Find the Balance to Reduce Falls

In this episode, host Mighty Fine talks with Kristi Ladowski, an Injury Prevention & Outreach Coordinator for Stony Brook Trauma Center in NY. In addition to coordinating health promotion programs, she is currently working on her PhD in Public Health with her research focused on older adult falls prevention program implementation and sustainability. In this episode Kristi shares statistics about adult falls and also goes 'indepth' about prevention programs offered through her hospital that reach across the nation and around the world thanks to "virtual" technology. Listen in and learn more about how everyone can apply ways to prevent falls and reduce injuries.

RESOURCES:

OLLI: https://sps.northwestern.edu/oshernrc/find-an-osher-near-you.php

The Osher Lifelong Learning Institutes (OLLIs) span all 50 states and the District of Columbia. Each is a part of a college or university. All Osher Institutes offer a wide variety of intellectually stimulating, university-level, non-credit courses and learning opportunities designed for people “50 and better.” Many offer lectures and educational travel opportunities as well as study groups and events that build a sense of community and camaraderie among their participants. There are no tests and no grades.  It is learning solely for the joy of learning. Membership fees vary by location. 

Falls Free CheckUp: https://ncoa.org/age-well-planner/assessment/falls-free-checkup

Stay healthy and independent by checking your risk for a fall. Falls are not a natural part of aging. Even if you’re healthy or have talked with your health care provider, it’s important to check your risk. There are many steps you can take to prevent a fall. Answer 13 simple questions to get your falls risk score and resources to prevent falls.

Stony Brook Trauma Center’s Falls Prevention Programs: https://trauma.stonybrookmedicine.edu/injury-prevention/falls

Click on the “Upcoming Workshop Calendar” link for information on registering for a virtual falls prevention program. 

Transcript

Mighty Fine  0:18  
Welcome to the Injury and Violence Prevention Indepth podcast. My name is Mighty Fine, and I'm the host of the Safe States Alliance production. In this space, we'll engage in dialogue with IVP professionals on a variety of issues. To help inform our listeners on the latest trends and hot topics. This episode is focused on older adult falls, and we'll highlight why this is such an important public health topic.

A special thank you to our sponsors American trauma society, who's an organization that's dedicated to the elimination of needless death and disability from injury, be sure to learn more about them by checking out a m trau. M A dashboard. Today's guests is Christie le darsky, who's an injury and violence prevention and Outreach Coordinator for Stony Brook Trauma Center in New York. Go New York. In addition to coordinating health promotion programs, she's currently working on her PhD in public health, with her research focus on older adult falls prevention, program implementation, and sustainability. Kristi, let's get started. 

Kristi Ladowski  1:21  
Well Mighty, thank you so much for allowing me the opportunity to chat with you about older adult falls prevention. So when it comes to falls, we all fall throughout the lifespan. But as we age, our body is not able to tolerate it as well. So again, little kids fall all the time, we trip and fall throughout our life. Again, everybody falls. But once we start to get a bit later in our life, you know, a fall can be completely devastating, where breaking bones, breaking a hip, head trauma, it really does have a significant impact. So I work for a trauma center and the leading cause of hospitalization and not just my trauma center, but trauma centers, both worldwide and in the United States. Its falls in our older adult population. So it's a big issue. It's again, devastating for both the individual, the folks that love that individual and care for them.

And it costs a lot of money to the medical system. In the United States, they're spending over $50 billion a year to treat fall related injuries. And Medicare/Medicaid is really shouldering that that cost. So it's it's, you know, really costing so much both, again, with our our well being as an individual who's looking to live independently for as long as possible, and then also just cost wise to the medical system. It's a huge expense that often does not get a lot of attention with the public. 

