Online Health Chat with Dr. Frederick Frost
September 15, 2011
Cleveland_Clinic_Host: Many caregivers involved
in the elder care of aging parents don't realize how many fall hazards can be
found in the common household until their elderly parent takes a bad fall,
breaks a bone, and is hospitalized for months. If you care for elderly parents
in the home, fall prevention must also be taken into consideration in order to
provide a safe and secure living environment for your loved ones. Nearly 1/3 of
seniors living in their own home or the home of adult children caregivers suffer
from a serious fall at least once every year, many of whom never completely
recover from the injury.
So many caregivers ask: is there anything I can do to
prevent this from happening to my loved one? Yes. Falls prevention tips and
therapy can help to reduce the risks to seniors.
Dr. Frederick Frost is board-certified in physiatry
(physical medicine and rehabilitation) and spinal cord injury medicine, and
specializes in falls prevention, as well as spinal cord and stroke
rehabilitation. He is also the interim chair of the Department of Physical
Medicine and Rehabilitation at Cleveland Clinic. Dr. Frost received his
undergraduate degree from the University of Illinois, Urbana, IL, and his
medical degree from Northwestern University Feinberg School of Medicine,
Chicago, IL. He completed his residency training and fellowship training at the
Rehabilitation Institute of Chicago, Chicago, IL, and completed an additional
fellowship at the Midwest Regional Spinal Cord Injury System/Northwestern
Memorial Hospital, Chicago, IL.
Cleveland_Clinic_Host: Welcome to our Online
Health Chat with Dr. Frederick Frost. We are thrilled to have him here today for
this chat. Let’s begin with some of your questions.
Elizabeth: Where do falls among older adults occur
Dr_Frederick_Frost: Bathroom is first. Wet surfaces
are also hazardous. Sleepy, older patients walking in the middle of the night
are also at risk. Stairs are the most dangerous area of the house. The Centers
for Disease Control and Prevention (CDC) guidelines/handout has some nice tips
to make the home safer: use of nightlights, removal of extension cords and throw
Marjorie: What are the major risk factors for falls
among older adults?
Dr_Frederick_Frost: There are more than 20 discreet
risk factors that we screen for in our Falls Clinic. Some are obvious, some are
not. Just to mention a few: age over 80, difficulty with bladder control,
impaired vision and hearing, taking more than 10 medicines.
Maak: My mother (86) recently purchased a cane
(because she thought it was cute!). She feels that it helps when standing up
from a sitting position. She has sprained her ankle twice because her foot fell
asleep while sitting. Is the cane sufficient or should we look into other
Dr_Frederick_Frost: It would be best to have a
physical therapist evaluation. Sometimes, a cane can confuse a patient and can
be an impediment. A therapist who specializes in older patients is a key member
of the team. A rolling walker (like a rollator) can sometimes be a godsend. It
allows the patient to exercise -- using it like a treadmill to keep the legs
strong. Then the patient can put it aside if the situation dictates.
Petrica: How do you determine the need for a formal
evaluation when tripping a lot, sometimes falling? Not sure if it is a balance
issue or clumsiness.
Dr_Frederick_Frost: Right! Some people are just
clumsy! It depends on the risk of injuring yourself. There are a lot of factors
to consider -- age, bone density, etc. Normally, we screen like this: if you are
over the age of 70, have fallen twice in the last year, or have fallen once with
an injury requiring medical care, we would look into it.
Hoda: When walking the dog, I tripped on the sidewalk,
hit my head, got cut above my eye, etc. But a couple of weeks later I fell while
waiting for an elevator. Should I be evaluated and what would it involve?
Dr_Frederick_Frost: Start with your primary care
doctor. He or she can screen for a number of correctable problems -- such as
poor eyesight, improper footwear, patterns of weak muscles -- and can design a
strategy to address these areas.
AGS: Any advice to give someone on how to get out of a
car? My father-in-law fell when getting out of his car. He is not even certain
how he fell. He was in the hospital after this for three weeks!
Dr_Frederick_Frost: Because this is so common, we
have driver’s evaluation therapists in three locations across Cleveland. These
are occupational therapists who are specially trained to assess and remedy
physical problems that affect the ability of the patient to use an automobile.
