Falls are no laughing matter

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 award winning veteran broadcaster Ron Aaron, will share information to improve your health and well being. And now, here are Ron Aaron and Dr. Tamika Perry.

RON AARON
Well, hello everybody and welcome to Docs in a Pod. I'm Ron Aaron, along with our co-host today, Gina Galaviz Eisenberg, who happens to be my wife. Gina's background includes a number of years as an award winning television correspondent, covered crime and a variety of other issues in San Antonio and Dallas and back in San Antonio. We're here today to talk about a really interesting topic that affects everybody, but especially seniors, and the issue is fall prevention. Our special guest, Dr. Samantha Erb. Dr. Erb is a medical doctor at Optum - Tyrone in St. Petersburg, Florida. She earned her medical degree from Lake Erie College of Osteopathic Medicine, Seton Hill in Greensburg, Pennsylvania. Completed a residency at Northside Hospital in St. Petersburg. Dr. Erb is board certified in internal medicine, and when she's not at the clinic, she enjoys reading, exploring St. Petersburg, and spending time with her husband, daughter, and her German shepherd dog. Samantha Erb, it's great to have you on again.

DR. SAMANTHA ERB
It's great to be back. Thank you for having me.

RON AARON
Talk to us a little bit about the issue involving, especially, seniors and falls, because we know a whole lot of seniors are going to fall, some today.

DR. SAMANTHA ERB
Absolutely, falls are something that we really worry about. Falls are a leading cause of injury in older adults and over 30 percent of people who are over age 65 fall every year. Of those, about half of them are people that are falling for a second or third or more times, so it's something that we really worry about for these patients.

RON AARON
Somebody told me that if you fall once, you'll fall again.

DR. SAMANTHA ERB
Absolutely. Of the people that fall, about half of them are people that have fallen at least once before. So, that's definitely something we worry about.

RON AARON
Well, I plead guilty to being one of those and my wife can verify that I saw you fall.

GINA GALAVIZ EISENBERG
Yes. I saw you fall.

RON AARON
I've fallen one time down by the Riverwalk here in San Antonio where I wiped out a whole roll of chairs. A row of chairs that went into the water.

GINA GALAVIZ EISENBERG
No alcohol was involved.

RON AARON
No alcohol involved. Then I fell once at home and broke my right ankle as a result. So, I'm aware of falls.

DR. SAMANTHA ERB
So, you know how important it is to try to avoid this from happening. We don't want you to break your ankle or something worse like a hip.

RON AARON
So, can we help seniors and others not fall?

DR. SAMANTHA ERB
Absolutely. There's a lot of things we do to look at your risk of falling and things that we can do to lower those risks. Then, once we figure out if you're at risk of falling and what risk factors you have, we can see what we can do to mitigate this.

GINA GALAVIZ EISENBERG
One time when I was reporting, we were at a rehabilitation clinic, but it was more than that, it was a gym as well. There were so many seniors, and they were teaching them just how to walk. They’d say, bring your shoes, wear your heels that you wear if you're going to go and be dressed up for the afternoon or you're going to church to practice to for mobility. I thought that was very interesting.

DR. SAMANTHA ERB
Absolutely. There's a lot of exercises that we recommend for patients to help prevent falls. There's physical therapy, like you mentioned, that can be specifically designed for this, which is great. At our clinic, we have a handout we give patients that’s exercises you can do when you’re sitting in a chair that can help.

RON AARON
I want to talk in a minute about what the risks are of falling, but first, let me remind folks who may have just joined us. You're listening to Docs in a Pod. I'm Ron Aaron, along with our cohost today, Gina Galaviz Eisenberg, and we're talking with Dr. Samantha Erb. She's a Doctor of Osteopathic Medicine at Optum - Tyrone in St. Petersburg, Florida. We're talking about falls and falling. Dr. Erb, what are the risks of falling?

DR. SAMANTHA ERB
Anytime we have a fall, we risk injury. We risk breaking a hip. We risk 10 injuries. Anytime somebody falls, there's a risk of falling again and having more problems. So, falling is definitely something we want to avoid. Falling is another major cause of hospitalizations and we all know that being in the hospital can get expensive and can take you out of commission for a while. So, we want to do everything we can to avoid falls and avoid everything that comes with that.

RON AARON
What are the reasons people fall?

