Falls are Personal

Louise was well on her way to living out her days in a nursing home. She'd had debilitating knee and back pain; refused surgeries and was finding it more difficult to get out and about. Her family had to pitch in more and more but they had their limits. And then the 911 call. She'd fallen on her way to the bathroom. She'd had her umpteenth urinary tract infection, always treated by antibiotics which seemed to upset her 'system' as she recalled and sapped her strength.

And that is where the storyline changed. She could have been transported to an emergency department with a short hospital stay and then a few weeks in a rehab facility, which even with the best of care would have increased her risk of falls even further. But instead, the paramedics checked her out, put her back in her chair and with  her personal safety alarm notified her daughter who arrived promptly and then made an appointment for her PT and her MD.

That was three years ago. Since then her family has convinced her to have day time help, periodic physical therapy -included a fall prevention protocol - to maintain her strength which has resulted in her remaining at home and doing all the things she really likes.

Long Beach has established a new baseline for fall prevention. Falls are no longer an inevitable part of aging. Fall prevention is no longer a simple awareness campaign or installation of grab bars upon hospital discharge. The causes and prevention of falls are better understood by organizations, hospitals and older adults.

With little or no financial support the purpose and vision of re-thinking fall prevention came from our ranks. Serendipity played as much a role as 'planning'. Heart of Ida, local non-profit, was able to take the need for a training site by the California Department of Public Health and turn it into a larger scale analysis of what should be occurring in a city of our size. This led to developing relations with SCAN Independence at Home, St. Mary's Medical Center, Long Beach's Department of Parks, Recreation and Marine Senior Center, and the Long Beach Department of Health and Human Services, and that was just the beginning. 

Three years ago there was not a single evidence based fall prevention strategy offered in the city limits of Long Beach; and almost none in LA County. Today the city is populated with a series of proven and highly regarded programs to reduce falls, fall risks and fear of falling. Throughout the year fall risk assessments are offered free at several convenient community locations. The city now boasts 7 community fall risk screeners. These screens are essential for older adults to understand the nature of their fall risk - a personalized assessment that helps direct their next step.

By 2014 we had developed a fall prevention faculty: 2 master trainers and 8 leaders with on-going classes all done at the community level. Mapping these opportunities shows that an older adult in LB is within 5 miles or less of a fall prevention program.  Most are closer.

Physicians and seniors alike are relieved but more importantly empowered with these changes. Seniors can arrive at their physician's office with a completed fall risk assessment that includes test data and solutions available in the community. The physician can confirm and discuss issues with their patient while their patient doesn't have to struggle trying to describe their concerns about falling and potential injury.

At the same time this means older adults are no longer stymied by denial and avoidance. With very little prompting an older adult realizes that falls and loss of function as we get older are no longer inevitable.

Seniors are not stubborn! But they seem so resistant to change, why is that? Older adults need personal information with their own action plan. Studies have proven and the Centers for Disease Control programs reinforce that personal action plans are key to reducing fall risk. Whether the issue is 'fear of falling'; or experiencing multiple fall risk factors; or just not taking care of oneself a personal action plan based on readiness to change is the tipping point. At a recent evidence based Tai Chi class at Houghton Park, older adults expressed that they no longer accept that "getting older means getting weaker" or the impossible task of remaining "independent" which translates to being alone and compromised. They believe that getting informed is the key to successful aging.

A new way of thinking is emerging. In June, the Long Beach Department of Health and Human Services hosted a Call to Action conference – rather than just complaining about what we didn't have, the 100 attendees were energized to plunge forward to create a falls prevention pathway. More community nurses have been trained in Fall Risk Assessment, more evidence based programs are being offered and supported. Hospital environments are considering how they can refer to the community. People are thinking outside of their box. "Our community has the all the right ingredients to offer fall prevention to our older adults", Pam Shaw, RN, MSN/MPH, Nursing Services Officer, Long Beach Department of Health and Human Services.

There are pathways for each older adult to follow. Some involve medical procedures e.g. joint surgery, while others are as simple as a wellness check-up and continuation in routine exercises. At specific times, such as after an infection or bout of depression, there is a risk for a loss of function, leading to an increased risk for a fall. Families and friends can now, with confidence and care, encourage their family member to develop a personal action plan for fall prevention, and get back out there and enjoy life. 

To be sure Louise had family and resources that not all our older adults have. However, she posed, like so many, a series of seemingly insurmountable problems that in the old way of thinking inevitably lead to falls. By taking Louise's personal risk factors into consideration and making the necessary changes, she is able to remain at home without subsequent falls, injuries or hospitalizations.  "Families are an important member of the fall prevention team. In Long Beach, family members serve as advocates and identify resources to help their older family member remain independent", Nancy Blair, Patient Family Adviser, Long Beach Memorial, Miller Children’s Women’s Hospital, Community Hospital Long Beach.

And the partnerships that have been forged still need a track record and refinement. "Long Beach has made great strides in fall prevention and our older adults and their families will reap the benefits for years to come", Kit Katz, Director of Community Benefits, Bazzeni Wellness Center, Dignity Health.

Plans continue to be made by our City's Department of Health and Human Services to host and facilitate work groups to identify the gaps and solutions in our fall prevention system. These discussions will offer community institutions and older adults a way to re-think the inevitable fall and establish sure footing on a course of prevention.

No longer are we confined to the 'help help' scenario of being trapped and panicked after a fall. LB's fall prevention programs teach older adults how to get up and recover. Watch out Long Beach - there is a tsunami coming of seniors ready and willing to stay healthy.