Car seats can be low and soft -- difficult to negotiate. Most of the time, if
the patient cannot rise from a low seat, it reflects weakness in the muscles
near the hip and buttocks. These can be targeted with specific exercises, but I
wouldn't start them without a physical therapist. The therapist designs a custom
exercise program that accommodates the patient's medical and orthopedic
Grannyscott: What kind of exercise helps improve
balance to prevent falls? Is Tai Chi helpful? I have two artificial knees, so if
I fall, I have a very hard time getting up unless there is some heavy furniture
there. Is aquatic exercise helpful (water walking and jogging, exercise with
Dr_Frederick_Frost: Tai Chi has been shown in
multiple research studies to be very effective in preventing falls and injuries.
It is a struggle to stay strong enough to rise from the floor if you fall,
especially if you are older with knee replacements.
I recommend water exercise only if the patient cannot
exercise on land (e.g., due to pain). Water exercises don't help keep your bones
strong; you need gravity for that.
SueB: I have deteriorating disc disease and have had
five back surgeries. I fall at least three times per year because I have
permanent numbness in my legs and a poor sense of balance. I occasionally
stagger when I walk. Is there anything specific to these conditions you would
recommend to prevent falls?
Dr_Frederick_Frost: Sounds like you have had more
than your share of troubles. Most people with falls have multiple problems --
neurological and skeletal. Whatever your combination of problems, it is best to
make sure that the muscles that are working are strong. I'm sure that you have
some home exercises from your physical therapy. We focus on strength and weight
Paisley: Do certain health conditions lead to falls?
Dr_Frederick_Frost: Definitely! Many health
conditions and the medications that are dispensed for them are major causes of
falls. Most commonly, patients with falls have subtle neurological conditions
combined with an aging skeleton. There are many diseases, such as diabetes,
whose side effects damage the nervous system and lead to an increase in falls
Talking to Your Loved One
toomuch: My mother has trouble walking. She does not
do much walking except where she can have something close at hand to hold on to
or lean against. She'll walk with her hand along a wall, pushing a shopping
cart, etc. She refuses to get a walker or cane. We worry about her. How can we
convince her to get some sort of walking aid?
Dr_Frederick_Frost: We run into this situation at
least two or three times a week in clinic. Sometimes, it is best to bring the
parent in so he or she can hear the message from a non-family member. I usually
"soft-sell" a rollator walker in this situation. I emphasize that this is an
exercise device that allows them to walk quickly and increase their distances,
otherwise the legs get weaker and weaker. Offer the older patient the option of
using the rollator walker in private, not out in public. Also, emphasize that
the patient DOESN'T become "DEPENDENT" on the walker. It is no different than
going to the grocery store and using the cart. This strengthens the legs!
horatio: What are the long-term consequences (effects)
of falls among older adults?
Dr_Frederick_Frost: The most serious is fractures. A
hip fracture in a person over the age of 80 has profound implications. Almost
half of people over 80 years who fracture a hip cannot return home from the
hospital to their previous living arrangements. Other effects center mainly
around the injuries, brain injuries, bleeding, etc.
BDW: Is there a formal falls prevention program at
Cleveland Clinic? If so, would you provide some information about the program?
Dr_Frederick_Frost: Yes. We have had a Falls
Evaluation Clinic at the Westlake Family Health Center since 2006. To access,
call 440.899.5555 and ask for Physical Medicine and Rehab. We are extending our
programming to an east side location in Beachwood by the end of the year.
Another option is the Geriatrics Clinic (X building), where we have a falls
specialist physical therapist who works alongside the geriatricians.
jasajass: Guidelines for preventing falls?
Dr_Frederick_Frost: Yes! The Centers for Disease
Control and Prevention (CDC) offers a wonderful handout for patients (www.cdc.gov/).
For medical personnel, my favorite is the Otago Protocol, from Otago Medical School in New Zealand. This is a carefully
researched and wonderfully organized program for medical professionals that has gained great popularity across the world (Otago Falls Prevention Programme). The website for the Otago Falls Prevention Programme is
jujub: My mother is very unsteady on the stairs. She
takes them one at a time and we have installed sturdy railings. We are still
worried that she might take a tumble, especially down the basement stairs. What
else can we do to help prevent this?
