- Good evening.
Welcome to Mini Med School.
I'm Rebecca Minter, I'm one
of the Mini deans
that's thrilled to be here this e
vening.
And before we get started, we wan
na give a big shout out
to our alumni who are here with
us from,
many coming from far away who ar
e here for Alumni Weekend.
So thank you for being here with
us.
And we hope this will be reminisc
ent
of your time here as medical stu
dents.
We have a record turnout tonight.
I think this is the largest numb
er of people
we've ever had at Mini Med.
There are 668 people here this ev
ening.
[audience applauding and cheering
]
Filling three auditoriums and it
's obviously a testament
to the importance of the topic
and the wonderful speakers
that we have here tonight.
But we also are really fortun
ate at UW and in Madison
to have really fantastic reso
urces
around fall prevention.
And so, thank you for being here
.
And I will turn things over t
o Dr. Rice.
[audience applauding]
- Good evening, we're so glad yo
u're here and we do have
a great program for you this eve
ning.
Now, it's my great pleasure to in
troduce
our emcee this evening, Dr.
Betsy Trowbridge.
She is the Interim Chair of Inter
nal Medicine
and the Philip August and Sarah
Herrmann
professor here in the department
.
She did her residency in med
ical school here,
she's all Wisconsin, and we
are very fortunate to keep her
on the faculty all these years.
She is pretty close to singul
arly responsible
for the transformation of our Pri
mary Care Unit
in the last 10 years, and has ju
st done a beautiful job
and continues to do so.
She's a graduate of a very prest
igious
women's leadership program at Dre
xel University, ELAM.
And she is the Helen Dickie Award
--
received the Helen Dickie Award
for Outstanding Woman Physician
for the American College of Surge
ons.
She's on the UW Authority Board,
and more importantly,
she's on the Green Bay Packer Boa
rds.
Come on up here, Betsy.
[audience laughing and applauding
]
- Thanks for that handoff.
So I was gonna do a pratfall up
here.
But I tried it in the hallway an
d it was a disaster.
So I'm not gonna pretend to fall.
We are so excited to have all of
you here tonight.
With this Mini Med about falls.
I think you're gonna walk awa
y from tonight
with a lot of knowledge abou
t falls,
some practical ways to prevent f
alls,
and you're gonna learn about so
me very exciting programs
that we have here at University o
f Wisconsin,
that can really make you and your
family more safe.
We have four incredibly fant
astic
expert speakers tonight,
and I'm just gonna tell you a li
ttle quick blurb about them
before I go in more detail later.
Our first speaker is a trauma sur
geon here who deals
on an everyday basis with people
who fall
and have complications from f
alls.
Our second speaker is a physical
therapist
who works in rehabilitative neuro
logy,
and works with patients who
have disorders
that put them at risk for falls
everyday,
and is gonna talk to us about so
me practical knowledge
that she has about preventing f
alls.
Our third speaker is a emergency
room physician
and geriatric physician who work
s in a clinic called
the Faint and Fall Clinic, wh
ich is quite a unique clinic
here at University of Wisconsin,
that diagnoses people, like m
any of us,
who might be in this audience, wh
o are falling for reasons
that can't be understood.
And our final speaker is a resea
rcher
who is a geriatrician physician,
who has spent her life studying g
eriatric issues
and really very specifically, fa
lls
and has done some incredibly
innovative work in finding out
and studying the science behind
falls, and really telling us
what does really work and does n
ot really work.
So all of us fall, people who ar
e famous fall,
people are not famous fall.
When I think about falling, and
I think about my life
and looking at the news,
I remember Ronald Reagan fell off
of his horse.
And when he fell off of his horse
,
he had bleeding in his brain.
And then I think I grew up in Gre
en Bay,
I'm on the Packer Board.
Max McGee, a beloved Packer, had
a horrible fall,
a few years ago, he was on his ro
of.
And I tell all my patients,
if you're over 40, four step
s up, that's it.
But he was much higher than that
,
he fell off of his roof and a
ctually died.
And then, you know, most recen
tly,
you might have all read
that President Carter fell a
nd broke his hip.
And these are all very serious e
vents.
But it is not just older peop
le that fall.
So when I was looking through pe
ople who fell,
my partner was like "You have to
have a woman who fell."
So Beyonce fell during a conc
ert on her dress,
walking upstairs, multitasking,
right straight down on her face,
and thankfully wasn't injured.
So, all of us have a risk of fall
ing.
So why am I the emcee, and wh
y am I here?
So I'm a primary care doc.
I'm a general internal medic
ine doc.
And I care about falls because my
patients fall,
and sometimes they're injured,
sometimes they've had complicati
ons where
they've actually passed away.
And many of my patients are just
simply afraid of falling
and need to know what to do to mi
tigate that risk.
And those of you who have primar
y care physicians
at UW Health, you might know, we
care so much about falls
here at UW, that if you're over 6
5,
you will be screened for falling
at UW Health
once every year and given litera
ture
about how to help you to not fal
l.
So, I've learned a lot, I've seen
this lecture twice.
And I've learned a couple things.
One of the things I'm gonna do t
o mitigate falls,
which I started already is this,
I walk and talk on my phone, I
watched my steps on my Fitbit
as I'm walking down stairs,
I've learned how dangerous that i
s.
And I'm gonna stop that.
And so you'll learn some of the t
hings you can do
to stop your risk of falling.
You'll also learn what you have
to do
when you just have things in you
r life that put you
at risk of falling and that you
don't wanna change,
and I'm gonna show you those two
things in my life.
So I have puppies, so Wally is t
hat poodle
and he's a pet pal at the Childr
en's Hospital.
And Sammy is the little white Bic
hon
and she is deaf and blind and 15
,
and I've fallen over her more t
han once.
And my other risk of falling tha
t
I'm not giving up is Melvin.
And Melvin is bigger than the Bic
hon.
(audience laughing)
So, I'm hoping that you'll
learn just a few tips and tricks
to make your life safer.
And with that, we're gonna start
with our first speaker.
So Dr. Ann O'Rourke, MD, PhD,
is the Trauma Medical Director
here at University of Wisconsin.
And you may not know this,
but we are a level one trauma
center here,
one of two in the state of Wisco
nsin.
She is an associate professor of
surgery here.
She's been part of the Peace Corp
s.
She did her MD and PhD,
both here at University of W
isconsin.
She also completed her surgical r
esidency here.
She then went away for fellowship
, she went to Memphis
for her trauma and surgical crit
ical care fellowship.
And like Dr. Rice said about me,
we are very lucky to have Dr. O'
Rourke come back
and join us here at University o
f Wisconsin.
She's very involved in education
as well.
And she's the Director
of The Medical Student Surgic
al Education here at UW.
And something not on your littl
e agenda,
she just received the Dean's
Teaching Award,
one of the most coveted awards h
ere
at the School of Medicine and
Public Health in 2017.
She serves on the board of dir
ectors
for the World Association
for Disaster and Emergency Medici
ne.
And she just has a fantastic talk
.
So Dr. O'Rourke, come on up.
[audience applauding]
- Thanks so much.
Thanks for that very nice introdu
ction.
I also will try to keep to the r
ight of the tape.
Thank you all so much for coming.
As a trauma surgeon, I think peop
le have ideas that
we like to consider ourselves li
ke
the rock stars of surgery.
But I would say the most common
problem
that I care for daily on my trau
ma service
is patients who've been inju
red with falls.
And I just wanted to share one of
the reasons
this is so important to me person
ally,
this is my grandmother, Ethele
ne Crowder Womack,
which is the most Southern name
you could ever come up with.
I'm from Tennessee originally.
And she broke her hip not once,
but twice.
And when I was in college,
was the first time she broke her
hip,
and I had all these devastating
horror stories
about "nobody does well after th
ey break their hip."
And I just wanna leave that up th
ere.
This is after she broke her hip.
And she always told me that s
he didn't care
what I did in life,
I could dig ditches, as long as I
had a good education
because I would be happy in my
mind.
And so she was a very much an in
spiration for me
to complete my education.
So that's my inspiration for toni
ght.
And really, I've been asked
to set the stage
Why-- I mean, clearly we have suc
h a big audience.
