Staying steady: Reducing fall risks as we age

Podcast transcript

INTRO
Welcome to Docs in a Pod presented by WellMed. Over the next half hour, Docs in a Pod will educate you about the health and wellness of adults everywhere. Co-hosts Dr. Tamika Perry and Carmenn Miles will share information to improve your health and well-being. And now here are Carmenn Miles and Dr. Tamika Perry.

CARMENN MILES
Hello and welcome to this edition of Docs in a Pod presented by WellMed. I'm Carmenn Miles alongside our co-host today, Dr. Tamika Perry. If you happen to be listening to Docs in a Pod for the first time, you can catch episodes of this award winning podcast every Saturday on your favorite listening platform, now including Amazon Music, audible, and iHeart radio. You can also find us on the radio in several Texas markets. Each week, we're here to tackle health and wellness topics, especially those that impact the senior community. Our goal really is to offer practical information on how we can all live healthier, happier lives and to help us better manage the chronic conditions that so many of us deal with. Thanks for listening in today. As I mentioned, our co-host today is Dr. Tamika Perry. You can find her at WellMed at Redbird Square in Dallas, Texas, where she cares for her patients. She's an associate medical director, overseeing several large clinics in the Optum Care North Texas Region. She's board certified in both family medicine and osteopathic treatment. Additionally, she earned a Master of Public Health from the University at North Texas Health Science Center. She says she was inspired to enter a career in medicine to help provide quality health care to the Disenfranchised, and she is absolutely fulfilling what she set out to do at WellMed at Redbird Square. She enjoys working with families and communities and as a whole, building relationships with her patients. Outside of medicine, she's a proud mother and she travels the world every opportunity she gets. Any upcoming traveling on your agenda for the balance of the year?

DR. TAMIKA PERRY
Not for the remainder of the year, but in January, when I turn 50, I'll be in Panama.

CARMENN MILES
Oh, nice. Very good. Will it be your first time to Panama?

DR. TAMIKA PERRY
No, it's actually my second time. I really like Panama. Maybe one day when I grow up, I'll live there.

CARMENN MILES
Fantastic. Let's introduce our guest today. Our guest is Shantrelle Lavigne, a dedicated family nurse practitioner also at WellMed at Redbird Square, where she provides compassionate, patient centered care to individuals and families. She earned her Master of Science in Nursing from Purdue University Global in Davenport, Iowa, and holds certification as a nurse practitioner. NP Lavigne is also certified in Basic Life Support, underscoring her commitment to clinical excellence and patient safety. Hello NP Lavigne, thanks for joining us today. How are you?

SHANTRELLE LAVIGNE, NP
I'm well, how are you?

CARMENN MILES
I'm doing great. This is your second time with us on the podcast.

SHANTRELLE LAVIGNE, NP
Yes maÕam, it is.

CARMENN MILES
Welcome back.

SHANTRELLE LAVIGNE, NP
Thanks for having me.

CARMENN MILES
Today, we're discussing a serious but preventable health issue. That is falls among older adults. Just to give a little bit of data behind what we're discussing, every year, millions of older Americans experience a fall. While some falls result in some minor injuries, others can lead to broken bones, hospital stays, compromised independence of our patients and just an overall fear of falling again, which leads many to become less active due to the sheer fear of having a repeat fall. We're here to help people understand the underlying causes toward fall prevention. What happens? How do these falls occur so often? In today's episode, we'll focus on four the most common reasons older adults fall. Before we jump into the causes, let's talk about why falls deserve our attention to begin with. Again, here's some data. Every year, 1 in 4 Americans over age 65 experiences a fall. Those falls lead to about 4.5 million emergency room visits, 1.5 million hospitalizations, and more than 43,000 deaths annually. We talk about fall position prevention a lot, and this data makes a compelling case for why fall prevention is one of the most important health topics for older adults and their caregivers and their health care providers. NP Lavigne, many people assume that getting older automatically means becoming unsteady on your feet, and that's why falls are just simply a normal part of aging. I don't know that I agree with that. Tell me what you think. Would you say this is factual or not?

SHANTRELLE LAVIGNE, NP
I do think that aging can increase the risk for falls, but I also do think that falls, for the most part, are preventable and that they are caused by many different accidents and/or injuries, I will say. Oddly enough, I had this morning in clinic, a 35 year old patient who tripped on her bedding coming out of her bedroom and fell. So, it's not always, I would say, more so our older adults, yes, they are at risk, but I think it's something preventable. Then always trying to identify the cause of the fall to prevent it in the future.

