Independence and Safety – A Delicate Balance (Part 2 of 2)

A 79 year old woman named Kay was afflicted with some arthritis in her knees, but was generally in good health and enjoyed her daily walks and traveling.

On a recent trip overseas last year, she missed a step and lost her footing. She could no longer stand; and with that misstep, Kay suffered multiple fractures of her pelvis.

The changes would profoundly alter her life.

In 2012, over 2.4 million Americans 65 and older were treated in emergency rooms as a result of falls. 201,000 Americans over 65 died as the result of falls between the years 2002-2012.

Death occurs within a year for twenty-five percent of older people who fracture their hip as a result of a fall. Debilitation is the fate for many other individuals, leaving them unable to walk any distance and profoundly affecting their way of life. Older adults who are in generally good health and who exercise experience better outcomes than those who are sick or frail.

Post-fall, individuals experience a loss of independence, reliance on caregivers and a heightened fear of falling. Their peers may also become fearful, knowing that they could be next.

Kay’s risk factors, which are common in many people over 65, included issues with balance, arthritis and previous falls. She had fallen previously during a trip to Europe, then fell twice more after that, but she had no lasting injuries from the falls….yet.

“Yet” is the most dangerous word in the English language.

As we age, our vision, muscle strength and attention deteriorate. Something called “proprioception” declines. This means that the body loses its ability “to know where it is in space.”  

Kay’s fall affected her independence, initially requiring her to live at her daughter’s home after her stay in a nursing home for rehabilitation, and finally, back to her apartment. Kay felt that things would go back to normal as soon as she was in a familiar place, surrounded by friends.

Kay initially soldiered through but realized that her recovery was proceeding much more slowly than she anticipated. Taking months to be able to move from using a wheelchair, then to a walker and then a cane was agonizingly slow in Kay’s eyes.

Kay spent more and more time in her apartment and was afraid of falling again. Her friends were more mobile than Kay; her isolation began when they did not come and visit as much as they had. Maneuvering her walker into the kitchen and then trying to bring the food into the dining room was too difficult so Kay ended up standing in the kitchen for her meals.   

A once vibrant and independent woman, Kay was indignant when her physical therapist told her that a harness would be necessary in order to practice walking outside. She felt her age and more, and lost her sparkly personality. Physically, Kay developed a compressed nerve as a result of the fall. The Vicodin which Kay was prescribed for pain left her on the chair, drooling and unconscious. If her daughter hadn’t come to visit Kay might have died.

It took at least six months for Kay to recover from her fall, but it took so much out of her. She walked cautiously, sometimes making a face that indicated pain.

Forward another six months to the year after the fall. Kay is doing much better, still hesitating when faced with even a low curb, but is again enjoying her daily walks and planning a trip.

It’s best to take preventive measures to help prevent falls or at least lessen the severity if a fall does take place. Older adults can strengthen their body by participating in balance classes, tai chi, walking regularly and avoiding dehydration, a common cause of dizziness. 

Kay now lives with nerve pain in addition to her imbalance and arthritis.  Her daughter wonders if there will be another fall and another blow to her mother’s independence and dignity.  The collateral damage of a fall is widespread and affects not only older adults but family and friends.

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