I think we all know that thi
s is important.
And it's something we worry about
,
but I just would like to kind of
talk about
the problem of falls in general.
And what we really know
is that falls are very common amo
ng older adults.
One in four people over the
age of 65 will fall each year.
One in four.
Even for me who has a master's
in public health,
that is a stunning statistic.
It's very costly to our heal
th care system.
But these things are preventable,
and the rest of tonight I th
ink will be, after I sort of
have been sent up here to be the
heavy
and talk about what a big prob
lem it is,
we'll talk about how we can keep
this from happening.
Over three million people are see
n
in the emergency department each
year,
and almost one million of those
are hospitalized,
and that's where I come in.
In falls and patients over 65, o
ne in five
of those falls result in serious
injury.
And by serious injury, I mean thi
ngs like broken bones
such as broken hips, or broken ri
bs,
or bleeding in the brain.
The death rates from falls are co
ntinuing
to go up in our country,
despite the fact that we know
and the Centers for Disease Co
ntrol know
that this is a serious problem,
fatality due to falls continues
to go up.
Here in Wisconsin, in year 2017,
eleven and a half thousand people
over 65 were admitted
to the hospital for a fall.
That's just here in the stat
e of Wisconsin.
And of those eleven and a ha
lf thousand people,
69% of those people went to
a nursing home,
after that hospitalization for th
e fall.
25% of them went home, and of th
ose patients who went home,
the majority of them went home
with some needing some extra hel
p,
such as home health or ongoing ph
ysical therapy.
And 6% of those patients who were
admitted for falls
did not survive.
About half of those progressed
into palliative care or hospice,
but half of them, 3%, did not su
rvive their injuries.
So here in Wisconsin, it is a pr
oblem.
I wanted to talk about the co
mmon injuries
that I mentioned,
the serious injuries that we see,
and the consequences in those.
A hip fracture I think is the
thing that I think many people
are very afraid will happen.
And my grandmother was one of
those people.
Of patients who break their hip,
20% of them die within
a year of their injuries.
30% of them go on to have some
sort of permanent disability.
40% of them are unable to wal
k independently.
And 80% of patients who break th
eir hips,
need some additional help with t
heir activities
of daily living.
Some part of their life, they
're not able
to do independently any longer.
Which I think is something most p
eople
in this room already know, and wh
y it's so frightening.
These are the injuries though, th
at I think people
don't take as seriously.
And I spend a lot of time actuall
y in my role
as a trauma medical director, go
ing
to other trauma centers in the s
tate
and talking about broken ribs.
I think when we hear the thing
like broken ribs,
"Ah, I just broke a couple of ri
bs, it's not a big deal."
I'm here to tell you broken ribs
are a huge deal.
They're a big problem; in our
patients
who are over 65 years old with
three or four broken ribs,
one in five of those people will
die from those injuries.
And one in three, will develo
p a pneumonia.
If you have greater than six bro
ken ribs,
one in three of those patients w
ill die,
and half of them get pneumonia.
When my patients are in the hosp
ital with broken ribs,
I come in and I meet them and we
have a little chat
about how I am not their frie
nd right now,
I am their coach, and it hurts t
o cough
and it hurts to take a deep brea
th.
But we're gonna do that anyway
because we wanna keep people
from getting pneumonia.
Our whole Intermediate Care Unit
on our trauma ward,
we built in mind for patients wit
h broken ribs
to try to prevent them from g
etting pneumonia.
And the other common injury I wa
nted to speak about
is brain injury, bleeding in
the brain.
Many patients, many of you probab
ly in this room
need to take a blood thinner beca
use of
other health problems that you h
ave.
What bleeding in the brain, I th
ink we all understand
maybe has some hot mortality asso
ciated with that.
But the other things that our pa
tients with brain injuries
will tell us about, is that after
their injury,
even after they're ready to go
home,
they had some sort of cognitive
impairment;
their memory is not as good,
they're not able
to multitask as well.
Patients also have some other
lingering symptoms
such as emotional problems, part
icularly depression.
Dizziness, which feeds into possi
bly another fall,
and sleep problems.
The good news though is, is tha
t rehab is slower
than if you were younger with a b
rain injury,
but real gains can be made.
So a brain injury is not a hopele
ss situation,
it just might take a little bit l
onger
for those symptoms to go away.
Trauma centers like ours and oth
ers,
patients who are elderly and who
fall
are actually less likely to be
referred to a trauma center.
I think we still think falling do
wn,
breaking a couple of ribs is not
really a big deal.
But a third of patients,
you'd be a third less likely to d
ie if you presented
to a trauma center with your inj
uries after a fall.
And here at UW, our level one tr
auma center has compared
to our peers in nationwide insti
tutions,
have better outcomes
in our injured patients, our elde
rly trauma patients
than other trauma centers that w
e're compared with.
I just wanted to finish up actual
ly
with my grandmother again, I love
this picture of her.
My eyes are closed, it's fine.
But as I said, she broke her hip
not once but twice.
She broke her wrist
and she had several compression
fractures in her spine.
Bone health is something I take v
ery seriously for myself.
She, after she broke her hip, was
fiercely
fighting for her independence,
and insisted on returning home
and doing her own rehab.
And her rehab included goin' to t
he Walmart everyday
and walking and going to the fab
ric department
and hanging out with her friends
.
But before she could go talk
to all her friends
in the fabric department,
she would do a couple of laps a
round the Walmart
with her walker, and then she gra
duated
to a cane and then nothing.
And then several years later, sh
e broke the same hip,
had a fracture around the prosth
etic hip she had in place,
and she did the same thing.
She's the strongest person I kno
w.
So even with two broken hips
, broken wrist,
a few compression fractures,
my grandmother lived independen
tly until
she died in her late 90s.
And so, these injuries are serio
us,
but they are absolutely reco
verable with help.
And with a fighting spirit like E
thelene Crowder Womack.
Thank you.
[audience applauding]
- Betsy: Awesome.
Thank you.
Is this on?
Yeah, nope, yes.
Thank you, that was fantastic.
I think those rib fractures stat
istics
are just mind-blowing.
And I think that take-home me
ssage about
you're never too old to ask
for the right care
like a level one trauma cente
r is great.
Our next speaker, Dr. Laura
Guse who actually is a doctor,
but she said physical therapists
don't necessarily like
to be called doctors, is a physi
cal therapist.
She has received her doctorate in
physical therapy
here from University of Wisconsin
.
And she is the person who has th
at specialty area,
she practices in our UW Health R
ehabilitation Clinic,
and the kind of patients that she
takes care of
are neuro rehabilitation patient
s.
They're patients who have co
mplex neurological disorders
like Parkinson's disease, stroke
s, traumatic brain injury,
and right up our alley, she
deals with people
who have had balance problems an
d inner ear problems,
another huge risk for falls.
She's a member of the American
Physical Therapy Association
in the Academy of Neurologic
al Physical Therapy,
and is a board-certified
Neurological Clinical Specia
list.
And this is the kind of person
you really want on your team
if you are having trouble with
fall.
So Laura, come on up.
[audience applauding]
- Thank you.
Can everybody hear me okay?
Very good.
I have been a physical therapist
for eight years.
This is a second career for me.
And I'm so glad that I made the c
hange.
Because this is a job that I feel
a lot of passion
for helping people to get back
to a higher level of function
and reduce their risk for falls,
so they can go out
and do the things that they
enjoy doing.
I'm here today to talk to you abo
ut risk factors
and mechanisms for falling.
So, I think Dr. O'Rourke made it
pretty clear
that falls are bad.
This is a huge issue for us.
And you have to wonder why hasn't
this been solved yet?
It's just a fall.
Well, the fact is, this issue is
really very complicated.
There are a lot of risk factors.
But if I leave you with noth
ing else today,
I want you to consider that there
is hope for us
to work on solving this problem
and actually make gains,
and making this a better situati
on for us.
So, let's delve right into t
he risk factors.
First, let's talk about risk fact
ors that we can't change.
So if you're over 80 years old,
you have an increased risk for f
alling.
Obviously, no one has figured ou
t how to change aging.
So we're stuck with that one.
