Las Vegas Sun

August 21, 2014

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Keeping them on their feet

On behalf of seniors, Las Vegas physical therapist Brian Werner is trying to find a cure for the common fall.

This much he knows: The causes - and the costs - are staggering.

Falls are the leading cause of injury deaths for people 65 and older. Yet clinical studies have found that about 25 percent to 30 percent of falls can be prevented through balance training and removing obstacles.

That's where Werner, who operates the Werner Institute of Balance and Dizziness, comes in. He is part of a nationwide group of therapists that is taking part in a study within the Social Security Administration to identify ways to significantly reduce costs associated with treating injuries resulting from falls.

The six-month study, starting in July, hopes to identify the kinds of patients who are at risk for future falls, Werner said.

He expects to test about 1,000 Southern Nevada Medicare recipients, using among other tools a NASA device to measure imbalance from a standing position, a diagnostic infrared video camera to examine the inner ear through the eye, and an electrode-based device that is designed to test the wobble of the eyes.

In 2004, the latest year for which statistics are available, 15,000 people 65 and older died after falling - many succumbing to complications resulting from broken hips, such as pneumonia and infection, according to the Centers for Disease Control and Prevention. Nearly 2 million seniors were treated for falls in 2004, up 100,000 from 2003, the CDC says.

The average cost of a fall-related hospital stay is $68,000.

Tonya Mailliard knows the scare of nearly falling. The 71-year-old Las Vegas woman became dizzy while making coffee a month ago and safely lowered herself to the floor.

"I felt my whole world was going caddywampus," Mailliard said. "I was being pulled in different directions."

After that incident, Mailliard said she tried to avoid situations that would put her in a position to get dizzy. Werner said that is a typical reaction - and the wrong thing to do.

People at risk of falling need to strengthen the three senses that deal with balance - sight, touch and sound - by practicing the behaviors that they fear will cause them to fall, Werner said. The more exercise, the better the balance, he said.

Indeed, during her month of therapy, Mailliard has been working on various balance exercises.

"When I do the exercises I feel in command," she said. "They keep me sharp."

At Werner's facility, patients wearing tethered safety harnesses walk in straight lines around the perimeter of the room. Other patients stand in place, practicing their balance by placing one foot in front of the other, heel to toe, closing their eyes and turning their heads from side to side. (Difficulty in accomplishing the feat suggests an inner-ear balance problem that can be addressed by repeating the drill.)

Simpler exercises include focusing on a light switch from across a room or watching your thumb while moving it from side to side.

Such a regimen has helped Mimi Singer, an 82-year-old Summerlin resident who has been hospitalized twice in the past two years after falling.

Singer said balance exercises have given her confidence and have strengthened her legs to further prevent another fall.

"I realize things are going to go wrong at my age," she said, "but doing the exercises helps me (physically) and makes me more aware of my surroundings to prevent another fall. That is the biggest thing."

Claudia Collins, associate professor of aging issues at UNR's Cooperative Extension program in Las Vegas, says common sense plays a big role in preventing falls.

Collins teaches a 16-week senior wellness course that devotes two sessions to fall prevention. Among her suggestions: installing night lights in bedrooms and along hallways to bathrooms, and removing throw rugs and other household items that can lead to slips and trips.

Collins suggests that when rising, seniors take a minute to sit up and place their feet on the floor. A sudden stand can result in dizziness and a fall.

Collins agrees with Werner that seniors should do balance exercises, perhaps by taking tai chi classes.

They should also avoid climbing on ladders or standing on footstools and chairs to reach high objects. Collins suggests the purchase of "reach extenders," which cost about $20 at most drug stores.

Other measures to prevent falls include installing chair lifts on stairs, handrails alongside toilets and nonslip mats in showers.

Larry Weiss, director of the Sanford Center for Aging at UNR, said a big hurdle facing fall prevention and similar issues is the lack of medical workers in Nevada and nationwide specializing in geriatrics.

"Only about 1 percent of our health force is trained in elder health care," Weiss said. "We do not have the curriculum in the medical schools."

Weiss said he hopes the Legislature will award $2.3 million to the School of Medicine to hire eight faculty - four in each half of the state - to teach geriatrics and related sciences.

Werner said therapy to improve physical balance is relatively new to many people.

"It's not an easy thing to address because a lot of people do not understand what we do," Werner said. "I have gotten calls from those who see the word 'balance' on our sign and ask if we balance tires."

Sun reporter Mary Manning contributed to this story.

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