CARMENN MILES
Wonderful. Let's take a moment to welcome those who may have just joined us. You're listening to the award winning Docs in a Pod presented by WellMed. This podcast is available wherever you listen to your favorite podcasts. That list recently expanded to Amazon Music, audible, and iHeart radio. I'm Carmenn Miles alongside co-host Dr. Tamika Perry at WellMed at Redbird Square in Dallas, Texas. We're chatting with our guest today, NP Shantrelle Lavigne, also from WellMed at Redbird Square. We're talking about older adults and fall prevention. We want to hone in on four main reasons. We may touch on a few other, but let's start with medications. Can medications have an impact on older adults and their succumbing to a fall of some sort?

SHANTRELLE LAVIGNE, NP
Yes, ma'am. Most common medications are our sleep medications. Something as simple as Benadryl, which is very common. It's an antihistamine, but it's not the safest in our elderly population. Anxiety medication is one of them, whether that is Adavan or Xanax, that can put an elderly individual at risk. We also have certain antidepressants that can cause falls or make a patient more at risk for falls. Also, sometimes blood pressure medications. Most common blood pressure medications that I think we come across may be hydrochlorothiazide, which is a diuretic, but sometimes if the patient is not properly hydrating or taking it correctly, it can cause them to be imbalanced and set them from being at risk for falls. Our most common is pain medications. If they're not taking the pain medications properly or if it is something that they just are not used to, their body cannot absorb correctly, that can put them at risk for falls.

DR. TAMIKA PERRY
Sometimes people will do something like take your hydrocodone for your chronic knee pain, and then you take a Benadryl because you know your nose is running. Now you've really been set up for the okie doke, per se. Do you remember that commercial when we were probably eight, nine, ten years old? IÕve fallen and I can't get up, right? At the time we would giggle a little bit. I think it was a life alert commercial. Well, I sent to my girlfriends recently. We were all in our 4 to 6 decades of life and I said, it's not so funny anymore, y'all. We're at the point where we're becoming at increased risk of falls from things that are very, very benign or what we perceive to be benign. Shantrelle brought up a good list of medications that we should watch out for, but this is also why it's important that we go over your medicines with your doctor every single time you come in, and you tell them what other doctors prescribed. What are you buying over the counter? Benadryl has been over the counter forever? Diphenhydramine. I don't want to give the brand Benadryl a bad name, but diphenhydramine. Or any of diphenhydramine cousins that we find over the counter can make that senior loopy and sleepy. Now you're setting yourself up. You're loopy, you're sleepy. You're a little bit confused. You're a little bit sleepy. You're getting out of bed, and your little dog, Poochie is underneath your feet because you're excited to see you. That is a set up for fall. That happens all the time. You can say, well, what's the deal? I'm falling and so what? I can get up. No, not always because one, if you have underlying osteopenia or osteoporosis, especially if you're a lady, you may fall and break a hip, then you can't get up, and that's a whole other situation, right? Arthritic complaints may physically prevent you from getting up. If you live alone or don't have someone checking on you, if you're down for hours, your muscles can start to break down. Your muscles start to break down, those muscle byproducts get caught up in your kidneys. It can lead to kidney failure. This is all because you took some Benadryl and little Tito or your little dog was excited to see.

CARMENN MILES
That's right. You brought up a great point about reviewing medications annually or even more often with your provider, which used to get on my nerves, but now that I'm hosting this show, I completely get it. Is it equally as important to follow that same practice with your pharmacist? Make sure that you're maintaining your prescriptions at one pharmacy so they too can track interactions. Is that important as well?

SHANTRELLE LAVIGNE, NP
Yes. I don't want to put one pharmacy over another. There is one particular pharmacy that I do like that when you get a prescription, that pharmacist explained to you that prescription, the side effects, the adverse effects, and then the other things that may interfere with what medications you are already on. I think that's really good, especially because sometimes patients will get a prescription because we're prescribing it, and of course, as our due diligence, I'm prescribing you this medication, but I'm also looking at the rest of your medications that you're taking to make sure what may be the other effects of this medication weÕre adding to your profile. This particular pharmacy, I appreciate, because everyone does not know that. So, I'm getting a prescription because my doctor sent it, so I need to take it, but when they give you that additional education of what we discuss as a provider, that really makes the patient think, should I be taking this? Is it okay for me to take it? We also get calls back to say, well, the pharmacist said, so should I be taking this? So, I think it's important that across the board you get that double education and preventative measure.

CARMENN MILES
Right. I don't think enough pharmacists are doing that because you can get a prescription from another doctor, take it to the pharmacy and it may be three months before they get back to you, and you don't even have an idea that they're taking this additional medication that actually interferes with a prescription that you've offered to the patient. I think it's also important to say, never stop medications without medical guidance. We talked about that on the show, Dr. Perry, if you remember me stopping a medication that I should not have stopped without medical guidance. So, I think that's probably important as well. Listen, we're going to take just a quick break, but please stay with us as we continue this great discussion on how to prevent falls as an older adult. You're listening to Docs in a Pod presented by WellMed, and we'll be right back.