DR. SAMANTHA ERB
That is a great question because there’s a lot of reasons and there's a lot of things that we can look at. Like you mentioned before, falling in the past is a risk for falls. People that have balance problems, obviously, are at risk of falling. Decreased muscle strength. We talk about that muscle strength just goes down every year after you turn 40, which is unfortunate, but there's things we can do to mitigate that. If you have problems with your vision and you might not see as well, that can cause you to be at risk for falling. Some of your medications can do it. If you have difficulty walking for a variety of reasons. If you have dizziness. All of those are reasons you might be at increased risk for falls.

GINA GALAVIZ EISENBERG
You just mentioned mitigating falls. What do you suggest to mitigate the risk of falling?

DR. SAMANTHA ERB
There are a lot of things, so it depends. Decreased muscle strength is where we talk about those exercises you mentioned. Things we can do to maintain your strength to decrease that risk. Dizziness. We can do a whole different interview about dizziness, but things that we can do to prevent you from being dizzy, things that we can do to treat that. Difficulty walking can depend on why you have difficulty walking, looking at what's going on there. There's just a lot of different things we can do.

RON AARON
I know a lot of people think that as they grow older, they're going to get dizzy, they're going to lose their balance, they're going to fall. That's the way it is.

DR. SAMANTHA ERB
To some extent, some of those things are going to happen, but there's things we can do to slow it down to prevent it and even if it does happen, decrease the risk of something happening because of it. So, even if you do have some dizziness, we can work with you and figure it out how to prevent dizziness from turning into something worse.

RON AARON
I know there have been some classes that are taught around the country, a matter of balance, teaching people how to maintain their balance. Is that something you'd recommend?

DR. SAMANTHA ERB
Absolutely. I'm not familiar with a class like that in my area, but I know they're around there. There's also, weirdly, some evidence that Tai Chi is great for balance and helps a lot of seniors. It's great for core strength, it’s great for balance. So, that's another option for a lot of people too.

RON AARON
Tai Chi being a form of martial arts?

DR. SAMANTHA ERB
Absolutely.

RON AARON
Low impact.

DR. SAMANTHA ERB
Low impact. There's no punching anybody in Tai Chi fortunately, but it does help with balance. It helps with stability, especially that core strength and with abdomen balance with that with your back, it can help a lot of people, too.

RON AARON
A concerning statistic that I've come across, 50 percent of older people 65 and over who fall and break a hip die within a year.

DR. SAMANTHA ERB
I have read that as well and that's something that we worry about, something that we keep an eye on.

RON AARON
What kills them?

DR. SAMANTHA ERB
It depends. Sometimes it's other chronic issues they have, but when people break a hip, they're out of commission for a while. It takes a long time to recover, which is hard for your cardiovascular health. Being out of commission, not being able to move puts you at risk for blood clots. So, it can be a lot of things, but a lot of the time it just triggers the downward spiral for other health conditions they might have.

RON AARON
All right. Now let's pretend for a moment, Dr. Erb, we're on HGTV and you're doing a virtual tour through my house. What do you look for that could be fall possibilities that could be triggers for falling as you walk through a home? Let's start at the front door. Take us on a tour.

DR. SAMANTHA ERB
Starting at the front door, the first thing I would say would be just to, when the HGTV man comes in, don't rush towards the door. It's rushing to the door and rushing to the phone sometimes that gives people a problem. Once you're in the door, you're looking at lighting. Can you see where you're going? Are there dark corners? Is it hard to see? We recommend night lights for people at night or making sure that you're not going to fall in the dark. We look for uneven surfaces. Throw rugs can be a hazard for a lot of people. If there's somewhere you can slip, slippery floors, making sure that if there's any spills, you wipe those up. Those are definitely hazards. We look at electrical cords, anything that you can trip over.

GINA GALAVIZ EISENBERG
How about pets, your dog, your cats?

RON AARON
They're terrible.

DR. SAMANTHA ERB
Pets are absolutely a trip hazard. They're good to have around. We love them for many reasons. They're great emotional support, but something to keep an eye on for sure.

GINA GALAVIZ EISENBERG
Maybe a bell. I know collars can drive some folks nuts, but at least you hear where they're at.

DR. SAMANTHA ERB
That is a great idea, especially with cats. We know they're sneaky.

RON AARON
At night, if you get up to go to the bathroom, you've got a dark dog on a dark floor, that's a trip hazard.

