Friday, November 7, 2014
Help, I've Fallen!
The New York Times second in the series of how to fall down and age badly seems to remind me a few years ago when they focused on autism. I thought then as I do now that some Editor or Journalist has a family member with the problem and they are going to make sure we hear about it and then we will never hear about it again as we have been duly warned and informed.
I want to note that not one of the individuals profiled in this series are "boomers" and this takes place in one of the second wealthiest communities in the U.S., San Francisco. I have no doubt that Granny in Oakiskogie is finding herself in the same situation but what seems to be the issue is the denial of aging, the lack of appropriate medical and psychological counseling to assist those adjusting to the physical limitations of aging, home visits by providers or care givers to ensure that homes and lives are safer and more importantly active involvement and communication between family members. Ahh fuck that just put them in a home and let them deal with it.
If this doesn't scream out for a way of examining the way we live and house ourselves nothing does. The issue of multi generational housing, aging-in-place, opportunities to retrain the mind and body and in turn access to affordable and well trained caregivers who are compensated appropriately for their work, are all possible alternatives than being relegated to institutionalized care or a wheelchair. This is not living nor dying well its aging badly and discrimanantly.
Here are two more articles about offering housing alternatives - to multi generational and its needs and aging in place. We need to see more than these horror articles that do nothing but lend to a fear of aging.
Tiny Stumble, a Life Upended
By KATIE HAFNER
NOV. 3, 2014
SAN FRANCISCO — Joan Rees, 79, had hardly been ill a day in her life. Her biggest problem was arthritis, mostly in her knees, but at home in San Francisco she walked every day and she traveled frequently.
At dusk last November in Istanbul, on the final day of a cruise, she missed a step and lost her footing. When she couldn’t stand up, she knew something was terribly wrong.
In that trivial act of misplacing her foot and falling, she had fractured her pelvis in multiple places. “It was a complete shock,” she said, “that I did something so destructive to my body.”
Her life would change with cruel, unanticipated swiftness.
The number of older Americans who fall and suffer serious injuries has soared. More than 2.4 million over the age of 65 were treated in emergency departments for injuries from falls in 2012 alone, and in the decade ending in 2012, 201,000 Americans over 65 died after falls.
Geriatricians generally agree that some older people possess an exaggerated sense of what they can still do, even as hazards lie in wait: staircases, throw rugs, slick bathtubs, concrete bumpers in parking lots, tree roots, their own pets. And medications like hypertension drugs and antidepressants, which can cause dizziness, are increasingly the cause of falls.
Twenty-five percent of older people who fall and fracture a hip die within a year. Eighty percent are left with severe mobility problems, no longer able to walk a city block. Those who die or become severely disabled after a hip fracture are usually people who were frail or sick — or both — before their fall, said Dr. Mary Tinetti, a geriatrician at the Yale School of Medicine who has studied falls for more than 30 years.
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.
A Painful Reality
Like many who fall, Mrs. Rees blamed herself for tripping over the unseen step in the chaos of late-afternoon traffic near the Grand Bazaar. “I just couldn’t believe I did something so dumb,” she said.
In the ambulance to a hospital, she was in so much pain that she insisted the driver put on his siren. She called one of her daughters, Joanna Rees, in San Francisco. “She sounded terrible,” Ms. Rees recalled. “She kept saying, ‘You have to get me out of here. I have to leave.’ But when I talked to the doctor, he said she wasn’t going anywhere. She couldn’t even stand up.”
Mrs. Rees was a textbook case of a serious injury waiting to happen. Her risks included previous falls, impaired balance, and the arthritis in her knees.
On a trip to London to visit her daughter Barbara in 2008, she stumbled and fell on the sidewalk just outside her daughter’s apartment. Embarrassed, she hoped her daughter hadn’t been looking out the window. She fell twice after that, but each time, she picked herself up without a scratch.
In hindsight, Barbara Rees, who has since moved to San Francisco, realizes that perhaps she should have paid closer attention to her mother’s balance. Yet none of Mrs. Rees’s children thought about suggesting to their mother that she take preventive measures — enroll in a balance class, for instance, or avoid dehydration, which can cause dizziness — just as people take precautions to stave off, say, heart disease.
Continue reading the main story Balance is a complicated equation involving vision, muscle strength, proprioception (the body’s ability to know where it is in space), and attention. As people age, those elements deteriorate.