People who have neurological pro
blems
such as a history of a stroke,
or Parkinson's disease,
or multiple sclerosis, also at a
higher risk for falling.
People who have cardiac issu
es, arthritis,
impaired thinking, history of f
alls,
these are all things we really do
n't have
a lot of control over.
But let's talk about the things t
hat we can change.
So, I don't advise doing this
on your own.
But with help from your physician
,
you could maybe have your medica
tions looked at
or solve depression, or chang
e your glasses,
or something to improve your vi
sion so that these things
could reduce your risk for falli
ng.
But only with the help of a phys
ician, as I said.
Now, here are some things that
a physical therapist can help wit
h:
walking and balance problems, we
akness,
talking about the proper foo
twear to wear
in summer and winter,
and working on your environment.
Now, I don't expect you to have
all of those risk factors memori
zed already,
although this is Mini Med School.
(audience laughing)
But I would like you to think a
bout this
in terms of this triangle, of the
individual,
which is you and me and the
characteristics
of our bodies and minds.
Also the second point in the tri
angle,
the task, what are you doing?
And the third point of that tria
ngle is the environment
and challenging features that mi
ght be in the environment.
So first, let's talk about the t
ask.
I have worked with people who
have fallen
getting out of bed.
I have worked with people who've
fallen standing up
and trying to sit down.
I have worked with people who ha
ve fallen on the stairs,
I have worked with people who
have fallen
while they're walking either by
themself
or with a dog who might have nudg
ed them a little bit
and pulled them right over.
These are things that most of us
do just about every day.
This is the picture of the envir
onment.
Now you might know that--
(audience laughing) (muffled tal
king)
What is so funny?
Does this look like your house?
(audience laughing)
So, I think a lot of people logic
ally know
that going up a ladder has hazar
ds,
that is a difficult environment
and a difficult task.
And being on a roof is a very dif
ficult environment,
especially if it's the middle of
winter,
and you're scraping your snow off
of the roof.
But something that we should con
sider also
is the hazards that are availabl
e to us in our own home.
So, here is a typical living roo
m possibly.
I'm gonna draw your attention to
the cane on the floor.
Now a cane is a very good device
for many people to use
to help them walk better and lowe
r their risk for falling.
But a lot of times people will s
et it on a table,
it'll tip over, they'll forget
about it, they'll step on it,
and they'll fall right on the
ir own cane.
I want you also to notice this t
able has some corners
that sort of jut out, and it's
kind of placed in the middle
of the furniture in such a way th
at there's not
a lot of room to maneuver betwee
n those items.
So trying to squeeze between th
ose areas
might also be challenging.
The throw rug, many of us have h
eard
that throw rugs are a hazard;
very easy to catch your toe on
when you're trying to walk a
cross the floor.
And then other things laying on t
he floor; newspaper, shoes.
Here's another pretty common envi
ronment, a bathroom.
And so on the picture on the left
we'll take note
of this drawer that's sticking ou
t,
someone could catch their hip on
it.
Another throw rug, more shoe
s, a trash can.
So, when we look at the pict
ure on the right,
not only have all those haza
rds been removed,
but I'd like to point out th
at in this slide,
you can see that things have
been added
to help make this space even mor
e safe,
such as the grab bar that's on
the wall.
The hardware around the toilet,
we call it a toilet safety frame
that can help someone stand up f
rom the toilet
and then they can grab the grab
bar to stabilize themselves.
There's also a chair inside the t
ub
so the person can sit down while
they're showering
so they don't have to worry as m
uch about falling.
And there's a handle to help the
m get over the tub
so they can hold on to something
while they're trying to step into
the tub.
Finally, we get to the individual
,
and I think this is where
a physical therapist probably of
fers the most value
in terms of these three conditio
ns:
task, environment, individual.
So, if you are referred to p
hysical therapy
to try to lower your risk for fal
ling,
a physical therapist would mo
st likely look
at the sensory system that you u
se for balance.
There are three primary senses
that we use for balance.
First one is vision, what you're
seeing through your eyes,
helps you orient yourself to whe
re you are,
so it helps with your balance.
What you're feeling through your
body and your feet,
your somatosensory system, in
other words,
is another key part of the senso
ry system
that we use for balance.
And the third one is the vestibul
ar system
which is found in the inner ear.
So a physical therapist will loo
k at how these items
are working together, and how ou
r brain
is organizing that information to
figure out
if we need to work on that aspect
.
But the bad news is as we are ag
ing, our senses can change.
Our vision can become impaired,
many of us are wearing glasses
as we start to get older.
Somatosensory system may become i
mpaired.
So what you're feeling through
your feet may be muted,
or distorted by conditions like d
iabetes, for example.
The vestibular system might also
become impaired.
In fact, there's literature to s
how that as we age,
all of these things start to dec
line.
A physical therapist, in addition
to the sensory systems,
will also take a look at the musc
les
in someone who comes to us to
reduce their risk for falling.
So, are the muscles flexible eno
ugh?
For example, does a person have e
nough range of motion
at their ankle to be able to pull
their toes up sufficiently
so that they're not catching the
ir toes
when they're walking down the str
eet?
Or how about the muscle strength?
So if someone does lose their bal
ance,
do they have enough strength to b
race themselves,
so that they don't go down?
And finally, muscle control and
timing.
So, those are very key things
for balance,
can you respond quickly enough
to keep yourself from falling?
And just as with our sensory syst
ems,
our muscle characteristics also d
ecline as we age.
A lot of us just become more sede
ntary
because we're not running around
with our kids anymore,
taking them to 12 events in a we
ek.
So, because we're maybe sitt
ing around more,
our muscles can get tighter, they
can get weaker.
And we might just be slowing
down our timing
and control just, things slow do
wn.
Another thing that a physical th
erapist is going to look at
is specialized balance tests
and gait speed.
We can tell a lot about a pe
rson's balance
by the speed that they're walkin
g.
And we also have a lot of standa
rdized tests that we do
that have been given to many, man
y people.
And they've been able to determi
ne
cutoff scores for those.
So, a physical therapist might te
st you
using some of those tests,
look at your score, compare you
to the other people who got
a similar score, to determine ve
ry objectively
if you are considered an increas
ed risk
for falling or not.
And the results of these balance
tests
can help us drive treatment.
So instead of doing an across
the board standardized program
for everybody, we can look at th
e specific characteristics
of each individual and really
focus heavily
on the things that they need
the most practice and work in.
These are some other things
that a PT is going to consider
are those other risk factors that
we talked about.
Age, medications, impaired thinki
ng, history of falls,
history of other medical cond
itions, and smart choices.
For example, I might talk to this
lady
about possibly considering more s
ensible shoes.
[audience laughing]
I would ask her to not wear her r
eading glasses
while she's walking around.
And I would encourage her to n
ot put so much stuff
in her purse that it makes her
tip over.
So a physical therapist is going
take all that information
and put it together to create an
assessment and a plan.
Again, I'm gonna look at the ind
ividual,
the tasks that they are doing,
the environments that they'r
e doing them in,
and then figure out what I can m
odify,
what can I work with this pat
ient to modify,
to lower their risk for falling.
And I will, with the patient,
create a plan,
which likely will include a home
exercise program.
Specific PT interventions typica
lly include,
strength training, balance trai
ning,
of course, in a way that is safe
,
we don't want people to fall
while they're doing their exer
cises
to train their balance.
Often, we also discuss modificati
ons to the environment
and maybe changing some habits,
which we've already touched on.
And finally, I'm gonna just e
mphasize that
if your physician refers you to a
physical therapist
to help work on your balance
and lower your risk for falls,
indeed, it is a partnership betw
een
the therapist and the patient.
I don't have a magic pill to give
you
that's gonna make this better.
I will give you suggestions and
coaching.
And the real rehab and fix for th
is
is gonna be you implementing some
of these changes
at home, coming back week after
week for more sessions
to progress your exercise program
and lower your risk for falling,
and ultimately discharge you
at a reduced risk for falling.
So, if you find yourself having b
alance issues,
and you'd like to make that bette
r, there is hope.
And I would encourage you to con
tact your physician
for a referral to balance physic
al therapy.
[audience applauding]
Thank you.