DR. SAMANTHA ERB
Absolutely. That's where having a nightlight comes in, maybe keeping a flashlight by your bed. Don't be a hero. Turn the light on when you go into a different room. Just making sure that we're doing everything we can to decrease you tripping over that black cat.

RON AARON
How much does age play a role in falling? If you're 65, 75, 85, 95, do fall risks increase as you age?

DR. SAMANTHA ERB
Absolutely. The number I have in front of me is that over 30 percent of people over 65 fall every year, and it gets to be over 40 percent once you're over 80. So, as you get older, all of those risks get higher, and we worry more about what happens to you after you fall.

GINA GALAVIZ EISENBERG
Is there one sign or one red flag or some signal? Is it from one day to the next? Like, yesterday I could get up a lot easier. I had better core, and today I can't. I mean, does it just happen overnight that you just can't move like you used to?

DR. SAMANTHA ERB
For most people, it's not overnight unless you have a specific injury of some sort, but it's more of a gradual thing where over time, you might, have not as much muscle strength as you used to. People have neuropathy for some diabetes or another medical condition that gets worse over time. So, sometimes they sneak up on you and that's where the falls can be a surprise and become dangerous.

RON AARON
Now, when you say neuropathy for those who don't know that's where you may lose feeling in your extremities.

DR. SAMANTHA ERB
Exactly. Neuropathy can happen for a lot of reasons. We worry about it, especially with people who have diabetes but there's other medical conditions that can cause it too. When you can't feel your feet as well, it's harder to know where your feet are and that can make it even worse. You have a harder time tripping, especially with those uneven surfaces or not great shoes, like you mentioned before.

RON AARON
Now, until it's diagnosed, and your doctor says, “hey, you got neuropathy.” Do you know you have it?

DR. SAMANTHA ERB
Not necessarily. Sometimes patients should ask about it if they have numbness and tingling in their feet. If they feel like their feet don't feel like they used to, that's a good thing to ask your doctor about if you're not sure.

RON AARON
All right, stay with us a minute. We're going to come right back to you. I'm Ron Aaron, along with our co-host, Gina Galaviz Eisenberg, and we're talking with Dr. Samantha Erb. She's a Doctor of Osteopathy. You can find her at the Optum - Tyrone Clinic in St. Petersburg. You're listening to the award winning, Docs in a Pod.

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RON AARON
Well, thank you so much for sticking with us right here on Docs in a Pod, the award winning podcast available wherever you get your podcasts. We're also on the radio in a number of markets in Texas and Florida as well. I'm Ron Aaron, along with our co-host today, Gina Galaviz Eisenberg. We're talking with Dr. Samantha Erb about falls and preventing falls, a huge, huge problem. Dr. Erb, do us a favor. Let's start over and do a 4-1-1. What is it about falls and especially seniors?

DR. SAMANTHA ERB
We worry about falls and especially seniors because they're a leading injury of serious injury for older adults. We worry because over 30 percent of patients who are over 65 fall every year, and that number just goes up as you get older. We worry because 10 percent of those falls lead to a serious injury. Falls cause a lot of hospitalization, and that's something that we want to avoid for everybody.

RON AARON
Occasionally you hear about people slipping and falling in a grocery store, in a department store, but correct me if I'm wrong, most falls happen in your own home.

DR. SAMANTHA ERB
I don't have a number about that, but I do think that's true. I think a lot of the time because people let their guard down and I have patients that say, “oh, I only take my walker out when I go out, I don't need it at home.” But home is really where you have things you might trip over and something bad might happen.

RON AARON
That's interesting. The same is true of canes. My mother-in-law has a cane that she looks at, but rarely uses.

DR. SAMANTHA ERB
I always encourage people to, if you have a cane, if you have a walker, there's a reason that somebody prescribed this for you, please use it.

GINA GALAVIZ EISENBERG
One of our neighbors fell in the backyard. She didn't break anything. Thank goodness. She's in her nineties, but she's still not home yet because she's in rehab because she was on the ground overnight and just that short period of time or what seems short to me, she lost a lot of mobility.

DR. SAMANTHA ERB
That is true. Anytime that you're stuck in bed for whatever reason, especially with a broken bone, like a hip, it takes a long time to get that strength back. The older you get, the longer it takes. That's one of the reasons we try so hard to avoid these falls and see what we can do to make that not happen in the first place.