“Falls are a very difficult thing, because it’s such a scary idea,” said Dr. Judy A. Stevens, an epidemiologist at the Centers for Disease Control and Prevention. “People don’t want to hear about it and people affected don’t want to talk about it.”
Indeed, one consequence of a fall is the effect on one’s peers. Word of Mrs. Rees’s accident in Istanbul spread rapidly among her friends back in San Francisco. The reaction was one of sympathy, followed by a collective shiver. Desa Belyea, a friend of Mrs. Rees’s who is in her 80s, said she feared falling more than she feared getting sick. “It becomes your worst nightmare,” said Cathy Fiorello, another friend who is also an octogenarian.
A Frustrating Recovery
A retired schoolteacher and former owner of a bed-and-breakfast in Montclair, N.J., Mrs. Rees moved to San Francisco in 2006. Her husband had died 13 years earlier and she wanted to be closer to her children, three of whom lived in California.
She quickly settled into a life of happy independence, renting an apartment in a high-rise overlooking San Francisco Bay. She joined a book club and a walking group, and established a new circle of friends, many of whom lived in her building.
After her fall in Istanbul, she went to stay with her son John and his family in Saratoga, south of San Francisco. But after three weeks there she began to feel like a burden and returned to her San Francisco apartment. Her son tried to persuade her to stay longer, but she assured him that she would be fine, that she needed to be in her place, surrounded by her friends.
At first, her sunny nature helped her through the days. But the excruciatingly slow recovery filed down her spirit. She felt as if she were trying to climb the slippery sides of a glass. The process from wheelchair to walker to cane took months. Friends and family members noticed that she seemed perpetually canted to one side.
Once back in her own apartment, Mrs. Rees soon felt isolated — and scared of falling again. “At first all her friends were around, but people are only going to help you for so long,” her son John said. “Suddenly she was sitting in her apartment on her own, and having trouble getting by with the walker.” Friends brought meals to her but she couldn’t get the food across the room to the dining table. She ate standing in the kitchen.
She kept her apartment door open, in case she fell and needed to call for help, despite her children’s deep fear that a criminal might walk in on her.
Across the nation, places like The Sequoias are trying to reduce the number of falls among their increasingly elderly residents while satisfying people’s desire to live life as they choose.
Mrs. Rees, who cherishes her dignity and independence, found the requirements of recovery humiliating.
A meticulous dresser who dyes her hair a youthful auburn, she cares about appearances. When a physical therapist told her she would need to fasten a leash-like harness to her for safety when they went outside to practice walking, Mrs. Rees refused to go. “What if one of my friends saw me with a leash on?” she told her daughter Joanna.
For the first time in her life, Mrs. Rees felt truly old. She grew cranky, even bitter. “She was very, very hard on herself, which made her hard on others,” Joanna Rees said.
One depressing setback came shortly after Mrs. Rees returned to her apartment late last fall, when she waited nearly two weeks for Medicare to transfer her case from her son’s location to San Francisco so she could resume physical therapy. Mrs. Rees developed sciatic pain from another byproduct of the fall — a compressed nerve — that was as excruciating as the fracture itself.
Mrs. Rees called the doctor’s office and after speaking with a nurse was prescribed a strong dose of Vicodin, to be taken several times a day. A few days later, Joanna arrived at her mother’s apartment to find her on the couch, unconscious and drooling.
Six months after the accident, with regular physical therapy, Mrs. Rees had recovered remarkably well. But to watch her move through her days was to see a lingering tentativeness. Where once her gait was strong and assured, it had turned cautious.
When stepping off a curb, she searched for handrails, or walls, or just about anything with which to steady herself. The nerve damage persisted, and she occasionally winced in pain. “I feel like I’ve woken up from a coma,” she said.
Nearly a year has passed since her injury, and now Mrs. Rees considers herself nearly fully recovered. Her sunny outlook on life has returned, and she is back to taking lengthy walks around San Francisco, with less hesitation at curbs. She is even planning a family trip to Arizona to celebrate her birthday in January.
Yet as her children see it, Mrs. Rees’s tumble in Istanbul was a defining event in her life, the moment when the roles of parent and child began to reverse. Said her daughter Joanna, “This is Mom 3.0, in terms of how things will go from here.”
Experts who have studied falls wish that people would take measures to protect themselves much as they do against heart disease or viral infections. Here are some recommendations from experts on how to protect yourself or someone you know is susceptible to falls.