Mighty Fine  3:03  
Yeah, I think that's a good point to make, recognizing the incidence, but also the cost behind it and where sort of the brunt of that expenses. And thinking about you mentioned that everybody falls right, I tripped on my way to work this morning. Thankfully, I did not fall. But I do have a grandmother who recently fell and it was quite scary for her and everyone else and just, you know, you start thinking about what we could have done a little bit differently to prevent it, or how can we mitigate it from happening again? So with that in mind, what are some things that adults can do to prevent or reduce falls thinking sort of on the individual level? And also, if you have any thoughts of more sort of broad level interventions or prevention strategies, I think it'd be great to elevate those as well. 

Kristi Ladowski  3:50  
Sure. So my goodness, I could talk a lot about this. Okay. So like you said, so again, everybody falls. But, you know, in looking at just overall statistics, one in four older adults fall. And actually when we look at our United States population, an older adult falls every second of the day, and we set it and that number is going to continue to grow. Because our older adult population is growing, we're living longer, the baby boomers are aging into that demographic. So the problem is not going to go away. It's just going to continue to grow. So what can we do to prevent it both for ourselves and for those that we love and care about as well. So the most effective thing that we can do with preventing falls across the board is staying active. So doing things to help continue to maintain and improve our balance and lower body strength. And when we talk about falls, whether it's someone has had a fall or not, we can still develop a fear of falling. And that is often not talked about, you know, falls can be stigmatized, it's, we don't want to have people worry about us or lose our independence because somebody is concerned that I can't maintain at home on my own safely. So this fear of falling actually starts to create this negative cycle of if I'm fearful of having a fall, I'm going to limit my activities, because I don't want to have that fall. And by limiting my activities, I'm actually losing some of that muscle strength and balance because I'm not maintaining that activity. So that is one of the most important things and that's just, uh, you know, for everything to stay healthy. 

Mighty Fine  5:43  
Sure 

Kristi Ladowski  5:43  
You need to stay active, right. So we our bodies are designed to move. So exercise, physical activity, those are the most important things and physical activity comes in a wide range of forms. So it's finding something that we really enjoy doing that we're going to keep up with. And again, it's going to help with our mental health to keeping us happy, engaged, social with doing the things that we really want to be doing. So that's probably what I would say is the most important thing is to keep, keep active. Now, to add to that, I would say there's two other big things, get involved with an evidence based falls prevention program, there are so many, and I'm happy to talk about a few of the ones that we're offering that, but there's lots of research into preventing falls in older adults, which is a good thing. So we have lots and lots of information on how do we reduce the risk factors. And a lot of that is is talking about it, it's the awareness. So there's evidence based programs, like one called "Stepping On", or "A Matter of Balance", which are group based discussion with some physical activity. And in those group based discussions, we're talking about, what are the risk factor for falls? How can we remove some of those? How can we modify some things to really reduce our risk of having a fall and also increase our physical activity. And then there's physical activity programs like Tai Chi, one of my favorites, I never, you know, knew about Tai Chi before 

Mighty Fine  7:22  
I love Tai Chi too actually

Kristi Ladowski  7:25  
Again, one of those things that's just so good for our well being overall, if you Google the health benefits of Tai Chi, my goodness, you it's like a cure all for everything. And it's just this magical. Not magical, because it's it's really based in a lot of good science that I don't know how they came up with all of this hundreds of years ago, but our science is catching up with kind of, you know, telling us well, why is it so effective, but the mind body connection, the movement, the breathing, so it's not just going to help us, it's one of the best things we can do to improve our balance. But there's so many other health benefits to it. So I definitely recommend trying it if you haven't done it before. And then there's traditional physical activity, right. So something like an Otago Exercise Program, where you're doing very effective strengthening and balance exercises, if that's more of your style. So there's lots of ways to get involved with evidence based programs. The other big important thing is to talk to your health care provider. So in the United States, it's currently still a requirement that our clinicians need to be screening folks for fall risk. So probably most of us are starting to recognize, oh, every time I go, or at least once a year, my doctor is asking me, Hey, do you have a fear of falling? Do you feel unsteady? Have you had a fall in the past something along those lines? But what's the discussion that happens after that? So we don't always do a great job in the healthcare setting of proactively following up on those things. And we get it the our health care providers, they have so many things to do. And there's competing priorities of how much can we fit into a 15-30 minute visit