RON AARON
Well, we're certainly hoping that she recovers fully, but she has for years, despite her daughter, who is an ER physician, telling her, “Mom, you need an alert button, mom, you need this.” She said, “no, no, I'm fine. I don't need it.” She doesn't want a cell phone. She just wants to hang out as she is now living alone in her own home.

DR. SAMANTHA ERB
I got you. Everyone wants to keep their independence, but what I tell patients is that having those alert buttons or some of the smartwatches now have a fall alert feature. Having those things is going to help you stay independent for as long as possible because you can be at home, but we have to make sure there's a way that somebody can come check on you if something bad were to happen.

RON AARON
My Apple watch has that feature. In fact, there were times I was playing with our boys and all of a sudden, my Apple watch went off and said, do you need help? It looks like you've fallen.

DR. SAMANTHA ERB
Oh no. I do remember when it first came out, there was a glitch where it alarmed a lot when people were on roller coasters.

RON AARON
I can believe it.

DR. SAMANTHA ERB
I think that's a great feature just so that if something bad were to happen, you have a way to get a hold of 9-1-1. You have a way to get a hold of a loved one who can come check on you. Nobody wants that to happen, but if something does, it's better to get help as soon as possible versus being stuck on the floor like your poor neighbor who I hope is okay.

RON AARON
Now, you know this so well as a primary care physician. A lot of folks are embarrassed and ashamed of admitting that they've fallen. So, when you ask the question, as my doctor and nurses often ask every visit, have you fallen? The answer that's easiest to give is no, no, no, I'm fine.

DR. SAMANTHA ERB
We really encourage patients to be honest with us, to tell us when this happens so that we can do a further assessment to see what made you fall. Is there a reason you fell? Is there something we can do to help prevent that from not happening again?

RON AARON
Is there a service that will make a home visit to look for fall hazards like throw rugs, like lifts going in and out of rooms, that kind of issue?

DR. SAMANTHA ERB
There are services like that, so that's definitely something you can ask your doctor about to see if you can get a home assessment to see if there are those things to look for and your doctor can talk to you more about things that might be at risk for. There are things that you can't change about your house, but there's definitely things that we can improve on things that you can change or make safer for you.

GINA GALAVIZ EISENBERG
What do you tell your patients as far as exercising in their home? They don't want to drive to a gym because that almost seems kind of reductive. You might hurt yourself if you're really having to drive somewhere, but I see a lot of things like chair aerobics or sitting in your chair and doing crunches and lifting your knees and your legs, or even when you're at the microwave, I tend to do that to try and build some strength. I mean, is it that simple?

DR. SAMANTHA ERB
Absolutely. There's a lot of classes you can do. If you look online search for exercises for fall prevention, lots of great things pop up. YouTube is a great resource for videos like that. But there's a lot of exercises that we recommend. We have a handout in our clinic that just is chair exercises, which is great. I mentioned balance exercises. All these things, I will give the caveat I want you to do while you're standing somewhere that's safe, while you're standing with something you can hold on to prevent you from falling while you're exercising to prevent falls. That would be unfortunate. But, practicing standing on one leg is good. We talk about sidestepping, where you take a little step to the side, move the other leg closer, take a few side steps, go back and forth in each direction that can help with stability. Practicing walking heel-to toe, if that's something you feel safe doing. That increases balance a lot as well. There are also things like you mentioned that can help strengthen your legs. Practice sitting, standing up from sitting down in a chair. If you can practice not using your arms and just standing up with your legs, that helps a lot. Heel raises, I think you mentioned, are great. Keep your legs stronger. Things like that. There are all sorts of things you can do just at home to help.

RON AARON
If you start those exercises at home, is it good to have a buddy with you to keep an eye on you?

DR. SAMANTHA ERB
I think a buddy is a great idea. Starting those as a group, starting that with a family member is always a good idea. I have one couple who one of them had physical therapy for falls for a while, and the other one just kind of followed them around and did all the exercises. Now they do it together. They haven't fallen for a while, which is lovely. Working on it together is great. Making sure somebody knows that you're doing these exercises is good. That's a great idea.

RON AARON
Now, years ago, my wife and I thought we'd do water aerobics, that looks pretty easy, so we joined a water aerobics class together. That was hard work.

