Natalie Fick (guest):
If you've known people that have had injuries, you've had loved ones that have had a very adverse outcome from a fall, we know that on the positive side that falls are very multifactorial. That it's a lot of things that you can do to prevent falls and to reduce your risk. And I think it's something kind of empowering for a lot of people to know that they can kind of take charge of that and they can do a lot to prevent those falls and overall keep them strong and moving well. And that's, I think, something that once they understand where those resources are, whether it's with their provider, whether it's with their therapist or any of like the community exercise programs and things going on too, that they can take those positive steps to keep them moving well and aging in place and maintaining their strength and their mobility too.
Cassie Alvine (announcer):
This is the “Health and Wellness” podcast brought to you by Sanford Health. The conversation today is about understanding falls and fall prevention. Our guest is Natalie Fick, Sanford Health physical therapist. Our host is Alan Helgeson with Sanford Health News.
Alan Helgeson (host):
Thank you, Natalie, for taking time to spend with us today to talk about this topic.
Natalie Fick:
Glad to be here.
Alan Helgeson:
Alright, well we're going to talk about falls prevention and let's get started here. I guess the big open question we want to start with: why is falls prevention an important topic for older adults?
Natalie Fick:
I think it's something that any older adult, no matter age, where they live, it's always a concern at some point. And it's a really critical topic for them too because it's such a leading cause of severe injuries and can overall kind of affect their mobility and their independence, which I think is a common concern for people as they age, you know.
Falls, they can increase your risk of hospitalizations, lead to a decline in overall health and function and mobility, which a lot of people, they want to age in place. They don't want to have to go to a nursing home, feel like they're more dependent. And unfortunately we know the adverse issues from falls, whether injuries or other things too can usually lead to more of like a dependent type lifestyle if they aren't able to recover well. So that is a big factor.
And then also we know just by working on preventing falls, we can just help to hopefully maintain people's physical health and mobility, allow them to age in place like a lot of people want to do, reduce health care costs, which is another huge worry for a lot of people. And support their overall emotional well-being. So kind of reducing rates of depression, anxiety and just kind of helping them feel more confident and safe with their day-to-day activities.
Alan Helgeson:
You talked about that costing, that's a biggie. Boy, we hadn't even really thought about that, but you talked about also, you know, all these different things. What really puts them at risks for falls?
Natalie Fick:
So we think of falls as actually a very multifactorial thing. It's not just one cause causes the falls like, oh, just a trip and they fell and had an injury. There's a lot of factors that go into it, you know, starting (with) a very common thing with any aging adult is just lower extremity weakness or overall weakness in their body that we know just puts them at a higher risk of falling.
We know that just in general, if they're having more difficulty with their balance and walking, whether or not they're using an assisted device or if they need it can put them at a higher risk.
Sometimes even medications that they're taking can greatly increase their risk of falling because of either side effects or interactions between medications. And people don't always realize that. So that's where it's a great conversation to have with your provider or your pharmacist to see if you are at a higher risk with that too.
We see a lot of people with even just poor footwear. So wearing good supportive shoes so that you're not tripping over your shoe, just have overall good stability can be a big factor. Vision problems – I don't know when everybody's maybe had the last time they've had their eyes checked, but other eye conditions too, whether like glaucoma or even just not having an updated prescription can greatly affect your ability just to see your environment and potentially identify or limit your ability to identify trip hazards or things in front of you and around you too.
And then another common one that I actually work with people a lot on is even like low blood pressure so that when they get up from either laying down or from sitting, they might get dizzy or they might feel really woozy and that potentially can cause a fall and an injury too.
Alan Helgeson:
So many different things you don't even think about.
Natalie Fick:
Right. Exactly. And the nice part in a way about this too is we know there's so many factors we can potentially control and we can minimize that risk by identifying where am I at risk and knowing that hey, I can get better footwear. I can talk to my doctor about medications. Or I can go get my eyes checked. Doing things like that greatly, greatly reduces your risk so that you're safer overall.