AD
For over 35 years, WellMed has redefined health care for older adults and people on Medicare. We're physician led and nationally recognized as an Age-Friendly Health System. Our doctors take time to listen and support your unique needs, working with Medicare and select Medicare Advantage Plans to keep you healthy and independent. With 24/7 nurse support, telemedicine, in-home and office visits, care is always within reach. WellMed. Compassionate care, proven results. Visit wellmedhealthcare.com to learn more.

CARMENN MILES
We're back on Docs in a Pod. I'm your host, Carmenn Miles, along with our resident co-host, Dr. Tamika Perry and our guest today, NP Shantrelle Lavigne, both from WellMed at Redbird Square in Dallas, Texas. Before the break, we discussed how medications and other things can often lead to falls for older adults. What are some of the other dynamics that can lead to falls in older adults?

SHANTRELLE LAVIGNE, NP
First, we'll go into vision. What does that mean? If you have not been seen by your ophthalmologist, your optometrist, eye doctor, you don't have your glasses if you need glasses. If you have cataracts, as sometimes we know, most commonly in our older adults, whether they have cataracts or glaucoma, that vision is a little fuzzy or a little hazy. So, if they can't physically see properly, then of course they may trip over something or take that chance of running into something. That's most common. We talk about glaucoma with diabetes, which is a chronic medical condition that most people often see cataracts and glaucoma with diabetes. So, I think that's one of the things that affects falls in our older population.

DR. TAMIKA PERRY
Absolutely. Like Shantrelle said, cataracts in particular affect night vision, and it may cause a halo around the light. So, even in your house, if you have all the lights on, your vision is still going to be obscured. You may miss a chair, you may miss your end table, once again, that pet. That set you up for a fall. Along with vision is also hearing. You might not hear that dog barking at you properly. It may sound muffled. You may hear a delayed hearing when someone's calling your name, and it causes you to move faster. The point of us talking about hearing and vision in terms of falls is, get these entities checked on a regular basis. Sometimes we don't even know something's going wrong because we've been used to that fuzzy vision. So many patients after they have cataract surgery said, I didn't even know I couldn't see. It's a whole new world now. Get your eyes and your ears checked on a regular basis. It could be something as easy as cerumen impaction. We can watch the wax out of your ears here in the office. ItÕs something easy to prevent this fall that put you in the hospital, that hospitalization leads to pneumonia, and then pneumonia leads to you going to the ICU, and this is because you had wax in your ear. That's really honestly how the progression goes. Shantrelle, we were talking a little bit off the air about strength training and balance, because if your core is not strong, and over time, our core has a tendency to get weak, when we do fall is hard to catch ourselves or to fall safely. In addition, if you have things like neuropathy or burning and tingling, your sense of sensation or step is off, so you're not even aware that you stepped off of the curve, or you went from the carpet to the slick floor because your feeling is not there. Treating your diabetes, and with that core strength. NP Lavigne works in the office with me, so unfortunately, I have been exercising with her before, and I assure all of you all that she has a very strong core. Me, on the other hand, it was sad. Our core is so important.

SHANTRELLE LAVIGNE, NP
I'm working on my core. Yes, your core strength is definitely one to maintain because if you don't have that core strength or that balance is off, then of course that means your gait, meaning your walking is off. Also tying that into what we call vertigo. Sometimes if you turn really quickly or bend over thinking, oh, IÕm just tying my shoe or I'm picking up something, that can immediately cause the room to begin to spin. When the room is spinning, then you lose your balance. Then doubling back to what Dr. Perry said about the earwax, that's the most common thing. Patients say, I can't heal or when they have an ear infection, that can also allow you to be dizzy or throw you off. So, balance is very important in a sense of that can be most of the common things that our patient experiences. Low blood pressure. If that blood pressure is low, you come up from a sitting to a standing position and then you kind of get woozy and then you fall or you trip over something. That's something that is one of the most common things that we deal with, or we see in patients and our elderly population with falls.

DR. TAMIKA PERRY
Falls are going to happen. They're going to happen to everybody. I've fallen in restaurants before. TheyÕre going to happen.

SHANTRELLE LAVIGNE, NP
I fell about a month ago.

DR. TAMIKA PERRY
You did? You want to have your core as strong as possible when you fall back so you can brace and catch yourself in the fall isn't as catastrophic. You always want to keep that in mind. We have a senior center next door to us and one of my older relatives in the family, she's really a cousin, but I call her my one of my aunts, but she goes to the senior center and she does chair yoga. When she started, of course, she was in the chair. After 3 or 4 weeks she said, I don't even need the chair anymore, baby. I have gone to Marshalls and bought my own mat because her core had become strong enough where she can get up and down from that seated floor position without using the chair and just using her core strength. So, now when that young lady falls, when my aunt falls, it's less likely to end up in catastrophe than before she started doing chair yoga.

