By No Falls Zone | March 02, 2012 at 04:22 PM EST | No Comments
Remember the old saying, “If the shoe fits…wear it!”It was originally a saying that was aimed at someone who fit a profile but refused to recognize it.Like… “I missed the last three appointments with my Tai Chi trainer, and they told me I’m not motivated!”The response could be, “If the shoe fits…!”
Many times in our practice, we see people who wear athletic styled shoes…cross-trainers, tennis shoes, gym shoes, etc. Sometimes we also see folks who wear the shoes with very thick “comfort” soles.Keep in mind, these folks see us because of balance issues…so one of our questions is commonly…”When was the last time you felt like you needed to start or stop quickly?”
Shoes…like so many other things…are hyped to the consumer with a backdrop of health, vigor, and athletic prowess that invites misconception.Unfortunately, balance issues…especially with older adults…can be made worse with this kind of shoe.When our balance capability becomes compromised, often due to lower body weakness, and poor inner ear/brain/muscle coordination…our reaction times require footwear that is more forgiving than the grip of an athletic shoe.The image is one where a senior’s feet stop on a dime, but the rest of their body keeps going…all the way to the ground.
The problem has been well recognized by researchers…and was accepted by Medicare as a problem that physicians could identify.In January, 2011 Medicare recommended to all physicians that they counsel patients on footwear…examine patient’s feet and their need for podiatry…and refer for Fall Risk Assessments when the patient exhibits or expresses their fall risks.
Bottom line…shoes should be comfortable, flat and have thin enough soles to allow the wearer to FEEL the floor/ground surface.The feet need to have their sense of touch so the wearer knows whether the surface is hard and flat, cushy, rocky, squishy like sand, uneven like a lawn, etc.The information is transmitted to the eyes and brain so the person can adjust the way they walk to the conditions.
Without the information from our feet, we are operating with less information and setting ourselves up for a fall.So…the lesson for today is: Just because the shoe fits…doesn’t mean you should wear it!
By No Falls Zone | February 17, 2012 at 03:35 PM EST | No Comments
On Valentine’s Day, I read an article written by Bernadette Baum for Rueters. It highlighted a program that has over $20 billion in benefits for seniors…and people aren’t asking for it! Here it is…in part.
NEW YORK (Reuters ) Feb 14 - Millions of seniors in the United States are missing out on more than $20 billion in aid that could help pay for food, medicine and heating, simply because they don't know it's there, according to a report released on Tuesday by organizations that advocate for seniors.
In response, the National Council on Aging (NCOA) and the National Association of Area Agencies on Aging (n4a) have launched a campaign, "You Gave, Now Save," to help bridge the gap between the available funding and those who need it the most. The two groups run Eldercare Locator http://www.eldercare.gov , a hotline that connects older Americans to services that can provide help.
The top reason people call the hotline is to find out if there is any financial support available to them. NCOA also runs a benefits screening site called BenefitsCheckuphttp://www.benefitscheckup.orgwhich helps consumers find lists of government programs and see which ones they qualify for.
Of the 57 million Americans aged 60 and above, many struggle to pay for basic needs, such as food, healthcare, and heating. Nearly one in 10 seniors live below the federal poverty line of an annual income of $10,890, the report said, citing Census data for 2010 and 2011.About 8.4 million older adults and disabled younger adults live in poverty, and another 13.5 million in both groups are at risk of poverty, the report said.
In addition, some older Americans did not apply for some benefits because they believed the application process would be complex, they did not understand the eligibility rules, or thought there was a stigma to receiving entitlements.
WHAT ARE THEY MISSING OUT ON?
Eligible seniors living alone could benefit from an annual $1,428 in food assistance through the Supplemental Nutrition Assistance Program. Others miss out on Supplemental Security Income payments of $6,000 a year.
Programs that are also overlooked include home heating and cooling assistance through the Low Income Home Energy Assistance Program, as well as free or discounted services from state and local governments and the private sector that provide tax breaks, transportation, respite care, legal assistance, and in-home assistance.
By No Falls Zone | February 10, 2012 at 03:38 PM EST | No Comments
Hurray for more research!As the boomers have highlighted the need for increased geriatric (older adult) medical research, we continue to discover how ineffective or harmful some treatments can be…even though the same treatment on younger people works well.Now, we have some evidence that the same holds true for dealing with anxiety in seniors…opting toward counseling rather than medication.In a recently published article by Kerry Grens:
NEW YORK (Reuters Health) Feb 03 - Cognitive behavioral therapy appears to help older adults battle anxiety disorders slightly better than other approaches, but not as well as in younger adults, according to a new meta-analysis.
"Cognitive behavioral therapy is the mainstay for treating anxiety disorders in younger adults. Its lower effect in older adults in this study is concerning," said Dr. Eric Lenze, a professor at Washington University School of Medicine, who was not involved in this research.
