Fall Risk: Who is at Risk and How to Prevent Them

Welcome to the Living to 100 Club Podcast. Here's our host, Dr. Joseph Casciani. Well, hello to everyone joining us today on our podcast. You're listening to the Living to 100 Club, and I'm your host Joseph Casciani. Before we introduce our guests, I'd like to remind everyone that I'm available for public speaking events, particularly to community organizations and senior groups. I love to talk to others about aging well and making it over those hurdles. There's an option on my website to book a call to discuss a presentation for your group. I also offer one-on-one coaching for help bouncing back from struggles and setbacks. You can see this option as well on my website. And one last item of self-promotion: if you're looking for a consultant or trainer on clinical topics like dementia or depression, this is my wheelhouse. So feel free to contact me if there's a need in your group or organization. Again, contact options are on my website, livingto100.club. Now, on to our podcast. We're pleased to invite Dr. Hannah Freyboth, a physical therapist, today as our guest. This is a conversation about ways older adults can avoid falls. We look at the incidence of falls in this age group, the consequences or results of falls, and how to measure our own risk of falling. Our guest brings her experience as a physical therapist to this podcast. And shares her recommendations for both our physical person and our home to prevent becoming another statistic. First, a little background. Dr. Hannah Freyboth is a physical therapist currently working in the acute care hospital setting. While her caseload includes a variety of conditions, she has developed a passion for helping older adults remain living safely at home without assistance. Anna received her Bachelor of Arts undergraduate degree with a major in biology from Concordia College in Moorhead, Minnesota. She then earned her Doctorate of Physical Therapy degree from University of Jamestown Physical Therapy Program, where she graduated with an award in excellence in evidence-based practice. It can be found serving her audience on social media as Revitalize Physical Therapy. Or in her private group, Revitalize Your Balance: No More Falls. Welcome to our program, Hannah.

Thank you. Thank you for the introduction. I'm glad to be here.

Great. Great. I'm glad to have you with us. We're looking forward to this conversation. I always like to open by asking our guests to tell us a little bit about the journey that brought you to where you are today.

Yeah. You hit it on the head there, right there in the introduction. And when I went into PT school, I didn't have a specific specialty in mind. Um, so I kind of just went there with an open mind and I saw myself drawn more towards the geriatric population and neurological conditions. And then from there I, uh, graduated, passed boards, um, and then I got my first job at working in a hospital in the acute care setting. And, you know, you learn all this stuff in school, but until you're working in the field, you, you don't see the reality of things. And so you learn, you know, you learn about all, like all the statistics about falls and the aging population. And, but really working in the hospital, I learned how much of a reality of a patient's life and their family's life can change after a fall.

Sure.

And so I just, I was just drawn to learn more about it. And then from there, I kind of realized I'm like, I have all this knowledge as a physical therapist and I'm seeing that falls are very much preventable. And so I was like, there's something more I can be doing. So I just recently kind of branched out and started serving people online via social, social media. I created a group. And so right now I'm just providing information, really just creating more awareness, awareness and providing more education to people as I'm able. And then of course, answering questions and anything like that.

So you completed all your training, your credentialing, and what I call the ivory tower meets the real world. So you bring all that academic background into the actual application of this information, how to apply it, how to implement it. So you've developed some special interest and specialty in falls, especially in the older age group. How common are falls in the 55+ age group.

Yeah, there's a lot of statistics out there. Um, the one that I like to say the most is in the population of people over the age of 65, 1 in 4 adults fall each year in the United States. And it's projected to increase quite a bit as the, because the population of older adults, the baby boomers are going to be moving into that category of 65+. And, um, so it's projected to increase quite a bit until, um, 2030 here. Right now, I think the last stat I got was about 36 million falls occurred in 2018. And of that, about 8 million falls required medical attention or at least, um, limited a person's activity. And in the United States, at least, um, there's kind of some conflicting stats on this, but falls are the leading cause of injury in older adults. Sometimes it's the second leading cause, but what I most recently found was the leading cause of injury.

Leading cause of injury. So, typical falls being slipping on throw rugs, stepping off the curb, slipping in the shower. What are the most common? Are there any?

Well, that's a hard question because part of the stats too is I think it's about half of the people that have a fall actually report it to their doctor. So, there's a lot of unreported stats out there. I wouldn't say that there's a necessarily a common way of falling, but there's, you know, common risk factors, I guess, that can contribute to it. So exactly all those things you just said, all things that are very realistic and happen.

