Aug 3, 2016

Interview Transcript

Interviewer: The real danger is fainting and falling when a person gets older. And how a faint and fall clinic can help your loved ones stay safe, that's next on The Scope.


Interviewer: There is a common misperception that falls are just accidental, but the reality is most falls aren't accidental and every fall or near-fall that does not result in an injury should be thought of as a crisis just barely missed. I know this sounds like a very strong statement. We're going to find out more about this now from Natalie Sanders. She is from the University of Utah Health Care Faint and Fall Clinic. It's a specialized clinic that helps track down the reasons why somebody you know and love fell and help prevent that.

First of all, falls are real serious when it comes to elderly people. We've all heard the stories, right, how the fall is kind of the incident that . . . from there it just doesn't get better.

Natalie: Yeah. Absolutely. Yeah.

Interviewer: Yeah.

Natalie: I mean falls are really just a marker of decline in older adults. So exactly like you said in your intro, Scot, when you have somebody who falls, it really needs to be thought of as a crisis.

Interviewer: Yeah.

Natalie: A dodged bullet.

Interviewer: It's a symptom just like, I don't know, maybe this is overstating, like a heart attack as a symptom.

Natalie: Yeah. Yeah. Absolutely, yeah. And it's . . .

Interviewer: And it's a sign that sums very, very wrong.

Natalie: Yeah. Yeah. The thing that's kind of fun about taking care of patients that fall is that it's due to lots of different factors. So with a heart attack, for example, you might have chest pain. With a fall, you have all of these different things kind of coming together and causing you to fall. So medications can be involved, problems with gait and balance can be involved, lightheadedness, problems with your blood pressure, not being able to see, all of these things can lead to a fall.

Interviewer: And when somebody falls, then, it could be more than just the injury. It could mean your independence is gone.

Natalie: Oh, yeah. Absolutely. You mentioned independence, that's one of the things that people really worry about as they get older. And then also, people that are taken care of their aging parents, or their grandparents, they worry about, "Gosh, if mom falls and she breaks her hip, then all of a sudden I'm going to have to start taking care of her and that means that I'm going to have time away from work and whatnot." And we know that falls are the number one reason why people are admitted to nursing homes in this country.

Interviewer: Wow, really?

Natalie: Yeah. Yeah.

Interviewer: Number one?

Natalie: And nobody wants to be in a nursing home.

Interviewer: No. And I've also heard something like adults that fall and break a hip, very few of them really get back to normal after that.

Natalie: Absolutely. Yeah. So less than a quarter of patients or adults who fall and break a hip, an older adult who falls and breaks a hip, will get back to their baseline function. So what that means is that if you were living independently, on your own, doing everything on your own and then you fall and break a hip, if you are over the age of 65, then you are fairly unlikely to get back to living independently like that.

Interviewer: Yeah. So when a fall happens, if nothing really comes of it, consider a bullet dodged, but go find out what caused it so more falls don't happen. And that's where a faint and fall clinic can help.

Natalie: Right. Right.

Interviewer: I mean, this isn't something, apparently, that I can just figure out on my own. Like I can't just say, "Grandma, we need to take care of these loose rugs because that's why you fell."

Natalie: Yeah. Yeah. No, exactly and that's how I explain it to my patients is that, yes, the loose rugs are one part of it, but really it's lots of different things that need to be addressed and that's challenging. And I think that it's very hard in this day and age for a primary care physician to be able to hit all of those different things that need to be addressed and so that's where a faint and fall clinic comes in.

We have the luxury in our clinic of having hour-long appointments for our new patients. And so, that really gives us the time to go through the history and to say, "Okay. Tell me exactly what happened with each of your falls. And then, all right, let's figure out the risk factors that you have that put you at risk for this. So was it medications, was it your home, that you were recovering from surgery and you were still really weak, was it the fact that you were depressed and you just haven't been able to get out as much? Do you have memory impairment that's playing a role there?" All of those things have to be addressed. And you can imagine that in a 15-minute visit, generally, most general practitioners can't hit all of those. So that's the value of going to a comprehensive clinic.

