What Causes Falls In the Elderly
The Caring Generation® – Episode 33 April 8, 2020 On this caregiver radio program Pamela D. Wilson, caregiving expert, talks about injury prevention and answers the question What Causes Falls in the Elderly? Guest Dr. Michele Bedard-Gilligan, Associate Professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington, talks about PTSD and caregiving relationships.
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What Causes Falls In the Elderly Radio Show Transcript
00:04 Announcer: Caregiving can sometimes feel like an impossible struggle. Caregivers may be torn between taking care of loved ones and trying to maintain balance in life. The good news is that it doesn’t have to be that way. The Caring Generation with host Pamela D. Wilson is here to focus on the conversation of caring. You’re not alone. In fact, you’re in exactly the right place to share stories and learn tips and resources to help you and your loved ones. So now, please welcome the host of The Caring Generation, Pamela D. Wilson.
00:45 Pamela D. Wilson: This is Pamela D. Wilson, caregiving expert. I’m your host. You’re listening to The Caring Generation radio program, coming to you live from the BBM Global Network, Channel 100, and TuneIn Radio. The Caring Generation focuses on conversations about health, well-being, caring for ourselves, and loved ones all tied together with a little humor and laughter that are essential to being a caregiver. Our topic for this radio show is what causes falls in the elderly. Let’s set the stage for the idea of injury prevention with fall statistics in the elderly who, in the research, are considered to be anybody over the age of 65. Answering the question of the most common injury in elderly, which is falls, is essential for caregivers so that you can take steps toward injury prevention. Knowing what causes falls in the elderly is basic knowledge to help you and your elderly parents so that they can stay living in their homes.
Caring for Aging Parents By Avoiding Falls, Fractures, and Nursing Homes
01:47 Pamela D. Wilson: According to the Center for Disease Control, the CDC, you’ve probably heard a lot about them in the news these days, falls are the number seven cause of death for the elderly. Research by the American Geriatric Society confirms that 33% of people over age 65 fall every year. This number rises dramatically to 40% over age 75. If we take this one step further, the National Center for Health Statistics confirms that elderly who use a cane or a walker are 11 times more likely to fall than an elderly person who does not use a cane or a walker because they are more physically weak. Falls are a major concern for caregivers, as is managing the health of elderly parents.
02:36 Pamela D. Wilson: Our guest for this program is Dr. Michele Bedard-Gilligan. She is Associate Professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington. She is affiliated with Trauma Recovery Innovations and the Center for the Study for Health and Risk Behaviors at the University of Washington. Her primary focus is PTSD and recovery from trauma. We’ll be talking about how trauma and traumatic situations affect family caregivers and care receivers, including all of this trauma related to the coronavirus. Do we visit our parents? Do we not visit our parents? What exactly should we be doing? These statistics that we’ve been talking about, the 33% of people over 65 and the 40% over age 75, return us back to that discussion of what causes falls in the elderly.
03:30 Pamela D. Wilson: The obvious but rarely admitted factor is a lack of physical activity that is present in all ages, not only the elderly. Few more statistics from the US Department of Health and Human Services confirms that less than 5% of adults participate in 30 minutes of physical activity each day. Only one in three, about 33% of adults receive the recommended amount of physical activity every week. More than 80% of adults do not meet the guidelines for both aerobic and muscle-strengthening exercises, which means that only 20% of adults meet the guidelines. We need to raise those numbers. Looking at these numbers confirms that being physically inactive and having weak muscle strength is one of the answers to why do elderly parents fall? What causes falls in the elderly?
04:25 Pamela D. Wilson: Let’s talk about injury prevention and how you can notice if a fall is going to be one of the most common injuries for elderly parents or family members. Is a lack of physical activity a concern for your parents? Do your parents worry, or are they afraid of falling? Have one or both of your parents fallen in the past year? More than 50% of older persons who have a fall; they don’t tell their doctor. They would never admit it to their children. Are your parents able to stand up steadily from a chair, or do they rock back and forth trying to get some momentum to stand up out of that chair? Do your parents rely on the arms of that chair to push up to stand? When they walk around the house, are they holding on to furniture or trying to hold on and balance against the walls with their hands? Are they physically unsteady? A yes to one or more of these questions confirms that the most common injury in an elderly is likely to happen to your parent. Let’s talk about a few simple tests. These are actually exercises you can complete and then ask your elderly parents to complete. These will indicate the level of physical weakness that may exist. Are you ready?