Alan Helgeson:
So I was just going to tell you here a couple of things while you're talking about that I'm going through the footwear thing in my mind of the different things I have and I'm going to admit I've got some things, they're not the greatest, you know. I've got some junky flip flops. I've got some slippers that my wife would say, you need to get rid of those, you know, we all have those.
Natalie Fick:
Exactly.
Alan Helgeson:
I had no idea about certain medications that could put you at risk for things like that. And then what about if you don't have vision issues strong enough or bad enough where you have prescription glasses but you've got readers everywhere and maybe you walk around the house with your readers down? They could be issues for tripping, right?
Natalie Fick:
Correct. So I mean it can potentially skew your vision just enough where you normally used to like a flooring transition or a small step. And you can misjudge that, or I've even had people that have had that discussion where they just got bifocals and all of a sudden they're having issues or trying to figure out the curbs.
So we see it in a lot of places, thankfully, where people are being more aware out in the community where they might highlight those transitions with like yellow paint or some extra grip on certain steps too to try and help minimize that risk. But they're still there. They can still happen. The sidewalk will heave in certain spots you might catch your toe. So we always have to be able to hopefully see those and be aware of that too.
Alan Helgeson:
Natalie, I want to go back here and the reason we have you here is that you're kind of special here with some special training in talking about falls. So let's talk about where do you work, what clinic are you part of and let's talk about the reason you're able to talk about this today.
Natalie Fick:
Yeah, so I work at Sanford here in the outpatient physical therapy department at the Madison Veterans Parkway Clinic. And so, I mean that's just part of my job is we have been trained in being able to help evaluate and assess people in their fall risk, overall strength and mobility concerns, and helping to improve those so that they are safer in the home.
I've also had the privilege over the last five years of working with some amazing people here to help implement some evidence-based fall prevention classes in the Sioux Falls area and the region. And so I am a master trainer with the Matter of Balance class. And then I provide kind of the health care professional viewpoint as well with these classes.
And then I've been able to work with this group too as they've implemented other classes including SAIL (Stay Active & Independent for Life) and Bingocize (combining bingo and exercise) in the community to again help to reduce this large issue that we have not only in the Sioux Falls region, but in the state as a whole too.
Alan Helgeson:
You've got some deep training to not only as a physical therapist, but you have a doctorate in physical therapy, correct? What does that mean, having a doctorate in physical therapy? Can you talk a little bit about that?
Natalie Fick:
So in order to get our doctorate, so in order to even just to get into grad school, you have to get your bachelor's degree. So I've had four years for that in kinesiology. And then I had a psychology and coaching BA minor too and then got into grad school. And so additional three years of training extensively, not only on the body mechanics, how the body function and works, but we when you get your doctorate level, they've expanded that training and that knowledge too to be able to better understand how all the systems work together. Not only just the musculoskeletal and the getting stronger too, but how the cardiovascular system affects things too. How the pulmonary system, you know, where we can identify some of those yellow, red flags, how can we work with our providers to help keep everybody as safe as we can.
Alan Helgeson:
So good to have expertise like yours and talking about this today. So let's keep moving on here because there are a lot more questions here to ask you and talking about falls prevention. Next question for you. What are some of those complications for older adults when falling?
Natalie Fick:
So I think one of the, the biggest ones that we hear a lot is, you know, the broken hip. So it's a very, very common place for people to have those fractures when they sustain the fall. But you know, we also see those broken wrists and shoulders or arms. I've even seen some people too that have had like compression fractures in their backs from the falls too.
Obviously broken bones are not good. They take time to heal. And especially as we age, healing takes longer. Mobility is usually greatly limited because of that for a period of time while things heal.
Other things that sometimes we kind of gloss over but actually can be very significant too are even just the head trauma and the head injuries from these falls where you can potentially get even just a concussion or a traumatic brain injury from that too.
Or we touch on a lot in our classes that we teach, especially if you're on blood thinners, just the risk of a potential stroke or some type of injury like that as well. And unfortunately those take a long time to heal too or potentially have some very adverse outcomes too, where sometimes we see some people that they have that head injury and they end up passing away too from that fall.
