FIRST IN A TWO-PART SERIES

ONE in three adults over the age of 65 will take a tumble this year, and up to a third of those fall victims will suffer moderate to severe injuries that will either limit their mobility, affect their ability to live independently or increase the likelihood of an earlier death, according to the U.S. Centers for Disease Control and Prevention.

In Hawaii, the number of fall-related injuries spikes during the summer lychee and mango season, said Stan Michaels, injury prevention coordinator at the state Department of Health.

"If people would stay off the roof and out of the trees, it might help. They have been harvesting their fruit for 30 to 40 years and their ladder is as old as they are," he said. "It’s OK to harvest your own fruit but find someone to help.

"We stumble a lot as humans, but it’s easier to catch ourselves as a young person. We don’t bounce anymore after the age of 65."

Hawaii’s growing population of aged residents and the incidence of fall-related ambulance calls and emergency room visits all demonstrate the need to educate seniors and caregivers about fall prevention, experts said.

The cost of treating elderly fall victims in Hawaii is estimated at $91 million annually, Michaels said.

Health Department epidemiologist Dan Galanis said falls, by far, are the leading cause of injury-related deaths among isle seniors (45 percent) followed by suffocation (12 percent), suicides (11 percent) and pedestrian crashes (7 percent). It’s also the second leading cause of traumatic brain injury among the elderly.

"For fatal falls, male victims outnumber females until about age 80 and have higher mortality rates," Galanis said. "For nonfatal injuries, it is the reverse. Females constitute two-thirds of all senior-aged patients with injuries from falls and have higher morbidity rates."

Dr. Jason Chang of the Rehabilitation Hospital of the Pacific said traumatic brain injuries, spinal cord injuries and fractures of the hip, pelvis, ankles and forearm are the most common injuries associated with falls. For many victims, those injuries lead to graver outcomes.

A quarter of elderly patients injured in falls die in less than a year, typically due to complications including thrombosis, pneumonia, wound infections and bedsores, he said.

"Depression, pain, isolation and a loss of independence are also significant causes of morbidity," said Chang, a physiatrist, or rehabilitation physician, and director of medical education at the rehab hospital.

FALLS ARE OFTEN due to hazards in the home that went unnoticed but are easy to fix. Chang said the risk can be reduced by eliminating unnecessary medications that may impair one’s cognition or balance, and by in-home evaluations that can assess whether grab bars or ramps are needed and whether rugs or furniture that can interfere with balance or trip seniors should be removed.

Chang also advises exercise to maintain strength and mobility, and proper use of assistive devices such as walkers and canes.

By making simple changes in the home, the odds of falls can be decreased. For example, "everyone loves rugs, but they are a major trip hazard," said Wendy Kondo, an occupational therapist at Rehab at Nuuanu, the hospital’s outpatient clinic. If rugs are placed in the home, double-stick tape should be positioned on the edges or floor-gripping mats placed underneath to prevent slips and falls.

Removing clutter is another good idea, along with arranging furniture to create wide passages.

Seniors also may want to adjust the seat height of their favorite chair. "The height should be above 19 inches so it’s easier to get up and down," Kondo said. "If a person’s legs dangle, they can put their feet on a stool. They also don’t want something too cushioned and soft. Something with arms is nice and it helps to have a lamp within arm’s reach."

Chairs should not have swivels or wheels.

The most dangerous room in a home is probably the bathroom, according to Kondo. "Tubs can be slippery and there are lots of hard surfaces to hit the head," she said. To be safer, remove throw rugs, use a shower curtain instead of a glass door, and make sure the bathroom has a wide entrance.

Raised toilet seats, which can be purchased at Longs Drug Stores, Walgreens and other stores, add about 4 inches of height, making it easier to get up and down.

Bars, a shower hose and chair provide added safety in the shower or tub, and those needing the wash basin may prefer a pedestal sink or other model that provides room for sitting.

In general living areas, tile is better than carpet if the occupant uses a wheelchair or walker. Electrical cords should be out of the way, and Kondo suggested keeping a cordless phone at your side while watching TV, reading or doing other things so you don’t have to rush to get to the phone, risking a fall.

Steps should have nonslip strips, and any tricky spots in halls and walkways can be highlighted with good lighting or brightly colored tape.

"A motion-sensor night light or automatic light that doesn’t need to be left on all of the time is a good choice," she said.

In the kitchen, frequently used items should be placed in top drawers or left on the countertop. "It’s a fall hazard if we have to reach too high. Heavy pots and pans should not be placed on the lowest shelves because they are hard to lift," Kondo said.

Tomorrow: Fall-proofing your body through balance training.