Sure. Yeah. I know we're going to talk more about the physical risk factors and then the environmental or home risk factors, but Typically, does the person who falls recover or are there long-term limitations? I guess that may be hard to categorize as well, but typically recovery or long-term consequences?

Yes, I mean, there's both. So there's more stats on that, of course. 1 in 5 falls cause a broken bone or a head injury. So that is one long-term limitation for either of those. So, you know, a lot of times when people fall, they have these injuries and then they have further complications because of these injuries. So the most common injury that happens after a fall is a hip fracture. Okay. So typically, depending on different cases, obviously, typically they, they go through surgery, repair the hip, um, and/or sometimes they, they're unable to repair the hip, but it dramatically reduces that patient's, um, activity level. So then they're stuck in bed a little bit more longer, and then therefore other complications, medical complications set in. And then of course you have to— every, every individual is going to be different with their their overall health and their background of their, if they have any medical comorbidities or other things that are going on. Some people will come in with a fall and they say they fracture their hip, get it repaired, and they're able to return home. Some people, I mean, some people fall and they don't even tell their doctor because they maybe, you know, bruise their, bruise their leg or kind of just shook themselves up a little bit. Um, but I will say, and I hate to like bring the scary statistic in, but there is overall, there, there, it can, um, a fall and an injury and a long-term complication, some of them can result in death. Um, and this is also increasing, um, in the last, so they're projected to increase to 30%, which is kind of goes with the, as the population of people that are age 65 and older kind of get into that, that population gets bigger, then the death rates are also expected to increase with falls. That one's a scary one, but it is out there.

Yeah. Ultimately, that could be the result with a cascade of other complications and other effects. But 50% of falls go unreported. I mean, that's startling in itself because then we don't know what the nature of those falls are. We don't know how to develop education or prevention plans. And we're left to the 50% that are reported. Maybe they're all the same, or maybe they're distinctly different than the ones that are unreported. I guess we don't know that. Yeah.

And I mean, I will add to that too, with somebody that falls, often they develop a fear of falling again. Right. And that can that can lead into a negative vicious cycle of, so they fall, fearful of falling, and then therefore they end up typically restricting, restricting their mobility a little bit, or they're a little more cautious, which, you know, obviously we want everybody to be safe, but it can lead to, you know, lower mobility, lower, lowering your balance, lowering your exercise, and then it just kind of keeps viciously, then you have more fear of falling and that can lead into a vicious cycle.

Yeah. Yeah. I'm glad you brought that up. I saw that often. In nursing homes, there are a lot of admissions due to fractures, shoulder or hips. And that fear of falling again really limits the person in their rehab, physical therapy, and they don't want to take those steps even though they're capable or the assessment says they should be capable of a few steps. But like you say, it restricts their activity, restricts their attempts. And it kind of narrows their potential even more. So yeah, we can't dismiss the emotional, the psychological component element that comes into these, these pictures of falling. Yeah.

Yeah.

That's really important. So how did, how do you, how does someone know if he or she is at risk of falling? Can we get some read on that?

Yes. I have a bullet point list here. I tried to narrow it down. Of course, you know, as a physical therapist, there's, a few things that are, you know, outside of my aspect of care, but I will kind of address them here. So things that I look at as a PT knowing if a person is at a risk of falling is lower body weakness, difficulty walking, balance concerns, vision issues or vision impairments, environmental hazards, impaired sensation, especially in a person's feet or legs. And then there's other things that definitely play a role, such as, like I said, the fear of falling that kind of comes after someone's already fallen. And then one I run into a lot is the use of certain medications, especially the ones that, you know, cause some sedation or drowsiness or lightheadedness, dizzy, dizziness. And a lot of times those medications obviously are controlling other medical issues, but, you know, having that conversation with your doctor about if something, if you're having side effects from medications is a way.

Sure. Sure. Sure. Yeah. Yeah. So lower body weakness. I mean, these are, these are factors that we can be aware of.

Mm-hmm.