Interviewer: Yes. Not only the time to be able to analyze what's causing it, because there are multiple things that could, but then also to have an expert that can interpret that information in a way that then can help. So what does a typical appointment look like if somebody were to come in?

Natalie: Right. So, in all of our patients who fall, there are a couple of standard things that we do. So, obviously, this seems like a no-brainer, but we always see them walk and we actually get a gait speed on them because we know that even just how fast somebody can walk at their sort of typical pace can be predictive for falls. So if they are much slower . . .

Interviewer: Yeah. That's not a no-brainer. I never would have guessed that.

Natalie: Yeah.

Interviewer: So you take a look at them walking, you can tell a lot of things from that?

Natalie: Yeah. You can tell a lot of things. So, we look at their gait, we look at their balance, we check their eyes, we check their blood pressures when you are lying and then also standing, because that's frequently a time when patients will fall. We also do a cardiac evaluation. And the reason behind that is because it will sometimes surprise people that heart problems can actually be a contributor for falls. And that's actually why the faint and fall clinic is located within the Cardiovascular Center at the University.

Interviewer: Okay.

Natalie: So the other really important thing that we do is take a very critical look at all medications that the patients are taking, including over the counter ones.

Interviewer: All right. So you take a look at what some of the possible causes might be. Do you also take a look at could it just be a physical decline and you need to do some exercises? Is that something you take a look at as well?

Natalie: Yes. Absolutely. And that's kind of where the frailty part of the evaluation comes in. Frailty is just a very broad term for physical decline.

Interviewer: Yeah. I don't know if I'm going to be able to convince my dad to come into the frailty clinic, though.

Natalie: Right. Right. Yeah. No, we might want to avoid that term.

Interviewer: But it just means that your physical ability is declining a little bit and you might have to figure out to do some exercises to avoid falling?

Natalie: Yes. Yes. Exercises and address other risk factors as well.

Interviewer: Got you. So you would go through this process with a patient and then what would you do at that point, after you've identified some things?

Natalie: Yeah. So we typically give all of our patients handouts in terms of some things that they can do. We have very specific handouts on specific exercises that they can do to help prevent falls and changes to their environment that they can make. We communicate our recommendations with their primary care provider, set up any further testing that needs to be done. For example, if there needs to be cardiac testing done or any kind of testing for neurology, then we can set that up and expedite those referrals.

Interviewer: So I feel like after this conversation, going to a clinic like this when you are older is just about as important as other common check-ups that you might have.

Natalie: Right.

Interviewer: Yeah, I mean I feel like falls can be very dangerous. They can really take away a lot from a lot somebody's life so to be able to prevent those happening is huge. What about somebody who's never fallen before? Would they benefit from coming in?

Natalie: Yes. I think that they would and the reason why is actually because a lot of patients that come in they have not fallen before, but they come in because they are scared of falling. And we know that being fearful of falling is actually a risk factor for falling.

Interviewer: Oh, really?

Natalie: Yeah.

Interviewer: Okay.

Natalie: So you are fearful of falling and so then, therefore, you restrict your activity, you don't get up, but then, of course, everybody has to get up and walk at some point, get out of bed at some point. And so then they do get up and then they fall and then that feeds into that vicious cycle of fear.

Interviewer: Or, worse yet, they don't get up. They limit the amount of times that they get up, and all of sudden, you have muscular atrophy.

Natalie: Right, exactly.

Interviewer: And loss of function just from not functioning.

Natalie: Yeah. Exactly.

Interviewer: Is there anything that I should cover here, or anything that you would like to get on top of the mountain and say as we wrap this up?

Natalie: So I think that my main message is that falls are not a normal part of aging. They are a crisis averted. So if you have somebody in your family or someone that you're taking care of and they are falling or they are telling you that they're scared of falling or their balance is off and you're worried about them falling, they need to be evaluated because falls are a marker of things not going well.


Sign Up for Weekly Health Updates

Weekly emails of the latest news from The Scope Radio.

For Patients