The other things that can happen you know, some people, they just all of a sudden whether they have a fall or a close call start to have a great fear of falling too. And that is a huge, huge precursor actually. And a huge risk factor of falls is the fear because we know when people are fearful of falling, they might avoid activity. They might avoid what they're doing.
I don't want to move or I don't want to do this because I'm going to fall. And in turn, because we're not as active, we see people actually tend to get weaker. And then unfortunately because of that you're at a higher risk of falling and then you actually might have more of a fall too. So it's this terrible cycle to get caught into. And so by addressing sometimes even that fear and that concern showing people, you know, how realistic is this? How can we work through this again? We can kind of decrease their risk too.
Other complications people have, and I know this is a big factor or a big thing for a lot of people is just the increased dependency is people don't want to depend on others. They don't want to have to have their children help them with things that they can do on their own.
They don't want to have to even consider leaving their home and going to assisted living or a nursing home or a long stint in rehab to recover. They want to be able to be independent and unfortunately if they have falls and have injuries or limited mobility, sometimes they have to have that assistance and it's hard to accept it or hard to ask for it too.
And then even again, just like the psychological effects that we see in a lot of people too, a lot of anxiety, a lot of fear and sometimes even that depression and that social isolation that can happen because if people are worried I can't leave my house, I can't navigate those stairs, or I want to go to a show at like the pavilion, but I can't navigate the curbs and stairs, you know, that depression, that isolation of not being able to even just be out with your friends really sinks in too and can be a big struggle.
Alan Helgeson:
Well I'll tell you, living in this part of the country also, when you have some tough winters and springs that can add even more fear and danger for people that might suffer from that. Right?
Natalie Fick:
Exactly, and we have a lot of discussions with people, not only in the classes I teach, but also in the therapy world. Like we enter unfortunately the winter seasons that are coming too, the ice, the snow, understandably. We don't like to go out there if it's icy and snowy no matter the age you are because of the risk of slips and falls. But we know there can be a higher risk of adverse outcomes too as you age, especially if you're having more issues with your balance and overall mobility too.
Alan Helgeson:
Well let's switch now. Let's talk about some ways to maybe get over some of that stuff. There's such a thing as falls prevention screenings. Let's talk about that and how these can help older adults and maybe identifying their risk. And this falls prevention education.
Natalie Fick:
So fall prevention screenings are things that we usually incorporate a lot in therapy if that's a concern for individuals. But also throughout Sanford we do that as a whole too. And we really just sit down and we talk to people too and just assess their risk factors and then, you know, potentially give them some recommendations as to how they can reduce their risk too.
So with the screenings, there's a lot of standardized tools that we use from a therapist whether we look at maybe their walking general balance assessments too, just to get us an idea of where they're at, how they're overall moving and able to maybe even recover their balance.
And then we talk to them too about if they've had past falls and injuries. If those individuals, they're feeling unsteady and when they're standing or they're walking, I mean overall again too, if they're having worries about falling because that's a huge factor as well with these screenings too, we even just assess modifiable risk factors.
So what are things that we can change to, again, to help make them safer? And that may be in their home environment, whether it's grab bars things, or rugs if they potentially even need an assistive device, which isn't always everybody's favorite thing to talk about, but sometimes depending on how their balance is overall mobility or if they've had past injuries or surgeries, sometimes we may need to start considering the use of a cane or a walker or something to help keep them a lot more stable and steady when they're out and walking.
We talk to them again about the vision side of things. So again, how can they see or have they had their vision checked? Good footwear, you know, we always are encouraging that so that they're not tripping on their shoes, let alone on the surface as they're walking over if needed.
You know, we intervene to reduce that fall risk with different strategies. Like sometimes we recommend just chatting with their provider again, especially if there's concerns of medication of maybe some dizziness or some blood pressure issues. Even if we talk about neuropathy where it can have a decrease in sensation, which can be very common for people, especially if they have diabetes in their feet where they can't really feel where their feet are, what they're walking onto, which, you know, greatly increases their risk of a fall because they're just not sure where their foot is. If they're stepping on something that could cause a loss of balance.