We do have that lower body weakness, difficulty walking, balance problems, maybe some vision problems. The environmental hazards, I mean, that's important too to be aware of what the risks are. Impaired sensation, meaning what? Lose our awareness of our perception? I mean, that kind of—

Yep, definitely. So like one good example I usually give is people that have diabetes, if they get neuropathy in their feet and they can't— they don't have— and they have impaired proprioception, so they can't feel light touch, and therefore they might not be able to feel the bottom of their feet. The other thing too, with proprioception is the ability to have the reflex that in your ankle, especially, and in your feet. So when you have normal sensation, your feet are constantly giving feedback, you know, to your brain, brain to the feet. And they're constantly adjusting to the surface that you're walking on or stepping on. Whenever you have impaired sensation, whether it be light touch or even more than that, feedback is not there.

Yeah. Well, that's really, really good information. Really a good list. Many of these things are preventable, or at least we manage the risks as much as possible. And some of them are not. If there's some decline in our physical functioning or balance, I mean, there might be some remedy for that too. But overall, a lot of this is just taking extra precautions. I mean, I can see that. So, yeah, what are, what do you think are the important ingredients to preventing falls?

So, this is kind of just continuing with that bullet list. Like you said, there's, there's definitely some modifiable or manageable issues with, or not, or modifiable risks. So, lower body weakness, that is one where, so basically, so, to help fall prevention is to address both the nonmodifiable risk factors and the modifiable risk factors. You know, so some of them obviously you're only going to be able to manage to a point, but I like to tell people that falling is not a normal part of aging.

OK.

So lower body weakness, yes, there's some things that happen with aging and that are to be expected. But, you know, so for one thing is just losing muscle mass or maybe losing your reflex or your quickness in reflexes. But this is definitely something that can be modified, lower body weakness. You can, I mean, strength training plays a large role. And I, some people get scared by the word strength training, but really it's just moving your body and using body weight as your resistance or as your strength training. So, sorry, back to your question.

No, no.

The ingredients to fall prevention. Essentially just addressing those. So lower body weakness, we address it with strength training, difficulty walking. A lot of times I see people in physical therapy just for that, to work on what we call gait training, ambulation. There can be, obviously we tailor it to the individual. Some people need, you know, use of an assistive device, or some people need to just work on the strengthening. Sometimes it's stretching or gaining more range of motion in order to walk properly. You know, vision issues, so that would be, you know, out of my scope of practice, but talking with your primary doctor or your eye doctor to address anything there. Um, balance concerns, that's huge, and that's like my favorite thing to work with. And that kind of goes along with, um, proper— having proper range of motion in, especially in your legs, and then also having proper strength. So addressing those via fitness or physical therapy. Obviously environmental hazards, so You can modify that to a point.

Mm-hmm.

Also, just like you said, being aware and managing things, you know, when you're out of your house or somewhere else traveling, whatever, being aware of things that could cause or increase your risk of falling. Impaired sensation, you know, a lot of times that is because of a medical comorbidity. So that can only be addressed so much. And again, I kind of mentioned earlier, just with the use of certain medications, talking with your primary doctor. And if you're having side effects from those, trying to figure out a better plan. Some people, some people fall because they get lightheaded when they stand up, things like that. Some people are just super drowsy on their medications and it's just not allowing them to be alert enough to be aware of their environment and react to it.

Right. And some of these medications might have more of these side effects than other medications. So, if we are experiencing the dizziness or the drowsiness, then we can look at having a change and maybe a med that doesn't have the same side effect. What about balance? How do, what do you recommend there? How do we improve balance?

Yeah. So, as I mentioned, I mean, this can be one aspect of fall prevention and for some people it can be the only aspect that needs to be addressed. So, one thing I often see in the real world here is After people retire, unless they consciously choose to remain active, people do have— it is common for people to become more sedentary. That goes back to that vicious cycle of once you lower your mobility or your activity and maybe you fall, your fear of falling increases and then you, you lower your mobility even more. So that is a huge part of it. So again, I just like to remind people, Falling and your, your lack of balance or your lack of mobility is not necessarily a part of a normal part of aging. So, I just encourage people, if you have any concerns about your balance or mobility to consult, it can be a personal trainer, a fitness coach, you know, your doctor, physical therapist, anybody that you think could help you address that is very well going to help your fall prevention.

