By ops@our-hometown.com | on August 18, 2022

THE RECENT HEADLINES ABOUT 73-year-old Ivana Trump dying from injuries sustained after falling down the stairs in the Manhattan home where she lived alone only hint at a significantly larger problem. According to government data, about 27% of people 65 and older in the U.S. live alone. And 28% of people 65 and older fall each year, although surveys indicate more than half won’t mention those falls to their doctors.

While someone doesn’t have to live alone to take a spill, the fact that there’s no one else around to help can complicate the matter. But falling isn’t the only danger that older adults can face when living by themselves.

Other issues include higher rates of poor nutrition, poor physical fitness, alcohol and drug abuse, susceptibility to scams and fraud, cognitive decline, depression, and suicide. The common denominator between this cluster of problems is social isolation, to the point where these seemingly disparate dangers might be thought of as effects, or symptoms, with isolation being the actual causal malady in need of treatment. While many of the older adults who fall this year will keep their secret because they were able to get up and walk away — this time — about 37% will sustain an injury ranging from mild to severe, according to the Centers for Disease Control and Prevention. About 20% of the roughly one-in-four older adults who fall this year will require hospitalization for a serious injury, typically for head injuries or broken bones such as a hip, femur, sternum or ribs.

TOP: Jim Manos, the owner-installer of Jim’s Bathroom Grab Bars in Charlotte County, comes to your house with a fully stocked van of different grab bar designs to fit your bathroom décor. ABOVE: Don’t try this at home! Shower grab bars must be installed by a professional, not a do-it-yourselfer.

“A lot of falls qualify to come into a trauma center because of the person’s age and what bone fractured,” said Syndi Bultman, the injury prevention resource coordinator of trauma services for Lee Health who also works with Step Smart, a falling prevention initiative in Collier and Lee counties. “The big one is head injury, especially if they’re on any blood thinners, because that whack to the head can cause significant bleed. And a hip or fractured femur is significant because of the amount of blood they can lose from that fracture. So, it depends on their medical condition, any medications they’re on, how they fell and what they hit against when they fell. Falls play tag with motor vehicle crashes here for trauma alerts, with falls sometimes becoming number one when more older residents are down here for the winter.”

PHOTOS BY JIM MANOS / COURTESY OF JIM’S BATHROOM GRAB BARS

Once a fall causes serious injury, the statistics become quite dicey. Of those hospitalized, 11% must be transferred to nursing facilities, never to return home to their previous lives. And 50% of older adults who were hospitalized for a serious injury sustained from falling will die within one year after that fall.

Falling deaths have been on the rise, with a 30% increase nationally in the decade from 2007 to 2016. Nationwide, about 34,000 older adults died from falling in 2019, the most recent year for which the CDC offers statistics, with 3,013 of those fatalities occurring in Florida.

Ms. Bultman said that falling deaths in Lee County run 4% above the Florida average, while Collier County deaths run 24% above the Florida average. The Florida Department of Health lists unintentional falls as the leading cause of fatal and nonfatal injuries among Florida residents 65 and older. The real take-home message is that people can go from living an active, independent lifestyle to one involving a long convalescence, a permanent disability, a loss of independence or even death — all in a split second. However, falling is neither inevitable nor unavoidable.

Typically, falls aren’t caused by a single problem but rather by a stew of physical, behavioral and environmental risks combining. These factors can include:

• A history of previous falls

• Vestibular (inner ear) issues affecting balance

• Dizziness or lightheadedness, which could be related to medications, blood pressure, alcohol use or poor nutrition

Vicki Elliott-Brown, owner of Ellio Pilates, Tai Chi & More studio in Fort Myers, leads an outdoor tai chi class. Research from the Centers for Disease Control and Prevention has determined that tai chi is the best evidence-based exercise program for preventing falls. COURTESY OF ELLIO PILATES, TAI CHI & MORE

• Loss of range of motion in the joints (especially ankles, knees, and hips)

• Numbness and loss of sensation, particularly in the feet

• Loss of stamina and endurance

• Pain, particularly in the back or lower extremities

• Fear of falling prompting self-imposed activity restrictions that exacerbate physical decline

• Tripping and slipping hazards in the environment

Notice that one specific factor is not on the list.