SHANTRELLE LAVIGNE, NP
Right.

CARMENN MILES
That's pretty remarkable. Three weeks. I mean, when you start a new exercise program, it feels like, oh, it's going to be six months to a year before I can see some progress, but three weeks, thatÕs outstanding.

SHANTRELLE LAVIGNE, NP
If you start something, it takes a good conditioning going into 21 days into that, 30 into the 60. It's just really consistency. That's why we offer physical therapy and occupational therapy because sometimes depending on the fall or the risk of preventing the patient from falling, if they're weak, we incorporate them in doing physical therapy and occupational therapy because that's where they can show them those strengthening exercises, those safety positions of how to move around in their home or from the driveway to car or things like that. They have that day to day activity of daily living that does not impact them or get in the way of them of taking away from their normal ability or agility.

CARMENN MILES
You mentioned the driveway to the car. Do we want to transition into some of those hazards that older adults may encounter at home or just outside?

DR. TAMIKA PERRY
The older ladies in my house, they have runner rugs and throw rugs. I don't know what the deal is. Mama, if youÕre listening to this, I'm so sorry. I'm not trying to talk about you or Grandma Shane's house, but they're everywhere. You need to realize that your foot can get caught in those, and you could fall. So, make sure that your rug is secure if you choose to have throw rugs or runner rugs in your house. Your pretty rug is not a reason why you want to fall, right? So, think about that sliding. My dad, when he was with us, was cheap as heck. He wanted all the lights off. Sunlight was free, so that's what we used. During the night, we just felt around. However, we need proper light in the house so we can see where we're going. Shantrelle, what would you say?

SHANTRELLE LAVIGNE, NP
I'm not going to talk about your late father because I open the blinds during the day. ThatÕs natural light. The light be on this high. I would say another one is cluttered walkways. I'm going to attribute this to, if my mother in law is listening. We call it loving to hoard and not get rid of things. So, we have a lot of things in the way of our pathway walking. We trip on something because it's there. Also, sometimes we have to think about our population in their homes. If they have older homes and we have the stairs that come here or the uneven floors where you walk and it just takes an immediate dip, you have to think about things like that, or sometimes stairs with no railings. If you're walking up and down steps, that's a huge common one. My grandmother, many, many years ago, was coming down her step to do something she did not need to do, which was smoke her cigarette, and at the time they did not have railings, and she slipped and broke her elbow. My grandfather immediately put railings up, but all things aside, that was a slow progression of her and her health. That simple fall just kind of downplayed her health over the years. So, you have to think about things like that.

CARMENN MILES
They lose their confidence when something like that happens right?

SHANTRELLE LAVIGNE, NP
Yes, absolutely.

CARMENN MILES
They lost a lot of confidence and dignity, and the less they move there, it's just a spiral effect. You're losing muscle mass because you're scared to move. You're scared to have a repeat fall. It's just a spiraling effect. There are some outdoor hazards like loose gravel or wet surfaces. There are so many older adults now opting to a new trend called aging in place. They are staying at home longer versus going to an assisted living or any other place like that. So, it's important that a lot of these hazards that we're used to seeing, like the electrical cord across the across the room, those are hazards. They've been there all along, but as we get older, they become more and more of a hazard. We have a little bit of time left here. Any closing statements?

DR. TAMIKA PERRY
Yeah. Very quickly. The National Council of Aging has a fall prevention checklist that you can go over. I encourage everyone to do that. You may think, I don't have throw rugs in my house. IÕve been taking my Benadryl for years. I'm good. Go through the checklist. Also, the CDC has a whole worksheet that you can look on about fall prevention. Shantrelle and I wholeheartedly encourage you to utilize these resources.

SHANTRELLE LAVIGNE, NP
Yes.

CARMENN MILES
Absolutely. Ladies, we are just about out of time. Thank you both for being so giving of your time. I do want to speak to caregivers. Our caregivers and family members play an important role in fall prevention. Sometimes older adults again don't notice changes in their balance or mobility. Caregivers, you can help by encouraging medication reviews, scheduling those version appointments, participating in the home safety checks, supporting exercise programs and observing any changes in walking patterns. Most importantly, just have the conversations. Thank you both for your time and thanks everyone for listening to Docs in a Pod presented by WellMed. We'll see you next time.

OUTRO
Executive producer for Docs in a Pod is Dan Calderon. The producer is Cherise Pendleton. Thank you for listening to Docs in a Pod presented by. WellMed, be sure and listen next week to Docs in a Pod presented by, WellMed.

DISCLAIMER
This transcript is generated using a podcast editing tool; there may be small differences between this transcript and the recorded audio content.

Health safety Podcasts