DR. SAMANTHA ERB
That is true. That's one of the deceptive ones where it looks easy when you walk by the pool, but those people are doing a good workout.

GINA GALAVIZ EISENBERG
It was funny because Ron was like, I can do it. Look at those little old women there. I can do it. I go, okay. He had new respect for the water-aerobic ladies.

RON AARON
I had to drag my butt out of the pool. I was exhausted.

DR. SAMANTHA ERB
I have to say the same thing for Tai Chi. I watched a video of it, and thought, “oh, it looks simple,” and no, that's hard work.

GINA GALAVIZ EISENBERG
We did try yoga one time. Remember we had the mats? Then we couldn't get it up and we said, this is not for us.

RON AARON
Then we had a walking video we used to watch, right?

GINA GALAVIZ EISENBERG
That was a good one, actually. That was really before YouTube had just about everything or even the Peloton app, you have simple things. I don't try to do crazy stuff, it's just simple walking. Or Ron, after you broke your ankle and you fell, your rehab was getting in and out of the car.

RON AARON
Exactly. Which can be rather exhausting when you do it enough, right?

DR. SAMANTHA ERB
I can see that.

RON AARON
Dr. Erb, you've got a dog, you probably walk your dog. For folks who are listening who are looking for ways to exercise without a risk of falling, is walking a pet a good thing to do?

DR. SAMANTHA ERB
I'm going to say that depends on the pet. I think that walking your dog is great exercise. If your dog is good on the leash. If your dog is going to pull and increase your risk of falling, maybe do the fall exercises without your dog for a little bit.

RON AARON
I was thinking a Chihuahua versus your hundred-pound German Shepherd.

DR. SAMANTHA ERB
Yeah, my 90-pound German Shepherd might increase your risk of falling, but he's a good boy otherwise.

RON AARON
Now, before we run out of time, let's talk about folks who live alone. There are a large number of seniors, like our neighbor who is currently in rehab, who live alone. Are there devices that you recommend they have like that alert device?

DR. SAMANTHA ERB
There are. I don't have a specific one I recommend. I just recommend you have whichever one works for you. There are bracelets. There are things that go around your neck. There are even smart watches. I just recommend you have something so that if you were to fall, if you were to have an injury, you have a way to contact a loved one or 9-1-1 so that you can get help when you need it.

RON AARON
It makes me so sad. She fell while she was watering in her backyard. If you look out my daughter's window, you see right into her backyard. We could have seen her, but of course we never looked.

DR. SAMANTHA ERB
No, and like we mentioned before, a lot of these are accidents that happen at home, not when you're out in public. We want you to be as independent as you can for as long as possible, and these devices aren't embarrassing, they're here to make sure that you can be as independent as you want for as long as you want.

RON AARON
As you think about your patients and some 30 to 40 percent are going to fall, some today, are there ways in which you can alert them to the danger before they fall?

DR. SAMANTHA ERB
There are. There are things we tell people to watch out for, like we talked about those risks at home to make sure you're not falling. If patients do fall, there's tests we can do in the office to see how they do getting up from the chair, how they can walk around at home. There's a test we do that's called the “time to get up and go” where we measure you getting out of a chair, walking down the hall and coming back, and we time you. It's not a race. I don't want you to rush and do it as fast as you can. I want you to do it at your normal speed. But if that takes you a while, that shows me that you're at risk for falling. Maybe we should do some exercises. Maybe we should do some therapy. But we need to look at something to make sure that doesn't happen again.

RON AARON
I can tell you one thing. If you take a diuretic, you can get out of a chair and walk pretty quickly.

DR. SAMANTHA ERB
That's absolutely true. Incontinence is one of the risk factors for falling because it leads you to have that rush where you have to run a lot. So, that's something we're looking out for. I mentioned medicines before. There's a lot of medicines that are necessary, but some of them do increase your chances of falling. So, I tell people that they need to talk to their doctor about that as well.

RON AARON
Well, I really appreciate you taking the time today to be with us, Dr. Samantha Erb. You can find her at the Optum clinic in St. Petersburg, Florida. Dr. Erb is a Doctor of Osteopathy. So pleased you could join us for Gina Galaviz Eisenberg, our co-host today. I'm Ron Aaron.

OUTRO
We thank you so much for joining us today on the award winning Docs in a Pod. Executive producer for Docs in a Pod is Dan Calderon. The producer is Cherese 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.

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