Farewell to Falls

Posted By SHL Librarian

Presented by: Ellen Corman, MRA
Injury Prevention Coordinator, Trauma Services
Stanford Hospital & Clinics

Lecture Overview:

  • Fifty percent of adults 80 and older fall each year
  • Most falls take place at home
  • Older adults who fall are two to three times more likely to fall again
  • Take proactive steps in your home to avoid falls by installing handrails, removing clutter and keeping floors clear
  • Exercise to maintain strength, balance and coordination
  • Have your physician check your medications

Nearly 1 million older Californians experience a fall each year. For people 65 years and older, falls are the most common source of injury resulting in a visit to the emergency room.

The odds of falling each year after age 65 are about one in three; after age 80 the chance of a fall is about 50-50. People are more likely to fall as they get older because of common, age-related physical changes and medical conditions, along with the medications prescribed to treat such conditions, weakness related to a sedentary lifestyle, and home and environmental obstacles. About 20 to 30 percent of the people who do fall face reduced mobility, and many people-even those who are not injured-develop a fear of doing it again.

“Older adults who have fallen are two to three times more likely to fall again within the next year,” said Ellen Corman, MRA, injury prevention coordinator for trauma services at Stanford Hospital & Clinics, who gave an hour-long presentation at the Redwood City Public Library on April 30. “The older you get-and the more risk factors involved-set up an even greater chance of falling.”

Corman asserts that falls do not take place because “I wasn’t watching,” or “I just tripped.” The reasons behind a fall can range from being tired and not lifting your feet properly to poor vision, distractions, slower reaction time and medications that cause dizziness or lightheadedness. Other factors can include physical weakness, cognitive impairment, depression, dehydration or a balance disorder.

But many falls can be prevented by making even small adjustments in three specific areas: your home environment, your medications and your exercise routines.

Taking Positive Steps
“When it comes to home safety, there are specific changes you can make to control your environment. Be proactive. There is usually a combination of factors so it’s important to take a multifaceted approach to making changes,” said Corman. “Most falls are preventable.”

Because more than 60 percent of falls occur at home, she stressed the importance of making some simple modifications to make it safe:

  • Get rid of your throw rugs. Hang them on the wall or give them to someone who will appreciate it.
  • Remove clutter-including papers, pet toys and the grandkids’ playthings.
  • Move electrical cords out of the way.
  • Wear thin-soled, non-skid shoes, sneakers or slippers, especially in homes with hardwood floors.
  • Use nightlights, and bring a nightlight with you when you travel.
  • Install grab bars in the bathroom. An occupational therapist can aid in making an accurate assessment of where to place the bars to suit your height and movements.

“My dream is that all homes have grab bars in the bathrooms, no matter what the person’s age,” Corman said.

Fitness is Key
Older adults generally score between 20 and 49 percent lower on strength tests-an impairment that makes them three times more likely to fall. While today’s older adults realize that exercise is important and tend to remain active in their later years, for too many people retirement means a sedentary lifestyle.

Corman mentioned one study of men and women aged 88 to 92 years involved in a simple exercise program: All participants showed improvement in strength and balance after only eight weeks.

“It’s never too late to start some kind of exercise,” she advised. “Keep moving, and try to mix it up.”

Corman recommended tai chi or a walking routine in a safe, flat location such as a mall or school track. She also emphasized the importance of including weight training to maintain strength.

Check Medications
The number, type and combination of medications can affect a person’s balance, perception and reaction time. Medications should be checked for side effects listed like lightheadedness or dizziness as these drugs could contribute to the potential for a fall. Check regularly for expiration dates, and be aware of possible complications from polypharmacy-the use of multiple medications that may interact.

Corman suggested that all medications be placed in a plastic bag and brought to a physician or pharmacist for review.

Support System
Stanford established the Farewell to Falls program in 2005 to assess potential trouble spots for seniors at risk for falling. The home-based program, free for Santa Clara and San Mateo county residents 65 and older, provides two home visits from an occupational therapist who evaluates the home for potential problems, performs a sensory-motor review and does a health risk interview. The therapist then offers individualized suggestions and a review of medications from a pharmacist. Participants also receive an exercise video to help improve strength and balance.

In addition to the home visits, participants receive periodic follow-up phone calls from volunteers to see how they’re doing. One year after the start of the program the occupational therapist returns to reassess the risk factors and to provide additional fall prevention tips.

“We’re hoping that seniors take advantage of this opportunity to participate in a program that can help them to maintain their independence,” said Corman, who added that more than 200 people take part in the program each year.

About the Speaker
Ellen Corman is the Injury Prevention Coordinator in the Trauma Service at Stanford Hospital & Clinics and has been involved in injury prevention activities for more than 20 years.