Yeah. Well, all right. Those are some great recommendations, preventive measures and attempts to reverse some of those aging risk factors. Yeah. So strength training is important. See some fitness coach. There are a lot of— I have had a couple of guests on who really recommend a lot of strength training with seniors and they have some online programs. So we know there's a lot of resources out there. Let's talk about our environment and where we live. And you mentioned that, you touched on it, being aware of what's going on in our home and when we step out, going to the store, going to a doctor's appointment, what to look for. What should we be on the alert for when it comes to culprits, causes?

Yes, so in your home it's pretty easy to modify things. So the bullet point list I have here is first couple of things, lighting. So making sure, like, making sure you have well-lit areas and that you're able to see where you're going. This is another thing, especially at night, people often get up to go to the bathroom. There's lots of different technology out there, but some people, you know, they just make a habit to turn on the lamp, or some people have automatic nightlights that when there's motion, it turns on. You know, maybe a handheld flashlight by your bed, something like that. Cause that's, this goes back with the vision. So the 3 main components of balance, and one of them includes your vision, your ability to see where you are and react to your environment. Another thing that often people may miss is having contrast between the wall and the floor. So if they're the same color, it can be harder to distinguish, you know, where you, where your body is at in space, which is a component of your balance. And so having that easily distinguish floor to wall can help keep your balance when you're in the house. And then, you know, things that are just around your house. So any clutter, cords, and we talk about area rugs a lot, ledges, a change in floor surface. So going from carpet to linoleum, you know, a lot of times there's that little strip or that ledge there. Another big one is if they, if someone has pets, you know, some pets get in the way very easily. And also just, you know, unkept areas. So maybe it's just, The floor needs to be swept, things like that. Another big one too that is easily modifiable for yourself is just picking proper clothing and proper shoe wear, especially if you have that impaired sensation of your legs or your feet. So with clothing, I just tell people, I mean, choose something comfortable, make sure it's not too restricting. But also the other thing that can cause issues is if your clothing is way too baggy or it gets in the way, you know, gets caught on stuff or caught in between your legs. And for shoes, I mean, we could have a whole segment on shoe wear, but, you know, something that I, I understand when you're in the house, people like to wear the slip-on shoes, but I try to tell people to get something with a back, back of your heel, something that usually you got to tie so it stays firm on your feet. So providing that support for your feet, but also having good soles on the bottom. So it's gripping onto the surface as well. So those are the main things I have.

Those are great, great list. Great list. And this applies, of course, in our own home and even going out of our home, wearing proper clothing, lighting, you know, any clutter that we encounter, maybe on the sidewalk or maybe in a parking lot. So wherever we are, these are factors to be alert to and be aware of that this could be potential trigger. Yeah. What about, we hear a lot about showers and bathtubs, serious, serious risk when there's falls there. What, Special recommendations? Yeah.

Yeah. I just, this is a large piece where I would just want people to have some more awareness. Two things happen when you're showering, bathtub. So, things get wet and therefore they get slippery. And then number two, whenever you're showering, oftentimes you close your eyes. And so those are throwing off two components of your balance, having a slippery surface and not having your vision to help stabilize yourself. So knowing that occupational therapists are great, great with showering and bathrooms, but from what I've told people is, you know, it's okay to be aware of your limitations with this. So it's okay to, if you feel like standing in the shower, or maybe you've already slipped in the shower, we got to think about adjusting that. So a lot of times people put, you know, like a bath mat or a those non-slip treads in the bathtub itself, or even on the outside of it on the floor there. You know, I love shower chairs or having a built-in shower chair. Sometimes it just gets to a point where you might need to sit to shower and in order to prevent a hip fracture, right? And a long-term complication. The other thing is grab bars and the good grab bars, the ones that you can screw into the wall and they're sturdy. Having them in the shower and right outside the shower, having proper placement of those two. And this is where I often recommend having a home assessment because, you know, obviously something is better than nothing, but having it properly done can make a big difference. Another thing to keep in mind too. So if someone has a bathtub and they have to step over into it, being aware that when you're stepping over, you're having to stand on one leg for, for a little while.. And that is challenging your balance. And so, some, for some people, that's what does it is just you have the slippery surface, you're getting out of the shower, you stand on one leg and down you go. So, bullet point list, I guess, would be non-slip surfaces and then grab bars and just being aware that being in the shower is a challenge for your balance system.