Dr_Frederick_Frost: This is a big problem. Although
the most common area of injury in the home is the bathroom, the stairs pose the
greatest risk of severe injury. It is very hard to convince an older patient to
move his or her bedroom downstairs, but the effect that this has on reducing
injury risk is huge! Every house is different, but there is no way to eliminate
the risk of stairs in the elderly without eliminating the stair use itself.
Power stair lifts are very expensive, and usually not welcomed by our older
smbart_1: Besides removing throw rugs, what other
precautions need to be taken in and around the home to prevent falls?
Dr_Frederick_Frost: There is a comprehensive list on
the CDC handout. Fixing leaky faucets, proper lighting, grab bars, and removing
clutter are among the dozens of simple things that can be done to reduce risk.
smbart_1: If you have non-diabetic neuropathy, what
steps can you take to help prevent falls?
Dr_Frederick_Frost: That depends on how the
neuropathy affects you. If the problem is below the knee, there are new designs
of lightweight leg braces that offer support for weak muscles, and sensory
feedback if your feet have impaired sensation. Other than that, strategies focus
on strengthening of the muscles that are not affected (i.e., teaching
compensatory strategies). We don't have a cure for neuropathy, so we need to
teach people to work around it.
stien76: When looking at a new home for an elder
parent, what should a person look at to minimize falls?
Dr_Frederick_Frost: No steps. Lots of light. Paved
driveway. Easy to maintain (i.e., free from ice and snow). When moving from the
old house, do your best to reduce clutter of years of accumulated belongings.
stien76: Bathrooms seem to be an area that my parents
seem to have problems with falling. Do you have any suggestions to make that
area of the house safer?
Dr_Frederick_Frost: Yes! Of course you deal with
water on the floor, throw rugs, and nightlights -- these issues. We also make
sure that our older patients are receiving the best treatments for the bladder
function. If you can cut down on the number of trips to the bathroom (especially
at night), you can markedly reduce the risk for injuries. Older men can take
medicines for enlarged prostate problems, and both men and women can benefit
from bladder relaxing medicines. This is one of my favorite treatments, because
the patient sleeps better and feels better, and this affects many of their
health problems for the better.
jujub: In regard to the stairs again, does it help to
put carpeting with extra padding on the stairs and at the bottom of the stairs
to help prevent injury if she does fall? Or would this make the stairs less
stable under her feet?
Dr_Frederick_Frost: Padding reduces feedback; this is
bad! As a matter of fact, our therapists use soft surfaces to challenge our
patients in therapy. Of course, it is wise to remove furniture with sharp/hard
edges from the area and clear clutter from around the stairwell. There is some
nice research on giving older patients padded hip protectors (like football
players wear!). These prevent injury nicely, but not many patients will agree to
wear them, and they are tough to put on and take off.
vivica: What is a falls specialist? Someone other than
my primary care physician?
Dr_Frederick_Frost: Lots of doctors take an interest.
At Cleveland Clinic, our interdisciplinary group includes endocrinologists,
geriatricians, neurologists, ear-nose-throat specialists, doctors in physical
medicine and rehabilitation, and -- of course -- our physical therapists. Most
of the time, it is best to start with a primary care doctor. They tend to know
the specialists in your area that take an interest.
stien76: What factors should a caregiver look for in
determining whether to seek emergency treatment after a fall?
Dr_Frederick_Frost: Good question! Falls are common.
Fortunately serious injuries are less common. Here, common sense plays a role.
Certainly, if pain prevents the patient from engaging in their previous level of
activity, some X-rays are probably in order. Of course, an injury to the head is
almost always a reason to seek immediate medical attention.
sgrossi: Is it balance or just insecurity?
Dr_Frederick_Frost: That is a good point! Our
patients lose their confidence and quickly become insecure and tentative after a
fall or injury. That is one of the great values of physical therapy -- to help
the patient get their confidence back.
Cleveland_Clinic_Host: I'm sorry to say that
our time with Dr. Frederick Frost is now over. Thank you again, Dr. Frost, for
taking the time to answer our questions today about Falls Prevention Tips and
Therapy Options for Caregivers of Elderly Parents.
Dr_Frederick_Frost: Thanks so much for having
Cleveland_Clinic_Host: To make an appointment
with Dr. Frost or any of the other specialists in our Department of Physical
Medicine and Rehabilitation at Cleveland Clinic, please call 216.636.5860 or
toll free 866.588.2264. You can also visit us online at
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This chat occurred on 9/15/2011
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