- So, Laura, thanks, that was f
antastic.
So for every talk, I'm gonna have
one little pearl
and I'd say that picture of th
e living room was awesome.
And and my pearl is pick somethin
g from that picture
that you do in your house that y
ou can change.
My household, it's shoes.
So, actually after we saw this
talk,
I have baskets in each room now
and all shoes get thrown in the
basket,
which has been super helpful.
So our next speaker is Dr. K
athleen Walsh.
Dr. Walsh is a clinical asso
ciate professor
in the Department of Emergency
Medicine.
And I think Dr. Walsh, you have a
joint appointment
in medicine, I hope actually.
She is the Associate Director
of the University of Wisconsin
Cardiovascular Faint and Fall Cli
nic,
which is a fantastic resource fo
r all of you in this room.
She's done two residences.
She completed her first residenc
y, Internal Medicine,
here at University of Wisconsin.
Then she went out to UCLA
and she did her fellowship in Ger
iatric Research,
and then, a glutton for punishme
nt, she came back
and did a second residency in Eme
rgency Medicine
here at University of Wisconsin.
And again, we were able to have h
er stay here with us,
which I think has been fantastic
.
So she is a co-director of the Fa
int and Fall Clinic.
And in that clinic, she work
s very closely,
she and her colleagues, with
people like me,
who is a primary care doctor,
doctors in the emergency departme
nt,
and inpatient doctors to be sure
that we are evaluating
and managing patients who have r
ecurrent falls,
and fainting spells with falls,
and helps us to diagnose tho
se people.
I also wanna say that this year,
she was awarded the Lecturer of t
he Year in 2019,
for the UW Physician's Assist
ant Program,
which is also a great honor.
So Dr. Walsh, please come on up.
[audience applauding]
Take it away.
- Am I on?
Good, good, good, good.
Now, I am not a believer in bi
focals or progressive lens.
And I'll let you know why in jus
t a little bit.
So I have to figure out which gl
asses I'm gonna wear here.
So, [audience laughing]
let's see, hold on here.
I think, oh boy, I don't know.
[audience laughing]
I'm good here, okay.
All right.
Oh, I can't see you now, okay.
[audience laughing]
It is time.
It is time for all of us to step
up to prevent falls.
I mean, it is really time.
The good news is, there are
only two steps
to start the process.
Are you ready?
This is the first step.
Are you at risk for falls?
Have you fallen in the last year
?
Do you feel unsteady standing or
walking?
Do you worry about falling?
If you answer yes to any of thes
e,
you are at risk for falls.
Number two.
The second step is if you answer
yes to any of these,
I encourage you to talk to your p
rimary care provider
to one, identify your risk factor
s,
which Laura just went over, tr
y to minimize,
and finally eliminate those risk
factors for falls.
Because if you don't, this may h
appen.
You have a fall.
And I can see you in one of two p
laces,
the emergency department, or in
my clinic,
the Faint and Fall Clinic, or pos
sibly both.
I have had that happen too.
So, if you fall, how do you know
if you need to get in ASAP to be
seen?
Let me go through some red flags
here.
If you say yes, you should be eva
luated right away.
If you are unable to recall the
fall.
I have patients that come in an
d they say "I don't know,
"I just found myself on the groun
d.
"I have no recollection between
when I started walking,
"and I found myself on the groun
d."
We don't like that.
[audience laughing]
Are you hurt?
Don't minimize hurt; we need to
see you.
Did you hit your head?
Or do you think you hit your hea
d?
Or you're not sure?
Have you been ill?
Are you on a blood thinner?
Dr. O'Rourke mentioned this b
efore.
Blood thinners, there's anti
coagulants;
Warfarin or Coumadin,
and then there are the newer anti
coagulants; Pradaxa,
some of you may be on those.
Or there are antiplatelet medica
tions like Plavix.
Those are blood thinners.
We worry when people are on bloo
d thinners and they fall.
Next, did you lose consciousness?
Some people lose consciousness an
d they fall,
some people fall, they stand up,
and they lose consciousness,
we need to see you.
And finally, have you had severa
l falls?
And this is number five,
in just a short span, we need to
see you.
What's going to happen when y
ou come in
to either the emergency departme
nt or even my clinic?
We're going to examine you ve
ry thoroughly,
I call it the crime scene inve
stigation.
[audience chuckling]
So, we will do blood pressure.
Many times I can figure out a
little bit more about you,
if I do a blood pressure lying
down, sitting up,
and then standing up.
I need to know if your blood pres
sure just plummets.
I need to know what your heart r
ate does.
For some of you, this may be due
to dehydration.
Due to some of your medicati
ons you're on,
some of it's just due to the med
ications.
And some of it is due to you
r health issues,
such as heart failure, or Par
kinson's disease.
So that's this first step we'll d
o.
The second and third step, may be
blood tests,
especially if you come into the
emergency department,
you've had a big fall,
I may do an EKG looking at h
eart rhythm.
And finally, if you are hurt, an
d if I need to get imaging,
I'm going to do that.
We're gonna find out if you have
any broken bones,
or broken ribs, or if you come
in at what's happening now,
is we're teaching people how to u
se ultrasound.
I may not be able to see all thos
e very fine broken ribs.
But if I put an ultrasound on th
ere,
I can usually find them.
You're not only going to see tha
t
in the emergency department, we'r
e training
a lot of primary care providers
on how to use ultrasound.
So you're gonna be seeing that m
ore in your clinic,
which is pretty cool.
Next, if you come in,
and you are particularly on a blo
od thinner,
but if you hit your head,
and if you can answer yes to any
of these:
over the age of 65, you've been
vomiting,
you have amnesia to the fall.
I've heard this before, the part
ner comes in and says,
"Well, honey, you fell."
Like, "No, I didn't."
"No, you did fall."
Blood thinner, again, there's th
at blood thinner,
and finally, are you disoriented?
More so than at baseline, right?
[audience laughing]
If you have any of these we, Dr
. O'Rourke and I,
we're gonna scan your head.
The reason why, is because we don
't wanna miss bleeding
in or around your brain.
When we age, when we physiologica
lly mature in life,
a couple things happen.
And one of those, is our brain st
arts to get smaller,
it starts to shrink.
No matter how much Sudoku we do,
no matter how many New York Time
s crossword puzzles
on Saturday that we try to get t
hrough,
our brain is still going to shrin
k in size.
And if we fall, our brain
can actually hit the side of our
skull
and cause microbleeds.
And over time, you may develop
the confusion, the nausea,
the vomiting, it may not happen t
he day you fall,
but it may happen weeks later.
And we will always ask somebo
dy who comes
into the emergency department wi
th those symptoms,
have you fallen in the last mont
h?
It is so important.
Subdural when our brain is covere
d, our magical brain
is covered by a thick covering c
alled the dura.
And you can have bleeding on the
outside of that,
or on the inside of that.
One of the most common bleeds
that we'll see
is a subdural hematoma that's
underneath
and against the brain, kinda push
es the brain aside.
The other one is called an e
pidural hematoma.
And that's on the outside.
Either way, these need to be
taken care of,
some of 'em can take care of th
emselves,
if they're very small, but ot
hers, sometimes
the blood has to come out and we
have to help with that.
When you come in either to the em
ergency department
or into the clinic, again, crime
scene investigation,
we will be asking lots of ques
tions.
And not only should we ask th
ese questions,
but if you have fallen at hom
e or a friend,
you ask these questions.
Well, where did you fall?
Is there a pattern here?
How did you fall?
Are you always falling to the fro
nt?
Or do you get up and you fall bac
kwards a lot?
We need to know what time of day
?
Are you always falling at 2 a.m.
when you get up
to go to the bathroom?
I need to know that.
What were you doing when you fel
l?
Were you trying to multitask?
Was the phone ringing, the do
g barking,
and someone asking for some water
?
That's multitasking.
I will give you a prescripti
on not to multitask,
as we get older.
We just, we shouldn't be doing t
hat.
I don't like to do that.
Were you carrying anything?
How many of you have fallen
and you've been carrying somethi
ng,
and it's still in your arms w
hen you wake up?
Right?
What were you wearing?