She is an occupational therapist and has a master’s degree in rehabilitation administration. Corman participated in the California state injury prevention strategic planning workgroup and is an active member of the California Stop Falls Network. She developed and manages the Stanford Hospital & Clinics Farewell to Falls program and co-chairs the San Mateo County Fall Prevention Task Force.

For More Information:

Stanford Health Library can do the searching for you. Send us your medical questions.

Stanford Hospital & Clinics Farewell to Falls

Centers for Disease Control

Fall Prevention Center of Excellence

American Geriatrics Society

Celiac Disease

Posted By SHL Librarian

Presented by: Nielsen Fernandez-Becker, MD, PhD
Instructor, Gastroenterology
Stanford University Medical Center
March 11, 2010

Lecture Overview:

  • Celiac disease is a digestive condition caused by eating gluten, which is found in wheat, barley, or rye. It affects the small intestine’s ability to absorb nutrients.
  • Its cause is unknown and may be a combination of genetic, environmental, and immune system factors.
  • Diagnosis may involve a blood test, intestinal biopsy, and a dietary assessment while still consuming gluten products.
  • The only effective treatment is to remove gluten from the diet.

Celiac disease is a digestive condition triggered by eating gluten, which is found in foods containing wheat, barley, or rye. These ingredients cause an immune reaction in the small intestine, damaging its surface in a way that interferes with the absorption of important nutrients. Over time, this decreased absorption can cause vitamin deficiencies that affect the brain, nervous system, bones, liver, and other organs.

About 2 million people in the United State have the disease-one in 133 individuals. That number increases to one in 22 people when there is a first-degree family member with celiac disease. Though common, its symptoms can mimic other conditions, such as irritable bowel syndrome, gastric ulcers, Crohn’s disease, infections, or anemia.

There is no one cause of celiac disease, though two specific genes have been associated with the condition. One or the other of these genes-DQ2 and DQ8-are present in more than 95 percent of celiac disease patients, although they also appear in 20 to 30 percent of the population who show no symptoms.

“Having one of these genes does not necessarily mean you will have celiac disease but that you may be at a higher risk,” said Nielsen Fernandez-Becker, MD, PhD, at a presentation sponsored by the Stanford Health Library. “It’s a combination of genetics, an immune system defect, and the environment-in this case exposure to gluten,”

The small intestine is lined with tiny, hair-like projections called villi that absorb vitamins, minerals, and other nutrients. Normally, villi look like a plush carpet inside the small intestine; celiac disease can be patchy, like a mosaic pattern, with scalloping of the intestinal lining, nodules, and ulceration.

Initial symptoms can range from abdominal pain to diarrhea, vomiting, constipation, and weight loss. In time, due to the loss of calcium and Vitamin D, patients may suffer from bone disease, fatigue, anemia, arthritis, rashes, and other complaints. Because of its wide range of symptoms, there are five different classifications of celiac disease, from classic conditions to no response to treatment despite a positive blood test.

Diagnosis often involves a blood test to measure certain immune system antibodies involved in modification of gluten peptides; high levels aid in the diagnosis of the disease. Intestinal biopsy is the “gold standard” to confirm a diagnosis. A trial of a diet containing gluten in patients who have been abstinent can also be used to confirm a diagnosis.

“Celiac can sometimes be tricky to diagnose because its symptoms can be non-specific. We often use a variety of tests before we can be certain its celiac disease. To diagnose accurately, the person must be consuming gluten,” said Fernandez-Becker. “Once gluten is out of the diet the intestine begins to heal, making it difficult to detect the disease in someone on a gluten-free diet.”

The only effective treatment for celiac disease is to remove gluten from the diet-that means no pasta, crackers, bread, or beer. There are also “hidden sources” of gluten: It can be used in soy sauce, vinegar, processed foods, and even some shampoos and lotions. Even a small amount of gluten is enough to cause symptoms and complications, she said, so read labels carefully.

“It’s difficult to follow this kind of diet, because gluten is often a hidden ingredient,” said Fernandez-Becker. “Patients benefit from seeing a specialist to evaluate what they’re eating. It involves a lifelong lifestyle change.”

She suggests that celiac patients keep products clearly marked and separate in the pantry to avoid cross contamination. Many people check directly, and regularly, with manufacturers to see if a product contains gluten. Once gluten is eliminated, inflammation in the small intestine will begin to subside, usually within several weeks, and many people notice improvement in just a few days.

About the Speaker
Nielsen Q. Fernandez-Becker is an instructor in gastroenterology and is Board Certified by the American Board of Internal Medicine. She received her medical education at Albert Einstein College of Medicine in New York, did her residency and internship at Massachusetts General Hospital, and completed her fellowship at Beth Israel Deaconess Medical Center. She joined Stanford in 2009.

For More Information:

Stanford Health Library can do the searching for you. Send us your medical questions.

About Dr. Fernandez-Becker

Gastroenterology at Stanford Hospital

The Division of Gastroenterology and Hepatology

Celiac Disease Foundation