Under normal circumstances, an older adult is treated every 11 seconds in an emergency department (ED) because of a fall.
These are not normal circumstances.
Older adults are most vulnerable to complications from the COVID-19 pandemic. They are also among the most compliant with social distancing guidelines. Avoiding infection is quite important, but you must also consider the unintended consequences of social distancing in older adults. While there are many, one of the most significant and manageable consequences is a further heightened risk of falling.
Older adults that fall while social distancing often end up in the exact place they were trying to avoid… the hospital.
Fewer Direct Care Options Exist Right Now
The people who older adults rely on to help manage their fall risk i.e., sons, daughters, grandchildren, and caregivers are less available. Many older adults are also uncomfortable seeing their healthcare providers in their offices. Recent reports show that telehealth isn’t a feasible option for many older adults either.
Medical professionals adept at managing fall risk i.e., physical and occupational therapists, are more effective in person. Home-based services should be a strong consideration for older adults in order to balance the unintended consequences of social distancing with infection risk. Ultimately, the risk is lowest when an older adult is seen at home by a professional adhering to infection control protocols.
How To Ensure Older Adults Reduce Their Fall Risk While Social Distancing
In general, less active older adults are 57 percent less likely to visit the ED and 86 percent less likely to be hospitalized. Falls are one of the primary drivers of hospitalizations in older adults. Being more active reduces fall risk, which lessens the chances your patient, mother, father, or grandparent being admitted to the hospital.
So how do physical, occupational and speech therapists make sure older adults stay active and reduce their fall risk during a time of social distancing?
We keep them strong.
Muscular weakness and slowness of movement are highly associated with falling. During normal life, everyday movement maintains some degree of muscular strength and speed, which are protective to some degree. Social distancing takes many of those opportunities away including walking up/down stairs, going shopping, and attending social events. Older adults who rely on these activities are pushed closer to the point of falling very quickly.
We safely challenge their balance systems.
The body has an incredible, inherent ability to learn new motor patterns and recover others believed to be lost if properly challenged. Once medical conditions and other risk factors are considered older adults learn new movement skills the same way the younger of us would. Repetitive practice that is guided, graded and challenging will improve the connection between the muscles, nerves, and balance systems and reduce the rate of falls by 23 percent.
We maintain their flexibility and posture.
More sitting within a consistent environment encourages tighter muscles and poorer posture. Many of us can identify with these issues as we work in less than ideal home setups during the pandemic. However, the repercussion for the younger of us is merely musculoskeletal pain. For older adults, it is pain and heightened fall risk from tightness in the foot, ankle, hip, or trunk. It is also a posture that is flexed forward, often to the point of increases their risk of falling forward while walking.
We reduce the likelihood of pain.
Pain is also associated with falls in older adults. That being said, osteoarthritis (OA) is among the most common conditions in older adults — and less active, social distancing, older adults will oftentimes experience increased OA pain. The professional use of joint mobilizations, among other techniques, will provide considerable pain relief. The use of heat, ice, and other modalities is also worth considering if you are a family member or caregiver.
We reverse cardiovascular deconditioning.
Poor cardiovascular function is a risk factor for falls, which is a focal point of home-based therapy. Physical and occupational therapists are trained and well-equipped to safely and appropriately challenge the cardiovascular system in older adults. This includes those with diabetes, high blood pressure, congestive heart failure, Parkinson’s disease and chronic obstructive pulmonary disease (COPD).
We contribute to the management or avoidance of depression.
Depression is another risk factor for falls. Being more active helps fight depression by enhancing Quality of Life. Performing moderate-intensity aerobic activity is also protective against depression and is a central aspect of exercise.
We contribute to the management of cognitive decline.
Social isolation may exacerbate or make the initial cognitive decline more apparent. Aerobic activity planned purposeful functional training, and caregiver/family education can lessen the effects of cognitive decline, which is negatively impacted by social distancing and elevates fall risk.
We consider their nutrition.
The body requires the proper nutrients to build muscle strength and the appropriate hydration to avoid falls due to low blood pressure. It also plays a role in pain management. Today’s economic climate and limited access to food stores likely heighten this issue in older adults.
We reduce their fear of movement.
An older adult who is afraid of falling has been scientifically proven to fall more often. They also sustain fall-related injuries more often, which will enter them into the physical healthcare system we are working to have them avoid. Building a relationship of trust between a therapist or a family member/caregiver and an older adult allows you to progress their movement slowly to manage their fear and help them understand what they can and cannot safely perform!
Although rarer, some older adults overestimate their capabilities, which is also dangerous. Plus that is probably more common in a time of social distancing.
We fill the current gaps in medical care.
Many older adults are not receiving routine check-ups, testing, and medication updates due to social distancing. Less insight into the current medical status of older adults puts them at increased risk of falling. We all need to be on the lookout for signs and symptoms we may typically brush under the rug during this delicate time.
The Centers for Medicare and Medicaid Services (CMS) have proposed a 9% payment cut for outpatient therapy during this time of public emergency and vulnerability for older adults. This cut will undoubtedly reduce the already limited resources of older adults, their families, and care providers have to combat the negative effects of the COVID-19 pandemic. Advocacy efforts on ongoing. If you would like to have your voice heard please contact your members of Congress and CMS.
What resources exist?
The National Council on Aging (NCOA) and its COVID-19 Resource Center provide a number of resources for older adults/caregivers and professionals. Falls Prevention Awareness Week begins on the first day of fall (September 21st). In support, information on how to prevent falls, practical tips for older adults, falls prevention programs and Facebook Live events have been collated and are available here. In addition, nutritional resources are available and a useful tool to locate your local Area Agency on Aging.
Perhaps most important is the Falls Free Check-Up designed to assess an older adult’s risk for falling. “This year during the pandemic, more than ever, falls prevention is vitally important because so many older people have been at home, many are not engaging in physical activity, which is leaving them weaker, less balanced, socially isolated and possibly sad and depressed, leading to increased risk for falls. The Falls Free Check-Up is an important first step in identifying risk and taking action to avoid a fall and a potential injury like a hip fracture or TBI” says Kathy Cameron, Senior Director of NCOA’s Center for Healthy Aging.
Like everything in life, protecting our older family members or patients is not simple. Social distancing is necessary to limit their exposure to COVID-19 but has unintended consequences that must be considered. If we aren’t pragmatic and nuanced in protecting older adults during the pandemic, they will likely end up in the exact place they were trying to avoid… only for a different reason.
About the author
Dr. William Dieter, director of PT clinical services, FOX Rehabilitation, received his doctorate in physical therapy (DPT) from Thomas Jefferson University in 2011 and graduated summa cum laude as a member of the Alpha Eta Honor Society. He has been the Director of PT Clinical Services at FOX Rehabilitation, overseeing the clinical practice of several hundred physical therapists, since 2014. He more recently became the Director of the FOX Geriatric Residency in Physical Therapy, from which he graduated in 2013 and obtained his board certification in geriatric physical therapy. He is also adjunct faculty at Rutgers University and has performed original research and presented on the topics of translational research and quality improvement in various settings. Two of his original research papers, on the topic, have been accepted for peer-reviewed publication.