Physical therapists have a tool belt loaded with testing and instrumentation used to determine fall risk. Some are simple and take a few seconds, some are complex and extremely expensive. 

We have the Timed Up and Go (TUG), Berg Balance Scale, Fall Risk Assessment Tool (FRAT), Tineti Test, Balance Master® instrumentation and too many more to try to list. We can determine with fairly accurate precision how likely our client will be safe at home and how likely a fall will impact their lifespan. 

Lifespan? A fall with injury after the age of 85 results in a 25.2% higher mortality rate within a year of the fall. Falls are the leading cause of injury-related deaths for those over 65, and the mortality rate is increasing.

Adults who take opioids for pain and who are over the age of 85 have the highest risk of serious falls, according to a new study. Of course, this shouldn’t be a surprise. Anyone of any age who takes opioids can be unstable on their feet, their blood pressure can drop without warning, and falls are frequent and expected. 

Those of us who work with this population see our geriatric patients on opioids and sometimes think, “Well, he’s gotten to be this old without a problem. Can his continued use of the meds really hurt him at this point?” Turns out it can. 

As healthcare professionals, we try to look at our patients objectively. They’re not family members; we don’t know them outside of the clinical environment — we see their demographics, their diagnoses, their med routine and their physical capabilities. It’s easy to see them as two-dimensional diagnostic cases and not as the three-dimensional humans who live and breathe in our spaces and theirs. I’m guilty, too. 

Evaluating Mrs. Jones, who’s 86 and living with her daughter, using a wheeled walker for assisted mobility in the home, and taking opioids for pain since her hip surgery eight years ago, I think it’s not a big deal. She’s lived this long like this; what harm can it do? 

For those elderly living at home and not in our facilities, the numbers are even worse. “Short falls” at home, i.e., slipping off a curb or step, can seem harmless but often lead to death. Those over the age of 70 who fall from standing on the ground (“ground-level falls”) are more likely to be severely injured and less likely to survive. They are three times more likely to die from that fall. Trauma centers of the future may need to focus less on gun-and-knife injuries and more on falling elderly as the geriatric population surges. 

Recently, an elderly family member was in the hospital for a wild escalation of her blood pressure. The cardiologist (who looked like he might be 19 on his next birthday) advised her that she might as well go home with her stroke-threatening BP, live her life, and not worry about it. I was initially outraged, but then I saw myself guilty of the same attitude. His superficially callous attitude changed how I see myself as a clinician and administrator. 

It’s not enough to see our clients get better physically if we’re going to send them home at risk. It’s not enough to ensure a “safe” discharge home if we’re not addressing medication issues that can impact their safety at home. Our focus for the last decade has been decreasing psychotropic use; maybe we need to amend that focus and add decreasing the use of any medications that can adversely affect their safety, health and longevity.

Psychotropic medications have long been known to cause falls, cognitive decline and death. Knowing what we know about opioid use in all populations, those negative effects are magnified and amplified in the geriatric population, especially over a longer duration. 

Instead of overlooking potentially harmful medications with the attitude of “What’s the worst that can happen at this age?” we can work with those clients on alternatives for pain management, substitutions for dangerous medications, and improving clarity, safety and quality of life. 

Get your physicians, CNPs, PAs, PTs and OTs involved in managing pain, symptoms and dependence. Statistically, the elderly are nearing the end of their time, but we can make that time safer and better for them and their families.

Jean Wendland Porter, PT, CCI, WCC, CKTP, CDP, TWD, is the regional director of therapy operations at Diversified Health Partners in Ohio.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

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