Tuesday, November 22, 2016

On Falling

One of our sisters who is 86 years old and up until last week was robust and sharp and in control of her life, is now dying.  She had a very very bad fall about two months ago; she fell flat on her face, walking on the sidewalk outside of her house. She sustained some broken bones, most notably her cheekbones, and was in rehab.  Then things went downhill from there.  She came up to our skilled care floor up here to continue recovering, but developed blood clots in her legs.  Two days ago she became very confused, disoriented, and was even hallucinating. They took her to the hospital for a brain scan and discovered a new and ongoing brain bleed.  Now she is unconscious and is on hospice.
It happened so quickly that we are all in shock.

She's not the first. I've known of at least five other persons who have fallen , with bad results, in the last year.

This brings me to an article I read recently in Slate  about how dangerous falls are , especially to senior citizens.    I'm quoting from it here:

"...All too often, this is the wrong reaction. The one-year mortality for patients who are admitted to the hospital after a fall is a staggering 33 percent. A fall bad enough to warrant hospital admission can carry as poor a prognosis as some stage IV cancers that have metastasized to the lungs and brain. Of course, the people who are hospitalized after a fall are much more likely to have a higher mortality rate anyway. (They’re going to be older, and have more comorbid medical conditions, but falls still pose a bigger risk than other conditions.) By comparison, the one-year mortality for older patients admitted to the hospital for pneumonia hovers around 21 percent...
"...Why are falls so dangerous? There are short- and long-term risks. In the short term, falls that involve trauma to the head can cause life-threatening intracranial bleeding. Broken bones have their own risk, including lung embolisms in which tiny fragments of broken bone make their way into our circulation and reach the lung, causing impressive and often life-threatening damage. But falls that cause broken hips and legs can cause death and disability even well after the acute phase. Blood clots to the lung are more likely in the months after surgery or prolonged periods of immobilization. People who become more sedentary are more likely to develop a host of other problems, including heart and lung disease...
"...one powerful prognostic information on fall comes from a careful assessment of the foot. Foot health, much like dental hygiene, provides tremendous insight into a person’s functional status and access to healthcare. The presence of nonhealing wounds imparts significant fall risk. But the biggest predictor of those who are least likely to fall is simply the ability to cut one’s own toenails. Even previous falls or near falls are less predictive...
"...You can also limit your risks by modifying your own environment and behavior. This hasn’t been empirically tested, but in my opinion, the most important thing an elderly person can do to protect themselves from the worst outcomes from a fall is to carpet their home. We often think about babyproofing the home. But geriatric-proofing them is not a bad idea either. Additionally, as we age, it is important that we realize our limitations. The older we get, the more we get up at night to use the restroom. This may sound silly, but turn on the lights. Your spouse may grumble, but it’s worth it so you don’t trip and fall. This happens all the time. Get up slowly, especially in the morning when you haven’t had anything to eat or drink in many hours. (Dehydration-related falls and even loss of consciousness are common in emergency departments.)
 Committed to staying in shape by taking the stairs? Fine, but try to only go up the stairs. Taking the stairs downward provides little exercise, and the momentum of a fall is far worse..."
This information is important to me, and unnerving too.

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