In a paper online January 27 in the Journal of the American Geriatrics Society, the researchers said three to 14 out of every 100 older adults has an anxiety disorder. While earlier studies have shown that cognitive behavioral therapy works well for younger and middle-aged adults, there has not been as much research into the treatment for seniors.
Among people who have fallen and sustained some injury, depression and anxiety (based on the fear of falling again) is a very common health issue among older adults.In fact, the mental state of the older adult will often predict the likelihood of falls.
Many of the patients who come to our clinics express their fears, but also state that they are not seeking active mental health help.This is an issue that all of us can change…simply by making the suggestion to those we care about, that having a chat with their primary care physician, a licensed clinical social worker, or religious leader may provide long lasting health benefits that no pill can match.
The aging of America has plenty of associated social issues…but I’m happy to see that older Americans are demanding more from their lives.
By No Falls Zone | January 27, 2012 at 04:39 PM EST | No Comments
Falls…Falls…Falls…Falls…Falls!
Like the owner of a brand new car…you see it the showroom and it is unique in every way…only to drive 5 miles and notice how many others are on the road.
Why didn’t you notice them before?People are very good at rationalization.We generate reasons that allow us to believe that something is true…and then we apply that deceptive logic to a rationalized outcome.So that…I haven’t seen this car in this color before…so there must not be too many out there AND since there aren’t too many out there, my purchase is a good one.
People who fall are no different.A dozen years of studies, including the one from the spring of 2010…from the Centers for Disease Control & Prevention…that concludes:
75% of all people aged 70 and above have balance deficits that create falls.
National Centers for Health/CDC Data BriefNo.31April 2010
That being said, in many different ways…by many different medical and social entities…people find a way to rationalize how their balance and/or fall scare was a one-time occurrence that really shouldn’t even be counted as a near fall or fall injury.Our clinic staff can remember many folks who called for an appointment, only to have a family member call to cancel because Mom or Dad was placed in the hospital (or worse) because of a fall.
We’ve had many older adults, who were coerced by a loved one to see us…with a history of fractures, black eyes and bruises…tell us that “black ice”, “the cat”, “a rug”…or a full moon caused their fall injury…and they didn’t have a falls problem.Then, after our tests document a medical problem …they admit their relief that the falls are treatable.
If you are a son, daughter, grandson or grand-daughter, with parents or grandparents who have reached their 70th birthday… ask yourself these questions?
·How did they look and act over the holidays?
·Do they appear to be more careful or hesitant when they move around?
·Have they admitted missteps, trips, or falls?
·Have they had a recent illness or hospitalization?
·Are they taking more than 4 medications?
If YOU are aged 70 or older…ask yourself the same questions as above and then ask yourself:
·Have I been injured (bruises count!) from a fall or near fall in the past 12 months?
·Am I anxious about maybe falling again?
If you answer YES to anything above…it’s time for a discussion with the doctor… and it’s also time for a Medicare recommended, Falls Risk Assessment.
By No Falls Zone | January 20, 2012 at 04:49 PM EST | No Comments
On January 1, Medicare reimbursements were reduced for many
(if not most) services rendered by medical providers.Adding insult to injury is the fact that,
even though insurance companies are not supposed to use Medicare as its basis
for coverage or reimbursements, non-Medicare insurance policies use Medicare as
its benchmark for what they pay for medical services.
As medical insurance premiums have increased drastically
over the past 10 years, the reimbursement dollars for service continues to drop.Primary Care Physicians are increasingly
closing the doors on their private practices.Over the next 3 years, the various medical associations estimate that
over half of all Primary Care Physicians will be an employee of a hospital
By No Falls Zone | January 13, 2012 at 05:42 PM EST | No Comments
As winter snows created havoc on Chicago area roads this week, many of us began making mental changes for the winter season, too.Shorter, colder days cause us to “hunker down” and do less outdoor activity…opting for our cozy chairs, comfort foods (… hot chocolate, grilled cheese with tomato soup, pasta, Mmmmm!), and maybe even an extra nap during the week.Of course, we can only stand this for so long before our emotional state and our bodies turn against us with the very real anxiety known as…. CABIN FEVER!!!!
As it turns out, these Chicago winters are the perfect time for people with dizziness or balance problems to become healthy.Last year, Medicare issued an appeal to all physicians to screen their patients for fall risks, and to refer those who exhibited risk for a complete Fall Risks Assessment.According to a April 2010 Centers for Disease Control and Prevention- NCHS#31 report, 75% of all people aged 70 and over have balance deficits that contribute to their falls.
