Falls spur prevention effort

Increase in accidents coincides with graying of North Carolina population

In a collision of trends, the number of people over the age of 65 in North Carolina is getting larger and more are suffering falls.

The population older than 65 in the state is projected to grow from about 1 million today to more than 1.6 million by 2020. Meanwhile, the rate of deaths from falls in that group has increased by more than a third since 1999.

Falls killed 477 older people in North Carolina last year, according to new data presented to Congress this month. The growing human and economic cost of these accidents has brought recent calls for action at local, state and federal levels.

"The trend for falls is going up, and the trend, population-wise, is getting older," said Ellen Schneider of the UNC Institute on Aging, a Chapel Hill think tank. "If we don't do something about it, we're really going to have a problem."

The institute, the state Department of Health and Human Services and the Division of Aging and Adult Services are among groups forming a new N.C. Falls Prevention Coalition. Other members include emergency responders, doctors, hospitals, pharmacists, academics, and physical and occupational therapists.

"This is a problem that has to be addressed systemwide," said Sharon Rhyne, health promotion manager at the state's chronic disease and injury section. "It would be illogical to address it in long-term care and not in home- and community-based care."

As the coalition prepares to make a case for funding, national groups such as AARP and the Council on Aging are lobbying Congress for more than $20 million in new money to prevent falls. Advocates cite a $19 billion annual health-care cost for treating the falls of older people in emergency rooms, hospitals and outpatient settings.

"You're trying to get trauma victims out of the emergency room, and you've got people upstairs in the hospital that didn't need to be there," Rhyne said.

North Carolina's new falls prevention group, which held its first meeting last month, wants to prevent falls by coordinating a long list of health-care groups and disseminating facts based on hard science. Among them:

* Leading risk factors for falls are lower body weakness, balance problems, impaired vision and the use of four or more prescription drugs.

* Environmental causes include throw rugs in houses, dim lighting, lack of grab bars in bathrooms and no railings on stairwells.

* Proven prevention methods include balance and fitness training, medication management, home surveys and vision checks.

Carol Battle, who teaches balance classes at the North Wake Senior Center in Wake Forest, said older people can reduce their risks of falling with a relatively small amount of balance training.

"They come back and they say, 'I can't believe how much better I am at this,' " Battle said.

Senior centers are viewed as a possible key for promoting exercise and getting out the word on how to ward off potentially deadly falls.

Carri Casteel, a UNC-Chapel Hill professor and researcher, is working on a federally funded $550,000 study of 500 centers across the country to see how falls prevention messages are best presented. The job can be a tough one given the attitude of some older adults, she said.

"Some are in the mind-set that 'I haven't fallen, so I'm not going to think about it,' " she said.

In some cases, even the best informed can run into problems.

As chairwoman of the Governor's Advisory Council on Aging and a longtime advocate on aging issues, Ann Johnson, 87, knew what to do. She had picked up the scatter rugs in her house and installed grab bars in her bathroom. But as she walked across her yard to a friend's car last year, she tripped on a tree root and fell.

"I could feel myself going around like a whirling dervish," she said. "It positioned my hip right on the edge of the cement sidewalk, and it broke the ball of my hip."

Johnson went through surgery and rehabilitation and remains active, but now uses a cane to get around. She sometimes worries that she may fall again.

About a quarter of older adults live with a fear of falling that can lead to social isolation and accompanying mental and physical ills, members of the falls prevention group said.

Lisa Walor, 71, a Wake Forest resident, said she has limited her activities since a fall this year. Walor and her husband, John, were heading out for the mountains when she turned to put her keys in her purse, lost her balance and fell.

She's still going through rehabilitation, learning to navigate steps, curbs and slopes at a WakeMed center on Wake Forest Road.

"I think rehab is very important," Walor said. "They are not going to sit there and feel sorry for you."