FALLS

held July 24, 2007

Falling and the Individual with Alzheimer’s Disease - a Caregiver’s Perspective

by Jan F. Bell

As a caretaker, you can get overwhelmed by all the suggestions, tips and guidelines for so many subjects from so many sources… There are many books, organizations, community support groups and training opportunities available but you really wish that you had trained for something in the medical field so you feel competent.

Our biggest arguments were concerning falling. I wanted Mom to do safe things: don’t pickup all the dishes, watch out when turning around, turn on the lights at night, take small steps at the front door. Mom wanted to continue what she always did: move about freely, cook, clean, help around the house. She struggled to maintain her independence and usefulness while I wanted to protect and prevent injury.

Finally, as her dementia and Parkinson’s progressed, I had to take falling seriously and our life would not be the same. I looked at everything from her perspective of losing balance, tripping and falling and made drastic changes so she could continue to move at will, do the things she desired and reduce our confrontations. The most helpful changes were exercise, medications and adaptations.

There are lots of sources for exercise: PT, yoga, the Y, etc. Since she refused to “exercise”, I substituted it for “shopping,” or pushing a grocery cart.
Her doctor was helpful in reviewing all drugs for side effects such as: balance, drop in blood pressure upon standing, dizziness, etc.

I switched to nice plastic dinnerware and drink cups and removed all sharp knives and the stovetop knobs. Small rugs, glass objects and low tables were removed as trip hazards or possible injury-causing. Walkways were cleared and widened for her walker (if she should use it) and other paths with unsafe step downs were blocked off from her wanderings. Furniture was turned so she could use their support. Night lights were positioned to give as much light as possible with her nighttime bathroom trips. Clothing was removed from low drawers and mirrors or reflecting objects were removed or covered. By the time she left, our house was pretty well stripped and “softened” and I generally let her move freely. Because of her dementia, if I removed objects discreetly, she never missed them or I was able to divert any questions without distress to her.

To my mother and me, the subject of “falls and falling” seemed so “unmedical.” But in the end, falls became the big issue. It was falls that brought the EMS to our house several times, trips to the ER and the doctor for X-rays and finally, the last trip to the hospital. Falls will happen. I am glad that I could make some changes that lessened the anxiety for both of us…

an Bell has been the caregiver of her mother, Ms. Frances Flagler, who passed earlier this month. Jan has graciously accepted to write this article during these sad times as, in her own words, “it will help me rethink this part of our passage.” Jan wishes to express her thanks to Manor Care staff at Imperial Plaza as well as those at Heartland Hospice, “all wonderfully trained staff for dementia and gentle, compassionate care.”

Yoga for Individuals with Alzheimer’s to Reduce Falls

by Nancy Glenmore Tatum MS, E-RYT 500, CMT, Owner and Director of Glenmore Yoga & Wellness Center

According to the Centers for Disease Control and Prevention:

  • 1 of every 3 adults age 65 or older falls each year.
  • Falls are the leading cause of injury and death among older adults.
  • Falls are the cause of 87% of all fractures and the second leading cause of spinal cord and brain injury among older adults.

Major factors contributing to older adults’ falls are: a history of a previous fall, dizziness, problems with gait and balance, neurological and musculoskeletal disabilities, side effects from medication use, problems related to confusion, visual impairments, and fear of falling. Muscle atrophy is one cause for balance and gait problems. If we become less active muscles atrophy, or reduce in size and strength. This reduces the mobility and balance needed to maneuver effectively.

An individual is more likely to fall if confused because the confused person is often unaware of the surroundings and unable to think clearly or react quickly enough to break the fall. People with Alzheimer’s have a higher risk of falls and fractures than do people the same age without the disease. Once injured, they are also more likely to re-injure themselves. These factors are directly related to impaired mobility and loss of independence.

The Mayo Clinic reports that people with Alzheimer’s feel better, both physically and emotionally, when they get regular, moderate exercise. As little as 20 minutes of exercise three times a week can boost mood, decrease risk of falls, reduce wandering and delay nursing home placement in people with Alzheimer’s.

The accepted view of the aging process has been one of stiffening, rigidity and closing down. Without proper exercise, the body contracts losing height, strength and flexibility. Gerontologists have proven that remaining active throughout life halts bone and muscle loss. Yoga softens the aging process by moving each joint in the body through its full range of motion. Yoga helps to prevent falls by improving balance, coordination, posture, and body mechanics.

Results from a study which I conducted in 2000 with assisted living residents concluded that weekly seated yoga classes increased feeling of general well-being of residents, increased knowledge of body awareness and body carriage, and decrease in the number of falls and resulting injuries. Yoga not only strengthens bones, it actually helps to prevent falls by improving balance and coordination, posture and body mechanics. When falls occur, yoga reduces the degree of trauma and likelihood of fractures by strengthening the muscles and making the body more flexible. Strong muscles are better able to control and absorb the impact of falls.

