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The Unintended Consequences U
nder normal circumstances, an older adult is treated every 11 seconds in an emergency depart-
ment (ED) because of a fall, according to the National Council on Aging. These are not normal circumstances. Older adults are most vulnerable to com-
plications from the COVID-19 pandemic. They are also among the most compliant with social distancing guidelines. Avoiding infection is important, but you
must also consider the unintended conse- quences of social distancing on older adults. While there are many, one of the most sig- nificant and manageable consequences is a further heightened risk of falling. Older adults who fall while social distanc-
ing often end up in the exact place they were trying to avoid: the hospital.
Fewer direct care options The people older adults rely on to help manage their fall risk—sons, daughters, grandchildren, and caregivers—are less available. Many older adults are also un- comfortable going to the office of a health care provider now. Recent reports, such as one by the Knight Family Foundation, show that telehealth isn’t a feasible option for many older adults either. Medical professionals adept at managing
fall risk, i.e., physical and occupational therapists, are more effective in person. Home-based services should be a strong consideration for older adults in order to balance the unintended consequences of social distancing with infection risk. Ultimately, the risk is lowest when an
older adult is seen at their residence by a professional adhering to infection control protocols.
Reducing risk while distancing A professional journal review shows active older adults are 57 percent less likely to visit the ED and 86 percent less likely to be hospitalized. Falls are one of the pri- mary drivers of hospitalizations in older adults. Being more active reduces fall risk, which lessens the chances that your patient, mother, father, or grandparent will be to be admitted to the hospital. So how do physical, occupational, and
speech therapists make sure older adults stay active and reduce their fall risk during a time of social distancing? We keep them strong. Muscular weakness
and slowness of movement are highly as- sociated with falling. During normal life— taking the stairs, going shopping, attending social events—everyday movement main- tains some degree of muscular strength and speed, which are protective to some degree. Social distancing takes many of those
opportunities away. Older adults who rely on these activities are pushed closer to the point of falling very quickly. We safely challenge their balance systems.
The body has an incredible inherent ability, if properly challenged, to learn new motor patterns and recover others believed to be lost. Once medical conditions and other risk factors are considered,, older adults learn new movement skills the same way the younger of us would. Repetitive practice that is guided, graded,
and challenging will improve the connection between the muscles, nerves, and balance systems and reduce rate of falls by 23 percent says, a University of Sydney study says. We maintain their flexibility and posture.
More sitting within a consistent environ- ment encourages tighter muscles and poorer posture. Many of us can identify with these
28 SENIOR LIVING EXECUTIVE NOVEMBER/DECEMBER 2020
issues, as we work in less-than-ideal home setups during the pandemic. However, the repercussion for the young-
er of us usually stops with musculoskeletal pain. For older adults, it is not only pain but heightened fall risk, from tightness in the foot, ankle, hip, or trunk, and a posture that is flexed forward, often to the point of increasing risk of falling forward while walking. We reduce the likelihood of pain. Osteo-
arthritis (OA) is among the most common conditions in older adults. With reduced activity, older adults will oftentimes experi- ence increased OA pain. Professionals can use joint mobilizations, among other tech- niques, to provide considerable pain relief. Family members or caregivers may want to try heat, ice, and other modalities. We reverse cardiovascular deconditioning.
Poor cardiovascular function is a risk factor for falls. Physical and occupational thera- pists are trained and well-equipped to safely and appropriately challenge the cardiovas- cular system in older adults—including those with diabetes, high blood pressure, congestive heart failure, Parkinson’s disease,
of Social Distancing on Older Adults By William Dieter, PT, DPT, GCS, FSOAE, Director of PT Clinical Services, FOX
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