Often fatal, many falls also are preventable

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Source: http://www.twincities.com/ci_11112042?source=most_emailed

By JEREMY OLSON St. Paul Pioneer Press
Updated: 12/01/2008 08:45:35 AM CST

ST. PAUL, Minn.—When Ron Fleischer got the call that his mother had fallen in a parking lot and broken her hip, he instantly knew "it’ll never be the same."
Doloras Fleischer moved to assisted living, where she suffered a head injury from a second fall, and a broken wrist from a third. With dementia taking its toll, Fleischer moved to the Anoka Care Center, where she used a wheelchair.

Confused and suffering from pneumonia on Nov. 16, 2006, she tried to rise—a strap across her lap hadn’t been secured—and fell one more time.

"Broken collar bone, broken ribs and the pneumonia," her son recalled. "It was just too much."

Fleischer died a week later at 83.

Her death offers important lessons for Minnesota, but not because it was unique. Rather, because it wasn’t.

Minnesota has the nation’s third-highest rate of elderly people dying from falls. And it’s not just the ice and snow. People who are 65 and older here are just as likely to die from falls in July as on slippery sidewalks in December.

The death rate is a mystery for Minnesota, and a top concern for state health leaders. Nursing homes are redesigning and adding technology to reduce fall risks. The state launched a falls prevention campaign last year to educate the public and award grants to communities with innovative ideas.

Minnesotans tend to live longer—reaching ages when fall risks are greatest—but health officials don’t believe fatal falls  are inevitable.
"We just need to improve," said Loren Colman, an assistant commissioner with the Minnesota Department of Human Services. "That’s not to suggest we are going to eliminate all falls, but we can certainly eliminate preventable falls."

Fall-related deaths in Minnesota jumped from 346 in 2000 to 522 in 2006.

Thousands more falls caused brain trauma, hip fractures and other injuries, adding $90 million to $180 million in annual hospital and emergency room spending.

For many seniors, falls hasten their placement in nursing homes. For those with hip fractures, odds are that one in four will die within a year. Preventing fatal falls is a challenge, because they happen in many ways.

Dementia caused 81-year-old Chick Moody to wander from his St. Paul home, especially to the nearby martial arts dojo he once owned. But nobody imagined the seventh-level black belt would fall until he slipped on loose carpeting on his basement stairs and hit his head. He died two weeks later, on July 7, 2005.

Contrast that with Clarence "Jack" Jackson, a "frequent faller" at the Minneapolis Veterans Home. His wife, Susie, said it was frustrating to visit the state home and see fresh bruises.

Jackson was moved closer to a nursing station and placed on an alarm that sounded when he got up. But his wife said alarms were ignored, and she never saw other safety interventions such as a lower bed or floor mats.

A fall in October 2006 led to his death at 76.

"This fall could have been prevented," she said. "He could have had many more years."

Many nursing homes come up short of minimum safety standards. There were 388 state inspections in fiscal year 2008, and 150 cited nursing homes for accident risks. Forty-six nursing homes have been cited four or even five times since 2005 for failing to prevent accident risks, ranging from defective hand railings to inadequate supervision of residents to carelessly stored chemicals.

Jackson’s death came at a low point for the Minneapolis home. State and federal inspections at the time found multiple violations, including fall risks, at the home. Complaints in early 2007 noted lapses in the care of three other Minneapolis home residents who died.

Gov. Tim Pawlenty then put all five state veterans homes under new administration. Fall risks appear to have lessened since then. Only two residents at the 402-bed Minneapolis home suffered fractures in the past year. New predictive software estimated 18 high-risk residents would fall during the first half of the year. Seven did.

Administrators credit many strategies, from broader use of floor mats, bed alarms and grab bars to better planning around shift changes when fall risks are highest. Units with high fall rates aren’t blamed but rather invited to suggest improvements, said Pam Barrows, a health care director for the Minnesota Department of Veterans Affairs.

Why do falls plague Minnesota? Doctors and coroners might be classifying more deaths in this state as fall-related, but health officials don’t believe that would be enough to make up the difference.

Minnesota has slightly higher rates of prescription drug usage among seniors, which might make them more prone to falls. (Any senior taking four or more drugs is at high risk.) Unnecessary drug use is found in half of Minnesota nursing home inspections as well.

A Pioneer Press analysis found falls causing deaths were four times more common in Ramsey and Hennepin counties than in Minnesota’s least populated counties. This contradicts trends for the nation, where fall-related deaths are equally common in rural and urban areas.

The weather factor can’t be discounted, despite the even share of fall deaths in warm and cold months. Other wintry states, such as Wisconsin, also have high fall death rates.

Cold weather keeps seniors cooped up, which makes them frail, said Pam Van Zyl York of the state Health Department. "When it does get better, and they do go out again, they are not in as great a shape as they were before."

Many nursing homes are adding fitness programs to keep seniors stronger year-round. St. Therese in New Hope has daily exercise and weight training in its nursing home and apartment units.

Three women in their mid-80s showed up one day last week for a class. Rosann Decker wasn’t hoping for cartwheels.

"Way past that," she said with a chuckle. "Just a little more strength."

Trainer Matt Koelewyn had them stretch, work on exercise machines and try balance exercises such as looking down and then quickly looking up. After one little misstep by 89-year-old Lillie Bluml, the trainer asked if they needed a break.

"No," Bluml said with spunk. "I think I’ll weather it."

The Galeon home in Osakis has incorporated fitness training into its recent expansion. Falls have increased since the fitness program started, because seniors feel healthy and move around more. But falls with injuries have decreased.

Risking more falls for fewer injuries is a shift for nursing homes, which historically have protected residents at all costs, said Dave Carlson, Galeon’s chief executive officer. "We used to do that for their own safety. We would strap them in their wheelchairs and strap them in their beds."

Restraints are rare now. Even bed and chair alarms are being phased out, because they are noisy and embarrassing for residents who set off alerts every time they stand.

"It almost promotes greater inactivity," said Stacy Lind, St. Therese’ nursing director, "because the person is fearful of actually moving."

Falls beget more falls.

Bernice Gorman fell once going to the bathroom late at night and suffered a stroke at her home in Little Canada. The 85-year-old fell again out of her hospital bed, despite a restraint meant to secure her in place. She died three weeks after the injuries.

Ron Fleischer knew one fall would be a downward spiral for his mother. So he tried to watch out for her while she still lived at home—stopping by on the way to work and coaxing her to help out at his printing business.

"It all started," he said, "with a fall."


Information from: St. Paul Pioneer Press, http://www.twincities.com


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