And then the other awesome thing that we can do too is we can give referrals for different classes that we're having in the community if we know that that would benefit them based on their current ability level. Or sometimes we recommend having that discussion with their provider too, if some physical or some occupational therapy would be warranted to help overall improve things.
Alan Helgeson:
Natalie, if somebody's listening to this today and they heard this thing about the screenings and that Sanford offers these, where would they maybe start? Would it be with their local provider in their community and ask about these screenings?
Natalie Fick:
So that would be a great first step too. I know their primary care providers, they can offer you sometimes just a very basic initial screening. Or even just having a chat with their provider too and say, here's my concerns, whether I'm having maybe some trouble with some balance, or I notice I'm dizzy with some transitions or certain movements so that we can kind of assess and again, then refer appropriately, if there's again little adjustments and things that their provider can do, or if therapy needs to get involved.
Or we can try to encourage and let a lot of the providers and people in the region know too of what classes might be available for these individuals. Whether it's like the A Matter of Balance classes, our SAIL classes, our Bingocize, our tai chi, different things like that just to help keep them moving and keep them strong.
Alan Helgeson:
Some really great things and some offerings for people. And again, if you're listening too, and you may have older parents, family members that might benefit from these, do some research and maybe ask your provider about these, beyond the obvious things, that are great about this stuff. Maybe share a little bit about how or why patients see these classes as beneficial in terms of giving them some of these tools and ways to prevent these falls from happening.
Natalie Fick:
I think a big thing that when I talk to people in these classes too is they feel like they can finally do something to help themselves too. Because sometimes it's a very helpless feeling when they're having issues and struggles but they just don't know where to start or who to turn to. And so whether the classes or utilizing therapy just to get them going and kind of empower them to show that they can help take charge and they can make some improvements.
Just like anything, the more you practice, the better you get at it too. So when we do that it helps to just get them going there and then they can also just have a better idea and they can see for themselves the different risk factors they may have and how they can potentially modify those too.
We hope and encourage them that by doing some exercises or different things too that they can just improve their overall strength and flexibility, which in turn makes them feel better. When you're active and you're moving, your body feels better and wants to do that too. And then again decreases their fall risk.
But the other benefit too, sometimes when they go to different classes or they go to the gym or they do some of these things with some friends working together is just that social interaction and aspect too, which is huge. Especially like we talked earlier too, coming into these colder months where it's hard to really get through these days when they're dark all the time. You just don't really feel like you want to be out and about. But when you have that kind of social pull of, I know my friends are going to be there too, you know, we can chat, we maybe have some coffee, we're going to do the exercises. I think that's always a huge draw and an extra benefit too.
Alan Helgeson:
Moving on as somebody that may have parents that we may be visiting during a holiday period, you know, as we, we transition to colder months or we might be seeing parents sometime soon. We go into their homes and we see that they might have some of these things, these fall risks. As a child or a caregiver, how can we look and fall-proof our parents’ or older family members' homes?
Natalie Fick:
So one of the first things that I have people do, whether your own home or in a family member's home too is looking at just clearing the waste. So are there trip hazards that are around that we can potentially just get rid of? Whether it's some cords, it could be rugs, just general clutter, whether we have maybe some boxes or things kind of sitting around too just to see. Can we have clear walking paths that we don't have to worry about tripping over things? The rugs can be always a hot topic for some people because they don't always want to get rid of them, which I understand, but can we look at if there's even some safer alternatives? So some non-slip rugs that maybe have that rubber backing so they're not sliding. They make some tape or different adhesive type things now too that you can utilize on them just so that they're not sliding around or they're keeping the edges down decreases your tripping risk there too.