05:41 Pamela D. Wilson: The first injury prevention exercise is called the chair stand, and you can actually do this while you’re listening. If you have a hard chair around without arms like a kitchen chair or a dining room chair, walk over to that chair. Sit down, and then you want to lean forward and stand without using your arms to push up off the chair. That takes a little bit of balance and some leg strength. Is that exercise easy, or is it difficult? Being unable to do that exercise 10 or 15 times in a row answers the question of what causes falls in the elderly. If you or an elderly parent has difficulty with the chair stand, keep practicing until you can do a full set of 15 repetitions consistently and easily. That exercise supports injury prevention by strengthening your thighs and your butt muscles. Warning though, do consult a doctor if you or a parent has had any type of physical injury or health issue that might cause further injuries from doing any type of exercise.
06:42 Pamela D. Wilson: Another activity to avoid the most common injury in elderly parents is called a time up and go. Basically, an elderly parent begins in the same position as the chair stand by sitting on a hard chair with no arms. They stand up, walk 10 feet forward, return to the chair, and sit down. Same repetitions. Repeat that exercise until doing 10 to 15 repetitions becomes easy, and you want to be able to do it in about 10 to 15 seconds. Poor balance is another concern that answers the question of what causes falls in the elderly. Can you or your elderly parent stand on one leg with the other leg bent at the knee and balance? Can you balance for 30 seconds without tipping over? What about standing with one foot in front of the other? If any of these three activities are challenging to perform, you probably want to see a doctor and request a physical therapy evaluation and a full set of exercises so that your elderly parent can regain physical strength and balance as a step toward injury prevention and avoiding falls, as being that most common injury in the elderly.
07:51 Pamela D. Wilson: The idea of being physically weak and being unable to perform these simple exercises, is really the first answer with recommendations to answer that question of, “How do I prevent my elderly parent from falling?” Number two, for the most common injury in elderly, is visual and hearing loss. Visual problems may relate to normal visual loss. So not wearing eyeglasses–slipping, tripping, or stumbling–which are very common actions. And then beyond usual nearsightedness and farsightedness, we have other vision problems like macular degeneration, cataracts, and glaucoma that can affect walking and balance. We’ll talk more about these vision and other issues after this break coming up. Up next, we have Dr. Michele Bedard-Gilligan, Associate Professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington. She’s going to talk to us about how trauma and traumatic situations affect family caregivers and care receivers. This is Pamela D. Wilson on The Caring Generation live on the BBM Global Network, Channel 100, and TuneIn Radio. Stay with me. We’ll be right back after this break.
11:20 Pamela D. Wilson: This is Pamela D. Wilson, caregiving expert. I’m your host. You’re listening to The Caring Generation, coming to you live from the BBM Global Network, Channel 100, and TuneIn Radio. With us is Dr. Michele Bedard-Gilligan, Associate Professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington. We’re here to talk about trauma and traumatic situations for family caregivers. Dr. Bedard-Gilligan, welcome. Thank you for joining us.
11:46 Dr. Michele Bedard-Gilligan: Hi Pamela, thank you for having me.
11:49 Pamela D. Wilson: My pleasure. So let’s start by having you give some examples of the most common types of experiences that result in PTSD.
11:56 Dr. Michele Bedard-Gilligan: Yes, so the range of experiences that can result in post-traumatic stress disorder or PTSD is, it’s quite large actually. So it can be anything from natural disasters and accidents, to combat experiences, to experiences of violence like childhood abuse, sexual violence, domestic violence, or other types of physical assault. And I would say of those experiences that I just named, comes the interpersonal violence. So the ones that involve either sexual assault or sexual violence or physical assault or abuse, tend to be the ones that are most likely to lead to a post-traumatic stress disorder, but really any of those traumatic experiences can result in symptoms of PTSD.
12:38 Pamela D. Wilson: I’ve had clients who were involved in very traumatic car accidents, where they were injured. Others were killed. Children who suffered from child abuse. Parents who watched their children have accidents. How does all of that affect the daily life of people?
12:54 Dr. Michele Bedard-Gilligan: Yes, so traumatic events can have a wide range of negative consequences on individuals. And I should also say that most people who experience traumatic events are actually quite resilient. So, certainly, these kinds of experiences change somebody, but many people come through them okay. They figure out ways to cope, and they get support, and they actually move forward, and they really do okay in the world. But then for up to 50% of people, so up to about half, will develop longer-term symptoms or they develop symptoms that really impair their functioning.
