Jane Bergen had fallen several times in her O’Fallon, Mo., home while trying to get items out of her closet or getting out of bed to go to the bathroom at night. She fell despite diligently doing her physical therapy and removing doors so her walker would fit.
A few years ago, Bergen, 83, had to have her lower left leg removed because of skin cancer complications. Her husband, Jack, 80, suffers with back problems. She hadn’t seriously been injured while falling, but she was worried.
“That’s my biggest fear for me and for Jack, because I know once I fall and break something at my age, I’m afraid we wouldn’t be able to stay here anymore,” Bergen said. She and her husband will mark 65 years of marriage in June. “One fall was going to do us in. One fall would be very drastic.”
Falls are among the leading causes of injury in people age 65 and older and the most significant threat to older adults’ ability to maintain independence. They can cause everything from minor cuts and bruises, to fractured or broken bones to serious — and potentially fatal — head injuries.
At least one-third to one-half of the population over 65 years of age will experience a fall, which accounts for more than 90 percent of the hip fractures suffered by older adults.
That’s why Bergen enlisted in a study at Washington University to teach her ways to more safely move about her home, outfitted her house with fall-prevention gadgets and removed potential hazards. She received special hinges that keep doors open and a stair lift to her basement. She rearranged items and placed a high chair in her kitchen to make it easier to help prepare dinner. She learned how to safely get in and out of the shower and use a tool to grasp items in hard-to-reach places. She streamlined her closet.
“When they came in with a whole new way of changing the surroundings in your home to fit your needs, it was like a godsend,” Bergen said.
The study, with funding from the U.S. Department of Housing and Urban Development, involves identifying each person’s abilities – such as vision, balance and strength – and environment. “Each design is tailored to each individual’s home and each set of unique risk factors a person may have,” said study author Susy Stark, assistant professor of occupational therapy, neurology and social work.
The first phase of the study finished last fall, and researchers determined the program can make a difference in preventing falls. The next phase is underway, testing whether the program can be implemented in the community. Researchers are partnering with the St. Louis Area Agency on Aging, which provides services such as meals, transportation and home repairs for older adults in the city. Anyone who receives services through the agency and is worried about falling can take part.
“Most falls occur in the home, so the home is a great place to intervene,” Stark said.
In 2013, 2.5 million nonfatal falls among older adults were treated in emergency departments in the U.S., and more than 734,000 of those patients required hospitalization, according to the Centers for Disease Control and Prevention.
Medical personnel expect to see more cases as the country’s population ages. The proportion of those age 65 and older is expected to peak in 2030, when 18.4 percent of the population will be in that age group, according to a University of Virginia study.
The death rate from falls among Missouri’s older adults has risen in recent years, according to a 2012 report by the Show Me Falls Free Missouri coalition, which formed in 2009 along with coalitions in several other states as an effort to raise awareness about fall prevention. Between 2000 and 2009, the fall death rate in Missouri nearly doubled from 30 to 73 deaths for each 100,000 people – much higher than the national rate of 48 in 2009.
Coalition member Helen Lach, a St. Louis University assistant nursing professor and researcher, said the coalition has since reached about 25,000 state residents with information on how to prevent falls, but 30 percent of older adults still report having fallen in the last year. “There’s been a lot of attention to this, but we are not seeing a big drop in the rate of falls,” Lach said. “We are making people aware, but we are not making that next step in making a difference.”
Lach and Stark said the biggest challenge is staying active. “The best intervention is exercise but older adults, like many, don’t comply with exercise guidelines,” Stark said. “So though, it’s the most effective intervention, they tend not to be adherent.”
Emma Harrington, director of injury prevention and education services at the Shepherd Center rehabilitation hospital in Atlanta, said the fear of falling causes many to avoid exercising, which creates a vicious cycle. “You start limiting your activities. You stop exercising or going out with friends. And that may make you more apt to fall because you’re weaker,” Harrington said. “Staying active is the No. 1 way to prevent falls.”
The Washington U. study is the first to implement a home intervention program through a social service delivery system, which could reduce barriers to participation.
“We would like to prevent all falls,” Stark said.
The Atlanta Journal-Constitution contributed to this report.
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