My current research study is nearing completion to determine the effects of yoga on older adults, ages 58-83, to increase their ability to comfortably transfer to and from the floor. The study has used a group of yoga exercises to strength and increase flexibility in the lower body, increase body awareness and balance. Midway through the study participants reported that their confidence had been restored and that they were no longer afraid to be on the floor. Results from the study will be available this August.


Nancy Glenmore Tatum MS, E-RYT 500, CMT, has practiced and taught Hatha Yoga since 1970 and is the owner and Director of Glenmore Yoga & Wellness Center. Nancy holds an MS in Gerontology. In addition to a 200 and 500 hour teacher training program Nancy has created a program to prepare yoga instructors to teach therapeutic yoga specifically to older adults.

Nancy is a Certified Yoga Instructor through the Himalayan Institute and is a member of the International Yoga Therapy Association. During the last decade Nancy has conducted two research studies on the effects of yoga on older adults.

Alzheimer’s Disease and Falls

by Kevin P. Walsh, DC, CCP, Doctor of Chiropractic and Chiropractic Pediatrics, Walsh Family Chiropractic

When defining the symptoms of Alzheimer’s disease, rarely does one find falls listed as one of its symptoms. True. However, falls are one of the common associated conditions due to the often seen age-associated factors of chronic conditions, physical deconditioning, medication related problems, and dementia.

According to the American Geriatrics Society, approximately 35% to 40% of generally healthy older persons over the age of 65 fall annually. Incidences increase nearly three times for those persons in need of assisted living services.

Unintentional injuries are the fifth leading cause of death in older adults according to a study by the CDC. More pointedly, 75% of unintentional deaths were the result of falls. Therefore, identifying risk factors, taking steps to prevent falls, and early intervention following a fall should be strongly considered when caring for a person with Alzheimer’s.

When identifying risk factors, you need to ask three questions about the physical, chemical, and environmental state of the person you are caring for.

  • First, does the person have any noted muscle weakness in the upper or lower extremities, visual deficits or balance disorders that may make him or her more prone to falls?
  • Second, is the person taking multiple medications or a medication which side effects may make him or her drowsy or impair their balance?
  • Third, what environmental factors such as loose carpeting, poor lighting, or lack of safety equipment near stairs or in the bathroom are present?

I suggest answering the questions and then create a check list of areas to address. Here are some recommendations:

THE PHYSICAL

If the person has muscle weakness or balance problems, take steps to improve strength and balance by enlisting in an exercise program that focuses on balance and coordination such as Balance and Gait Training, Tai Chi, Yoga, and/or Pilates. Use canes, crutches, walkers, and other assistive devices to keep mobile.

As a Chiropractor, I take balance and coordination a step further. I work with my patients not only to improve balance and coordination of their skeletal and neuromuscular systems, but to also improve their functional mobility and efficiency. Postural inefficiencies resulting from prior injuries along with often decades of adaptation create inefficient or aberrant movement of the spine and extremities which can lead to imbalance and/or falls. Doctors of Chiropractic use specific chiropractic adjustments along with stretches and strengthening exercises to help restore normal spinal movement and function.

Vision should be monitored regularly to prevent falls resulting from loss of visual acuity, decreased visual fields, cataracts, etc.

THE CHEMICAL

Become informed of the side effects of medications the person is on by researching the meds and/or consulting their pharmacist and physician. In some cases, there may be an alternative treatment that does not cause dizziness or impair balance. If the person is seeing multiple physicians, keep a list of medications prescribed by each physician to ensure that there are no adverse reactions when combined with other medications.

THE ENVIRONMENTAL

This is an area that you may be able to evaluate and make the necessary improvements on your own. If you need help, consult a licensed home inspector, handyman, or health professional who is familiar with the safety needs of a senior. Have them come to the home to perform an evaluation and make recommendations. Simple home repairs, additions, and subtractions can go a long way to preventing falls.

Finally, it is important to intervene immediately following a fall. Many times the injuries from a fall are not visible. If you are aware of a fall be sure to seek medical evaluation. Internal bleeding and fractures are the most common injuries from a fall with the 65+ age group. It is also important to investigate how they fell. It may be because of one of the physical, chemical, and/or environmental influences that were not noted in your evaluation previously. Because Alzheimer’s is a memory disorder, I would also recommend training him or her to write down in a journal how and where they fell and what areas hurt following the fall since they may not remember to tell you about the fall. Check the journal regularly to ensure falls aren’t overlooked. The frequency may be more frequent than you think.