13:30 Dr. Michele Bedard-Gilligan: And this can be anything from mood or anxiety symptoms, and from general distress-type symptoms to the symptoms that we think of as more specific to the PTSD diagnosis and those are really symptoms where the person kind of gets stuck on the traumatic events. So there’s lots of reliving of the experience. There’s lots of nightmares, kind of a flash backs, those kinds of symptoms. There might be things around kind of making sense of it in ways that’s really can be problematic, like blaming themselves or feeling like the world and everything is dangerous. Lots of kind of increased anxiety, physical symptoms. So breathing hard and feeling really on edge and then as well as avoidance symptom. So people can really start avoiding things that remind them of the trauma. Avoiding things that make them feel unsafe — so even if those things are kind of objectively safe –just because they’re so afraid of getting hurt again.
14:24 Dr. Michele Bedard-Gilligan: And so what ends up happening is people can suffer a great amount and also really end up kind of limiting their lives a lot. So their world can get very small. Where it can become very difficult to go out and do things and interact because it just feels really scary because of what happened to them. And so those are some of the most common ways when we see PTSD develop if that individuals are impacted.
14:46 Pamela D. Wilson: So when those people then are interacting with their family members, they’re experiencing all of this, and what can the family members do? How do they respond when somebody’s reliving these traumas? What can they do to kind of help?
15:00 Dr. Michele Bedard-Gilligan: Yeah, it’s really hard because you can imagine from some of the things that I just named, those are things that can really have a significant impact on relationships. Obviously, if you’re experiencing a lot of those things about feeling really on edge and scared all the time, or I’m avoiding things and not going out, so you might be isolating. Those are going to have negative impacts from the way you interact with important people in your life. And so we can see a lot of negative consequences to family relationships, romantic relationships, friendships, which can be really challenging. I think it can be really hard for people close to someone affected by these kind of symptoms to know how to help the person cope or how to help the person deal with these symptoms the best they can. And I think we do know that providing positive social support or for being a positive presence in someone’s life when they’re suffering from trauma-related symptoms is actually really important. It’s extremely protective.
15:50 Dr. Michele Bedard-Gilligan: And so I think when we have someone we care about who’s suffering from those symptoms, some of the things that we can do are really around kind of validating the way the person feels. Really trying your best to understand where they’re coming from and see their perspective on why it’s affecting them or how it’s affecting them, as well as certainly avoiding a kind of judgment or blame of the person in terms of why they’re so impacted by what happened to them or not holding them or communicating to them that you find them at fault for what happened to them. Those are kind of really important pieces. As well as encouraging the person to get help, if that’s indicated or to try and do things that would be good for them even if they feel scary. So encouraging the person to go out, even if it feels scary. Talking with them about how they could stay safe and go out so that they’re not so isolated or how they could do the things they used to do before the trauma happened and feel safe, to kind of encourage them to engage so that they don’t kind of isolate and get really stuck. But I think it’s really about being able to validate the person’s experience and, at the same time encouraging them to try to adapt and move forward.
17:01 Pamela D. Wilson: So here’s a situation. I’ve had adult children who are caregivers who come to me and say, “My parent abused me when I was a child, and now they need care, and there’s nobody else, and I have to do this.” How do they put themselves back in a situation with a person who abused them when they were a child?
17:17 Dr. Michele Bedard-Gilligan: Yes, that’s a really hard one. That’s a really challenging position to be in because the person obviously feels some sense of either obligation or it’s within their values to want to provide this care for this person despite the negative experiences they’ve had. And so it’s really difficult, and I think everybody’s going to handle that one a little bit differently. [chuckle] I think getting support around it can often be really helpful. So making sure that you are getting the support you need if you have to put yourself in that situation each day to care for this person who has hurt you in the past, as well as really trying to figure out where do things stand now? So someone who was abused as a child, that’s a really different dynamic than now being an adult caregiver of that person. Everything has shifted in terms of power and in terms of who has influence over what’s happening. And so it’s not the exact same situation you’re going back into, and so really trying to see it from that different perspective of now being a grown-up and having a lot more choices about what you give, what boundaries you set, and so forth.
18:22 Pamela D. Wilson: Perfect. Thank you for that answer. We will continue our conversation with Dr. Michele Bedard-Gilligan after this break. Helpful information for caregivers and aging adults is on my website at www.PamelaDWilson.com. This is Pamela D. Wilson, your host for The Caring Generation, live on the BBM Global Network, channel 100, and TuneIn Radio. Stay with me. We’ll be right back.
21:01 Pamela D. Wilson: This is Pamela D Wilson, caregiving expert, and your host. You’re listening to The Caring Generation Radio Program for caregivers, and aging adults coming to you live from the BBM Global Network Channel 100 and TuneIn Radio. Let’s continue our conversation with Dr. Michelle Bedard-Gilligan. So Dr, let’s talk about the coronavirus. A lot of caregivers are worried about going to see their elderly parents because they might give them the coronavirus, or they’re worried their parents are going to get sick. What advice do you have around this for children who are caregivers?
