Mikulski effort for senior health no accident

The Baltimore Sun

Some lawmakers want to call attention to a little-discussed problem among the nation's senior population: falls.

Falls are the leading cause of death stemming from injury among people over age 65, accounting for 1.8 million emergency room visits and $27 billion in health care costs every year.

President Bush is expected to sign a measure this week sponsored by Sen. Barbara A. Mikulski and passed by Congress that aims to raise awareness - through education and research - of how falls affect seniors and what can be done to protect them.

"This is a serious public health problem that directly affects our seniors and their family members," Mikulski, who has been promoting the measure for six years, said in a news release. "This legislation provides a framework to reduce and prevent elder falls through public education campaigns and important research." The bill does not specify funding.

About a third of people over age 65 fall at least once a year - as do about half of all older people who live in institutional settings, said Dr. James Richardson, chief of geriatric medicine at Union Memorial Hospital.

"Falls wouldn't be an issue if everybody who fell just got right up and they were fine," Richardson said. "Unfortunately, with elderly people it's not the case, and about one in 10 falls results in a serious injury."

Complications from falls include bone fractures, bleeding in the brain and other medical problems. Hospitalization or nursing home placement often results, which can leave the person who fell feeling weak or depressed - which in turn can lead to more falls, experts said.

"And the risk of dying following a hip fracture increases substantially with age," said Robyn Stone, executive director of the Institutes for the Future of Aging Services at the American Association of Homes and Services for the Aging.

The problem is expected to grow as the population ages, experts said.

"By 2010, 20 percent of this country will be over 65," said Dr. Elton Strauss, chief of trauma and adult reconstructive surgery at Mount Sinai in New York. "And with more people ... [in] that group, falls will become even more prevalent."

In recent years, many health care providers have increased their focus on preventing falls among the elderly.

"People are living longer and ... they're trying to be able to stay at home as long as they can, and the prevalence of falls may very well be increasing because of [that]," said Jean Costa, who, as rehabilitation manager for the Rockville-based Adventist Home Health, oversees fall prevention for clients in Anne Arundel, Montgomery, Prince George's, Howard, Calvert, Charles and St. Mary's counties.

Older adults can do several things to make their homes safer, Costa and other experts said.

Some of those things include removing scatter rugs from floors, moving dishes to a lower shelf in kitchen cabinets, using brighter light bulbs, decreasing glare from windows and keeping sharp-edged furniture out of walkways.

Seniors also can make small changes to their wardrobes to help prevent falls.

"I have to tell a lot of my older lady patients who still insist on wearing high heels [that] they need to think about wearing a shoe that grips, that's not slippery, that either has a low heel or no heel at all," Richardson said.

Mikulski wants such one-on-one education to take place on a much larger scale.

As the chairwoman of the Senate Health, Education, Labor and Pensions Subcommittee on Retirement and Aging, she has been made aware of the growing problem of falls among seniors.

"We know that baby boomers are getting older, and we know that costs are rising," said Melissa Schwartz, a spokeswoman for the 71-year-old senator.

Mikulski's bill, the Safety of Seniors Act, which the House and the Senate passed this month, will, among other things, establish public education campaigns for older adults, family members and health care providers; require the Secretary of Health and Human Services to evaluate the effect of falls on health care costs and how to reduce them; and support research that identifies older adults at high risk of falling.

Experts say such legislation can help. "I believe," Stone said, "that part of the success of this is to have individual elders and their families, as well as architects, city planners, and people who are designing communities, as well as individual households - to have everybody attuned to falls prevention."


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