The newspapers and magazines have been swamped with articles about falling, the consequences of the fall and prevention strategies. If you can read only one article, go to Bracing for the Falls of an Aging Nation, by Katie Hafner, a two-part article in the New York Times. My readers are also gravely concerned about “falling.” As the ‘runway’ of life becomes shorter, I (age 75) and older seniors are facing new and difficult decisions in the journey of aging. I have received several questions about falling and the consequences of these falls; especially the questions “How to approach the decision to move into a seniors residence?”; “How to decide when one needs assistance?”; “How to assist parents and friends to accept their vulnerability and the importance of changing living conditions and circumstances?” We are dealing here with issues of independence, potential for harm, resistance to change and denial of weakness. This column is dedicated to these questions and concerns.
So What is the Price of Independence?
Independence vs. Vulnerability—Dependence vs. Safety
I will present two cases at the beginning of the article and deal with them both together.
I am a woman of 89 years old, I live alone and have the support of my daughter who lives nearby. I walk to the nearby village to do my personal shopping, enjoy the company of neighbours and, in general, am very happy. Two months ago I answered the telephone. It was a telemarketer! I was angry because he had interrupted me while watching a TV show I love. I slammed down the phone, lost my balance and hit a big piece of furniture on the way down. The results: I called my daughter, at the hospital they discovered that I had broken my humerus, a long bone in the upper arm. My arm was immobilized for 6 weeks. I had to live with my daughter. A physiotherapist came to the house after several weeks to get me back in good working order. What happened to me? I thought I was healthy and active. I didn’t want to, but now I have to use a walker. Am I being foolish continuing to live alone?
Mad & Sad
I am a woman of 78 years old. I live alone and have no one who is involved with me on a daily basis. I go to the gym, do weight-training, and take spinning and yoga classes at least 4 times a week. I drove to my son’s house. While walking around my car, I did not notice the two-levels of pavement on the driveway. My feet got caught against the ledge, I fell flat on my face – hard! I cut and bruised my cheek and lips, gashed the palm of my right hand and bashed and scraped my right knee. BUT, I got up, brushed myself off, went into the house and surveyed the damage. Nothing was broken, it was a miracle. That was a bad fall, the worst I have ever taken; and as an athletic person I have fallen many times. What happened there? I was swollen and bruised, but I was so glad that I did not have broken bones. Should I consider getting an emergency alarm system in my home? Do I have to give up my independence?
Bad & Glad
As the population ages, people live longer and health deteriorates. The number of older Canadians who fall and suffer serious, even fatal, injuries is soaring. Many people do not, or refuse to, recognize their own gradual deterioration, leaving them vulnerable. The experts agree that sitting is bad, walking is good, but that is not enough in terms of physical fitness. “Strong” has become the new “skinny”. Strength and balance are the key elements to strive for. Start regular exercise as soon as possible: weight-training, core and aerobic exercise, flexibility and balance work – any combination of these elements and keep it up in order to keep bones and muscles strong. Tai Chi is an excellent example.
There are pitfalls everywhere we turn, whether it be in your home, on the sidewalk or in the supermarket. Losing one’s balance in not unusual, the issue is having the core strength and sufficient muscle strength in the arms, legs and torso to regain one’s balance; or, at least, to mitigate the fall by bracing and falling against something stable like a counter or large piece of furniture. It is not the actual fall but rather the consequences of the fall that make the difference. In the Mad/Sad Case, she did not have the arm bone density or the protection of muscles to withstand the shock of the fall. In the Bad/Glad Case, her cheek, wrist and knee bones and the surrounding muscles were able to withstand the trauma. A current buzz phrase is ‘exercise is medicine,’ which definitely applies to mobility and falls.
Falls happen, whether at home alone or in senior residences. Environments can be made safer: bathrooms can be retro-fitted, better lighting can be installed, furniture can be arranged so that there is something to lean on in an emergency. Softer flooring is available so that the senior will “bounce” rather than smash into the floor. Certain medical conditions cause the incidence of falling to rise. Medications are also the cause of seniors falling. Fears about falling become a self-fulfilling prophecy.
Katie Hafner writes “After a fall, life is upended in an instant –a sudden loss of independence, an awkward reliance on family and friends, and a new level of fear for those who fall, and their contemporaries” (Hafner, part two). In both of the above cases falling has become a worry and a cause for concern about living alone. Many people resist wearing emergency pendants, people do not want to recognize that they are in mortal danger if they have an injurious fall when they are on their own. It’s likely to be catastrophic if they don’t get help in a timely manner. Moving to a senior residence is resisted, often until it is too late and a serious incident occurs. Most seniors dread leaving behind their home and their neighbourhood. Yet some senior homes are being designed by enlightened architects and interior designers to promote wellness and a happy state of mind.
There is no one answer to the issue of independence/vulnerability versus dependence/safety because this juxtaposition is false. Living in a senior residence is no guarantee of safety and happiness; living alone does not necessarily mean that the person is in danger and unhappy, if certain conditions are met. Each decision is an individual scenario which requires thought, discussion and good professional advice. A team approach consisting of medical doctors, psychologists or social workers, family and friends can inform and guide the senior to make an informed, personal decision about their lifestyle and their lives.
Hannah, M.Sc. Counselling
Mail: Ask Hannah, Jewish Seniors Alliance, 949 West 49th Ave., Vancouver, BC V5Z 2T1
Disclaimer: The statements and opinions stated in this column are not intended to replace the professional advice of physicians, psychiatrists, psychologists, lawyers, notaries and accountants. They are intended as guidelines only; please consult your professional caregivers and consultants.