We talked about that with sh
oes, and particularly shoes.
Do not wear the Crocs.
I don't have stock in it, but pl
ease don't wear Crocs.
We see that a lot.
Were you using your assistive de
vice?
Do you have one and were you usi
ng it?
Did you have any recent illnes
ses, any injuries,
were there any witnesses to y
our fall?
New or recent changes in medicat
ions,
and not just prescription medicat
ions.
But those wonderful medications
that we see at the store
that we look at the box.
And we like "Ooh, I wanna look
just like that person, right?
"I wanna get rid of all this
sinus congestion
"and swing through the fields
and feel great.
"I'm gonna buy that."
Well, if you combine that with so
me
of your other medications, you co
uld be in trouble.
So what happens is, we'll see th
is prescription
or the prescription cascade.
This happens to almost all of us
.
And over time, we'll have pages
of medications.
Let me give you an example.
High blood pressure.
Well with high blood pressure,
you're gonna be given a bloo
d pressure pill.
And a lot of these blood pressure
pills,
what they do is relax our vessel
s.
And when our vessels are relaxed,
I mean our veins and our arteries
,
blood seems to pool, so we'll ha
ve swelling in our feet.
We don't like that.
So, you have swelling on your fe
et,
you'll get the water pill, right?
Then you're up at night urin
ating and everything else.
Sometimes that water pill causes
dizziness
and lightheadedness.
That's what caused your fall.
It was all due to the prescripti
on cascade.
Well, if you combine these pres
cription,
what happens is with the prescrip
tion cascade,
eventually you're going to be on
a lot of medications.
And all of these that I have
listed up here,
they can, especially combined tog
ether,
bring you at risk for increased
falls.
For example, sleep medication,
we all want to sleep.
I had a friend stop by, I was wa
lking my dog yesterday
and she stopped by and she said,
"What do you do
"for people in menopause that jus
t wake up at night?"
Well, I'll tell you later, meet
me afterwards,
I'll tell you what I told her.
[audience laughing]
Sleep medication, seizure medica
tion,
antipsychotic, pain medication,
blood pressure,
cardiac medications, antidepressa
nts, anxiolytics,
medication for anxiety, or even
muscle relaxants.
Many of us in this room are on o
ne or more of these.
And you combine these togeth
er, increased fall risk.
The next one is what I call t
he fall trifecta.
And sadly, we see it a little too
much in Wisconsin.
You have poor balance, you dr
ink alcohol,
and you're on multiple medicatio
ns.
These are risk factors that you n
eed
to recognize and minimize.
That is the trifecta.
The next and last two risk facto
rs
that I really wanna hone in on.
I have seen so many people comin
g in
to the emergency department,
falling while texting or rea
ding their email,
while going up and down stairs.
Don't do it.
I can say job security, but I re
ally don't want to.
Don't do that.
Now the other thing that I've no
ticed lately
are more people tripping on step
s
that don't have any contrast or
color to them.
So if you think about, if you
have steps going
in and out of your garage or up
your steps to the house,
and it's all cement the same co
lor, certain times a day,
you may not be able to see that,
or if you have macular degene
ration,
cataracts, or glaucoma,
you're making things worse,
or, and you combine that with bi
focals or progressive lens
and trying to find that, what the
y call the sweet spot
to get up on that step,
you're gonna be in trouble.
I highly recommend, highly enc
ourage you
to put a contrast in color on you
r steps.
My father had terrible glaucoma,
vision was so impaired
we finally put, it was a phys
ical therapist
that said "Why don't you put thes
e
yellow strips on the step?"
'cause he'd always trip on the
step.
No more tripping on the step, he
could see the step
every time he went up.
Something to think about.
Finally, you're gonna get into w
hat we call
the fear of falling cycle.
If you fall, you will have a fall
,
you'll fear of falling again,
less activity,
decreased muscle strength and bal
ance,
and an increased risk of falling.
Well, guess what?
We are here to help.
Break that cycle, we are here to
help.
The UW Center for Wellness is at
the American Center.
They have group medical visits,
they are absolutely wonderful.
There is one group medical visit
that I particularly would like
to talk about tonight called
the Wellness in Seniors Empowerm
ent.
It is a four to six week program
,
once a week for a couple hou
rs I believe.
Looking at successful aging, hea
lthy aging,
and falls is one of the topi
cs that they cover.
Luckily tonight, we have Dr.
Melissa Stiles
who designed this program,
and Katie Schwartz, the well
ness coach for the program
with us tonight.
Dr. Stiles is in the back, can yo
u raise your hand?
There we go, Katie?
[audience applauding] Thank you,
thank you.
They will be here afterwards to a
nswer any questions
that you may have about the pr
ogram.
Theirs is just one of the group
medical visits offered out
at the American Center, they're
absolutely wonderful.
Other opportunities for us to
get you healthier,
are at Research Park and the Amer
ican Center.
These are just a minimum of the
classes that we have.
And I've chosen just these for n
ow.
But there are plenty of classe
s you can look at.
Living Falls Free, Aqua Yoga
, Dance for Health,
Mindful movements for arthritis,
and Strength and Flexibility.
Great classes.
Finally, we have two clinics
at UW for falls
and we have one in the geriatric
division called
the UW Falls and Mobility Clinic
, seeing those people
over the age of 65.
And for the clinic that I'm c
o-director of
is UW Faint and Fall Clinic
and we see people over the age o
f 18.
So those are the two clinics that
we have here
at UW hospital, you can talk
to your provider
about those, getting a consult
or you can self-refer as well.
So I'm going to end this with,
take the two steps.
It could change your life.
Thank you very much.
[audience applauding]
- And I can see why you got the
Lecturer of the Year award.
That was fantastic.
It was so great that I'm not sure
even where to focus,
although I want a prescripti
on to not multitask.
So can I get that for you afterw
ards?
But I would say that one of the t
hings,
that first slide pertains to alm
ost all of us,
I mean, have we fallen in the pa
st?
Are we unsteady on our feet?
And do we have fear of falling?
I mean I think that really hits
home
of looking at our risk for falls,
so, thank you.
Our last speaker tonight is Dr. J
ane Mahoney.
Dr. Jane Mahoney is a professor
in the Department of Medicine
, specifically
in the Division of Geriatrics.
She received her MD degree from
UCSF.
She did her residency here at Uni
versity of Wisconsin,
and then did her geriatric fellow
ship
at the William Middleton Hosp
ital VA.
She is a Principal Investigator
of the Community Academic Aging
Research Network.
She is a fantastic researcher,
incredibly well-funded,
she's nationally recognized for
her pioneering research
for falling after hospitalizatio
n,
and novel interventions to reduce
the risk of falls
in those of us who live in th
e community.
So what she's really done is
she's conducted
dissemination and implementation
research,
based on what we know about falli
ng,
and figured out programs
for healthy aging people in
the community
to reduce our risk of falls.
One of those is the Stepping On F
alls Prevention Program,
which has been widely spread acro
ss the United States.
Her work is really very impressiv
e.
And Dr. Mahoney, would you plea
se come up and finish
our discussion, our talks and th
en we'll discuss.
[audience applauding]
- Thank you.
I get the fun part, which is talk
ing about preventing falls.
We've heard all the doom and g
loom about
how bad falls are and I agree.
But this is the fun part where
I can talk about,
yes, we can do things, these are
things that we can do.
So, many studies now have shown t
hat
we can reduce the risk of fallin
g.
The U.S. Preventive Services T
ask Force,
the American Geriatrics Society,
the Centers for Disease Control,
all recommend screening
for falls risk and taking prevent
ive steps.
And the first step is to tell yo
ur provider
if you've fallen.
I think you're gonna hear some th
ings
that you've heard before.
So, it's good that we all agree,
and we all agree that telling yo
ur provider
is the first step.
So, once you've done that,
and once your provider has helped
you with recommendations
to reduce falls, there are also t
hings that you can do
in the community setting.
There are a number of
evidence-based community progra
ms,
and the first one I'm gonna talk
about is Stepping On.
This is a seven week small group
program that teaches people
about strategies to reduce falls,
it includes balance and stre
ngth exercises,
so people can actually improv
e their balance
and reduce their risk.