After a Fall Risks Assessment, most people can go into Balance Correction Training™ (BCT).BCT is supervised by experienced vestibular (balance) physical therapists… and is customized for each patient, taking into account their medications, chronic health concerns like arthritis, diabetes, cardio-vascular disease, etc. , and personal goals for achievement.Recent geriatric studies have shown that, after several weeks, patients who are even in their 70s, 80s, and 90s, become better coordinated, stronger, and more confident in their stride and balance capability.Can you say “OOOH RAH! ?”
So…as the howling winter winds threaten even the heartiest of us…older adults can use the time to get healthier by improving their balance function…and preparing for the spring greening of the Midwest.
For more information on falls, balance and Medicare assessments, please visit:
By No Falls Zone | January 06, 2012 at 04:30 PM EST | No Comments
Yesterday, a couple came into our Naperville clinic.They both appeared to be in their mid-to-late 70s…both used canes…and each was worried about the other one falling and getting hurt.
The wife looked at the husband and said, “I thought we came in for you?”The husband said, “I thought we could both benefit?”The wife responded with… “My balance is too poor and I’m just not going to get any better.”
It turns out that to one degree or another…we all suffer from the stereotype that the older we get the less we should expect.We all witness age bias everyday….whether we speak more loudly to a senior even though they are not hard-of-hearing…or expect that a senior would enjoy Guy Lombardo music instead of Bluegrass…assume that a senior’s memory is bad…or that years of reduced activity and declining balance function is the unwavering beginning of a downward health spiral.In the above mentioned study, the individual physicians were more influenced by their personal age stereotype than the growing research that suggests…
Regardless of age…a person’s motivation and enthusiasm toward effecting change or improvement can trump whatever others may expect.So …the new mantra for all of us should be…IF I WANT TO GET BETTER AT SOMETHING, OR TRY SOMETHING NEW…JUST DO IT!
The wife looked at me and paused… “Do you really think I can benefit from your program?”
“You won’t know for sure until after you’ve had a chance to talk with our medical team, and had a Medicare recommended fall risk assessment.” I replied.“It’s your opportunity to see what you can do!”
She thanked me for the encouragement…mentioning that she has had very little of that in recent years. She then scheduled appointments for her husband and herself.
Happy New Year!Here’s to Great Expectations for Us All !
By No Falls Zone | January 02, 2012 at 08:59 PM EST | No Comments
When patients come to us, our physicians ask for a complete listing of medications.We ask…How long have you been on the medication?Do you know why you’re taking the medication? Many times, the responses are very vague OR the patient simply states that they do not know the “when” or “why”. All too often we find that the patient has been taking a pain medication for a condition (like a sprain or a surgery) that occurred months or years earlier…the prescriptions continue to be refilled, so the patient doesn’t question whether or not they should still be taking them.
Then we move on to the non-prescription/over-the-counter medications and supplements. While we Americans enjoy a wide availability of medication for colds-allergies-flu-pain relievers-ointments-dietary supplements-and more…we also are not well educated about their purpose or side effects.Often, we have patients who are taking a prescription for pain which includes acetaminophen (Tylenol)…only to find that they also take other cold or flu medicines which also have acetaminophen (Tylenol). This is VERY bad…since the patient doesn’t realize that they are taking too much…and that the side effects could be significant.
Because of the way our bodies react to medications, the American Geriatric Society and most all public health organizations recommend that:
1.If you take 4 or more medications, you should review them with your primary care physician EVERY 6 months.
2.If you have a hospital or rehabilitation stay, have a friend or family member write down the medication and the schedule of doses. Have that person hold a copy and keep one copy by the bedside for your reference. Always ask the nurse to verify why you’re taking the meds and what the dosage is.
3.If you think you need an over-the-counter medicine, take your medication list AND the medication you are thinking of buying to the pharmacy window…then…ask the pharmacist if they see a potential problem.
4.Lastly…if you’re taking a prescription…follow the schedule that the doctor gave you.
Remember, the pills you took for headache over the past 20 years will treat you differently over the next 20.Doctors are learning more about seniors and medications every day…so ask questions and learn right along with them.
By No Falls Zone | December 23, 2011 at 02:15 PM EST | No Comments
The medical world continues to change. Last year, in December of 2010, our U.S. Congress passed a 1 year bill to stop a 25% decrease in Medicare reimbursements to physicians. That was the 10th time they had done so since 1997. This year…bundled inside of the bill that holds the payroll tax cut, is another delay of a 27.4% Medicare physician reimbursement reduction.
On Monday, (12-19-11) the American College of Physicians (ACP) issued a statement. “With each passing day, it appears more likely that Congress will just allow the 27.4% cut to go into effect, despite lawmakers’ repeated promises all year that they would prevent it,” said Virginia Hood, MBBS, MPH, FRACP, FACP, president of the organization. “Most physician practices are small businesses, and they can’t stay open for business as usual if Medicare doesn’t cover their practice costs. Physicians will have to make very difficult—and painful—choices such as closing their practices, laying off staff, or limiting how many patients they can see, choices that will be foisted upon them by Congress’ irresponsibility.” MODERN MEDICINE Dec 21,2011;Morgan Lewis, Jr.
