Help - I'm falling ......

People fall all the time – and most of the time we brush ourselves off and resolve to be more careful next time. Unfortunately, 20-30% of older adults who fall suffer moderate to severe injuries that reduce mobility and independence and increase the risk of premature death.  But are these falls ‘accidents’ or events that could be prevented?

Falls can be caused by faulty consumer products or products used in a way that was not intended. Chairs are for sitting – not to allow one to reach a high shelf or change a lightbulb. Towel bars and faucets are not designed to be grab bars.

At least one-third of all falls in the elderly involve environmental hazards in the home. The most common hazard for falls is tripping over objects on the floor. Reduce clutter and make sure that electrical and telephone cords are out of the way.

Alcohol is a risk, both alone and combined with medications. Another risk factor is poor vision (including poor lighting). Cataracts and glaucoma alter older people's depth perception, visual acuity, peripheral vision and susceptibility to glare. These limitations hinder their ability to safely negotiate their environment, whether in their own home or in a shopping mall. Young people use visual cues to perceive an imminent fall and take corrective action. Older adults with visual impairments do not have this advantage to the same extent.

A person who has fallen is at great risk to fall again – two-thirds of those who fall will fall again within six months. Don’t wait for the first fall to take action! Failure to exercise regularly results in poor muscle tone, decreased strength, and loss of bone mass and flexibility. Clear out clutter and have grab bars professionally installed. Report side effects of medication and get your eyes checked regularly.

Preventing falls is not just for the elderly. Anyone can be temporarily off her game and not see the electrical cord. Anyone can sprain his ankle and be off balance and trip on the rug. Anyone can lose his mind and try to reach a high object by climbing on furniture.

Tips on preventing falls in the home.

Check for safety 

Sweet Dreams

If you need an alarm to wake up in the morning, you are not getting enough sleep. You have an internal clock and if that doesn’t correspond to your daily schedule you may have “social jet lag.” Socially jet-lagged people are three times more likely to be overweight and performance at work and in school may suffer.

Your biologic clock works best if you awaken at the same time every day. That said, your body needs enough time to complete the metabolic work of sleep:  tissue growth, energy is restored and hormones are released. The brain cools down and consolidates memories: much like a computer rebooting after having too many open programs.

Go to bed at least eight hours before you plan to awaken. Establish a regular relaxing, not alerting, bedtime routine. Create a sleep-conducive environment that is dark, quiet and cool. Turn off all screens well before bedtime.

When you do get up, try to get some sunshine on your face. You will get into gear faster.

The Harvard point of view.

Three Stars

When I get a letter from an insurance company the greeting is usually “Dear Provider,” since the same letter (usually bearing bad news) is sent to doctors, nurse-practitioners, physical therapists and social workers. The letter usually details how we “providers” will be paid less money or will face additional roadblocks in getting care for our patients.

I should have known that something was up when I received a letter addressed “Dear Physician.” The letter, from a major insurer, informed me that I received a 3 star designation for care – in fact, my score was 95%. I supposed that I should be flattered, but in actuality my score could have just as easily been 65%. I was being measured on the percentage of my patients that had received services such as mammograms.

I don’t have a mammogram machine in my office. Patients need to make another appointment at another office. I treat my patients as the grown women that they are and ask them to have a mammogram. I hand them a referral slip and hope that they will make an appointment. I remind the patient at almost every contact, but I cannot drag the patient to the mammography suite and hoist her breasts onto the machine. It's up to the patient to have a mammogram, not me.

Mammograms help find breast cancer. The jury is out if they actually save lives. They are inconvenient, uncomfortable and can be expensive (thank you to insurance companies that will weasel out of paying for services). I do think that they are a good idea and actively promote them.

So, this year I am a 3 star physician. From what I can see, my 2 star and 1 star colleagues are taking good care of their patients too. 

A Fork in the Road

Too many people beat themselves up constantly over what they have eaten that day. And the day before. And last week. And last Thanksgiving. Leading a life of regrets is no fun and not mentally healthy. What is done is done – time to move on.