Yeah. Extra extraordinary risk of being in the shower or bathtub. Yeah, that's a great list. Thank you. What about travel for maybe going to the airport or taking a flight somewhere or anytime we get into a car or cab or Uber? I mean, what things should we be aware of when we travel?

So one thing I like people to think about when you're in your house or it's a fairly controlled environment, and you're familiar with it. So whenever you leave your house, just be aware that there's going to be numerous things that are changing and are different. And that's, you know, that's pretty common knowledge, obviously, but just being aware of that can help you already. So when you leave the house, you're just— you're exposed to the elements. So things like weather. So right now it's winter, ice, wind, those types of things. Other, like I said, when you leave your house, things aren't controlled. So there's going to be ledges or uneven surfaces where you might not expect. Other buildings and structures might not be as reliable. So if you were to, if you're used to kind of grabbing onto the wall or onto the furniture in your house, when you leave and you start doing that, it might not be the same as at home. Right? So it could be something could be on wheels or it could be on hinges and then you grab onto it and there you go, there you fall. Yeah. Just being aware that there's going to be other ledges and curbs and things that are, you're just not used to.

Yeah. Unfamiliar spaces, as you say, we're not used to maybe missing a handrail somewhere, going up and down some steps when at home we have that. But yeah, that's, that's great. Really, this is a wealth of information, Hannah. I think it's so important to continue to educate people about managing our risk because we do, we're living longer and we wanna be able to live at home as long as we can. And yeah, certainly to put these precautions in place, it really increases our success rate. That's great. So anything else that we didn't cover?

Yeah, I can, I maybe didn't give you a full answer back to that strength training.

Okay.

Just kind of more specifics on it, I guess. I said, you know, obviously consult somebody, but just in our conversation here, strength training, and as you've had other guests on your podcast as well, it's very, very important. It helps individuals remain strong, and this therefore makes them remain independent. And whenever someone is in— when I use the word independent, that carries a heavy definition for physical therapists. You know, for us, that means that when someone is independent, they're able to move themselves throughout their home. They're able to take care of all of their, what we call our activities of daily living.

Sure.

So things that you and I maybe take for granted, being able to get in and out of bed, you know, get to the bathroom by ourselves, brush our teeth, walk without an assistive device, be able to make our own breakfast, you know, let the dog out and not having to have any help with any of that stuff. I mean, I meet a lot of people that that's really their goal. They just want to remain independent for as long as they can. And that's great. I love that when people have that goal. So strength training, that's your best bet. Obviously too, there's all these, your health benefits for strength training. It can reduce your risk of osteoporosis, which therefore can help if you, you know, help your chances of not breaking a bone if you do fall or having a better recovery. And it can also help just other medical issues, underlying chronic conditions like heart disease, your arthritis. Help improving your sleep, improve your depression, things like that. So I just love strength training, and I think, I, I think, um, sometimes seniors can get, I don't know, discouraged by it because maybe they haven't done it before, you know. Um, it wasn't really introduced until probably when they were older, and then, so then now they're just starting at age 65 or age 70. Sure. And I just, I like, I want to encourage people to not be afraid of it and find somebody that can help them. The other thing about strength training that people maybe get scared about is they think that they have to, or they picture, I guess, with maybe this in their mind that they have to be lifting these heavy barbells and these heavy dumbbells. And really, if you're new to strength training, I don't think anybody would even recommend that. I mean, using your body weight is resistance enough. And so, I just, I like to stick with the basics when someone, if they were to start strength training, I just tell people to do squats or what we call sit to stands. So finding a sturdy chair and sitting down in it, standing back up, sitting, standing, and doing that for repetitions. And then there's obviously different progressions of that. So when you first start, you maybe are using your hands on the armrests for that sit to stand. And then as you get better, you don't use your hands. Or maybe you start by— or you use one hand. And then you don't use any hands. And then the next progression would be maybe you are going to sit down, but rather than sitting, you just tap your bottom on the chair and come back up. Right? So that's a progression towards a squat. And you're strengthening all of your major leg muscles there. And you're also increasing your range of motion whenever you do that. Another big one for strengthening, I try to combine strength and balance. To kind of get the best bang for your buck. So that one right there. And also a standing exercise, it's called hip abduction. So when you're standing, taking your leg away from midline, so you're, you're kicking it out to the side. And so doing that, but doing it while you're standing, and that will strengthen a major butt muscle, your glute muscle that stabilizes your hip, which therefore help increase your balance.