21:34 Dr. Michele Bedard-Gilligan: This is a really challenging one. It’s a really challenging time for all of us right now. I mean, we’re all being exposed to this pretty high-level stressor, and that’s somewhat chronic, right? I mean, it’s already persisted for quite a while, and it seems like it’s going to continue to persist for quite some time. And so we’re sort of all living in this elevated state of stress and anxiety around a lot of things, and for people who are interacting with really vulnerable individuals like elderly for example or anyone else who’s immune-compromised in some way, that stress is certainly even more high and intense. So yeah, I’m hearing that a lot too around people who are really concerned about how they can interact safely with either the elderly in their lives or other people in their life to need care for one reason or another.
22:22 Dr. Michele Bedard-Gilligan: And I think it’s really a challenge because we know that, so like I said earlier, social support is so important to our mental health and feeling connected to people is so important, and that can have effects on physical health as well. So we want to make sure that we do stay connected but that we keep people as safe as possible and so I think it’s really about trying to approach it with as much rationality as we can, and we really look at relatives and actual risk in terms of how likely it is that we could make somebody sick by visiting them or what are the best practices to decrease as much as we possibly can. But the reality is if it’s between providing care and not, then we might have to do something that’s more risky than we would like, and there may not be anything we can do about that. So it’s about just knowing, controlling the things we can. Following the best practices and the guidance whenever it’s out there and just doing what we can to minimize that risk and having to be okay with sort of tolerating that uncertainty, of really not knowing but also making the best kind of choices and decisions we can.
23:35 Pamela D. Wilson: And before, before the last break, we were talking about children who were abused by parents and getting back into that situation. So in situations where there’s a person who had trauma, is there group counseling or group counseling for both, or what can those children do or what can anybody do who’s experienced trauma, who needs a little bit of help?
23:54 Dr. Michele Bedard-Gilligan: Yeah, it’s a great, a great question. I mean, I would say there is great treatment options out there for people who are suffering from trauma-related symptoms. Sometimes they’re delivered in group format, but often they’re delivered individually. We have medications that work really well for managing symptoms, but we actually have therapies that work even better. So there are generally tend to be short-term therapies which surprises a lot of people, but we have some pretty effective what we call cognitive behavioral therapies that can treat symptoms of PTSD and other trauma-related symptoms and just three to four months of individual therapy working with someone and the effects are really strong, and many people who go through these therapies get significantly better, and for individuals who are in the situation you previously described right before the break of having to care for someone who maybe was abusive to them. These kinds of therapies and these kinds of treatments are highly recommended because you have to take care of yourself before you can effectively take care of somebody else, and so I think really knowing your own limits and reaching out for support and help is a big piece of that.
24:58 Dr. Michele Bedard-Gilligan: And like I said, fortunately these treatments exist, and they’re out there, and they do highly encourage people who are suffering from trauma-related symptoms to really look into what options they can find to help them manage that and recover because many people who go through these treatments really do recover. Their symptoms get significantly better, and they stay better for a long period of time.
25:19 Pamela D. Wilson: Well, and thank you for mentioning the fact that caregivers have to take care of themselves because so many times they don’t, and they become the ones that become sick. So let’s say that I’m listening to this and I’m thinking oh, counseling. I don’t know. Maybe I’m embarrassed to go talk to a counselor. Maybe I can’t afford it. What can they do? Does insurance work with counseling, or what can they do if they’re afraid to take that first step?
25:39 Dr. Michele Bedard-Gilligan: Yeah, insurance does usually work. So insurance does usually pay for some kind of therapy. And like I said, these treatments are short-term, and so that’s good because often there’s a limit on how many sessions the insurance will cover or something like that, but something we can do in a relatively short amount of time. But for some people, insurance is not an option, or even the co-pay that comes with an insurance is not an option, and so there will be times where professional help is not an option. Sometimes, there’s free resources and communities that people can find for professional help. But in the absence of that, I do think there’s some self-help things people can do. So I think there’s some, believe it or not, apps out there for iPhones and Android phones that can talk about managing symptoms, trauma-related symptoms, and PTSD, and there’s things on the web and the Internet. There’s self-help books out there, and they all sort of kind of suggest some similar things around finding supportive people to help you kind of process what happened. Supportive people to keep you going and kind of encourage you to do things even if they feel scary or difficult to approach.