“Most people think they’re falling because they’re old and that it’s just normal, but falls are not a normal part of aging,” Ms. Bultman said. “There is some reason why you are falling, so if someone is having difficulty with their balance or having some issues with walking or falling, they need to talk to their physician. The sooner we can catch it and get you treated, the less likely you are to fall.”

By correcting or removing as many factors from “the stew” as possible, people can significantly reduce their risk of falling. Yearly hearing and vision exams can catch problems and get eyeglass and hearing aid prescriptions updated. Switching from house slippers, flip-flops, or crocs-style shoes to secure, supportive footwear makes it easier to stay balanced while walking, thus avoiding tripping. Free balance screenings offered at events such as community health fairs can help identify balance issues so that they can be treated.

In terms of exercise for falling prevention, the CDC’s research indicates that tai chi — the slow, flowing exercise form from China — is the best evidence-based exercise to help older adults gain strength and balance to avoid falling. One version of tai chi specifically for older adults is the Tai Chi for Arthritis and Fall Prevention Program designed by the Tai Chi for Health Institute. A large health department study in Australia found that the program reduced recurring falls by nearly 70%. Among the instructors certified to teach the program in South Florida is Vicki Elliott-Brown, owner of Ellio Pilates, Tai Chi & More studio in Fort Myers.

Elyse Brown, community education supervisor for the Palm Beach County Fire Rescue Department, is available to speak at community meetings about safety and injury prevention. COURTESY OF PALM BEACH COUNTY FIRE RESCUE DEPARTMENT

“Tai chi can be very gentle but can offer more physical challenges as one becomes ready and able to learn the deeper principles of tai chi movement,” Ms. Elliott-Brown said. “(Tai chi) helps build our leg, ankle, and foot strength, leading to better balance. We pay attention to our balance and become very self-aware in our movements. When we recognize how a movement might cause us to be out of balance, we learn how to correct it. People of all ages can practice tai chi, and it can be practiced for a lifetime, as the movements can be modified to accommodate almost anyone. I currently have people in their late 80s and early 90s still attending classes.”

Ms. Elliott-Brown said that modifications in this specific tai chi program include eliminating the high kicks and deep knee bends often seen in other tai chi forms. She said the classes have chairs available, if needed, as aids to use while learning balance. The chairs may also be used for rest as students work on building physical stamina.

A Palm Beach County Fire Rescue Mobile Integrated Health medical social worker looks up information to assist an older adult patient who is experiencing a crisis. COURTESY OF PALM BEACH COUNTY FIRE RESCUE DEPARTMENT

How can home falls be prevented?

Another controllable factor about falling is based upon where most falls occur. While 10% occur in healthcare settings and another 30% occur in public places, 60% of falls occur at home. In part, this can be explained by the fact that people — especially retirees — spend a substantial amount of time in their homes, but there’s another factor.

“Part of it is because your home is the area where you feel the safest, so you’re not as worried about it,” Ms. Bultman said.

But this also means that many of the potential falling hazards can be corrected since people have a substantial amount of control over their own homes. Making homes safer starts by knowing what tasks are do-it-yourself tasks, as well as knowing when to call a professional.

Start with the easy, cheap DIY fixes. Cut the clutter on floors and stairs, such as the piles of shoes, books, and papers many people have on their floors. Throw out (or tape down) the throw rugs. Move power cords against the walls and tape them down. Arrange furniture to create clear, open walkways. Cover sharp, hard corners on furniture with padding. Add bells to pets’ collars to reduce the potential for tripping over them. Add nightlights throughout the house to help prevent falls in the dark. Place frequently used, as well as heavy, items where they can be easily reached without a stool. Buy a sturdy ladder-style stepstool that has a handrail to hang onto or buy a long-handled grabber device to skip climbing entirely.

And since 70% of home falls happen in the bathroom, start by adding non-skid strips or mats to the shower and buying a shower bench, if needed. But there’s one safety modification that must be left to the professionals: grab bar installation. From hitting the structural support studs inside the wall so that the grab bar can support hundreds of pounds to avoiding drilling into the plumbing and wiring, grab bar installation isn’t a DIY job.