And they're invited experts, a ph
ysical therapist,
a low vision expert, and a pharma
cist
to come to the sessions.
You can see here, this is one
of the first
Stepping On workshops in Wiscons
in.
And you can see two people doing
their balance exercises very
happily.
And in the bottom photo, there is
a physical therapist
in session six, who is working wi
th the participants
on safe negotiation of curbs.
Was originally studied in Austral
ia,
and where it showed a 30% re
duction in falls.
We, at UW working with commun
ity partners,
had the good fortune to research
it and package it
for the United States.
And our research has shown very s
imilar reduction
in falls in multiple studies.
So, it works, it's fun, people lo
ve it.
And it has snacks, which we know
is a key factor.
[audience laughing]
So Stepping On is now in 22 stat
es and in most counties
in Wisconsin, and research conti
nues.
Going on right in Wisconsin, we h
ave done cultural
and linguistic adaptations for Hi
spanic seniors.
And we've also worked with the H
mong community
to adapt it for them.
And lastly, exciting new work goi
ng on with people
with dementia who can go togethe
r
with their care partner.
And we've done preliminary work
on a Stepping Online program,
which is for those who graduate f
rom Stepping On,
who then say, "I wanna do more.
"I want new balance exercise
s to practice."
So this is an online version
that gives them new exercises,
tracking a way to track that at h
ome and progress them,
and ways to have interactive feat
ures
to maintain those falls strategi
es,
that are falls prevention str
ategies.
It's easy to find a workshop.
Safe Communities of Dane County
has listings
of all the workshops for Stepping
On
and other falls prevention works
hops
and programs right in Dane County
,
and Wisconsin Institute for
Healthy Aging
lists all Stepping On worksh
ops in Wisconsin.
In general, exercise programs hav
e been shown
to reduce falls.
But that's general, and the spec
ifics are important.
We'd like to be able to say tha
t walking
reduces falls, but it doesn't.
It's wonderful, we recommend it.
But it has not been shown to red
uce falls risk.
What does work is balance exer
cises.
And balance exercises reduce fal
ls by up to 30%.
That's great news.
Tai Chi, which is modified for o
lder adults,
is one of the best studied of t
he balance exercises,
but there are others that are o
ut there.
In general, to be effective,
they need to be of long duration
.
You're not gonna improve your bal
ance in one day.
It's practicing day by day over
time.
And they need to actually progre
ssively challenge balance.
So that means standing exercises
,
it's really hard to improve yo
ur balance
when you're sitting.
So standing exercises where you'
re doing weight shifts,
where you're actually making it
slightly,
where you have to practice your
balance
and practice makes perfect.
One of the exciting programs
which has been researched right
here at UW,
Tai Chi Prime is a six week pro
gram,
that encourages home practice
of what they call the Fab Four m
oves.
Their idea was, if we can get so
me basic Tai Chi moves,
and integrate them into what
you do every day.
So while you are making your cof
fee in the morning,
you're practicing your Tai Chi.
If you make it easy to integrate,
then you'll practice it more,
then you'll improve your balance
more quickly.
That's exactly what they showed f
rom a six week program,
significant improvement in b
alance,
strength, and gait speed
compared to a control group that
was on a wait list.
And most importantly, I don'
t know about you.
But when I took Tai Chi or anot
her exercise program,
and they said practice every day,
it didn't happen.
But in this program, participants
did practice
a half an hour per day on averag
e of six days per week.
So we're very excited about this
.
And here's the type of practice.
This is the Tai Chi developer
who's actually practicing at the
kitchen counter
and with her flowers.
[chuckling]
And here is a senior gentleman wh
o's practicing
what's called the high step T
ai Chi stance
with his granddaughter.
So, making it fun, making it eas
y to do at home.
What else works to prevent falls
?
Well, I gotta start by telling y
ou
what we used to think worked,
but now we know the most recent
data
is vitamin D does not prevent
falls.
The 2018 U.S. Preventive Services
Task Force looked at
all the research studies on vit
amin D and falls,
and found it no significant bene
fit.
So, it's no longer recommended
a vitamin D supplement
to reduce falls.
But, vitamin D may be helpful an
d still recommended
by your provider for other things
.
First of all, if you're vita
min D deficient,
which is determined by a blood t
est,
and second of all, if you ha
ve osteoporosis.
So, if you're trying to prevent f
alls,
vitamin D won't help you.
But there may be other reason
s to take it
in discussion with your provider.
Home safety.
Home safety is important
because half to three quarters
of falls occur in the home.
They occur most often in the
living room, or in the bedroom
where people spend quite a bit of
their time.
But, a fall is most likely to re
sult in injury
in the bathroom.
And if you think about it,
there's very tight, narrow surfa
ces,
narrow area to move around in,
and there are a lot of very
hard surfaces.
So, when we focus on home safety
,
often we really focus on the bath
room for that reason.
An occupational therapist can
evaluate your home for safety.
And the result may be what you se
e here in the shower,
with multiple handrails to m
ake sure that
that dangerous area is safe.
You should also evaluate you
r footwear.
And that you can do.
We have good research that shows
that walking barefoot
is actually, you have worse
balance barefoot,
than wearing shoes.
But it depends on the kind of
shoes.
So, shoes that improve your balan
ce,
have thin soles, very firm soles,
and good heel support.
And here's a photo of that kind o
f shoe.
That will help you with your bala
nce.
When we talk about home safety,
we have to talk about pets.
[all laughing]
And I'm not saying to give up a
pet.
They have many wonderful benefits
.
But, falling is not a benefit
from pets.
23,000 fractures a year due to do
gs
and 3,000 related to cats.
And I learned these statistics
after a pet caused my fall.
And then I realized how common i
t is.
This is how a pet can cause a fa
ll.
This is a hallway with a dog bed
in it,
and you can see the dog bed
with the dog in it
or what looks like a dog because
of the nightlight.
But look at this same hallway,
this is the same hallway,
the dog bed is still there withou
t a nightlight.
And this is the situation I face
d,
when I walked into that hallway,
my dog had moved his dog bed ther
e.
Which he liked to do, and pu
t himself in it.
I fell, and the result was a frac
ture like this
of the hip socket.
[audience murmuring]
And the result was six weeks of n
o weight bearing
on the left leg, and a slow retur
n to function.
But I'm here.
And now I am careful to actually
do
what I always tell other people t
o do,
which is put those night lights i
n your house
and be careful and mindful when y
ou have pets.
So in summary, to reduce you
r falls risk,
this is really what you've heard
this evening.
Is it's a combination of working
on individual risk factors,
risk related to the task, how yo
u do your activities,
and the environment.
In the environment, we can reduce
tripping hazards,
improve lighting, install rails.
We can pay more attention as we'
re walking,
scan ahead when we're walking,
be mindful of our movements rath
er than multitasking.
Certainly, texting while you're w
alking down the steps
is not a correct way to do that t
ask.
And we can practice safety with
our pets.
For the individual as we mentione
d,
we can improve our balance, we c
an improve our vision,
we can minimize sedating drugs an
d alcohol.
But all of these steps, with all
of these steps together,
we do know that prevention works,
so thank you.
[audience applauding]
- Rebecca: Well those talks were
wonderful,
and I'm clearly not wearing ap
propriate,
safe shoes this evening. [laughin
g]
So, we'll ask all of our speake
rs to come up.
- Laurel: Come on up.
- And Dr. Rice and I noticed we h
ave an all female team
this evening for you.
[audience applauding]
Let me kick us off with the
first question.
What other balance exercises have
been proven
to reduce the risk of falls?
- Jane: So in addition to Tai Ch
i,
there's a set of exercises called
the Otago exercises,
originally done by a physical t
herapist.
And the exercises were actually
what you saw on Stepping On.
That's a version of what we call
a Otago exercises.
And what we've realized is what
they have in common,
is this idea of challenging your
balance
and making-- learning how to bal
ance better
by making things more difficult.
So, you saw in that picture, peo
ple standing
with one leg in front of the oth
er.
So, we have what we understand
are common elements.
One of the things that's been stu
died most recently
is some kinds of dance.
