Guarding Health, And Independence

As Populations Age, Localities Tailor Services to Help The Elderly Stay in Their Homes While Avoiding Falls

Helen Sellevaag knows her next fall could be fatal. At 97, she also understands her chances of falling have increased as she has gotten older, and the slightest misstep could lead to a life-threatening injury.

So Sellevaag listened carefully during a recent visit from a social worker. Then, with the help of a walker, Sellevaag took a room-by-room tour of her home in Annandale to see for herself the possible dangers posed by ordinary objects. Throw rugs. Low-watt light bulbs. Electrical cords on the floor. Medications.

Jennifer Edge, a social worker from ElderLink, lifted each rug in the kitchen to see whether it had an anti-skid bottom. She flicked switches and discussed handrails. She catalogued Sellevaag's medicines and vitamins -- 24 in all -- while explaining that taking four drugs or more affects your sense of balance.

More than a third of people 65 and over fall every year. For those 85 and over, the odds are four to five times worse. Falls are the leading cause of accidental death in the elderly, surpassing vehicle crashes.

All it takes is a single fall for an older person to lose his or her home. And with the first baby boomers hitting 65 in three years -- and expected to live another 18 -- Fairfax County officials are taking urgent steps now: They're helping residents age-proof their homes so they can stay put.

Home visits are the latest sign that Fairfax, like many other local governments, insurers and health-care providers, is preparing for a vast demographic shift toward a grayer America. With the nation's aging population projected to double by 2020, the county has put together the "Fairfax 50+ Action Plan" for new transportation, building codes and other measures.

Montgomery County offers similar fall-prevention programs as part of several services for older residents. Home visits are usually in response to a call for acute needs, said John J. Kenney, chief of aging and disability services in Montgomery. Prince George's County also offers educational sessions on preventing falls.

"People want to stay in their own homes and take care of each other. This is a way of doing it," said Cathy Cole, director of ElderLink, a cooperative program among Inova Health System, the National Capital Area Chapter of the Alzheimer's Association and the Fairfax Area Agency on Aging.

As people age, arthritis can inflame joints and hinder movement. Muscle mass and strength diminish, reducing the ability to retain balance and coordination. Because women have less muscle mass than men to begin with, older women are more likely to fall than men, at least until both reach 85 and the rate of falls becomes more equal.

Eyes also falter, reducing depth perception. Older people need more light to distinguish objects in detail, Edge said.

Medical conditions sometimes cause momentary dizziness, such as when a sudden drop in blood pressure occurs when a person stands up abruptly. Researchers also have found that balance can be hindered by the side effects of certain medications and combinations of drugs. Depression, for reasons that are not clear, can contribute to falling, perhaps because a person's low mental state might distract them.

Studies have found that about half of those who are hospitalized for serious injuries after a fall are able to return to their homes and live independently. One found that, in 1998, the average cost to treat the injuries of a 72-year-old person's fall was $19,440.