Mighty Fine  9:13  
Doctor Appointment

Kristi Ladowski  9:14  
But so both we're hoping our clinicians are going to be asking and being a little bit more proactive in the what are that that patient's individual risk factors for a fall. But we also want to encourage the the patient, the older adults to speak to their health care providers. We said one in four older adults has a fall each year, less than half of them tell their health care provider about that fall. So again, bringing it bringing that awareness to your clinicians and your clinical team because sometimes we just think falls are inevitable part of aging, and they are not. We, you know, aging is not about a number. It's again how we're living our lives, right. So there's so many things we can do to prevent a fall from happening, but if we're in the mindset of, oh, it just happens, I'm getting older, it's going to happen. We want to kind of switch the narrative and say, No, I can be proactive. There's lots of things that I can do. And that I can speak to people about, and even asking for help. So a lot of us, we like to be the caregivers and the one offering the support. So in those programs that I mentioned, like A Matter of Balance and Stepping On, we have discussions of you know, it's not that we can't do things, but maybe it's better that we do ask somebody to help out. And we have a lot of friends and family who want to offer support. You know, if it's changing a light bulb, or getting the gutters cleaned? 

Mighty Fine  10:44  
Sure

Kristi Ladowski  10:44  
 Is that something that we should still be doing ourselves, or is it worth asking someone else to do it? And when we ask, we're often surprised how willing and interested our friends and family really do want to help out? 

Mighty Fine  10:58  
Yeah, I like that. It's really shifting the culture and normalizing aging and recognizing come some limitations, right. And so I like the idea of normalizing asking for help if you need it. My grandmother, perfect example. She would get on like the stepladder to try to like change something. And I'd be like, girl, what are you doing? Right, so it was even a balance between she and I, and ensuring that I was still creating space for her to have her own independence and autonomy, but ensuring that she was doing it in a safe manner. The other piece of that is, I remember going to a mission trip in Cuba. And we learned about an older adults university. And it's where older adults would come together sort of like what you're saying in a group setting, they would do a physical activity, they would do engage in physical activity and engage in a host of other sort of communal issues to support each other and aging and recognizing what all that entails. So I like what what you're saying, there's some corollaries to what I'm seeing elsewhere. One thing again, back to my grandmother, so sorry, guys, I love my grandmother talk about our lack is that she said, and I don't know if you've seen this in your work. And it was advice that she had gotten from a friend of hers and one of her communal groups that she participates in. He's about 93, I think, or something like that. So quite active. And one of the things he told her that was helpful and help in ensuring that he was not falling or tripping up is that he said he would think about what he had to do before he did it, you know. So it's like if I'm going to open this up, or whatever. And so she said, that was very helpful advice for her as well. So it's sort of not an immediate reaction, but really processing and thinking about what you want to do before actually doing it. So I don't know if that's something you can speak to as well. 