26:43 Dr. Michele Bedard-Gilligan: People who either by yourself or with people that are close with you that you can talk to about the ways the trauma has affected how you make sense of the world. The ways you can maybe shift your thinking if you’re blaming yourself or if you’re thinking everybody’s dangerous and no one can be trusted. Ways you might be able to help train yourself to think differently than that, to be a little more balanced and to see that some people are dangerous, but not everybody, right? And so being able to sort of shift kind of the thinking, and the behavior pattern is kind of what we recommend. In addition, there’s some anxiety management strategies that people can do as well, so reading techniques, mindful techniques. And those can be things that really can help us get through those acute moments of anxiety or fear that can often be triggered in people who have trauma symptoms.
27:30 Pamela D. Wilson: Fabulous. Thank you so much for joining us. Listeners, that was Dr. Bedard-Gilligan. She talked to us about caregiving trauma. Please do share this interview with your family members, especially if you’re feeling anxious these days about the coronavirus, or you’re just trying to figure out how to get over anxiety and taking care of your loved ones. Up next, we’re going to have more on this subject of what causes falls in the elderly. You can follow me on Facebook, watch my videos, share my posts, my page is PamelaDWilson.page. On Twitter, I am Caregivingspeak, on Instagram, I am Wilson Pamela D, and on LinkedIn, I am Pamela D. Wilson, Caregiver Expert. This is Pamela D. Wilson, your host. You’re listening to The Caring Generation, live on the BBM Global Network, channel 100, and TuneIn Radio. Stay with me, we’ll be right back after this break.
30:33 Pamela D. Wilson: This is Pamela D. Wilson, caregiving expert. I’m your host. You’re listening to The Caring Generation radio program for caregivers and aging adults, coming to you live from the BBM Global Network, channel 100, and TuneIn Radio. The Caring Generation is the place for tips about health, well-being, and caregiving. Let’s return to our conversation of the number two issue of what causes falls in the elderly. At the end of the first segment, we were talking about falls being related to physical weakness and poor vision. We talked a little bit about macular degeneration and glaucoma. Cataracts are another concern for injury prevention. If someone has cataracts, their vision may look foggy, filmy, or cloudy. A lot of elderly actually have successful cataract surgery that resolves these vision concerns, and they tell me it’s like magic. Like one day, they couldn’t see, and the next day, they can see everything. Regular eye exams with dilation or the use of a piece of equipment, it’s called an Optomap, that can allow your eye doctor to complete a more thorough examination to see if you have any vision problems that are more likely to contribute to a fall. Hearing exams are another important component of injury prevention for the elderly. Research from the Johns Hopkins School of Medicine and Luigi Ferrucci from the National Institute on Aging, they confirm that hearing loss significantly increases falls in the elderly.
32:02 Pamela D. Wilson: There is this vestibular function associated with the ear that helps you hear things from all around your head, and you can, it helps you navigate. Also, issues with the ear can result in balance issues, motion issues, and difficulty with spatial orientation. So that’s like seeing the distance down a curb, feeling that you’re getting close to a wall or something else. Wearing hearing aids can actually reduce fall risk. The number three issue of what causes falls in the elderly relates to one of our favorite subjects. Elderly parents being told that they should use a cane or a walker and refusing to use the equipment. Earlier I mentioned that research confirms that elderly who use a cane or a walker, they are 11 times more likely to fall than an older adult who doesn’t use that cane or walker. Now that seems to be contradictory, but it’s really not because falls for people who use canes and walkers happen for a couple of reasons. The most common injury in the elderly falls is associated with incorrect use of canes and walkers because you can go out and purchase a cane or a walker at a Walgreens or a drug store, and you don’t get any instruction from a physical therapist on how to properly use that equipment.
33:21 Pamela D. Wilson: How many older people do you see in public who I call it walker chasing? They appear to be chasing the walker. This chasing is a body position where the older person is leaning forward, and their arms are outstretched, and that walker is one to two feet in front of their body. So that body position of leaning forward and chasing a walker increases the likelihood of a fall because the walker is going to go forward, and they’re going to go down. If you can imagine like you’re out walking your dog. Untrained dogs walk in front of their owner. They’re pulling the leash. They’re pulling the owner. But a well-trained dog walks at the side of the owner with a loose leash. That’s the proper stance. The proper stance for using a walker has the walker frame in a position where the person’s body is in the middle. So the walker’s on the left, the front and the right. They lift the walker, or they roll it forward, and then they take a step inside the walker so that their body is supported by that walker.