So holding onto a counter or something, right?

Yeah. I call them my kitchen, kitchen countertop exercises. Yeah. So holding onto something or like a sturdy back of a chair or a wall sometimes works. I mean, I actually have often, often I'm doing this with people with when they're using a walker. And so they're also, they would just hold onto the walker as well. That's my, so that's number 2. And then my 3rd favorite exercise is just calf raises. So just again, probably holding on to something. So their walker, countertop, chair, wall, and then just raising onto your toes. So lifting your heels off the ground, but doing it in a slow and controlled motion. And then, you know, doing it for repetitions. So I like those 3, best bang for your buck, strengthening plus balance.

Yeah. I remember Dave Durrell was the fitness expert who talked about that chair tip-toe stand exercise. And there are some metrics on that, what we should be able to do, the number of times we should do it in a minute or a couple of minutes. But I'm glad to hear you repeat that because that does, I think, does tax a lot of the different muscles and, you know, balance features. So that's good to hear. Yeah. And then the strength and balance, the hip abduction, and then toes raising our heels. Good stuff. Really good stuff today here, Hannah. Mm-hmm. Really a wealth of information. I know it's very helpful to everybody listening. So, what would you like our listeners to take away from this conversation? Talked about so many important things. What would you like them to take away from today?

Yeah, I would say main thing, falling is not a normal part of aging. So just being aware that if you're falling, I don't want people to feel embarrassed or shameful about it. But rather, you know, accepting it and then addressing it. Tell your doctor about it, get, you know, assessed for your fall risk and prevent it from happening again. Just because you're aging doesn't mean you're bound to lose your strength and your balance. I just want people to feel like they are able to control or at least manage that part of their lives. And I, Again, today we did, I like, we highlighted some statistics and some frightening ones too, but I just want you to know that falls are preventable. So they're not a normal part of aging, but they're also very much preventable. I mean, we talked, like I said, like you said about a lot of information here today, but if you feel like any of this stuff we talked about applies to you, I want you to reach out to your primary care doctor, or even if you're already seeing a physical, physical therapist or another trusted healthcare professional, You're, if you're concerned about it, it can be addressed. So I just want people to feel like there are things that can be done. And it's, you know, I don't want— it's never too late to start.

Yeah.

It's all— I don't want people to feel afraid either.

Yeah. Because if they fall at age 75 or 85 or 95, that doesn't mean it's normal. Let's still address it, accept it, address it. And try to get some fixes for it. That's really crucial. Yeah.

And I imagine if they're listening to your podcast, they probably have goals or things that your listeners are wanting to live for. And so that can sometimes be a good motivator as well.

Yeah. Yeah. It's a good— certainly it's a good topic to be aware of and be alert to and really try to mitigate it, reduce it whenever we can. Stay healthy. Yeah, great. Well, Hannah, it looks like we're out of time for today, but before we wrap up, I just want to remind our listeners about a co-sponsor for our program, A Mighty Good Time. Are you looking for ways to engage and stay active? Check out amightygoodtime.com. It's a one-stop shop for events and activities for those 50 and over. It's free to search and it's free to post. Amightygoodtime.com. And be sure to visit the Living to 100 Club website to sign up for our weekly podcast announcements and monthly newsletters. And while there, be sure to download a free copy of my 9 Tips for Living Longer. Lastly, pick up a copy of my book, Living Longer Is the New Normal, all about maintaining a positive mindset in all we do. It's on Amazon as an ebook or as a hard copy. Thanks so much again, Hannah, for people that might want to contact you, if they want more information, how can they do that?

Yeah, I, like you said earlier in the beginning of the podcast, um, I'm on social media. I'm on Facebook and Instagram as Revitalize Physical Therapy. Um, you feel free to message me there. I am in the future working towards creating a YouTube channel and my own website, but right now, Revitalize Physical Therapy.

RevitalizePhysicalTherapy.com?

Nope, just on Facebook and Instagram.

Revitalize Physical Therapy. Well, really, thank you so much again, because this is really important information and stuff I love to hear and share with our listeners. So, um, much appreciated.

Yeah. Thank you for having me and thank you for having the show.

Yeah. Well, glad to have you and you're welcome. Many thanks to everyone for tuning in as well. Hope to see you next time.

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