Duluth and Northland seniors: The fight against falls

• Edith Bubli

Edith Bubli
• Sue Dumas

Sue Dumas

Talk about it

If it happened again, Edith Bubli said, she might just let the garbage fall to the floor.

“Please tell me you would,” said her friend Sue Dumas in a mock-scolding voice. “We can clean garbage.”

But the 82-year-old Bubli wasn’t inclined to make a mess as she used her walker to get from her apartment in the King Manor high-rise in Duluth’s Central Hillside to take out her trash one evening just after Thanksgiving. In the hallway, as the trash bag started to slip, Bubli grabbed for it. The walker got away from her, and she fell flat on her face.

Bubli crawled forward 20 feet to the walker and carefully pulled herself up before returning to her apartment. It took at least an hour, she said.

Bubli, a Newfoundland native whose speech still carries the lilt of her homeland, wasn’t seriously injured.

Her glasses are taped together where they broke. She still has some dark bruises near her eyes, but they’ve diminished considerably from when Dumas first saw her the next day.

“She looked like a raccoon,” Dumas said, as the two chatted at the Rainbow Senior Center.

Dumas, 71, and Bubli can laugh about that incident now. But falls are a serious menace to many senior citizens. Fear of falling can keep elderly people confined to their homes, or their rooms. The consequences of a fall can be deadly.

Among adults 65 and older, falls are the leading cause of injury death, according to the Centers for Disease Control and Prevention. In 2008, the most recent year for which statistics are available, more than 19,700 older adults died from unintentional fall injuries. And in 2000, direct medical costs of falls totaled a little more than $19 billion.

Brett Osborne, a physical therapist who is director of rehabilitation services for St. Luke’s hospital, said it’s predicted the national bill for falls will rise to $55 billion by 2020.

Falls become more likely as we age, Osborne said, but they aren’t inevitable.

“The risk will rise to some degree with aging, but just because you’re getting older does not mean you have to fall,” he said.

The good news, Osborne and other experts said, is that there are things senior citizens can do to minimize the risk of falls.

We all fall down

Everybody falls.

“If you think about it, we fall throughout life,” said Siobhan McMahon, a nurse practitioner in the Eldercare Department at Essentia Health. “It’s not a phenomenon unique to older people. … We are more prone to fall with aging, but it’s not something that hasn’t happened before in our lives.”

What really changes as we age, said McMahon, is the extent of injuries and the likelihood of fatalities.

Twenty-five percent of nursing home residents who fall die within a year, Osborne said, and 33 percent of older adults who sustain a hip fracture from a fall die within a year.

Bubli had a hip replaced and suffered a stroke about eight years ago, she said. But she fought back, and after four months in a nursing home was able to live more independently at King Manor. “When I came out I could walk and talk because I was too stubborn (to give in),” she said.

Why we fall

Risk factors for falls are divided into extrinsic and intrinsic, Osborne said. The former relate to environmental factors, such as throw rugs and poor lighting inside, and icy sidewalks outside.

Bubli said she has never had throw rugs, and Dumas has gotten rid of the loose rugs she had in her eastern Duluth home. Bubli also has five handrails she can grab in her shower.

“Winter presents problems if it’s slippery or a lot of snow,” Dumas said. “I always try to engage my brain if I go out.”

For at least a decade, Minnesota has had one of the highest rates of injuries from falls in the country, McMahon said. That would seem to be the consequence of a northern climate. But the surprising thing, McMahon said, is that the rate of falls doesn’t significantly change from season to season.

Still, she added, “I think from a practical perspective we do see plenty of people falling on ice.”

Intrinsic factors have to do with individual qualities such as balance, vision, flexibility and strength, Osborne said.

Even as early as our third and fourth decades we start to lose muscle mass and strength, McMahon said. “But much of that can be attenuated with attention to strengthening exercises and strengthening strategies.”

Trying tai chi

Osborne said participating in tai chi, an ancient Chinese form of exercise, can help seniors. Richard Tosseland, who teaches a tai chi class for all ages on Tuesday evenings at the Duluth Congregational Church, said an Emory University study in the 1990s was the first to suggest learning tai chi could reduce the chances that elderly people would fall.

“I can see how it would definitely be helpful for seniors,” Tosseland said. “Tai chi increases strength, flexibility and balance.”

Dumas has taken two eight-week tai chi sessions through Duluth Adult Community Education and found it useful, she said.

McMahon said tai chi is a good choice, but it’s not for everyone. “Some people feel funny about it,” she said. “In some of those studies men have said: ‘It makes me feel funny making those movements’ or ‘I feel feminine.’ ”

Another good choice, McMahon said, is the “Matter of Balance” program offered by the Arrowhead Area Agency on Aging.

Debra Laine, special projects coordinator for the agency, said the program was developed at Boston University and has been offered locally since 2009. So far, 453 people have completed the 47 classes that have been offered across the region.

Fighting fears

“Matter of Balance is a class that’s designed to reduce the fear of falling and increase the activity levels of older adults,” Laine said. “Because activity is the No. 1 way to prevent falls.”

Fear of falling actually is a risk factor for falls, McMahon said. Senior citizens who are afraid of falling tend to stay in and isolate themselves, “so they don’t go outside and they become less active.” Then when they must go out, they are weaker and more susceptible to falls.

Laine told about three women from the same apartment building in one of her classes. They were afraid to go down the stairs, because another woman had died from a traumatic brain injury after falling down those stairs. It turned out the victim had something in her hands and had hurried because someone waiting below was honking their car horn.

“So we talked about how you can be safe going down the steps,” Laine said. “Well, by making sure you aren’t holding anything in your hands. And if someone’s beeping the horn, they’ll just have to wait.”

There’s a difference between being afraid and being careful, Dumas said.

“There is no fear,” she said. “You engage your intelligence.”

Agreed Bubli: “You’re cautious, you’re not fearful. If you go around being afraid of stuff like that, you really will fall.”

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