So things to look at in your environment, but also even then looking at moving furniture if needed. So sometimes our environments, we have a lot of pieces of furniture or how the layout is can make it very tough to navigate. And so can we shift things a little bit so that I don't have to be kind of scooting sideways to get past this chair or to get in and out of bed? Can I have a better space?
The next thing we always talk about too is how is the lighting in your environment and do you have a good source of light by your stairs, in your bedroom or your bathroom as you're navigating around so that again, you can see where you're going? Replacing light bulbs if you need to or looking, is there ways that I can potentially add lighting on these low-light areas so that I can see better and reduce your tripping risk?
When you talk about like your bedrooms too, even just is there a chair? So if you need to be able just to sit down and put your shoes on or to get dressed, depending on where you're doing that, like your shoes too throughout the house, do I have a surface that I could sit? And it could be as easy as bringing a chair into your bedroom or making sure you have a nice sturdy bench in your porch to put your shoes on too. But just to have that as an option so that you don't feel like you have to try and just stand on one foot and balance or very precarious with that securing or adding support.
So especially like in your bathrooms, do you have adequate grab bars that you can utilize? And ideally we want them installed well so you know, screwed into a stud, something sturdy that's not going to pull out of the wall. And I know that another option that we have as an a temporary option if you can't do the ones that are manually fastened to is sometimes the really strong suction cup ones can be a nice temporary benefit too, that you have something sturdy to grab onto instead of can I just try and grab the shower curtain rod or kind of some of these different things that are around that really weren't meant to be a grab bar.
Alan Helgeson:
And one of these things too that I would go out to say here too, Natalie, is that working with a trusted and medical equipment facility like Sanford Equip too because they're skilled at finding the right pieces for the right job that you're looking for. Because oftentimes you find some of these that are less quality and all it takes is one time for this stuff to bust loose or to break or to not adhere in the right way and that's when a fall can happen. Correct?
Natalie Fick:
Correct. They have, you know, like toilet risers or shower chairs, things like that too, that if you need it, they have that as something that you can go look at. You can try it out and see if it works in your space and can be a great solution to again, help keep you safe with those areas.
And then the last thing I always like to have people look at too, especially in your kitchens, but just throughout your house too, is just where do you store your most commonly used things too? So are the things that you use a lot, are they really up high in your cabinets or are they down low tucked away where you are either going to have to potentially use a step stool or do some unsafe reaching? Can you potentially shift things so that it's maybe stored between your waist and your shoulder height so that that's easily accessible and that you don't have to constantly be putting it up and down or using the step stool? Especially if that's not something that's either safe for you or comfortable for you to use too. And that's where I know sometimes people prefer like a clutter-free counter, but sometimes we maybe leave that mixing bowl that we use all the time just on the counter so it's easily accessible instead of lifting in and out of the cabinet all the time too.
Alan Helgeson:
That sure is hard though for people, right?
Natalie Fick:
It is.
Alan Helgeson:
Getting used to it though.
Natalie Fick:
<Laugh>. It is <laugh>.
Alan Helgeson:
Alright, well, let's move from the physical things. Let's talk about some of those situational signs though as we may be visiting older adults and see some of those things. We've talked about those physical things, but some of those situational things.
Natalie Fick:
Yeah. Sometimes just to keep an eye on your loved ones too and just see, sometimes you can quickly see better than they can if there's areas that they're just maybe struggling a little bit more with. So watching like how they navigate stairs into and out of the house, if they're really having to pull themselves up or really rely on those railings or somebody else to kind of assist them up. Making sure, do they have good railings or is there another option that they could potentially have for added support or safety navigating there?
Looking at just when they're kind of going around the home too. Do you notice if they're making quick turns, if they're losing their balance or kind of stumbling? Or sometimes you'll see them too where they're really relying on furniture and the walls to walk and maintain their stability too. That could just be an indication that either, again, they're not feeling very steady on their feet. Or do we need to potentially entertain the idea of an assistive device just to help to maintain their stability as they're navigating their home environment or when they're out in the community too?