(NOTE: On Thursday, 12-22-11, the temporary bill was passed and will again be taken up in January.)As physicians, politicians and big medical wrangle for position…patients are largely unaware of the implications…and more likely to focus on the “Don’t Mess with MY Medicare, I Earned It” sentiment…or the “I Know Things Need to Change” attitude.Regardless of your views…or what happens in our political processes… colds, flu, fractures, and falls continue.
Market Strategies surveyed a national Web-based panel of 601 physicians, including 200 in primary care, in August this year. They found 77% of Primary Care Physician’s and 76% of specialists expected that solo and small practices would be absorbed by larger independent group practices or hospital-owned group practices in the next 5 years, according to the survey results.MODERN MEDICINE Dec 21,2011;Morgan Lewis, Jr.
Medicine, and its physicians, is being forced to behave more big-business like…Profits & Loss…and, unfortunately…Production…which translates into:How many patients need to be seen per hour in order to maintain profitability? Over the past few years, I have heard increasing numbers of physicians who are fired because they take too much time with their patients!Many of those M.D.s chose to leave medicine altogether. One, that I know, moved to another state and started an organic farm!
Aside from the tumult, there remains one truth:We must take responsibility for ourselves…and in a medical sense, that means we must try to develop healthy and PREVENTATIVE measures that will reduce our need for medical intervention…and the cost uncertainty that surrounds it. Over the past dozen years, studies of Medicare aged adults provide a common ray of hope and encouragement…NO MATTER HOW OLD, OR WHAT OUR CONDITION, OUR BODY AND MIND WILL RESPOND TO IMPROVED NUTRITION, INCREASED ACTIVITY AND SOCIAL INTERACTION!!!!!
To get started, simply make an appointment with your Primary Care Physician for your 100% free Medicare Annual Wellness Visit.
By No Falls Zone | December 16, 2011 at 12:46 PM EST | No Comments
Today I met with a social worker from a nationally known retirement community. The community is experiencing an increase of residents who opt out of activities; coupled with an increase of residents who appear to be suffering from mild to moderate depression; AND an uptick in reported falls incidents. As she described the emotional and physical stress on the families and the residents, one thing became clear...as a society, we still haven't provided our older adults with the right tools for aging well.
Over the years, when Grandma fell we understood that falls were to be expected in our waning years. This expectation was then often reinforced by the family doctor, who prescribed a walker and maybe some physical therapy. That historically uninformed approach resulted is older adults who reconciled themselves to the expectation that...in order to be safe... I need to sit more…which often translates into reduced participation in "fun" activities.
Safety issues become a worrisome social issue for family, friends, retirement community staff, and stressful for older adults who have experienced a fall or a near fall. "If I fall again, will I be forced into a nursing home?" "I don't want anyone to know that I fall sometimes." "I need to just sit so I don't risk falling."
Depression, self-limiting activities of daily living (ADLs) and general physical weakness are the veil of the person who is fearful of a falls injury. The Center for Disease Control and Prevention(CDCP) states that falls injury is the number 1 cause of injury among older adults; AND the 5th leading cause of death. So the threat is real, but our society response is not! According to a July 2001 and Dec 2010 Journal of the American Geriatrics Society study...falls among our older adult population are largely avoidable. Further, in 2011, Medicare announced its Annual Wellness Visit program to encourage physicians to screen ALL older adults for falls risk, and to refer for intervention as necessary.
We must teach our seniors (and physicians, too!) that the tools exist for diagnosing and intervening with falls risks. We must also shed the long held notion that falls are an inevitable part of aging. Instead of handing out walkers and waiting for the ensuing fall…we should be educating our seniors and their families on how falls risks can be reduced.
By No Falls Zone | December 09, 2011 at 04:33 PM EST | No Comments
Earlier this week, I had the pleasure to speak at a local AARP chapter meeting.Since I represent Fall Prevention Clinics of America™, the topics are focused on falls, falls injury among seniors, and discussion on the medical interventions that are available now compared to years past.After 30 minutes of expected interaction….how balance works; how it changes as we age; steps we should take to keep our balance function active…etc…a lady raised her hand. “My knee aches and sometimes gives out on me, so I can’t count on it.I’ve also fallen a couple of times…should I make an appointment with your physicians?” she said.
When I asked her how long she had the issues with her knee, she simply said that it had bothered her for a few years.After that response, I paused slightly…not knowing how to approach my next thought…like…What in the world are you waiting for?Luckily, one of the group took the words out of my mouth, and asked his fellow AARP friend what her doctor said about the offending joint. This led to a non-scripted, therapeutic exchange that I hadn’t thought about…
As the lady reacted to others in the group…it became obvious that she was trying to avoid talking to the doctor about her knee.She does see her doctor…working with him for high cholesterol, blood pressure and weight management…and she has Medicare and a supplemental insurance. Why had she avoided talking about her knee?She didn’t want to face the idea of a possible knee surgery, recovery and therapy in a rehab facility (she lives alone), and pain.Fear kept her from getting the help she needed.