“It’s really not about just buying a drill and a bar and knowing it’s going to hold you, and not knowing if it’s going to rust, if it’s the right bar and if it’s the right size,” said Jim Manos of Charlotte County, who has been the owner-installer of Jim’s Bathroom Grab Bars for 28 years. “If you get your brother-in-law to do the job and he just puts it through the tile, when you take a slip and fall, you come down with a grab bar with two tiles connected to the ends in your hand, and you still have a broken hip.”

Like other safety remodelings, bathroom grab bars can be a selling point for a home, plus they can lower home insurance premiums. However, the insurance agent will want to see a receipt to prove the bars were professionally installed.

“It’s not about getting up in age,” Mr. Manos said. “It’s about enjoying what you’ve achieved and enjoying your life. People are living longer and enjoying active lifestyles, such as going out to dinner or bike riding. One second is all it takes to fall in the shower, and then that all changes. Don’t wait to fall to call.”

Other professional home remodeling projects that could reduce falling dangers include replacing entry steps with ramps, replacing flooring with nonslip tile or wood surfaces, making all floor surfaces level and flush to one another, installing handrails on both sides of stairwells, installing a curb-less shower that eliminates the usual four-inch stepover lip or installing a walk-in bathtub that allows the bather to step into the tub through a door that seals. Although these professional home modifications could cost anywhere from a couple of hundred into the thousands of dollars, that cost should be weighed against the price of an emergency room visit, a hospital stay, physical therapy and home health care, not to mention the risk of permanent disability or transfer to a nursing home. By comparison, remodeling a home to protect the safety and health of its occupants is an inexpensive investment in the future.

Help from agencies, authorities and technology

One other home remodeling project to consider might be a keyless entry pad to replace the front door lock, or alternatively, a key safe to stash a door key. Beyond eliminating the need to fumble with keys, consider what happens when emergency services respond to a 9-1-1 call to the house of someone who lives alone but cannot answer the door because they are experiencing a medical emergency.

“One of the scariest things I have to do as an EMS fire rescue provider is to go to a medical alert (button) call at 2:30 a.m. where there’s a car in the driveway but no answer at the front door,” said Capt. Tom Reyes, a firefighter and paramedic with the Palm Beach County Fire Rescue Department. “I need to see what’s going on because somebody might have fallen inside or be having a medical emergency, so we must break in. Our mantra is ‘try before you pry,’ so we try to see if there’s an open door or window to get in, but we have to get in. So, sometimes that means we have to force the door. It’s very dangerous not only for us, because we’re crawling through a window, but also imagine if someone accidentally hit the alarm pendant rolling over in their sleep, and now they hear somebody crawling in their window. They’re going to act appropriately, and I understand that.”

Palm Beach County Fire Rescue has a program where residents can place their front door or garage keypad code or their key safe code on file so that, if emergency services are sent to a house, the dispatcher can tell the crew the code to unlock the door. Beyond saving the unpleasantry of a busted front door, this also saves the time it would take the crew to check for an unlocked window. In a medical emergency, time can make the difference between life and death. Capt. Reyes said that homeowners who participate in the program do have the responsibility to check in yearly to verify or update the key code on file for their homes.

While the emergency medical alert button pendants proved a gamechanger when they were originally introduced in the late 1980s with the much-mocked “I’ve fallen and I can’t get up” television ads, Capt. Reyes pointed out that more sophisticated and versatile technology now exists. Smart watches allow the wearer to call a variety of phone numbers, such as a neighbor in the instance of a small incident, whereas the medical button pendants are locked into contacting emergency services. The watches are harder to dial accidently than the button pendants, and some even have fall detection programs on them. Of course, any device needs to be waterproof because the most likely place to fall is the bathroom.

While responding to emergency calls, EMS personnel sometimes see situations in homes that could use quality of life improvement, but those needs fall beyond the scope of emergency services. Six years ago, Palm Beach County Fire Rescue was the first department in the state to implement a program called Mobile Integrated Health, where emergency crews could refer situations for follow-up by a multidisciplinary team with a community paramedic and a medical social worker.