And so we're beginning to lea
rn more,
that dancing can be very helpful,
not only to your balance,
but to learn how to move in a wa
y that prevents falls.
So there's a lot more to be done,
but we're starting to learn that
there's many types of exercise pr
ograms
that can reduce balance, but they
all have in common,
this idea of you work on balance,
as opposed to working on flexibil
ity, for example.
- Here's one, so, this is for
Dr. O'Rourke.
Please define a level one trauma
center,
and can you tell me how rib frac
tures cause death?
- Ann: So a level one trauma cent
er, the trauma centers
in the state of Wisconsin are di
vided
into four different types of tra
uma centers,
level one through level four.
And the easiest way to answer
that question
is what we're prepared to do
for you.
Any trauma center should be able
to see someone
in the emergency department and
stabilize them.
But a level one trauma center
has basically all the resources,
we're the one stop shop.
And so, many patients who are se
en at a level three
or a level four center are tr
ansferred on
to a level one center.
We have surgeons in house 24/7,
I'm looking pretty fresh for some
one who was up all night
a couple of nights ago on trauma
call, I think.
And so, we're here and we have a
huge blood bank,
and we have operating rooms stan
ding by,
and we have neurosurgeons and or
thopedic surgeons
and trauma surgeons, and the CT s
canners, everything we need
sort of at a moment's notice.
And that is really what a level
one trauma center is.
Rib fractures, there's a coup
le of things
that rib fractures lead to p
atients dying from.
And mostly, if you think about,
if you hit your chest hard enough
to break your ribs,
there can also be injury to the l
ung underneath it,
bruising to the lung,
and that injured lung is at risk
for pneumonia.
And even if you don't have bruisi
ng to your lung,
has anyone in this room ever
had broken ribs?
They're incredibly painful.
We don't put your ribs in a cast
,
you have to be able to breathe,
every breath you take causes thos
e broken ribs to move,
and it's very painful.
And the last thing on earth you
wanna do,
is take a deep breath, or to coug
h,
and the normal things that we do,
clearing our throat,
bringing up little bits of secret
ions,
it's very uncomfortable to do.
And so people don't do that,
secretions and things build up
in their lungs, and patients
get pneumonia.
And that is really the reason
for mortality
in our broken rib patients.
- First, I have a comment from t
he audience,
I took the seven week Stepping
On class, it is awesome.
A must do for over 65s. [che
ering]
- Kathleen: Yes!
- Then some seasonal questions,
as I fall in my shoes.
What shoes do you recommend for
summer?
And any specific tips for wint
er walking activities?
- Jane: So for summer, I know w
e'd all like
to wear Birkenstocks or Crocs.
And actually, that's actually no
t going to be the safest.
The safest is wearing these firm
,
thin-soled shoes with good heel
support.
Some people--
For some people, sneakers
can actually be a little bit of a
falls risk.
If you don't pick up your feet,
and you can actually stub your to
e on 'em.
For others, sneakers are fine.
So it kinda varies,
but I would say I agree with
the, Dr. Walsh?
- Kathleen: The Crocs?
- The Crocs.
For winter, there has been one
study looking at
what we call, you know the Yaktr
ax,
but there's other names for them
.
So I'm not recommending one i
tem.
But those, it's like little trea
ds
that you put on your boots,
and those have been shown, it w
as done in Marshfield
to reduce outdoor falls in the w
inter.
But the most important thing
is really learning how to walk
safely in the winter.
And there are safe ways to walk,
partly scanning ahead,
partly, really paying attention
obviously.
I don't know if Laura, you have o
ther comments on that?
- Laura: Say one more time, pleas
e.
- Jane: Going walking.
- Laura: I think you should pengu
in walk.
[all laughing]
So, if people have, for the firs
t thing
is if you don't have to go out w
hen it's slippery,
don't go out when it's slippery.
But if somebody goes out to a
restaurant, it starts snowing.
And then they have to get to thei
r car in the parking lot,
I would have them penguin walk.
So typically when we walk, we put
one foot out
and we land on our heel, which is
a pretty small base
and easy to slip on.
So I would have somebody just wei
ght shift,
so your weight's going straight d
own.
It's a little slower,
and it doesn't really look that
ridiculous, does it?
[all laughing]
- Laurel: Well, first a comment,
are there any male physicians
at the University of Wisconsin?
[all laughing]
That is cute, I like that.
Here's another comment.
I've got some good stuff here.
Should I just wear shoes with cle
ats?
I'm not reading that. [audience
laughing]
I'm not gonna go through with tha
t, okay.
So, Rebecca, you wanna go ahead?
- Sure.
Great question, when will we get
railings at Camp Randall?
I'm not sure, any of our panel he
re can answer that.
[audience applauding]
How about this one?
My balance and steadiness seem t
o vary day by day.
Why might this be?
Balance and steadiness varying.
Things that can impact that, rea
sons.
- Kathleen: So, variability in y
our balance
and how you feel can change day b
y day.
One of the things that we look a
t is hydration status.
Dehydration can present in many,
many, many different ways.
And one of it is fatigue, and
dizziness.
And so that's why we look at
the blood pressure lying, sittin
g, and standing.
So we encourage hydration as muc
h as you can.
And there's your magic six cu
ps a day or eight cups a day
and that necessarily depends
on who you are,
if you have heart issues or anyth
ing else like that.
Sometimes the medications.
The other issue is how well ar
e you sleeping that night?
Have you been traveling?
How much activity you've been
doing?
So there's a lot of questions to
ask
on why particularly that day,
you're a little bit more fatig
ued
and your balance is off.
Usually it's a combination of thi
ngs a day or two
ahead of time that caused them.
- Laurel: How much blood thinner
does a one a day coated 80 millig
ram aspirin cause?
Is that a problem?
Who wants this?
- Ann: I'll get it.
So that is a good question.
And we actually argued about that
here amongst ourselves.
If you present to the emergency
department here
and you have fallen and you are
taking a blood thinner,
you will actually be seen by a tr
auma surgeon
because we consider that a high e
nough risk for injury
that we wanna do a very thor
ough evaluation.
The one exception to that is if
you take a baby aspirin.
So, it definitely is a blood thi
nner.
It affects the way your platelets
,
which are little tiny sticky cel
ls in our blood
that help us make clots, it effe
cts how your platelets work,
but that was where we drew the
line.
So the baby aspirin a day
would not have you be seen by a
trauma surgeon.
But if you take a baby aspirin pl
us something else,
that counts, and many of our pati
ents
take both aspirin and Plavix.
- Betsy: And I say, aspirin is no
t something without risk.
The U.S. Preventative Task Force
many of you know,
the recommendation now is that no
one
should be on a baby aspirin a day
to prevent heart attack or stroke
if you have not already had a he
art attack or stroke.
So, that's something you shou
ld really talk
to your primary care physician ab
out.
And that's because more mild
kinds of bleeding
have been shown to be more detrim
ental
than preventing the heart at
tack or stroke
in someone taking an aspirin.
- Rebecca: Dr. Walsh, you talked
about not liking bifocals.
Why?
- Oh, yes, am I on?
Good.
So, personally I see, probab
ly because I see
the patients I see falling, right
?
So not just in emergency departme
nt.
But bifocals, what happened, I
mean,
you can have reading glasses,
but if you have the regular glas
ses,
the midrange or long-range and yo
u have bifocals,
I see more difficulty with folks
trying to find that step.
And it's usually where they're we
aring the bifocals
with a curb or up and down steps
.
And so trying to find that spot,
it's not that you can't wear the
m,
but if you can switch over to a s
ingle vision lens,
if you're going out and about an
d you need to get up on,
off and up curbs, or up and dow
n stairs,
that's what we prefer.
It's finding that spot
and I've seen too many people
trying
to multitask wearing bifocals,
and they didn't get the right sp
ot in their glasses
to see where that step was.
That's why.
- Laurel: Okay, the fall rates
continue to go up.
Why is that so?
Who wants to answer that?
Jane, you can answer this too.
- Kathleen: Well, no, well.
One, we're asking, right?
- Jane: Yes.
- Kathleen: We are asking it in
Wisconsin, particularly
our primary care clinic.
So, our data is changing a l
ittle bit.
