The oldest patient I ever treated was an 101-year-old woman from northern Bergen County. She was sharp, intelligent and determined. I’ll never forget her, not only because of her age but also because of what she told me as I evaluated her.
Teary-eyed, she said that she had been completely independent until she fell and fractured her hip the year before. I could see the anguish in her eyes for grieving her independence. While she was grateful to have a full-time aide and to be able to get around her home with a walker, her mobility had been stunted. She couldn’t get on a plane and visit her daughter, grandchildren, and great-grandchildren in Europe. She kept asking me, ”Is this normal?”
As a physical therapist who mainly treats the geriatric population, it’s not uncommon for me to hear about falls. And if a patient isn’t concerned about a fall, they often recall moments of imbalance and near falls or express a fear of falling. In fact, one in three community-dwelling older adults is at risk of falling.
That’s not a surprising statistic. No one’s risk of falling is ever zero. When I was 23, I stepped off a curb haphazardly and broke a bone in my left foot. Beyond broken bones, falls can also have more dire consequences, including severe brain injury and even death. Think about Ivana Trump, Bob Saget or Senator Joseph Lieberman. All suddenly passed away after suffering falls.
Older people who suffer and survive a fall often find themselves in a vicious cycle: the fall leads to hospitalization, which leads to debilitation and an enduring fear of falling. Due to that fear, people significantly reduce their activity level, which then puts them at an even greater risk of falling in the future. I want to help stop that cycle by working on fall prevention with my patients.
My approach starts by educating patients about why elderly people fall. First, there are normal changes that occur within the body due to aging: weaker muscles and decreased muscle mass, decreased flexibility, changes in posture, gait changes, cardiovascular changes, vision changes, decline in vestibular function and sensory deficits, to name some. Together, those changes make it harder for older people to maintain their balance while doing everyday activities, like stepping onto an uneven surface or reaching for something in a cabinet.
In addition, patients who suffer from cognitive deficits or dementia are at higher risk of falls, as are patients who have incontinence. There are also conditions such as Parkinson’s, stroke, multiple sclerosis and other neurological conditions that contribute to declines in balance. Certain medications have side effects that can put people at risk for falls. Besides these intrinsic factors, there are also extrinsic factors that contribute to falls: a cluttered home, slippery surfaces and throw rugs, poor lighting and improper footwear, to name a few.
As older adults confront these contributing factors, they can take steps to significantly reduce their risk of falling. Physical therapists like me are here to help them take those steps.
In my physical therapy practice, I start by completing a comprehensive assessment, looking at the patient’s strength, balance, endurance, posture and flexibility. I also assess the patient’s overall cognition, safety awareness and home environment, and evaluate risks associated with cultural values and beliefs, medical history, current diagnosis and medication side effects.
After completing the assessment, I provide a detailed plan of care to address issues I identify and begin to work on specific strength, balance, endurance, postural, cardiovascular and flexibility exercises that will help to mitigate the patient’s risk of falling. Where appropriate, I recommend that the patient use assistive devices, such as a cane or walker, or invest in home modifications, like grab bars or railings, to increase safety. I demonstrate safer ways to move around the home and accomplish daily tasks. When needed, I also educate family members and other caregivers on assisting the patient at home.
When I think back to my now almost 103-year-old patient, I’m amazed at her progress. Working together, we have strengthened her lower body, improved her walking indoors and outside, completed stair and safety training around the home, and engaged in dynamic balance exercises. In completing physical therapy, she has taken major steps to reduce her fall risk.
As a physical therapist focused on geriatric care, I love to see this kind of patient progress. There is no greater feeling than knowing I have helped someone become stronger, more independent and confident. Empowering others to feel and be their best selves is something I’m passionate about. When I help someone achieve their goals and reduce their fall risk, I know I’ve made a difference.
Dr. Jordana Burstein PT, DPT, GCS, is a physical therapist who is a board certified geriatric clinical specialist. In addition, she is LSVT Big certified for the treatment of Parkinson’s Disease. She works one-on-one with patients in their homes in Bergen County, and specializes in fall prevention, Parkinson’s, dementia, stroke, multiple sclerosis and other geriatric and neurological conditions. Dr. Burstein is currently holding a series of classes at Congregation Beth Sholom in Teaneck on fall prevention and related topics for seniors. For more information call 201-663-3059 or visit BursteinPT.com.