34:16 Pamela D. Wilson: Using a cane also has a process to support injury prevention. If you can imagine, you hold the cane in your good hand on the good side of the body so that using the cane provides support to the other side, which is weak. You take a step with the bad leg, and you move the cane forward at the same time. You can lean your weight on the cane, and then in addition to all of this, if you’re not using the walkers and the canes right, you are not getting good physical activity. Your muscles are not strengthening. You still have poor balance. You’re more likely to fall, 11 times more likely to fall. The number four reason for what causes falls in the elderly is rushing to go to the bathroom. The most common injury in the elderly, it results from people who all of a sudden realize that it’s time to go, they get up, they rush, they trip on a rug, they trip over their walker. Elderly parents go to the bathroom quite frequently.
35:13 Pamela D. Wilson: Sometimes they experience what’s called urging continence, which means I have to go now because they have an overactive bladder. So one solution for that is to just go on a regular basis. So every two hours, so that elderly parents don’t have to rush. They don’t have to increase the likelihood of a fall. Other solutions, especially at night time, is the use of a bedside commode so that if they do have to get up from the bed, they’re walking two feet and then being able to use the commode there. A lot of my older clients would constantly complain about having to get up from a chair to go use the bathroom. So you know what would happen? They would avoid drinking liquids. That is two problems. So first of all, walking to the bathroom is physical exercise. It’s good for our elderly parents, and if they walked more, we wouldn’t have these full issues. The other problem with not drinking water and to avoid not having to go to the bathroom, elderly parents become dehydrated. They also, because of that, come down with urinary tract infections. Dehydration and a urinary tract infection, you put those together, and you’ve got a lot of confusion, mental disorientation, and they usually end up in the hospital emergency room, which is where they don’t want to go. So walk, drink, stay hydrated.
36:28 Pamela D. Wilson: The number five reason to support injury prevention is a diagnosis of chronic disease. So we’ve talked about chronic disease before. It’s heart disease, diabetes, arthritis, dementia, Parkinson’s disease, things like that. They have far-reaching effects on the body that we’ll talk as we go through numbers five through 10 of what causes falls in the elderly. Heart disease can result in poor circulation. The veins and arteries and your legs hurt, it makes walking and standing painful, so there’s less physical activity. You lose muscle strength. You have poor balance. People diagnosed with Parkinson’s have gait and walking issues that result in slipping, tripping, and stumbling. Number six are environmental factors. You’re walking outside. You’re going up and down curbs. You’re getting in and out of the car. Tripping on uneven sidewalks. You trip over a rock. Injury prevention also involves vision — so you may not see a curb — you may not see an uneven surface — you may trip in the home. Injuries happen everywhere, not just in the home. They happen out in public.
37:34 Pamela D. Wilson: In the house, you want to remove loose rugs. Get rid of electrical cords. Put night lights in so that you can see the house more easily when you’re getting up and going around at night. Other things in the bathroom like raised toilet seats, grab bars, shower seats, handheld showerheads, all of those very simple things are more likely to reduce falls. We will continue talking about tips seven to ten after this break. You can listen to podcast replays of The Caring Generation on your favorite apps, Apple, Google, Spotify, Spreaker, Stitcher, Pandora, Castbox, SoundCloud, Amazon Alexa, and more. My goal is to make The Caring Generation available to you wherever you are. This is Pamela D. Wilson, caregiving expert. I’m your host. You’re listening to The Caring Generation live from the BBM Global Network channel 100 and TuneIn Radio. Stay with me. We’ll be right back.
40:37 Pamela D. Wilson: This is Pamela D. Wilson, caregiving expert. This is The Caring Generation, coming to you live from the BBM Global Network, channel 100 and TuneIn Radio. Share The Caring Generation, one, for people you know, are caregivers looking for hope, help, and support, that is here on The Caring Generation every Wednesday, and in the podcast and transcripts on my website at www.PamelaDWilson.com. Let’s continue talking about what causes falls in the elderly.
41:03 Pamela D. Wilson: The seventh topic relating to the most common injury in the elderly is the fear of falling and depression that relates to that. For the elderly who have fallen, research confirms that 25% to 50%, almost half of them, restrict their physical activity, which has the opposite effect. Low physical activity results in worse balance, poor gait, less ability to walk, no muscle strength, they get tired more frequently, and more physical issues, more health issues.