Kristi Ladowski  12:53  
Oh, my goodness, you nailed it. So again, in a lot of these, so you, you covered so many things, that again, I just get so excited to talk about this topic. Because it is so important. And because there are so many things that we can do and to first normalize the discussion. Yes. And that's why we love these community based evidence based programs, because it's a group of folks coming together with a shared concern. So realizing that I'm not the only one with this concern, people aren't talking about it, but we're worrying about it. So now it's bringing it together in that group setting, bringing that awareness. So exactly what you said, What a great tip that too. We live distracted lives right now, and it's not just related to our phones, it's our minds, we are thinking about everything we need to do, what we're worried about what we're concerned about. And when we're walking and moving around in our lives, we are moving and walking distracted most of the times. And when our mind is elsewhere, we're not focused on how we're moving throughout our space. Almost every fall story that that we talk about in these in these programs. When we share, we invite folks to say hey, we share a story. We all have stories about a fall, and most of them include I was rushing or I wasn't paying attention. Of course, there's a whole bunch of other factors that come into it that again, hindsight is 2020. So we start to pick it apart. Sure, again, just that awareness and mindfulness is so important. We've heard folks will really say You know what, I take the time to literally count the steps as I'm walking up or down them because I was missing the last step because I wasn't thinking about it. I wasn't paying attention to it. So now they count and say okay, I know there's 12 steps, let me count all 12 so that way I know I made it to the bottom step. mindful. And again, back to the Tai Chi. Gosh, it really you have to be mindful when you're practicing your Tai Chi that's a part of it and so many times it that then just carries over into our everyday lives and talking about out the risks of false sharing stories about false that occurred for them or a family member, we we take that opportunity as a learning experience to say, Okay, this is how they can happen. So I'm mindful and you know I'm be by doing these programs, I am incorporating a lot of lessons learned from the shared stories among our participants into my own life to create these habits now. So even though I don't physically feel like I always have to use a handrail going up and down the stairs, if I do it now and make it my habit to always have my hand on that handrail, because again, it's I may not need it, which is fine. But if I needed it, and I don't have it, that's where the problem is. Sure. building these habits now. So awareness, absolutely talking about it normalizing it so important.

Mighty Fine  15:52  
Yeah. So interestingly enough, as you were talking, I was thinking about, just as what you mentioned, is that I count steps. I'm like, oh, maybe I'm preparing myself, or you know, how the escalator if it's off, the steps are uneven, right. And so I'm always a little bit more mindful when I'm walking down the escalator if it's in a static form, and holding on to the side row. So it's interesting that you say that. And I just chuckled to myself, too, because I recently joined AARP because I found that like, you don't have to be like, retired. So I feel like I'm doing all these things in preparation for myself,

Kristi Ladowski  16:32  
You're not alone. I'm an AARP member myself

Mighty Fine  16:35  
I love it. I love it. And you sort of touched on this already. But is there anything else that you would like to share that you learned something new that you learned while working with or teaching adults, I know, you've talked about sort of incorporating things into your own life, but anything in addition to what you've already shared, because

Kristi Ladowski  16:56  
Probably so many things. But I think something newer that I'm really excited to talk about, is was is our ability to just shift and adapt it that and again, it's nonsense that you can't teach an old dog new tricks. Prior to COVID. No one imagined, well, maybe there was people that imagined this. But for most of us, it was never on our radar to think, hey, let's offer virtual programming for our older adults to join, everyone just falsely assumed, it's never going to happen, they're not going to be interested in it. Of course, COVID was terrible. It's still ongoing. We know that but being able to take out some some silver linings, one of those is this virtual programming, where we weren't able to reach everybody with you know, a handful of programs here and there in the community. Yes, it's so important to still do that. But by going virtual, we are reaching so many more people. So I can tell you for our our Tai Chi programs, when we we were in person, and I still remember, it's so clear in my mind when everything started to, you know, just kind of make its presence. And I'm based out of New York. So back in March of 2020, when we heard you know what, we're going to have to take a pause from these in person things. We jumped right into the virtual because our participants in the Tai Chi said, well, we want to keep going, though, what how can we get together? So we said, Alright, let's give it a try. Okay. And then, you know, we thought it was of course, like everybody else going to be a two week pause, which it was not. We kept going and we have our Tai Chi, virtual Tai Chi program, is so robust. We can't really you know, we're building the, to keep up with the demand offering regular opportunities for folks to join. And we've not only gone national, we are international, which is a really cool thing. That where we could only reach a handful of folks in a certain zip code. In the past, we now have folks logging in again, from everywhere, word of mouth is spreading, we say of course, tell your friends and family about it. All they have to do is pop on their device to join us and we know it's not accessible for everyone. So it's still very important to offer in person programming. But at the same time folks are sharing they're like well first Don't ever let this virtual thing go away. They made us promise that we can never stop doing this because it's so well received. But we have harsh winters in New York sometimes so it's you know, we log on now and we say how great is it that we didn't have to leave our house to see each other and to join into our practice? Very busy schedules. Gosh, is it you know, like, it is there is no truth to like anything slowing down in retirement. Let me tell you they are our participants are way busier than we are with me managing so many different schedules. So we've gotten creative and said okay, you know what, it's virtual if we're offering, you know, the same level class be on a Tuesday, Thursday morning, we can also offer it on a Wednesday, Friday afternoon. And if you can't make one regularly, you have another option to pop into which again, you wouldn't have that capability for an in person class, because there's only the Tuesday Thursday morning, let's say. So I think that was one of our, you know, biggest things recently is just how well received the virtual delivery is how beloved it is, from those folks who it is accessible for and who do like that platform. And again, we still, it's really exciting to see the in person really pick back up and get into the communities too

