to the National Council on Aging, falls are the
leading cause of fatal and nonfatal injuries for older Americans. Falls
threaten seniors’ safety and independence and generate enormous
economic and personal costs.
But there’s good news too. Experts say that evidence-based fall prevention
programs and practical lifestyle adjustments (Torrance Memorial Medical
Center has programs addressing both) can reduce your risk.
First, a few statistics from the U.S. Centers for Disease Control and Prevention (CDC):
1 in 4 Americans aged 65+ falls each year.
In 2014 older Americans experienced 29 million falls, causing 7 million injuries.
Every 11 seconds, an older adult is treated in the emergency department
(ED) for a fall.
Falls result in more than 2.8 million injuries being treated in emergency
departments annually, including more than 800,000 hospitalizations and
more than 27,000 deaths.
In 2015 the total cost of fall injuries was $50 billion. Medicare and Medicaid
shouldered 75% of these costs.
The financial toll for older adult falls is expected to increase as the
population ages and may reach $67.7 billion by 2020.
“Yes, it’s pretty much an epidemic,” says ED doctor Eric
Nakkim, MD, medical director of the Richard and Melanie Lundquist Emergency
Department at Torrance Memorial. “And as our population ages, it
continues to grow.”
Every single day, he says, “we see an older person in the ED who
comes in because of a fall. You might not notice [a rise] year to year.
But I’ve been working in the ED for 25 years, and it’s very
clear we are seeing more and more.”
The most common causes of falls are in the home and include tripping over
rugs and pets, getting up too quickly from a chair or bed and overall
weakness. “The problem,” Nakkim explains, “is gravity
never takes a break. Our whole life is a battle against it, and we have
to remember that as we get older.”
Many times falls are the first step in decline. An older person falls and
breaks a hip, the surgery itself is a risk, and recovery is a risk from
blood clots and infections. Then, says Nakkim, “Deconditioning advances
pretty quickly, and people literally stop moving. And pneumonia becomes a threat.
“In our younger lives we are always trying to lose weight,”
he continues, “But as you get older, you want to keep the weight
on. You need to stay active to stay strong and maintain that muscle mass.
The irony is that staying active can also put you at risk of falling,
so it’s important to engage in safe activities like tai chi and
The Prevention Rx
Torrance Memorial offers classes that can help you get stronger to prevent
falls, as well as practical consultations both in home and out, that doctors
like Nakkim are happy to recommend and prescribe. “It’s important
to work with family members and patients,” he says. “We talk
to them about using their walkers or canes—even at home—and
reducing clutter and moving deliberately. Don’t wear socks walking
on bare wood floors; don’t get distracted. We also look at the medications
they are taking, and if their blood pressure is too low. Most of the time
a fall could’ve been prevented.”
Prevention means getting stronger physically, improving balance and adjusting
your home to be safer. Physical therapist Julie Roukos is with the Torrance
Memorial Home Health Department and is part of a team that will go to
a patient’s house to evaluate and enhance its safety.
“Unfortunately usually we get a referral after a fall, but more doctors
are realizing when their patients might be a fall risk and will write
a prescription to get a consultation from us. We love when we can get
in before there is a fall,” says Roukos.
She sees the same hazards as Nakkim: slippery floors and throw rugs, animals
and leashes, not enough lighting and also she mentions polypharmacy. “When
people are taking a lot of different medication, it can do crazy things,” she says.
The Home Health Department uses a checklist that includes items such as
making sure your lamp is reachable from your bed, marking edges with bright
tape or paint, and taking time to sit and stand up slowly.
“It can be challenging to come into someone’s home and tell
them to change things, especially if the patient isn’t the one who
asked for us,” Roukos continues. “They usually don’t
mind changing things like throw rugs, but if I tell them they need a grab
bar, only about half will do it.”
Safety in Strength
Evidence-based fall prevention and balance improvement classes are offered
by the Torrance Memorial physical therapy department, a program Yolande
Mavity, PT, has helped build. “The fall prevention classes are for
anybody. They come in with their walkers, wheelchairs and canes, and it’s
a good place for a beginner,” she explains. “We present practical
solutions and segments on evidence-based methods to get you stronger and
improve your balance, with exercises like tai chi.”
The Balance, Endurance & Strength Training (BEST) classes are more
advanced, she says. “These are designed to improve your endurance
and strength as well as your balance. There are eight stations, and each
focuses on a different exercise that will help with impaired balance,
such as core stabilization station or strengthening your shoulders.”
And it doesn’t stop there. The Power Balance class is the most advanced,
using balance disks and boards. The occupational therapists and physical
therapists also do one-on-one evaluations by prescription, following the
CDC STEADI guidelines, which often leads to a class recommendation or
“The main problem when someone has taken a fall,” Mavity says,
“is it makes them fearful of falling again, and they stop moving—often
without really noticing it. It’s important to strengthen your muscles
and keep moving. A fear of falling makes you at risk for falling. We help
them improve their confidence.”
What First Responders Say
Alec Miller, assistant chief of Torrance Fire Department (TFD) and head
of the EMS division, confirms fall-related calls have increased. “We
get at least one every day,” he says.
Miller has additional tips: “Many times we get a call, arrive with
two paramedics, a four-person engine and usually a two-person ambulance,
and the door is locked. We are pretty good at getting access without causing
damage, but we also will check with neighbors to see if they have a key.
Good neighbors are great to have—they can be your best advocate.”
The TFD saw falls as such a concern that it has joined with Partners in
Care to present fall prevention programs at local hospitals and libraries.
“Our fall prevention class is called A Matter of Balance,”
“We didn’t anticipate a huge response, but we have a waiting
He says his crews will take time at the house to educate caregivers and
family about hazards and safety measure such as bed rails. New classes
are starting in October. For more information contact Christy Lau at Partners
in Care, 818-837-3775 x159.
Fall prevention could be one of the most important factors in improving
our lives as we age, yet it doesn’t get much attention, laments
Nakkim. “Because it’s not as glamorous as opioid overuse and
other injuries and conditions, it doesn’t get the discussion it
deserves. But we have to be diligent and also be aware of and accept our
limitations. Slow down and don’t try pushing so hard.”
Doctors and occupational and physical therapists at Torrance Memorial use
the STEADI fall risk assessment to incorporate fall prevention into their
care; you can download it for free. (cdc.gov/steadi)
Several balance training classes are taught at Torrance Memorial. You can
get a balance assessment and find the class most suited to your needs
by calling 310-517-4711, or view details at TorranceMemorial.org/classes.