Alan Helgeson:
Well, Natalie, let's switch gears a little bit here. I want to go back to – we mentioned this just briefly as we were talking about fall risk way at the beginning of the episode – but let's talk about bone health and osteoporosis and the role that that might play in fall risk, like healing broken bones, brittle bones. Is that gender specific? Does it play even more role in certain genders? But you know, kind of pick and choose where you want to go with that.
Natalie Fick:
Yeah, so when we hear osteoporosis, I think most often you think of women that this is a concern for too because any woman over the age of 50, usually one in two will have issues with osteoporosis in their lifetime. But I never say rule the guys out with that too, because in that same age bracket, so over 50, one in four men potentially have some osteoporosis too, or osteopenia, which is just kind of that precursor. And showing that there's some weakening of bones as well.
Just even to assess your risk factor of this, again, your providers usually are recommending getting a DEXA scan right around that age 50 just to look and see where that bone health is too.
And from there, if we're identifying that osteoporosis is something that is of concern for you, they might recommend either some medications or something that is actually very beneficial too is exercise.
So we adding the, the strength training, the resistance, because we know by challenging our bones, by providing some impact safely can actually help to strengthen our bones too. So trying not to shy away from that. And that's where either therapy or some exercise classes can be very beneficial on finding a way to start with that too and keep you safe and decrease your fracture risk too because we know when osteoporosis is around you are at a higher likelihood of sustaining a fracture. And sometimes then too it may take a lot longer for that fracture to heal.
Alan Helgeson:
Really good information you've been talking about here today, Natalie, but let's go back to your education here as a physical therapist now. Let's talk about as a physical therapist, discuss how therapy can come in and play a role in helping people preventing falls and in that recovery should a fall have happened in the injury.
Natalie Fick:
With fall prevention and physical therapy, we love to even work with people proactively. So they might have had a fall or they might have had some instances where they're noticing that they're a lot more unsteady and this is something that we can gladly jump in and help people out with before we're even starting with some just general balance and coordination training. So providing them with some exercises and things that they can do at home and in the clinic with us just to improve that overall balance and stability. Just making sure that they feel more confident with their coordination, to be able to react to those different perturbations and challenges out in the community or at home where your balance might be challenged, and knowing that you can hopefully take the steps or adjust to be able to maintain your upright posture so that you're not ending up on the ground.
We also work with people too and just overall with some strengthening. Because we know that by strengthening those major muscle groups, especially in your legs, that increases your overall stability and reduces your fall risk, and shows that it's easier to get up out of a chair, do some of those things that also can be very challenging as we age.
And we want to make sure that again, we can age in place, we can maintain that mobility that we want to and not have to struggle with just those daily functions as well. And then we also can work with people too just with assessing their gait, their walking, seeing if there's that need for an assistive device or if there's little adjustments and things that we can help recommend just to keep them safer when they're navigating certain challenges.
Alan Helgeson:
So much good information. Any last thoughts that you want to share today and maybe that takeaway nugget here about falls prevention, Natalie?
Natalie Fick:
We know that falls is a huge concern for the aging population, and it doesn't necessarily mean that you've had to have a major fall in the past. That fear can kind of creep in even if you've known people that have had injuries, you've had loved ones that have had a very adverse outcome from a fall.
And so we know that on the positive side that falls are very multifactorial, that it's a lot of things that you can do to prevent falls and to reduce your risk. And I think it's something kind of empowering for a lot of people to know that they can kind of take charge of that and they can do a lot to prevent those falls and overall keep them strong and moving well.
And that's I think something that once they understand where those resources are, whether it's with their provider, whether it's with their therapist or any of the community exercise programs and things going on too, that they can take those positive steps to keep them moving well and aging in place and maintaining their strength and their mobility too.
Alan Helgeson:
Natalie Fick, thank you for being our guest today. It's been a pleasure having you here.
Natalie Fick:
Yeah, thanks for having me.
Cassie Alvine:
This episode is part of the “Health and Wellness” series by Sanford Health. For additional podcast series by Sanford Health, listen on Apple, Spotify and news.sanfordhealth.org.