“Mobile Integrated Health is about meeting the individualized need of the patient in a different way than that frontline response can do, managing the care of individuals in a way that ensures their unique needs are not only identified and considered but are planned for,” said Lauren Young Work, LCSW, the medical social worker and MIH coordinator for the Palm Beach County Fire Rescue Department. “Sometimes their needs extend beyond the reason that they’re calling 911, or they have needs that are causing them to use 911 when it’s not actually the right level of care for what’s going on in their world. The MIH team not only reaches out to the patient to offer support but to assess their situation with them and their family, creating a care plan that hopefully is going to address their needs, improve their quality of life and level of functioning, their health, and wellness, improve social service issues that are barriers in their everyday life and, in some cases, improve their safety. It’s innovative, and it’s helping take EMS into the future in terms of recognizing the trust that we have in the community.”

The fire rescue department also does outreach through its community education division. Along with making safety presentations at organizations such as clubs and HOAs, the division distributes materials to the public for the department’s Vial of Life and Yellow Dot programs. The Vial of Life is a form to hang on the refrigerator where people can list their medications and health conditions. EMS personnel check the kitchen for this information when they find a patient who is alone and cannot speak. The Yellow Dot is a similar program for automobiles. An unobtrusive yellow dot decal on the windshield alerts EMS to check the glovebox for the medical information form.

“We talk to them about the necessities that they may need as they progress in age and mobility and being OK with the fact that they may need some help and adjustments in their living environment to make them safer,” said Elyse Brown, community education supervisor for the Palm Beach County Fire Rescue Department. “A lot of them have fallen in the past and kind of joke about it. But there’s also a population that starts to regress in their social activities for fear of falling, so they end up staying inside more and don’t exercise as much. By staying indoors and not participating in things, it makes them more likely to fall. A lot of groups we speak to aren’t aware of that connection. We try to empower them and enlighten them that they do have the ability to make adjustments so they can be safer. Sometimes it’s a conflict with medications, so we remind them to have all their doctors on the same page. That’s one way the Vial of Life can help because they document all their medications and medical history in one place. Not only can they keep it updated for their medical providers, but it’s something that they can provide to emergency responders when they respond, so they don’t have to memorize everything.”

Other community organizations offer services to help overcome the isolation that older adults living alone can face, while also offering a layer of safety. These can range from Meals on Wheels, which can provide a quick well-being check along with a nutritious meal, to senior centers, which offer services such as social gatherings, meals, and wellbeing calls.

While these checks verify physical well-being, people living in isolation tend to be vulnerable to the emotional manipulation of scams and fraud. If seniors are ever in doubt about requests they receive by phone, email, social media or even in person, they can contact their local sheriff’s or police department to verify the validity of these contacts.

Angela Larson, supervisor of the victim and senior advocacy unit of the Collier County Sheriff ’s Office, said most criminals make contact by phone or email to run their scams. There are three red flags to watch for, which are urgency, threat, and method of payment. Often, the criminals will pose as someone official, such as a government agency, financial institution or computer tech support. Rather than focusing on the exact scenario and language of scams, since those keep evolving, Ms. Larson said to focus on the red flags and assume it’s a scam if they’re present.

“The urgency is ‘you’ve got to do this now,’ the threat is ‘or this bad thing will happen,’ so ‘go buy these gift cards now,’” Ms. Larson said. “Who pays a bill with any kind of gift card? In a normal, nonstressful situation, your brain would probably pick up on it, but they use the scare tactics to make you think there’s trouble. The scams and frauds will be more successful if there’s nobody else in the home because there’s nobody to intervene.”

She said another way seniors living alone fall prey to fraud is they will hire household helpers from Craigslist, Facebook or the seemingly reliable venue of their church congregation, rather than from an agency that runs background checks on its employees. Now this person has access to the home to steal or to abuse the older person.

Ms. Larson has seen another problem related to living alone occur in households where a caregiver lives with a family member who has cognitive disabilities. What happens if the person with dementia is suddenly left alone because the caregiver becomes hospitalized? She said caregivers need to make arrangements with friends, neighbors, and family for an emergency care plan that can be activated in this instance. The plan should be posted on the refrigerator so EMS can find it.

“Isolation is a big factor in somebody being vulnerable to elder abuse, neglect, and exploitation because there’s nobody there for the older person to ask questions of and nobody to notice behaviors or to notice signs of abuse,” Ms. Larson said. “They can always call the sheriff’s office, and we’ll check. ¦

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