At this point I became more a facilitator than a guest speaker…as I called on raised hands who offered support, like...”I had my knee done 2 years ago and it hurt for about 2 weeks before the pain was under control…but I could walk without the knee giving out”or, “ If you need surgery, I’ll come by to help you with your chores”, and my favorite (because we had previously discussed how traumatic head injury is the leading cause of death among senior fallers)….”I’m sure we’d rather see you gimp around for a few months after a knee surgery than to see you slip away in a hospital because you hit your head after your knee gave out.”
After another 20 minutes of support coming from her comrades, I asked if she had her original question answered.With moistened eyes she shook her head with a “Yes”…I thanked the group for their participation…and received a resounding round of applause as people got up from their seats to approach the knee lady.
AHHHHHHHH…the sweet smell of success! And I didn’t do anything!I love this job!
By No Falls Zone | December 05, 2011 at 12:17 PM EST | No Comments
Over the past decade or so, the average Primary Care medical doctor has seen their patient population move from a majority of family practice…children and adults … to a majority of Medicare aged patients. Over the same time frame, research into geriatric health issues has increased…including studies into falls injury, prevention and interventions among older Americans.
FALLS AMONG OLDER ADULTS ARE LARGELY PREVENTABLE...
So states the American Geriatric Society in their 2006 and 2010 white papers about falls among seniors. This white paper was a follow-up to their ground-breaking 2001 report which was co-produced by the British Geriatric Society, the American Academy of Orthopaedic Surgeons, and the American Academy of Otolaryngology-Head and Neck Surgery.
Since 2001, with the groundswell of evidence that links early falls risk assessments and intervention with a decrease in mortality due to fall related injury is undisputed. That said...many physicians do not screen their older patients…opting to refer only those patients who express balance difficulties or fear of falling.
Fall-related injuries in elderly people are reduced when primary care clinicians adopt effective risk assessments and strategies to prevent falls, according to the results of a nonrandomized study reported in the July 17,2008 issue of the New England Journal of Medicine. "Falling is a common and morbid condition among elderly persons," write Mary E. Tinetti, MD, from the Yale School of Medicine in New Haven, Connecticut, and colleagues.
"Effective strategies to prevent falls have been identified but are underutilized.... Reported barriers to incorporating evidence about fall prevention into practice include ignorance about falling as a preventable condition, competing time demands, a perceived lack of expertise, insufficient reimbursement, and inadequate referral patterns among clinicians."
How do we get physicians to look seriously at their role in preventing falls?
If you or a family member has concerns about falling or instability...let your doctor know about it...and tell them you want a falls risk assessment. Refer them to us and we'll provide the information resources to assist your physician. The more they know...the better they can work with you.
By No Falls Zone | November 18, 2011 at 06:30 PM EST | No Comments
Thanksgiving planning has always been a month-long event for my wife (and by default – me)…get yams that are all uniform in size and shape…allow for the possibility that the non-committed grandson and girlfriend will call to confirm 4 hours before food is passed…provide sufficient time& space for the bread to “open air” dry for the dressing…paper napkins or cloth…make certain that left-handed family members are seated at corner or end positions…and last but not least – make sure that there are enough give-away containers for folks to take left-overs….(Except for the pumpkin pie, of course!)
This year is unchartered territory for my wife and me, since none of our family is able to make it to town this year.I am a little scared of the recurring vision: my wife and I wandering aimlessly around the house…cook a turkey or not…have a ham sandwich and call it Thanksgiving…endless channel surfing, since neither of us really likes college football…breaking open a special bottle of wine and NOT liking it…and it’s not even noon!!!As I’ve mentioned this depressing aside to folks who come to the clinic…I’ve had more than one all-knowing smile and a nod of appreciation for the situation.
I remember that Mary, my Mother-in-Law, was a highly energetic person…on multiple boards and committees, department chair at the large high school where she taught, always taking classes toward her Masters or Ph.D., and volunteering at endless church events.A few years after her retirement, I noticed that her pace hadn’t changed much…but instead of the sea of times in a jumble of pencil and ink notations, her calendar now had only a few neatly printed appointments.She planned those appointment days down to the minute…taking into account traffic patterns, wardrobe, appropriate notes & documentation, and consultation with my wonderfully understanding Father-in Law, Smith (yes…that’s his first name).I also remember how tenaciously she held onto the tradition of hosting Thanksgiving…and how saddened she was when that role was relinquished to my wife. That year, we started a new tradition.