Treat each decision independently – it doesn’t matter what you did last time. Make the best choice available at that time. If the best choice at your business dinner is steak - enjoy it. Don’t worry that you had a burger for lunch. That being said, chances are that at noon you knew that dinner would be at a steak house; thinking ahead would have prompted you to choose the salad earlier.

Even at the steakhouse, wise decisions can be made. Order the ‘ladies’ portion. Skip the creamed spinach and enjoy the salad. Don’t get cheesecake for dessert but order the berries. Be careful of the calories in the beverages.

Make the better choice when shopping: buy the fat-free yogurt that is right next to the 2% variety. Planning ahead will help you make a better decision as to what to eat for breakfast. Choice the more distant parking space: your car is less likely to get dinged and the exercise is good for you (even if you have already been to the gym or will be doing later).

It doesn’t matter that you ate too much on vacation – eat less now. So what if you gained weight – it’s a new day and the weight will come off.

“When you come to a fork in the road …. Take it.” Yogi Berra

A Trip to the Pharmacy

Since I was running some errands today, my husband asked me to pick up an over the counter medicine that was on sale at the local pharmacy. The several hundred prescriptions per week that I write are sent electronically so I have very little actual contact with the retail stores other than an occasional chat with a pharmacist clarifying directions. It had been a very long time since I was last in a store. I could not have been more dismayed at the apparent state of retail pharmacies.

First all, calling the operation a pharmacy is disingenuous at best. There is a prescription dispensing area at the back of the store, past the aisles of shampoos, Halloween and Christmas decorations, socks and electronics. The queue to attract a pharmacy technician was quite long; there was plenty of time to read the posters for flu shots, glucose meters and frequent buyer clubs. The perimeter of the store held refrigerator and freezer cases with an assortment of beverages (milk, juices, soda) and frozen dinners. There was a dazzling display of potato chips and other snack foods and the assortment of Halloween candy and Xmas wrapping paper was impressive.

The shampoo aisle ran the length of the store; the “professional” section had products for all types of hair all labeled “to be sold in professional salons only.” Nice selection of batteries and lots of laundry supplies as well. The school supply section was cleaned out.

I had plenty of time to observe the other customers since there was only one checkout person for the fifteen people in line. No one seemed too happy, but no one seemed to be sick. The candy display under the checkout counter had plenty of offers: buy 2 get one for a penny, 4 for $5, buy 10 and get a $2 credit to use next time. Maybe the ad for glucose meters should be moved from the back to the front?

Beer Here

The NFL is doing its best to play football and part of the fun of watching the game is having a beer or two. Moderate consumption of any alcoholic beverage is associated with lower rates of cardiovascular disease From a nutritional standpoint, beer contains more protein and B vitamins than wine. The antioxidant content of beer is equivalent to that of wine, but the specific antioxidants are different because the barley and hops used in the production of beer contain flavonoids different from those in the grapes used in the production of wine.

Where we run into problems is that there are a lot of games on Sunday and a couple of beers per game soon adds up. Binge drinking is defined as drinking five or more drinks on an occasion. Beer accounted for two thirds of all alcohol consumed by binge drinkers and accounted for most alcohol consumed by those at greatest risk of causing or incurring alcohol-related harm.

Overall, 74.4% of binge drinkers consumed beer exclusively or predominantly, and those who consumed at least some beer accounted for 80.5% of all binge alcohol consumption. By beverage type, beer accounted for 67.1%, liquor for 21.9%, and wine accounted for 10.9% of binge drinks consumed. Beer also accounted for most of the alcohol consumed by those at highest risk of causing or incurring alcohol-related harm, including people aged 18-20 years (67.0% of drinks were beer); those with three or more binge episodes per month (70.7%); those drinking eight or more drinks per binge episode (69.9%); those binging in public places (64.4%); and those who drove during or within 2 hours of binge drinking (67.1%).

Don’t forget that many beers have a lot of calories. There are plenty of lighter options – and watch out for the snacks!