Falls

Of all the numerous issues the elderly face, one of the most challenging and potentially life-altering is falling. When I practiced emergency medicine, I treated many with this very problem, and on occasion these events led to permanent disability or even death.

The causes of falls are too voluminous to list, but in general, they can be placed in three different categories: First, environmental hazards can be a culprit, such as throw rugs, uneven steps, or floor clutter. Second, age-related changes, typified by balance and vision issues or muscle weakness, can be implicated. Finally, falls can be caused as a side effect of certain medications, such as diuretics, sedatives and antidepressants. Add to this extensive list other issues such as anemia, which can cause low blood pressure, neurological concerns like diabetic neuropathy, multiple sclerosis, etc., and healthcare providers can have quite a diagnostic dilemma on their hands. Remember, the list doesn’t include syncope – passing out – a whole other ball of wax.

I personally encountered a number of family-member falls, as both of my parents experienced this problem a handful of times, which sadly enough, were a harbinger for their eventual deaths. In my emergency career, I had learned the occurrence of falling was mostly a concern of the elderly, as after all, Mom died at 84 and Dad at 92. Somehow, I never really pictured myself as what I actually was, an aging senior citizen.

Imagine my surprise, dismay, and astonishment when I recently took a fall. I was walking down the stairs from my home office, when I lost my balance and went flying down the remaining steps onto a wooden floor, landing with a thud on my hands and knees. Sheridan was nearby, but the fall happened too quickly for her to try and help.

A quick assessment revealed a bloody scrape on my right forearm, some aching pain in my knees and left hip, and so, bewildered and embarrassed, I quickly sprang to my feet. After all, I was too young for this sort of thing. Wasn’t I?

For me, in the aftermath, the first misconception to deal with was that this episode was the beginning of the end. In other words, because I was now falling – like my parents and a number of others I had seen as patients – the deterioration associated with old age was rapidly approaching and there was little I could do to prevent it.

In my mind’s eye, I saw myself over time become bedbound in a nursing home, arms and legs in restraints, complete with a feeding tube, foley catheter in my bladder, garbled speech, foul-smelling decubitus ulcers on my hips, and not recognizing anyone who braved seeing the shell of the man I used to be. In my confused state, I was certain I saw the Angel of Death in his prototypical long black robe, scythe in hand, hovering ominously at the bedside. As I miserably lay there, I somehow realized that this outcome was not what hospice and palliative care physician, Dr. Ira Byock, had in mind when he penned the classic text, “Dying Well.”

As you can see, an active imagination coupled with medical knowledge can be a powerful, double-edged sword.

Moving past my unpleasant fantasy and looking deeply at my fall, I believe there were two main issues. First, I have chronic numbness and weakness to my right leg, a problem which has puzzled my neurologist, and secondary to that, my balance is not good. Second, when I went down the stairs, I was not being mindful, and not only was I not focusing on safely getting down, I chose not to use the handrail for support. What was I thinking?

While this accident was a terrible mistake on several levels, I have learned from my experience, making such a fall in the future far less likely. As a matter of fact, I feel greatly blessed not to have sustained more severe injuries. As Oprah Winfrey so wisely said, “Mistakes are the stepping stones to wisdom,” and I couldn’t agree more.

In the meantime, I now view this episode as a gentle nudge from God to be more attentive, and I hope to minimize any further falling episodes. As opposed to my initial fear of being at the beginning of a death spiral, I plan to have a long, healthy life. With a little common sense mixed with a generous amount of mindfulness, I’ll do everything in my power not to potentially short circuit a rich, joyous, elderly existence.