At the end of our Thanksgiving Day, after everyone had gone…we would pack 4 pieces of pie and go to Mary and Smith’s house.We had a great time!Mary had some fresh brewed coffee ready for us, and her best china for hosting the pie.We often visited and laughed past midnight…a small party in an otherwise empty house…and some of our best memories. So…while I dread next Thursday…I am hoping that a new tradition will emerge.
If you have family or friends, older adults who have relinquished their holiday hosting duties…maybe you can make a visit to their space…re-creating their sense of nurture, importance and energy that comes when serving others.
By No Falls Zone | November 11, 2011 at 02:52 PM EST | No Comments
“Prevention” is a curious word. Curious because we talk about it all the time...and seldom use it appropriately. Prevention assumes a posture that looks forward and takes action to keep a situation or series of circumstances from happening. Mitigation assumes a posture that looks at today's problems and takes action to minimize the effects of the situation or circumstances.
Prevention is a much harder sell than mitigation. Physicians have a much tougher time getting people to be preventative ( i.e. exercise, eat more veggies ) than by doing heart by-pass surgeries, tummy tucks or prescribing cholesterol medicine...so they spend less time educating or counseling than they do diagnosing and prescribing. In health care, people often talk about their procedures or medications as preventative...when the treatment is really mitigating a health issue that has already taken place. As a culture, we have become reliant on the quick fix to mitigate all aspects of our lives...and our health care system has responded in kind.
Remember all those Public Service Announcements (PSAs)...Stop Smoking; Stop Drinking & Driving; Stop Littering; Buckle Up! Those messages are developed fora 5 -10 year public awareness and education campaign series…that are intended to change behaviors that require a “mitigate” approach ( like cleaning up road litter), to a “prevention” approach (which reduces or eliminates litter and saves taxpayer money). We all would be better off by adopting prevention strategies rather than looking for the quick fix...no matter how effective the fix.
Last year, Medicare adopted a prevention approach to many health care issues…creating a free Annual Wellness Visit (AWV) for Medicare recipients to discuss general health concerns with their Primary Care Physician. Among the discussion and screenings topics in the AWV is FALLS INJURY…(falls injury is the 5th leading cause of death and the leading cause of injury among older Americans).In this scenario, a screening would identify a health concern BEFORE it becomes a problem….PREVENTION!!!!!
The biggest hurdle to prevention is the lag time involved with the awareness and education.So…for everyone reading this post….SPREAD THE WORD.Every person aged 70 and above, regardless of whether they have had a fall, should have a Fall Risk Assessment.It saves lives, money and grief!
By No Falls Zone | November 06, 2011 at 11:02 PM EST | No Comments
November is here…and, alas, another cycle of salacious seasonal sales, shopping, and shipping.At Fall Prevention Clinics of America, we always laugh and force a smile when a patient makes a joke about preventing “fall”, and what a wonderful time of year it is!!!(If we had a nickel for every time…!)
This is also a great time of year when family gatherings produce warm memories for future smiles…and sometimes serious observations.As multi-colors fade to white, our offices receive an increased number of calls from worried spouses, daughters and sons.Whether they witnessed a slip, trip or fall; an awkward misstep at a crowded dining room table; a new sense of apprehension or reluctance when multi-tasking a glass of wine and some hors d’oeuvres; the simple truth sets in that someone they love may be in danger of getting hurt from a fall. While the fact remains that if we do things right, and if we are a little lucky, we will get old...reaching that tenuous time when CDC statistics show that we will likely succumb to the number 1 cause of injury for people aged 65 and older…falls.
Until the 1990’s, when a person fell…they were often set aside while the physician and the faller’s family members frantically plotted for a nursing home placement.As geriatrics medical research increased from the mid-1990s (in preparation for the Boomers) many studies documented how balance, falls and dizziness effects people of all ages.Then, in April of 2001, a ground breaking report, American Geriatrics Society/British Geriatrics Society: Clinical Practice Guideline for Prevention of Falls in Older Persons, documented how balance assessment and falls intervention could successfully provide seniors with an escape route from the dreaded nursing home.Falls, as it turns out, is actually a symptom of other medical issues...OR…it can be a devastating event which overshadows other ailments.
Recently, Medicare has begun to adopt a more proactive, preventative posture toward medicine, and older Americans are less willing to accept the “…AT YOUR AGE YOU HAVE TO EXPECT THESE THINGS…” attitudes from their physicians; (and you’d be hard pressed to find a building that proclaims to be a nursing home, instead of the less menacing“nursing and rehabilitation healthcare center” ).
As the last few months of the year tick by, older Americans and their family members can look at the season’s new opportunities to build memories for tomorrow, armed with the knowledge that a misstep or a fall is not a final step, but a chance to look ahead...take charge… and decide the next path.
