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Whitecaps Forum

The Danger of Declining Balance Control

Lack of balance control leads to falls. Falls lead to emergency rooms, hospitalization, nursing homes and death. One out of three people over 65 years of age fall every year, many averaging three or more per year. Maintaining good balance control is a deadly serious business.

Here is the entire article on the subject from this CDC website: www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html

Falls Among Older Adults: An Overview

How big is the problem?

• More than one third of adults 65 and older fall each year in the United States (Hornbrook et al. 1994; Hausdorff et al. 2001).
• Among older adults, falls are the leading cause of injury deaths. They are also the most common cause of nonfatal injuries and hospital admissions for trauma (CDC 2005).
• In 2005, 15,800 people 65 and older died from injuries related to unintentional falls; about 1.8 million people 65 and older were treated in emergency departments for nonfatal injuries from falls, and more than 433,000 of these patients were hospitalized (CDC 2005).
• The rates of fall-related deaths among older adults rose significantly over the past decade (Stevens 2006).

What outcomes are linked to falls?

• Twenty percent to 30% of people who fall suffer moderate to severe injuries such as bruises, hip fractures, or head traumas. These injuries can make it hard to get around and limit independent living. They also can increase the risk of early death (Alexander et al. 1992; Sterling et al. 2001).
• Falls are the most common cause of traumatic brain injuries, or TBI (Jager et al. 2000). In 2000, TBI accounted for 46% of fatal falls among older adults (Stevens et al. 2006).
• Most fractures among older adults are caused by falls (Bell et al. 2000).
• The most common fractures are of the spine, hip, forearm, leg, ankle, pelvis, upper arm, and hand (Scott 1990).
• Many people who fall, even those who are not injured, develop a fear of falling. This fear may cause them to limit their activities, leading to reduced mobility and physical fitness, and increasing their actual risk of falling (Vellas et al. 1997).
• In 2000, direct medical costs totaled $0.2 billion ($179 million) for fatal falls and $19 billion for nonfatal fall injuries (Stevens et al. 2006).

Who is at risk?

• Men are more likely to die from a fall. After adjusting for age, the fall fatality rate in 2004 was 49% higher for men than for women (CDC 2005).
• Women are 67% more likely than men to have a nonfatal fall injury (CDC 2005).
• Rates of fall-related fractures among older adults are more than twice as high for women as for men (Stevens et al. 2005).
• In 2003, about 72% of older adults admitted to the hospital for hip fractures were women (CDC 2005).
• The risk of being seriously injured in a fall increases with age. In 2001, the rates of fall injuries for adults 85 and older were four to five times that of adults 65 to 74 (Stevens et al. 2005)
• Nearly 85% of deaths from falls in 2004 were among people 75 and older (CDC 2005).
• People 75 and older who fall are four to five times more likely to be admitted to a long-term care facility for a year or longer (Donald et al. 1999).
• There is little difference in fatal fall rates between whites and blacks, ages 65 to 74 (CDC 2006).
• After age 75, white men have the highest fatality rates, followed by white women, black men, and black women (CDC 2005).
• White women have significantly higher rates of fall–related hip fractures than black women (Stevens 2005).
• Among older adults, non–Hispanics have higher fatal fall rates than Hispanics (Stevens et al. 2002).

How can older adults prevent falls?

Older adults can take several steps to protect their independence and reduce their risk of falling. They can:

• Exercise regularly; exercise programs like Tai Chi that increase strength and improve balance are especially good.
• Ask their doctor or pharmacist to review their medicines–both prescription and over-the counter–to reduce side effects and interactions.
• Have their eyes checked by an eye doctor at least once a year.
• Improve the lighting in their home.
• Reduce hazards in their home that can lead to falls.

There are many other articles on the subject such as this one from WebMD: "Seniors' Falling Injuries Are Preventable"

News about Helicopter Ambulance Services

Whitecaps members may recall that about a year ago I talked about very beneficial offerings from REACH and CALSTAR helicopter ambulance services: for a few dollars a year a family membership would cover the costs of using their services. This is a huge reduction - a helicopter ride could cost as much as $25,000! BUT there was a hitch. The County Dispatcher had three agencies providing such services and the third, which could be called by the County Dispatcher, did not have any waiver of charges program. Well, all of that has changed. Not only that, the Coastal Health Alliance (our clinics) has negotiated a reduction in the annual membership rates for our communities. Lisa Bell, the Chairwoman of the Board of the CHA sent me a letter clarifying all the issues. In turn, I sent the following letter to the Editor of The West Marin Citizen which was published in the last issue. I think the rest is self-explanatory. Lisa will be at our next meeting on Oct. 16th to answer questions.br /> Roger Kovach
 
Jim –

You may remember that I wrote a note which you published pointing out a sort of “trap” in using helicopter ambulance services in Marin, that one could sign up for membership with REACH and CALSTAR and end up unwittingly and unwillingly using the third provider with very grave financial consequences. Last week Lisa Bell published a note in all the local papers describing a slightly improved rate with REACH and CALSTAR that was arranged by the Coastal Health Alliance. When I told her of my doubts about the value of such an arrangement she sent me a nice long response setting me straight on the facts; my objections are no longer valid (although they were correct at one time).

I would like to set the record straight and encourage people to avail themselves of the memberships, either through the CHA or on their own. I think it is important enough, particularly for our elder population, to merit a box or some other special treatment in the Citizen.

Here are the relevant parts of Lisa’s letter, very slightly edited by me:

CHA approached REACH and CALSTAR to see if they would be willing to allow our patients to apply for their services using their group discount rates (regardless of whether we can get 150 people to sign up or not). It may not be a huge discount, but we see it as a benefit to West Marin residents who are interested in signing up. For REACH membership, the discounted membership rate is $40 for families and $20 for individuals. For CALSTAR, the discounted membership rate is $30 for either families or individuals. So the total combined cost for both would be $70 for Families or $50 for individuals. But each organization is separate and requires its own application. And as noted, you never know who will be called so you'd want to belong to both services.

As Lisa Bell mentioned in her original letter, which was printed in full in the Citizen and the Hearsay, there are three helicopter services that the County Dispatcher uses: REACH, CALSTAR and the Sonoma County Sheriff's search and rescue helicopter unit. She checked and double checked this information with Anita Tyrell Brown before writing her letter and had Anita read it for accuracy after she wrote it. According to Anita, The Sonoma County Sheriff's Search and Rescue Helicopter Unit no longer charges for helicopter ambulance services (so if you are a member of REACH and CALSTAR, you will not have to pay for air ambulance service), but the Sonoma County Sheriff's Search and Rescue Helicopter Unit is rarely used except when needed for tricky search and rescue purposes, or unless both REACH and CALSTAR are unavailable. Anita stated that last year there were 10 air ambulance trips from Bolinas, 4 by REACH, 4 by CALSTAR and 2 by the Sonoma County Sheriff's office.

It was also explained to Lisa that REACH and CALSTAR do not have partnership arrangements because they can't -- one is a non-profit organization and the other is a for-profit organization, so any arrangement between them would threaten the non-profit organization's non-profit status.

CHA is getting no financial benefit of any kind in its arrangement to act as a "group" for obtaining discounts for our patients. And although REACH and CALSTAR do not partner together, they've both separately agreed to provide our patients with their respective group discount rates (with the hope that enough of our patients will sign up to make the discount worthwhile).

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