The common assumption when one sees an ambulance, lights and siren blazing, is that it’s en route to a car accident, or maybe a heart attack or stroke victim.
But they’re just as likely to be on their way to assist the 1 in 3 seniors aged 65 and older who fall each year.
“When we talk about responding to trauma calls, people assume the majority are for car accidents or things like that,” said Chief Bruce Evans of the Upper Pine Fire Protection District, “but 70 percent of our trauma calls are for elderly people who have sustained a broken hip or head injury.”
That doesn’t even count the calls for lift-assists, people who have fallen and, while not injured, can’t get up without help. Evans said his district saw a 26 percent increase in those calls during the first quarter of 2015.
The Centers for Disease Control and Prevention considers seniors falling a public-health problem that is “largely preventable,” it says in its Stopping Elderly Accidents, Deaths and Injuries program. An injury from a senior’s fall can have long-term effects, such as disability, dependence on others and reduced quality of life, the CDC said.
There’s good news for seniors. Research into the problem found consistent reasons why seniors fall, and a number of things they can do to significantly decrease the odds of hitting the floor.
Losing muscle tone and balance, vision problems, medication interactions, bad lighting and hazards in the home top the list. Solutions include “four pillars,” said Amy Allen, executive director of the Southwest Regional Emergency and Trauma Advisory Council: Improving physical fitness, particularly with tai chi to improve balance; checking medications with your physician; getting annual vision checks with your ophthalmologist and keeping eyeglass prescriptions current; and removing hazards in the home while installing additional safety features.
“And then there’s the aspect of the fear of falling,” she said. “Seniors worry so much about falling, they restrict themselves from moving, which makes it worse and stops them from doing daily things, like going for the mail.”
Less than half of seniors who fall are talking to their doctors about it, another major obstacle to making their lives safer, the CDC said.
A use of resources
“Those calls are something we do on a daily basis,” said Scott Sholes, the Emergency Medical Services captain for the Durango Fire Protection District. “It can be very straightforward, maybe someone felt dizzy first or was having some unusual difficulty, or it might be someone we help over and over, then we get involved in exploring alternatives because they’re intending to remain where they are.”
Getting a solid count of the number of calls the district gets regarding seniors who have fallen is difficult, he said.
“If we do any kind of assessment, it ends up in different categories,” he said, adding that the district uses Medicare rules for coding all calls, since that makes billing easier. “It could be categorized as non-motor-vehicle trauma, or any other medical complaint, like maybe they’re on oxygen, and it could respiratory distress.”
None of the emergency medical services in La Plata County charges for a simple lift-assist unless the patient is transported, a medication is administered or a billable assessment conducted.
“That may change over the next decade because these calls can take a lot of resources. When you consider how big our district is, a call from Station 15 could take 15 minutes just to drive each way, so resources may be tied up for an hour or more,” Sholes said.
And when DFPD has the resources available, it sends two ambulances and two crews, he said, because they don’t always know what they’re going to find, and four people is a minimum standard. It’s not unusual to find seniors who have fallen between the toilet and the bathtub, for example, an awkward position for lifting.
“That’s also for the safety of the staff,” Sholes said, “because lifting someone off the floor is the physically most dangerous action for them. Nationwide, 1 out of 4 EMS workers suffers a career-ending injury in the first four years of their career. That’s why we mandate they be fit because then they’re less likely to be injured.”
It may cost resources, but EMS crews also get to know the seniors they help on a frequent basis.
“These familiar faces have become part of the fabric of the fire district,” Evans said.
Calls for lift-assists and trauma falls come in around the clock, he said.
Upper Pine’s chaplain of 25 years, James Newman, is in his late 80s now and becoming more frail, Evans said. He knows their staffing situation so well, when he fell in the middle of the night, Newman would stay on the floor until the 8 a.m. shift arrived and call for help 10 or 15 minutes later.
“‘Chappy’ was trying to be kind, but we told him not to do that anymore,” Evans said, “that we wanted to come whenever he needed us.”
A growing challenge
With La Plata County’s senior population predicted to almost triple by 2040, the number of calls for fallen seniors will just keep increasing as baby boomers age.
Seniors are hospitalized five times more for falls than for any other type of injury, according to the CDC. And forget skiing or mountain biking, the Southwest Regional Emergency and Trauma Advisory Council, which includes first responders from around the region, has identified elderly falls as the number one injury cause in Southwest Colorado.
The council is putting resources into preventative activities, including training instructors for tai chi for arthritis and fall prevention that graduated 11 instructors in 2014, Allen said. It also started a STEADI toolkit from the CDC’s program, including prevention assessment tools to help area health-care providers better assess their patients. Another course for providers, A Matter of Balance, will be offered in September.
In the end, EMS service and health-care providers have the same objective – keep the golden years golden.
“We want to get them back in bed, off the toilet or whatever else they need,” Evans said, “so they don’t end up institutionalized and can live where they want to live.”
The Centers for Disease Control and Prevention have identified four key ways seniors can reduce their risk of falling:
Follow an exercise program to improve balance and strength. Tai chi, in particular, is recommended.
Conduct a home assessment, including looking for loose rugs, a night-light between the bed and the bathroom, access to hand rails, improving the lighting and always wearing shoes, not slippers or barefoot, inside and out. Many falls are caused by small dogs and cats in the home; the CDC did a separate study on it.
Review medications, including over-the-counter drugs, with your physician, minimizing dosages and number of medications wherever possible.
Have your vision checked and keep your eyeglass prescription current. Poor vision, including cataracts and glaucoma, increases chances of falling.
Visit www.ncoa.org/healthy-aging/falls-prevention for the National Council on Aging’s Fall Prevention information.
Visit www.cdc.gov/steadi for information and a household assessment.
Visit www.swretac.org/injury-prevention/elderly-fall-project to learn more about what area agencies are working on to decrease falls in our area.
Visit https://vimeo.com/114399174#t=0s to see SWRETAC’s public-service announcement about fall prevention.