Mighty Fine  20:37  
Yeah, I like that, because to your point, it does increase the reach, and maybe some folks who hadn't considered doing it before, are now able to log in, I do a virtual stretching class, which is pretty cool. And at first I was like, like online stretch, you know, but it's it, it certainly for me makes it more likely for me to do it, as opposed to me having to go somewhere. So I love that you have this sort of a hybrid option where folks can come in person, because there's something to be said about those interpersonal dynamics that happen in person, you can touch folks feel them, and just engage in that manner, but also having it available for those who are able to access it virtually. I love that. That's great.

Kristi Ladowski  21:22  
And I would just add to that, you know, in a, from a professional standpoint, a lot of folks who offer these programs, it's really hard to say, Hey, I, you know, I need somebody to partner with or to work with, and you might not have someone regionally available to join you and to help offer. You know, we went statewide where we have instructors working throughout our state, logging into our zoom and this past or this current one that we're working on. Now, we have another instructor joining us from Massachusetts, because again, there's no geographic boundaries. So now we can partner up. And wow, that's like just to be able to partner with folks from again, I'm in New York. So my colleague up in Buffalo, my colleagues in Westchester, again, somebody from Massachusetts, so not only are our participants, you know, all over the from all over our instructors now can really team up. So, you know, instead of saying I can't find someone to co teach a class, I can't offer it. It's Oh, no, if we do it virtually, we can get it up and running.

Mighty Fine  22:25  
You can log in right. From anywhere. You know, I love that. That's awesome. Well, you and I both are members of Safe States Alliance and on the executive committee and just curious, from your perspective, thinking about how your work ties in with your involvement with Safe States?

Kristi Ladowski  22:44  
Oh, great question. So of course, we love Safe States, that's our people right where we connect. So one of the first things is that Safe States has their special interest group. And one of them is for the hospital injury prevention professionals. So and we call that the HIP, the HIP SIG for hospital injury prevention

Mighty Fine  23:06  
the hip people are on the HIP SIG 

Kristi Ladowski  23:10  
So it's such a great opportunity to say you know, what Safe States brings together professionals and individuals from all different types of organizations, backgrounds, skills. And so for me, I, again, am someone who works for a trauma center in a hospital. So I have my my trauma center colleagues who who know what's going on. And you know, we have our pulse on things when it's very trauma specific in how we run things and deliver things and share successes and lessons learned. But we don't work and operate in a bubble and we can't do it alone. So to be able to have safe states as a platform to first come together nationally. So what we're doing in New York, we're learning from our colleagues down in Texas, where we're like, oh, gosh, you guys are great. We just had, you know, we have calls with folks from Pennsylvania and say, What are you guys doing? And how do you address this issue? So it's connecting us nationally with other folks both in the hospital setting, but then also in the non hospital setting. So the department's of health, the offices of aging, all the nonprofit organizations that are involved, what a way to strengthen all of these partnerships to bring us together to work on these shared concerns and really working to prevent injury. But then the other thing I'll say is, they're safe states advocacy, they are at the forefront, really pushing these things at the state and federal level. So to have an organization who is supporting us like that is amazing. So they are continuing to advocate for more federal money to be focused on falls prevention. I told you earlier that, you know, we're spending over $50 billion and I believe a little over 30 billion of that is directly being charged to Medicaid/Medicare. So again, that's our federal money being spent on treating falls. And then we're only allocating 9 million or 9 billion to preventing it. So to have safe states advocate for Congress, and to increase the funding towards preventing the falls, I can say personally, we are grantees of Administration for Community Living, which is a federal organization. And that's where some of that allocated money goes to. They provide those grants to offer to the evidence based programs in the communities and really working on sustaining and growing the delivery of those programs. So again, that's that federal money coming toward to grantees to run these programs and to offer them so thanks to Safe States and their other partners for advocating to get that money, and then to continue to say, thank you, but it's not enough. And we need more because this is a growing problem. So they are our national voice.