By No Falls Zone | October 28, 2011 at 05:03 PM EDT | No Comments
BOO! Yes…we all know lawyers are scary…But, a few weeks ago, I met with Natalia and Jeff Kabbe at their Kabbe Law Group offices in Naperville, IL.The topic was focused around some of the upcoming changes in Illinois law regarding how older Americans spend their own money AND how Medicaid may impose penalties on that spending when that same person needs medical assistance.
Many seniors are not aware of the fact that when a person needs Medicaid, per Illinois law, Medicaid is required to “Look Back” at a person’s financial history to determine if the person asking for assistance gave away, or hid, financial resources in order to qualify for taxpayer funded medical programs.Oh…by the way…the new Illinois “Look Back” period is 5 years.
Natalia and Jeff indicated that while many clients begin the legal planning process with basic wills and trusts…clients soon realize that…as weeks turn into months and years…personal requirements and the needs of children, grandchildren, savings accounts, pensions, etc….can fluctuate dramatically (especially in today’s turmoil economy).
Consider this common scenario:
Bill and Marge have modest pensions and savings in the bank, Medicare and supplemental insurance. One day Bill falls and sustains a traumatic brain injury (TBI) which requires a difficult hospitalization, rehabilitation & long term care. (According to the Centers for Disease Control & Prevention, 75% of all people aged 70+ have balance issues; up to half of them fall each year; and 33%of falls result in a TBI.) The couple is now faced with worrisome housing costs for Bill and medical expenses beyond what insurances cover. After a 12 month cycle of care, Bill dies…leaving no savings left, and minus one pension check for Marge. Now, Marge is left to figure out how to pay for care if something happens to her.
So…while nobody wakes up one day to say …“Honey, this Medicaid program is pretty darned great. Let’s sign up!”…it is crucial to all of us to understand what options we have when dealing with our money and the state’s rules.
That’s why we tell our patients… “Make a plan for your assets…BUT then you have to SURVIVE THE PLAN for 5 years.”To do that, you need to stay healthy. ..and that includes getting your Medicare approved Fall Risks Assessment.
By No Falls Zone | October 21, 2011 at 02:13 PM EDT | No Comments
For decades, we have been taught that when family members become unstable around the house...we should begin senior-proofing their environment. Often, the whole project involves installation of grab-bars or handrails, pitching the throw rugs and floor mats, trying to get Dad to replace that 25 watt bedside lamp bulb with 40 watts of improved visibility; and cajoling them into recycling old accumulated stacks of magazines, newspapers and other "valuable papers".
The worry, frustration, depressing and often patronizing nature of this exercise is based on the premise that senior-proofing will keep Mom or Dad from falling and breaking a hip…or worse. Unfortunately, the premise was based on common sense rules that research shows are not directly applicable to falls avoidance. Truthfully, any household should be “senior-proofed”…since statistics tell us that people of all age groups fall in their homes…and we all can benefit from clutter reduction, throw rug patrol, grab-bars and handrails.
Several medical research studies took people at risk for falling and put them in a cluttered environment and a non-cluttered environment. The results? People in both environments still fell. The studies then took high risk fallers and provided interventions to diagnose and remediate or mitigate their individual fall risks. These folks were placed into the cluttered and uncluttered environments. Results? These folks either did not fall, or fell fewer times than those who had received no intervention. Theses amazing results clearly show us that working with the individual’s fall risks provides a benefit that transcends their environment.
What’s it mean? If you want to help Mom, Dad, Grandma and Grandpa...do the work around their home, but don’t forget to help them understand that they can actually retrain themselves to become more stable…and safer…around the house. Medicare approved Fall Risk Assessments are a key component of any older adult healthcare initiative and can be initiated directly, with a specialty provider like Fall Prevention Clinics of America, or through the Primary Care Provider.
By No Falls Zone | October 15, 2011 at 01:34 PM EDT | No Comments
Do you know what the Annual Wellness Visit is? If you don’t, you’re in the majority. The Affordable Care Act of 2010, (aka Obamacare), provides for an Annual Wellness Visit (AWV), including Personalized Prevention Plan Services (PPPS) for Medicare beneficiaries beginning January 1, 2011. The purpose of the AWV/PPPS is to review the individual’s current health concerns… screen for health issues that may be hidden…and work with preventative measures to keep them under control.
How does a Medicare aged person get their AWV/PPPS? Simply call the Primary Care Physician (PCP) and ask for an appointment for an AWV. Now…here’s the hard part! When you are making the appointment, be sure that the scheduling person understands that you do NOT want a physical. You will be charged for a physical. The physician’s AWV billing code is G0438 and is 100% paid by Medicare…so be sure that the two are not confused!!!