Jane I will let you finish with
that.
[laughing]
- I think part of it is,
we're living longer, and we'r
e living longer
with multiple conditions, multip
le medical conditions.
And we're a very sedentary societ
y.
If we--
If the combination of age-relate
d changes,
plus your medical conditions, pl
us being sedentary,
and this can be as we're learnin
g,
sedentary through your middle ag
es, you still lose ground
that puts you behind when you
retire and can be more active.
So, we have not yet I think turn
ed ourselves as a society
into sort of the high level of p
revention
that we need to do.
The other thing, that I thin
k is part of this,
and we were reflecting on thi
s today,
was that we are becoming mor
e and more
a multitasking society.
And there's very good data that w
hen we multitask,
our balance gets worse.
And particularly if we alread
y have balance problems.
But all of us are on the go,
we've been--
this is what we do as a society.
So to change our way of thinking
and say, when we walk,
all we're doing is walking, that
's gonna be a big change.
But I think that's part of what w
e're gonna need to do.
- Rebecca: For seniors living a
lone,
what devices and services can yo
u recommend
to support them living indepe
ndently at home
and also to summon assistance if
needed?
- Laura: Okay, I'll start.
So devices, so I'm not exactly su
re
what they mean in the question.
But when I think of devices,
I think of the things I showed y
ou in the bathroom,
adding grab bars,
especially in places where you're
vulnerable,
getting in the house, the two st
eps from the garage
to get into the house, the bathr
oom,
especially if you have a tub s
hower,
trying to step over the tub.
Also, if you feel like you're los
ing your balance
or are unsteady while you're
walking around,
a cane, or a walker could do won
ders for you.
Make you feel more steady, yo
u would have
a higher degree of confidence in
your balance,
and it would lower your risk
for falling.
A lot of people tell me, "I don'
t wanna use the walker
"because I'll look like that pe
rson.
"I'm not ready to be that old
yet, it has a stigma."
And I usually ask them if that wo
uld look better
than lying down on the ground fac
e up after a fall.
And I-- that sounds a little bru
tal and harsh.
But I would admire somebody
who recognized and took action
to prevent a fall by using an
assistive device like a cane
or a walker, walking sticks even.
Walking sticks are really hot rig
ht now,
people take them hiking,
I see them walking in my neighbor
hood
on the sidewalk with a walking st
ick.
Someone else had, yeah there we
go.
- Betsy: Yeah, I think the other
big thing is
if you're alone, Lifeline,
something where you can conn
ect immediately
to an emergency service.
A lot of my patients, again don'
t want Lifeline
'cause the bracelet looks ug
ly, the necklace looks ugly,
and they have their phone on the
m.
But you never have your phone on
you when you fall,
I can just tell you that.
I think the other thing is like
Alexa,
many of these devices, actual
ly now have
an option for an emergency system
.
If you buy Alexa, that you fall,
you yell out "Alexa,
"call my emergency people,"
it calls your daughter, it c
alls your son,
it calls your best friend, it do
esn't cost anything more.
I think another great tip th
at a couple patients of mine
have done who live alone is,
they have a check in person and e
very day.
They don't have to chat,
but someone just has to call and
be sure they're alive.
And if they're not, they have a
system.
[audience laughing]
Not if they're not alive.
- Rebecca: Not alive, yes le
t's clarify that.
- If they don't answer the phone
.
[all laughing]
- Jane: One more thing that I
would recommend is,
it's very individualized to get
the right assistive services
and services in the home.
And this is where seeing a physic
al therapist,
and potentially an occupation
al therapist
can really help you,
because it depends on what's dif
ficult for you,
how the task would be modified,
or what they'll do with the envi
ronment in terms of changes.
So, I would say, as a geriatricia
n,
my best friends are physical and
occupational therapists.
And so go see them. [laughing]
Oh, yes, right.
And with an occupational the
rapist,
they can do home evaluations
for safety.
So it is a tremendous service,
if you're having problem with f
alls or function.
- Laurel: Are the wellness classe
s free
or covered by Medicare?
- Rebecca: And a related question
to that,
while you're answering is, do
you need
a referral from a health care pr
ovider
to attend the strength and flexib
ility sessions
at Research Park?
- Laurel: Oh.
- Rebecca: So do you need a refe
rral,
in addition to, are they free?
- Yes, at Research Park, you do
need a referral.
- Does essential tremor resu
lt in special risk
for balance and falling?
- Jane: Essential tremor, if
it involves the hands
is not necessarily, unless it's
causing you problems
with your assistive device or ho
lding on.
There-- some essential tremor ca
n involve the head as well.
And that could change your abilit
y to sort of gauge
how you're walking safely in you
r environment.
But there are other kinds of tre
mors.
And those kinds of tremors are as
sociated with problems
with balance, because it comes f
rom
the same part of the brain.
So Parkinson's has a tremor and
has balance problems.
And then there's--
I think we're familiar with t
he problems
with too much alcohol can damage
a part of your brain
that affects balance and ofte
n causes a tremor with it.
- Laurel: So, is there any correl
ation between
more falling and obesity?
- Ann: To my knowledge, as far as
looking at the correlation
and risk factors for falls, obes
ity has not been associated
with increased risk of falls.
But, being the voice of doom, as
I was asked to be,
it does.
Our patients who are obese do hav
e worse outcomes
from their injuries.
And so, if you fall, and you have
to rehab
or you have fractures,
they are oftentimes can be a litt
le tougher to rehab.
And some of the braces and ot
her devices
we use for spine fractures can be
very challenging
in patients who are obese.
- Rebecca: Any suggestions on how
to land?
I'm going to fall, it's inevitabl
e,
where can I learn about landing?
[audience laughing]
[muffled talking]
- Jane: So, I wish that I had
known how to land.
But the problem is that landing
happens so quickly.
It's really hard to adjust yours
elf, cats can.
But we're not as good at adj
usting ourselves
in the middle of the fall.
And I did have a patient who told
me,
"Doc, I know how to land, and I
know how to fall."
And he never got hurt,
so, but I didn't get to ask him
what his secret was.
So, we know a lot about how to g
et up from a fall.
And that is something that a the
rapist
can train you with Stepping On,
the therapist goes over how to g
et up from a fall.
But how to land, I don't think we
're there yet.
- Kathleen: It is difficult, I kn
ow it wasThe New York Times,
I remember teaching people how t
o fall.
And it would talk about the roll
ing
and not putting out the outstret
ched arms and such
but then, we worry about our head
s.
So, I think it is difficult.
But if you've ever been an,
and like I remember
I was a volleyball player, we
learn how to roll
when we dove on the floor.
So there are techniques,
you try to avoid the arms stretc
hed out if you can,
and just kinda roll but the
key is dropping what you have,
which is very difficult to do.
We tend to have that when we are
on the ground.
So there's no studies looking at
the role of rolling, I guess.
- Ann: And I just wanna re-e
mphasize
what Dr. Walsh actually said abou
t
as we age, our brains inside of o
ur skulls are smaller,
and it doesn't matter how you lan
d
if your brain sort of sloshes a
round
and hits the inside of your skul
l,
you can bleed into the brain
without even
ever hitting your head.
Just again to serve this role o
f doom and gloom.
[all laughing]
- Rebecca: You have to finish
with something better than
your brain sloshing.
- I've been diagnosed with osteo
porosis
and have no cholesterol problem.
What type of milk should I drink
for bone health,
whole, 2%, or skim?
Betsy, that's all you.
- So, it's a Wisconsin question,
no question about it.
So, this is a whole, could be a w
hole 'nother Mini Med
is like what do we really kno
w about diet?
There's a lot of myths about diet
.
Is the whole milk diet really
better for you
and cholesterol?
And what I would say is, we don'
t really know a good answer.
And I would say 2% milk is the b
est bet right now,
actually is what I would actually
drink
if you had osteopetrosis and ne
ed to drink milk.
And I do think in all seriousnes
s,
we are learning a lot more about
nutrition.
There's a lot of urban myth out t
here.
And it's something we're learning
more and more
about every day, and we're gonna
have some very good answers
in the next few years.
- Thank you all for coming.
- Thank you. [audience applauding
]