41:36 Pamela D. Wilson: Injury prevention steps for regaining confidence in physical abilities and safety cannot be underestimated in anyone who is falling. Go out and walk with your elderly parents, especially if they have no one to walk with. They can become more anxious, more worried, more depressed. And then, the effects of that depression translate into more problems. They can’t sleep at night, they have a poor appetite that results in poor nutrition. They’re losing weight. Then, you’ve got doctors throwing around all of these medical-speak terms like failure to thrive and geriatric syndrome. Those are used by physicians, but they’re mainly associated with weight loss, physical frailty, poor nutrition, and then the spiraling effects of all of those added up together. Answering what causes falls in the elderly does include depression and anxiety, and that can be associated with cognitive deficits.
42:30 Pamela D. Wilson: So a cognitive deficit is a medical-speak term that means less attention. So reduced attention span and what’s called poor executive function. And that is just having difficulty organizing things and processing things, which, processing speed for our brains, is the time that it takes us to perform a task that we have to recall how to do something. So, maybe you’re recalling how to make a recipe, or you’re driving somewhere, and you’re thinking, “Okay, I turn right here, and I turn left there.” So it’s kind of just how our brains work. But when our brain is more stressed to perform a task, sometimes we are less attentive. And especially in an older person who’s trying to think and they’re trying to walk at the same time, that can turn into a cycle of falling. Because they’re trying to do two things at once. And when we’re older, that’s a little more difficult.
43:20 Pamela D. Wilson: Let’s talk about the eighth topic that relates to the most common injury in the elderly. It’s, believe it or not, our feet. What are our feet like and the state and care of our feet? This might seem obvious. But many of us don’t give a lot of credit to our feet. We don’t give them a lot of attention. Our feet carry our entire body weight, and they’re the mechanical part of the body that gets us around, a lot like a car has mechanical parts, and that car drives us around. Identifying foot pain for your elderly parents, managing foot numbness, and having really good walking shoes help with injury prevention to reduce falls. Research from another study, it’s called the Framingham Foot Study, indicates that 24% to 30% of older adults have foot pain, aching, or stiffness. You might not realize this, but just like our body has a posture, where we’re standing upright or bending forward or backwards or we lean to one side, our feet have what’s called foot posture. Answering the question of what causes falls in the elderly relates to poor foot posture. Which is how your foot is aligned. Your feet actually align your leg, your pelvis, and your back. So, for example, if you have a normal foot posture, that is good.
44:33 Pamela D. Wilson: Pronated posture means that your foot rolls inward, and it can result in arch pain. There’s another term called supinated foot posture. Which means that your foot rolls out with an elevated arch. If you have ever rolled your ankle by stepping off a step or a curb, I have done that. It is so painful. You know how painful that rolling your angle is to your foot, and then you have difficulty walking because your feet hurt. Body weight is another factor in foot, knee, hip, and back pain. If we have excess body weight, that can make performing physical tasks more difficult, and sometimes it just hurts to stand on our feet. How many of you remember our discussion in the first part of the show, about those measures to determine physical weakness, and balance concerns? Those were the chair stand exercise and the timed up and go exercise. If your parents have foot pain, moderate or severe pain, they will have difficulty performing those exercises. So when you do those for yourself, measure yourself, see if you have any foot pain.
45:34 Pamela D. Wilson: When you do the exercises with your elderly parents, you’re watching for physical weakness and weak muscles but also ask them if their feet hurt. Look at what kind of shoes they’re wearing. A lot of elderly parents wear slippers around the house, and they don’t have really good shoes to wear when they go out. Part of the foot pain issue to resolve that is requesting a specialty medical appointment to see a podiatrist, who can identify foot pain and address injury prevention for that most common injury in the elderly, which is falls. There’s another less known specialty that relates to physical medicine and physical rehabilitation, it is called a physiatrist.
46:12 Pamela D. Wilson: Chronic diseases can also contribute to foot pain. So people with diabetes can experience neuropathy, and that is a medical speak term for numbness. So people with diabetes will have numbness in their feet, their toes, their legs, other body parts. Imagine you’re trying to walk, and you can’t feel your feet. So you can’t feel your feet touch the ground. So much easier to trip. There are special diabetic shoes available for people with diabetes. There are shoe stores for people who have low arches, high arches, uneven leg lengths, hammertoes or other foot issues, and people who have poor posture. The difference between wearing a really good pair of shoes and a bad pair of shoes; it feels like you’re walking on a pillow or rocks that cause your feet pain. Don’t neglect your feet. They are another answer to what causes falls in the elderly. Dry skin on your feet can also result in issues with skin and wounds.