The AWV requirement states, “…the PCP will furnish personalized health advice to the individual and a referral, as appropriate, to health education or preventive counseling services or programs aimed at reducing identified risk factors and improving self-management, or community-based lifestyle interventions to reduce health risks and promote self-management and wellness, including weight loss, physical activity, smoking cessation, fall prevention, and nutrition.”
Keep in mind…the PCP may be able to do many of the screenings…but they probably will need to refer patients to specialists whenever there is a need for more in depth assessment processes. In the context of falls and dizziness, we receive referrals from many area physicians who recognize balance deficits in their patients and make referrals to Fall Prevention Clinics of America for a complete Falls Risk Assessment.
For patients who come to us and have not heard of the AWV/PPPS, we encourage them to take advantage of the free service as soon as possible.Here’s a link for a complete description of all the AWV/PPS initiatives.
By No Falls Zone | October 09, 2011 at 08:47 PM EDT | No Comments
After a dozens of presentations about falls, dizziness and balance to retirement communities and Medicare aged social groups, I generally get questions from the audience are basically the same. As it turns out...these questions are ready made for good blogging!
DOES A PERSON WITH POOR HEARING HAVE POOR BALANCE?
I have heard our Director of Audiology, Dr. Lisa Prather, tell so many patients that a person's hearing is not...I repeat, NOT related to their balance. The ear has 3 segments: The Outer Ear -where the ear canal and ear drum is; The Middle ear- where the conductive bones are (remember the hammer, anvil and stirrup?);and The Inner Ear – which has one structure dedicated to hearing and another for balance.Therefore…if someone suggest that a hearing aid will improve your balance…they are either misinformed, or they are in the business of selling.
CAN YOU TEACH US HOW TO FALL SAFELY ?
When this question comes up…I often repeat it…then I offer the reality that people begin overestimating their physical abilities in their late 40s and early 50s.I liken this to “…when your brain writes a check that your body cannot cash.”We WANT to catch that Frisbee that was just tossed to us, but an aging nervous system, reflexes, muscle response, strength and speed just aren’t up to it.Therefore, for you 65+ year olds, the answer to your question is NO…This is not stunt school…and you will not be learning how to fall safely!In actuality, most fallers don’t recall the moments prior to the fall…they typically only describe events AFTER they are on the floor.So the question based in reality is: Can people aged 65+ learn how to avoid falls injury?This answer is resounding YES!
I WALK MORE THAN A MILE A DAY, AND I STILL HAVE BALANCE CONCERNS.WHY?
The short answer is that, for most seniors, all exercise is good…but all exercise is not helping your balance.While current studies tell us that general exercise can improve balance by up to 30%...we need to look at the whole person so we don’t ignore the other 70%. Like a fever…balance and/or dizziness are symptoms of other health issues; and so, a person’s health issues should be reviewed for their impact on balance.The relationship between a person’s health issues is called “co-morbidity”, and creates situations where one problem contributes to another; like severe arthritis in a knee creates a limp, which causes low back pain, which can lead to instability and falls.Add other health concerns to the mixture, and it’s easy to see why the American Geriatric Society-January 2011 calls falls among seniors a national health issue.
Until next time…encourage all seniors who have concerns about dizziness or balance to see their physician and ask for a Falls Risk Assessment.
By No Falls Zone | September 30, 2011 at 03:52 PM EDT | No Comments
In our clinics, we often have patients tell us that they have been diligent about those things that have been preached for many years....
Get an annual physical...have your heart checked...take your medications as prescribed...don't wait if you find a lump or an odd shaped mole...keep tabs on cholesterol and blood pressure...Oh, and brush your teeth! Great advice for anyone who wants to maintain health.
Last week, a lawyer friend mentioned that in their elder care practice, too many of their clients come in and develop a good financial plan...exhibiting the sound judgement of those older adults doing their best to maintain health...only to fall, fracture a hip and die within 12 months, which negates the effectiveness of the legal planning and associated look back periods.
It is incumbant for all us who work with older adults to let them know how important a Falls Risk Screening (which is now covered 100% under the Jan. 2011 Medicare Annual Wellness Visit) and a Falls Risk Assessment can be to their health plan. After all, falls injury and death statistics for older adults have ranked in the top 6 for decades...but most people do not yet treat a fall with the respect it commands.
"Falls are one of the most common health problems experienced by older adults and are a common cause of losing functional independence," said Mary E. Tinetti, MD, from Yale University School of Medicine in New Haven, Connecticut, in a Jan-2011American Geriatric Society news release . "Given their frequency and consequences, falls are as serious a health problem for older persons as heart attacks and strokes. All healthcare practices for older adults should include fall screening and prevention, with new assessments involving feet and footwear, fear of falling, and ability to carry out daily living activities.”
We wouldn't think of not brushing our teeth, and taking our heart, cholesterol, diabetes, and blood pressure medicine...before we fall and fracture a hip walking out of the bathroom !!!
Mike
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