Dr. Walsh holds a Doctorate of Chiropractic from Life University and is the owner of the Walsh Chiropractic Center in Williamsburg, VA, which is a center dedicated to treating the patient as a whole by reducing stresses on the spine through quality chiropractic care and promoting optimal health through education and guidance concerning diet, exercise, and stress. Dr. Walsh began his chiropractic career in Lilburn, Georgia at Multi-HealthCare Plus, a multi-disciplinary practice. As a result, Dr. Walsh had the opportunity to work hand-in-hand with an orthopedic surgeon, pain management physician, general practice physician, chiropractors, physical therapists, and massage therapists.

Falling and the Individual with Alzheimer’s Disease – the Educator’s Perspective

by E. Ayn Welleford, PhD – Chair & Associate Professor, Department of Gerontology, Virginia Commonwealth University

Ayn WellefordAs an academic educator much of my responsibility is to clarify ageist attitudes, miscommunication and misunderstandings presented in the media and held by the public and professionals who care for our elders. One rampant ageist misunderstanding is that Age causes terrible things to happen to people. I know some of you are thinking, “Oh brother, here she goes again.” The truth of the matter is, there are good and bad things about all stages of the lifespan (Do you remember adolescence? Either yours or your offspring’s?). Each stage involves development which includes both growth and decline. As an educator, my responsibility is to tease out the truth and share it in order that we may all pursue improved eldercare and our own vital aging.

Falling is one of those issues where we need to better our understanding. Our experts in this month’s newsletter are aiding our understanding by getting to the heart of the matter of Falling and Individuals with Dementia. One of the frequently cited risk factors for falls is age. However, researchers know that age cannot be considered a causal risk factor due to the numerous confounding and extraneous variables often associated with age. By this I mean the numerous other issues that are age-related or that make people so different from each other as they age. Some of these mentioned by our panelists include: weakness due to deconditioning, visual impairments, medication related problems (MRPs), environmental factors (due to a lifetime of accumulation of memorabilia). Other confounding variables may include: fitness history in addition to present activity level, nutritional status, presence of osteopenia, level of education, health status, existing chronic diseases, cognitive ability, presence of dementia, genetics, sensory function (vestibular and kinesthetic sense), and vascular health. When people say “age” they are really referring to so many other issues. Still people believe that age predicts falls. In reality age is shorthand for all of these other confounding factors. When you compare yourself with your neighbor of similar age you see that we cannot compare two people much less thousands of people simply based on age without considering the numerous factors that impact functional health that have little really to do with chronological age.
This month, our panelists encourage us to do two things:

(1) To get to the heart of the matter in terms of what really precipitates falls among individuals with dementia, and
(2) How do we consider the diversity of precipitating events and conditions (i.e., confounding risk factors) to reduce fall risk and recover post fall in order to promote the best quality of life among our elders.

OSTEOPOROSIS – CAN IT HAPPEN TO YOU?

Prepared by Nancy DeNike, VCU Department of Gerontology, Richmond, VA

Source: National Osteoporosis Foundation (www.nof.org)

Osteoporosis is a bone-thinning disease that causes serious fractures, commonly of the hip, spine and wrist. Known as “the silent thief”, it progresses without symptoms until bones begin to break. Osteoporosis is a major public health threat for the 10 million Americans who already have it and the 34 million who are at risk. Risk factors include:

  • advanced age
  • female
  • small, thin frame
  • Caucasian or Asian
  • low lifetime calcium intake & Vitamin D deficiency
  • family history of osteoporosis
  • postmenopausal  or early menopause
  • suffering from fractures after age 50
  • smoking cigarettes or drinking alcohol in excess

Don’t let this “silent thief” sneak up on you!  Use PREVENTION as your first line of defense!

  • Make sure you include C-D-E in your lifestyle.

    CDE = A Diet rich in Calcium and Vitamin D and regular Exercise.

  • For people of any age, staying active and performing both weight-bearing and muscle-strengthening exercise stimulates bone growth and helps prevent osteoporosis. So get up and……………….

  • Take a stand, walk the dog, climb some stairs, pedal a bike, hike a trail, jog in the park, walk your favorite golf course, play tennis or go dancing.

  • Also include muscle-strengthening exercises such as lifting weights to improve agility and balance and reduce the risk of falls/bone fractures.

  • Try to make daily exercise deposits into your “bone bank,” especially prior to age 30 when your bones reach their peak bone mass.

  • Women, don’t stop at age 30!  If you do, you might deplete your “bone bank” deposits by the time you reach middle age.

  • Men, don’t think you are immune! While the majority of osteoporosis victims are women, 20% are men. YOU could be one of those men.

  • If you are at risk, continue to strengthen your bones and discuss additional options with your doctor. These options include bone density testing and certain medicines that have been proven effective for increasing bone mass.

 

REVIEW THE RECORDING

REVIEW THE SLIDES