47:04 Pamela D. Wilson: Again, it’s very common in people who are diagnosed with diabetes, dry or skin thin is another issue in the elderly. You can go out and get those fragrance-free lotions like Cetaphil. If your parent is diabetic, there are special skin products made by CeraVe and Gold Bond, special foot creams. Good shoes and socks are injury prevention tactics to avoid more falls. And while you might think, those shoes are expensive. They are what get you around. They are what make your feet feel better, and honestly, if you pay a little more for a pair of shoes, they probably will last longer. There are also special socks if you have ankles that swell, special socks for diabetes, ankle swelling, and neuropathy that you can get. You can find a lot of those online. After this break, we’re going to talk about topics nine and ten for what causes falls in the elderly. Two more ideas that are not commonly investigated unless you as the caregiver for an elderly parent mention these to your doctor. Please share The Caring Generation and my website www.PamelaDWilson.com with your family and friends. This is Pamela D. Wilson, your host. This is The Caring Generation live from the BBM global network channel 100 in TuneIn radio. Stay with me. We’ll be right back.
51:26 Pamela D. Wilson: This is Pamela D Wilson, caregiving expert. I’m your host. This is The Caring Generation Radio Program for caregivers, and aging adults live on the BBM Global Network Channel 100 and TuneIn Radio. Visit my website www.PamelaDWilson.com for podcasts of all The Caring Generation shows. Check out my caregiver library of articles and visit Caregiving TV on my YouTube Channel. We’re back answering the question of what causes falls in the elderly.
51:53 Pamela D. Wilson: The number nine most common injury in elderly happens because of a vitamin D deficiency. According to research in today’s geriatric medicine, vitamin D is an injury prevention factor that reduces the risk of falls in older adults by improving muscle strength and function. Studies combining results have shown that individuals taking 700 to 1000 IUs of vitamin D each day have an approximate 20% reduction in falls. But before you decide to go up and load on vitamin D, see your doctor, have a full panel of blood work drawn to see if you’re low in vitamin D and how much you should take and make sure there’s nothing else going on. There are also other medications for people with low bone density, which is osteoporosis. A lot of women have that. Osteoporosis can increase the risk of a fracture when you fall. Seeing a doctor for a full check-up really is the answer to questions for elderly parents who are having balance issues and to answer that question of what causes falls in the elderly, fall risk can increase due to one or more of the factors that we’ve talked about during this program and other factors that exist that we haven’t even gotten to.
53:06 Pamela D. Wilson: The number 10 and I say number 10 because these are not presented in order. Any more or one of these issues could be the number one cause for the most common injury in the elderly, a fall for your parents. Let’s talk about blood pressure. There’s a term called orthostatic blood pressure, and that is a medical speak term that describes a change in blood pressure that results from a change in posture. So let’s say your parent sits all day and they stand up and when they stand up they’re starting to feel dizzy or light-headed or faint. That could be orthostatic blood pressure. It could also be a balance issue or an ear issue. But if you are an elderly parent, and notice that you feel dizzy or light-headed or faint when you stand, you might have orthostatic hypotension or another condition. Your doctor can test for that, and he can also test for inner ear issues. So things like dizziness, it’s called paroxysmal positional vertigo, it’s abbreviated BPPV, and that type of vertigo actually begins in middle age and it just kind of happens one day.
54:15 Pamela D. Wilson: The explanation of that is that crystals in our ears become imbalanced and so we turn our head one way and all of a sudden everything is spinning and that dizziness is like if you’ve ever had a little bit too much to drink one day and you’re having the spins, that BPPV vertigo feels like that. You feel like everything is spinning in front of you, and it’s nauseating, and you get really dizzy. So all of these issues for dizziness, go see an ear, nose, throat doctor. See your primary care doctor, make sure that you’re getting medical care because you don’t want to have a fall for an elderly parent that breaks a hip, you have a fracture then you’ve got way more issues to deal with.
54:53 Pamela D. Wilson: Next week, we’re going to talk about spousal caregiving and caregiver resentment. That is a request of our show listener. I thank you so much for being proactive and interested in caregiving, aging, and health and well-being. Share The Caring Generation with your family, your friends, your social groups, your workplaces and everybody so that we can make caregiving something that we talk about, podcasts of The Caring Generation are on my website at www.PamelaDWilson.com and all of your favorite sites, Apple, Google, Spreaker and others.
55:26 Pamela D. Wilson: Thank you so much for joining me on The Caring Generation Radio Program for caregivers and aging adults coming to you live from the BBM Global Network Channel 100 and TuneIn Radio. I am Pamela D Wilson, caregiving expert advocate, and speaker, join me on The Caring Generation next Wednesday evening. Invite your friends and family members to join us. God bless you all, sleep well tonight, and have a fabulous day tomorrow and a great week until we are together again.
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