Mighty Fine  26:13  
Advocates- advocacy piece is critically important for sure. And as you mentioned, really focusing on preventing the falls from happening in the first place, we really want that attention there. Obviously, if someone falls, certainly want them to be treated for sure. You know that better than I, given where you work, yet we recognize the prominence of prevention in that dynamic. And you shared a lot of information today. I know I learned a lot. And I'm sure folks listening at home, have learned a lot as well, just to sort of wrap up the conversation today, what's something you want our audience to take away from this conversation. So whether that's the folks working in the space, the advocates, the family members, community, members, whomever use sort of deem appropriate, we're just for you to share with us what you want the take home message to be for today.

Kristi Ladowski  27:07  
If you don't use it, you lose it. So really staying active in our everyday lives. And circling back to what you said earlier about normalizing the discussion around falls falls are preventable. So let's talk about it. And let's increase our awareness, both for us as individuals so that we can age in place age healthy, stay independent, and then also for our clinical providers, and, you know, insurance companies, they're the ones footing the bill, when somebody does have a foul and it needs to be treated. So can they also invest in prevention, too. So really, preventing falls is a huge priority, because it is the leading cause of injury, and it's a second leading cause of injury related deaths. But in older adults, it is the leading cause of injury related death. So it's preventable. Let's talk about it. Let's work together and partner. There's lots of ways to collaborate on it. There's power in numbers, of course. Yep. And stay active.

Mighty Fine  28:20  
To love it and being active. There's so many other benefits to that as well, as you already mentioned. Well, I can't thank you enough for shedding light on this critically important topic. It was such a pleasure chatting with you today. I'm fortunate enough that I get to work with you beyond this podcast, so I'm thankful for that. And again, thank you for your time and your information and your talents today. I'm sure folks who are listening, have found what you shared extremely useful. Thanks, Kristi.

Kristi Ladowski  28:50  
Thank you so much Mighty.

Mighty Fine  28:52  
Thanks for listening to IVP INdepth, feel free or be sure actually to subscribe and listen to us on Apple podcasts, Spotify and Google podcasts. You can also follow safe states on Twitter at Safe States. The same for LinkedIn. And don't forget to check out our website SafeStates.org. There you'll learn so much more about what we're doing in the injury and violence prevention space, tools resources in the light. Again, I'd like to thank our sponsor, the American trauma society for supporting Safe States in helping us to create space for programs such as this. Today we talked about older adult falls and it makes me think about all the different things we should consider as we age. And fostering a community is certainly something that I think is important across the lifespan. So before I close I like to uplift the Osher Lifelong Learning Institute or Ollie's, a program that spans all 50 states and the District of Columbia. Each is a part of a college or university and all Osher Institute's offer a wide variety of intellectually stimulating University led noncredit courses and learning opportunities designed for people 50 and better. Many offer lectures and educational travel opportunities as well as study groups and events that build a sense of community and camaraderie among the program participants. There are no tests and no grades love that. And it's learning solely for the joy of learning membership fees vary by location. So I encourage those of us that are 15 better or you know someone in your life that's 50 and better to certainly look at this opportunity as something that continues to help us build the relationship in network. And with that, this is your host mighty fine signing off, and until next time, stay safe and injury free.

Transcribed by https://otter.ai