Senior citizens face huge health crisis due to falls

One February night in 1999, Joan Robb rose from her bed to visit the bathroom.

In the dark, her foot tangled in a quilt.

“I went down,” said Robb, now 89. “I heard a crack.”

Robb’s left hip was broken.

“I finally woke my husband up a half-hour later and he said, ‘I’ll call a cab.’ I said, ‘You don’t call a cab at midnight. You call 911.’ And then, with the pain, I don’t remember much after that.”

Robb, of Lake Oswego, Ore., had slipped into one of the biggest health crises facing older adults. Falls kill dozens of people 65 and older in the United States each day. And though recent research shows people can do much to avoid falls, doctors say many don’t think about their risk until after a first fall, when they face a struggle to regain their health and mobility.

“People don’t understand how dangerous these falls can be,” said Dr. Owen Black, an expert on balance problems with Legacy Health System in Portland.

Falls kill more than 15,000 U.S. residents a year, including almost 12,000 ages 65 and older. That’s a higher toll than more dramatic and publicized deaths from drownings, fires or poisonings.

More commonly, falls inflict serious, nonfatal injuries, as happened recently to Oregon Sen. Mark Hatfield and Cuban dictator Fidel Castro. The U.S. Centers for Disease Control estimates that emergency rooms treated 7.4 million falling injuries in 2001, more than 1.6 million of them in senior citizens.

Those numbers are rising with the aging population. Older people are both more likely to trip and more likely to be killed or injured when they fall, said Rachel Rosenberg, an Oregon Health and Science University injury prevention expert. She cited studies that estimate a third of adults older than 65 living independently will fall each year, rising to half of adults 80 and older.

As people grow older, age-related vision problems, including cataracts, glaucoma and presbyopia, contribute to many falls.

Older diabetics are prone to nerve damage that can limit information from the feet and legs, hampering balance.

And problems with intricate balance-sensing systems in the inner ear may affect as many as half of adults older than 55, Black said.

Muscle and bone strength also decline with age, causing problems. Osteoporosis contributes to serious falls, though there is a “chicken and egg” question about its role, said Dr. Lucien Kavan, a retired physician who has broken both his hips. Some think that osteoporosis makes bones break spontaneously, causing falls. Others think it simply makes breaks more likely when people fall.

Weaker muscles, meanwhile, make it hard for people to recover their footing when they start to slip, said Marjorie Woollacott, a balance expert who leads the University of Oregon’s Department of Human Physiology. Also, she said, “we have slower reaction times as we get older.”

Strangely, a fear of falling can also make falling more probable, said Susan Pesznecker, a research nurse who works with Black at Legacy. People who fear falling often avoid moving around, which leaves them weaker and less coordinated.

Staying active is one of several habits that can significantly reduce the risk of falling, research shows. Rosenberg said studies, including one of her own, show that moderate, weight-bearing exercise – such as walking – improves balance.

When prevention fails, doctors said good treatment for injuries sustained in a fall is crucial. People who have limited mobility after falls fare far worse than others. A vicious cycle can form where someone who has fallen moves less, grows weaker and is more prone to fall again.

That’s one reason doctors almost always operate to repair broken hips, even in very old and sick patients, said Dr. Thomas Ellis, an OHSU orthopedist. Restoring even limited mobility makes a big difference in survival, he said.

As many as a third of seniors who break a hip die within a year, studies show. Doctors don’t know just why hip fractures are so deadly, but the risks extend beyond the broken bone and last for as much as a year after the fracture, Ellis said.

“It’s a whole-body insult,” Ellis said. After a hip breaks, he said, patients “have problems with delirium, they have problems with urinary tract infections. If they’re not able to move well, they have problems with bed sores.”

After Robb broke her hip in 1999, she went through surgery, therapy and months using a walker. She did not return to live in Lake Oswego, instead moving to an apartment in a Portland assisted living center. Eighteen months later, she broke her right hip, needing more surgery and therapy.

But today, Robb moves around her apartment with no assistance, using a cane only for longer walks.

“I was very lucky,” Robb said. “I came out of it fine. But when I hear someone break a hip, I think, ‘Oh, boy.’ Because you might not come out of it.”