Ask the Expert: Wendy Ferguson

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The risk of sustaining a serious injury from a fall grows considerably as people get older.

According to the Centers for Disease Control and Prevention (CDC), one in four Americans aged 65 and older fall each year and nearly 2.8 million fall-related injuries are treated in emergency departments every year. The American Geriatrics Society estimated in 2015 that total medical costs associated with fatal and non-fatal falls was approximately $50 billion.

Wendy Ferguson, RN, BSN, CEN, is the Injury Prevention Coordinator at Kootenai Health. Last year, Kootenai Health treated roughly 500 trauma-related ground falls in the area. Some of the most common injuries that lead to serious complications are broken bones (hip, ankle, wrist, arm) and traumatic brain injuries (which can be much worse when people are taking blood thinners).

“When a person falls they often cannot get up without help,” Ferguson said. “This can lead to even more complications, including the compression of muscle tissue, leading to rhabdomyolysis.”

Often these falls lead to the inability for people to return to a previous way of life, such as living on their own, Ferguson said.

Live Well asked Ferguson to share her expertise on falls, how to prevent them, and what exercises people can do to reduce serious injury should a fall occur.

LIVE WELL: Is there a good way to fall, assuming you have some control over it?

FERGUSON: There is no good way to fall, however, avoiding falls altogether is the best strategy. If you know you are going to fall, slow down your fall by sitting down.

It is best to avoid falling by changing positions slowly, such as sitting on the edge of the bed for a few minutes before standing. Listen to your body, and sit down when you become light-headed. Take your time going up and down stairs. Wear properly fitted footwear and appropriate footwear for the conditions. Wear shoes with good gripping soles for icy or slippery conditions.

LIVE WELL: What are some exercises people can do to avoid falls or minimize the chance of injury?

FERGUSON: Exercise programs are a great way to build strength, balance, flexibility and mobility while decreasing your risk of falling. Kootenai Health offers a free Balance and Fit class every Monday from 1-2 p.m. in the Heart Center classroom. It is important to first consult with your healthcare provider prior to starting a training routine, and medical clearance is typically required prior to signing up for any exercise class.

A good exercise for balance is standing on one foot. This exercise is easily done with the help of a sturdy chair or an additional person if you feel unsteady. Start by standing on one foot behind the chair, holding on for balance. Lift one foot and hold the position for up to 10 seconds. Repeat this exercise 10-15 times. Switch legs and repeat 10-15 times.

The Stork is a great balance and fitness exercise that uses the body for resistance and helps to stabilize the core. In the standing position, lift arms forward to chest level and look forward at a stationary (fixed) point on the wall. Now lift one leg up to a 90-degree angle while balancing on one foot. Hold for 10-30 seconds. Repeat on other side.

Another great exercise to complete while sitting in a chair is the Seated Single Leg Raise. Sit and lift one leg up to almost parallel with the floor. Return leg slowly back to the start position. Repeat exercise on the other leg. These are courtesy of Fit and Fall Proof training manual from the Idaho Department of Health and Welfare.

LIVE WELL: If you fall and can get up, what are some symptoms to look for that indicate the need to seek medical attention?

FERGUSON: Obvious deformity or shortening of a limb, uncontrolled bleeding, confusion and or loss of consciousness all warrant medical attention. People who are taking blood thinners such as Warfarin (Coumadin), Xarelto, or Plavix should have a medical evaluation after a fall.

“Battle’s sign” is bruising that appears over the mastoid process of the skull (behind the ear) and appears up to a day after a traumatic basal skull fracture (fall to the head). This sign is sometimes noticed with bruising around the eyes (raccoon eyes). Anyone with Battle’s sign needs to be seen by a medical professional immediately.

Any soreness that results in extreme pain upon movement or the inability to complete simple motions should be seen by a medical professional.

LIVE WELL: If you fall, what should you do? Are there strategies to better help yourself in that situation?

FERGUSON: Call for help, either by yelling or by dialing 9-1-1. Keep emergency numbers in large print near your phone or easily accessible in your cell phone directory. Put a phone near the floor in case you fall and can’t get up.

Wear an alarm device: You can activate a “Lifeline” medical alert services in the form of pushing a button on a necklace or wrist band. Also you should have family members nearby or routinely checking in.

LIVE WELL: What do you communicate to others around you if you have fallen and need assistance?

FERGUSON: Instruct someone to call 9-1-1. First responders are trained to assess for injuries and have many available resources, including communication capabilities with local emergency departments. You can always decline ambulance services if you change your mind. You can also communicate pertinent medical information, such as medication allergies and medications that you may be taking, such as blood thinners.

LIVE WELL: Are there safe methods to moving someone who has fallen and can’t get up?

FERGUSON: If someone has fallen and has difficulty getting up, obvious deformity of a limb, uncontrolled bleeding, and or loss of consciousness, then the person witnessing the fall needs to call 9-1-1 immediately.

When in doubt, avoid moving the person unless they are at risk of further injury, such as falling in a busy street or waterway. If you are a bystander trying to assist an injured person, always make sure the scene is safe before helping.

LIVE WELL: What are some of the risk factors that increase the risk of falling and injury?

FERGUSON: Risk factors include lower body weakness, difficulties with walking and balance, medications, vision problems, foot pain or poor footwear, home hazards such as poor lighting, lack of grab bars in bathroom, throw rugs, clutter, broken or uneven steps. The CDC says the more risk factors a person has, the greater the chance they have of falling.

LIVE WELL: What is the major takeaway for people to know about falls and reducing the risks?

FERGUSON: You can take steps in your daily life to prevent falls from occurring. These steps include consulting with your healthcare provider to identify any medications that may increase your risk. Make sure your home is safe by removing tripping hazards, increasing lighting, making stairs safe and installing grab bars in key areas.

Get routine eye exams and make sure eyeglass prescriptions are current. Finally, talk to family members and make sure everyone is doing their part to reduce falls.

• • •

Ferguson cited the following references in her answers. Follow the links for more information on the subject:

Centers for Disease Control and Prevention, 2017. Retrieved from: https://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html

CDC - Hip Fractures Among Older Adults. September 20, 2016. Retrieved from https://www.cdc.gov/homeandrecreationalsafety/falls/adulthipfx.html

National Council on Aging, 2017. Retrieved from https://www.ncoa.org/healthy-aging/falls-prevention/preventing-falls-tips-for-older-adults-and-caregivers/take-control-of-your-health-6-steps-to-prevent-a-fall/

National Institute on Aging, 2017. Retrieved from: https://go4life.nia.nih.gov/exercises/balance

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