George Smith had become unsteady on his feet. “My balance was off,” says the 76-year-old from Hamden. He’d already fallen twice, once at home, another time while shopping at a nearby Sam’s Club. When he went in for an unrelated surgery at Yale New Haven Hospital, his healthcare providers asked if he’d ever fallen. He confessed to his two recent tumbles, and they encouraged him to make an appointment at a Yale Medicine clinic that focuses specifically on falls.
Falls are a serious problem among older people. “They have terrible consequences for many patients,” says Leo Cooney, MD, of Yale Medicine, who leads the Syncope & Falls Assessment Program at the Dorothy Adler Geriatric Assessment Center. A fall can lead to a fracture of the wrist, shoulder and/or pelvis. “Hip fractures are the worst, with a devastating effect on independence,” Dr. Cooney says. Falls frequently lead to nursing home admission.
But such unfortunate outcomes can be avoided by preventing the fall in the first place. “We know the risk factors, we evaluate them, and we try to put in place interventions to diminish those risks,” Dr. Cooney says. He uses a protocol developed by Yale Medicine Geriatrics Chief Mary Tinetti, MD, who has published her extensive research on fall prevention in the New England Journal of Medicine.
At the falls clinic, Dr. Cooney and his colleagues use an assessment system that considers a range of issues. These questions could help determine if you, or an elderly person or any person with problems relating to balance, may be at risk for a life-altering accident.
To contact the Dorothy Adler Geriatric Assessment Center, click here:
Do you have a health condition that increases risks?
Many health problems can lead to dizziness or poor balance. For instance, a person with diabetes might experience a drop in blood pressure while moving from sitting to standing. Another diabetes-related problem is impairment of nerves in the upper leg, which can weaken leg muscles. “I recently saw a patient who’d had seven falls in the last few months because of this,” Dr. Cooney says. His patient told him that she'd once lost her balance when she tried to put on a pair of slacks, and another time while shaving her leg in the shower.
Are you on a medication that causes dizziness?
Some medications cause dizziness or drowsiness. Studies show that a person’s risk of falling increases with the number of medications he or she is taking. When the staff at Yale Medicine’s falls clinic suspects that a problem may be related to one or a combination of drugs a person takes, they will work with the prescribing doctor to find the right balance between treating the condition while also preventing a fall. “It’s a risk-benefit thing,” Dr. Cooney says.
Are you thinking clearly?
If your mind isn't working well, it can an increase the likelihood of falling. For example, a person with Alzheimer's disease or who has suffered a strong might tumble after misjudging the height of a curb, or grab for the soap instead of the safety bar when starting to slip in the shower.
Is your gait or balance off?
Maybe it’s an old tennis injury that's affecting the way you walk. Or perhaps arthritis is progressing through your joints, which is what happened to Smith. “My hips were off,” he says, explaining that this had been causing him to lose his balance. Following Dr. Cooney's advice, he began to work with physical therapists to improve his balance. The therapy program focused on strengthening his legs and feet. His care providers also suggested he use a cane for extra stability.
Is your home a trip trap?
A throw rug in the wrong place can make you stumble. Or, in dim lighting you might not see the toy car your grandchild dropped earlier in the day. Simple adjustments can fix both of those problems. An important room to assess is the bathroom. It's where most falls occur, both at home and in the hospital. “Grab bars attached to walls are very, very helpful,” Dr. Cooney says. Installing a raised toilet seat can also make life easier. And all stairs should have railings, especially those that go into the basement, which is another place where falls often occur.
What are you wearing on your feet?
Footwear with good traction is vital. Dr. Cooney advises against high heels and slippers, but doesn't want you to walk around the house in socks or stockings, either, because they're slippery. “You want shoes that have plenty of space in them, that are basically solid. They don’t need to be fancy or orthopaedic, they just need to give you a good grip on the ground," he says. An excellent and inexpensive solution: Sneakers.
Could an assistive device keep you steady?
Many people resist using a cane or a walker because it makes them feel old. “We see so many patients who, every time they fall, they’re not using their walker,” says Dr. Cooney. He and his colleagues tell patients that maintaining good health and mobility is much more important than keeping up appearances.
A patient undergoing an assessment at the Falls Assessment Program can expect to first see a nurse, who performs a brief mental status examination and measures a patient’s blood pressure in both the lying and standing position. Then, Dr. Cooney asks a long list of questions. He also observes each patient's way of walking.
“We assess someone walking, look at their gait patterns, look for balance problems or abnormalities, such as limps. We have no fancy instruments, except for our eyes,” he explains. After a thorough physical exam focusing on muscle strength, neurological abnormalities and musculoskeletal problems, he addresses each factor that may contribute to fall risk.
George Smith has been very happy with the results of his assessment. Balance-focused physical therapy and increased use of his cane have kept him steady on his feet ever since his visit with Dr. Cooney. Says Smith, “I’m almost completely cured.”