Harbachan Kaur Mudhar was taking a shower when her knee gave out and she suddenly found herself sitting in her bathtub, her leg bent in a peculiar way.
“I saw my leg in a different kind of position and shape,” she said. “And I thought, ‘Here we go.’ ”
There was no pain, until the paramedics came to lift her out of the tub. Then there was a lot of pain.
Surgeons at the Lakeshore General Hospital installed a metal rod to repair her fractured femur in late October. After a week, she was transferred to a rehabilitation centre in Côte-des-Neiges where she will have to live for another five weeks, undergoing two physiotherapy sessions a day. Doctors estimate a full recovery will take three to six months.
For the active 73-year-old who used to keep busy by driving other seniors to their medical appointments, the change has been abrupt and destabilizing. She said she feels fortunate to be convalescing under excellent care, but worries about her 81-year-old husband fending for himself at their home in Kirkland.
Many seniors who suffer a fall are far less fortunate, and experts worry that the confining nature of the COVID-19 pandemic will lead to an increase in incidents. Falls are the No. 1 cause of injuries among those 65 and over, accounting for 61 per cent of injury-related deaths and 81 per cent of injury-related hospitalizations in Canada. November has been designated Fall Prevention Month to bring attention to the scope of the issue — there are close to 5,000 deaths each year linked to seniors’ falls, and nearly 100,000 hospitalizations. The non-profit prevention awareness group Parachute estimates the cost at $5.6 billion a year. And with the ice and snow season officially underway, there is a need for heightened vigilance.
In Montreal, roughly 275 seniors die every year due to complications resulting from a fall, and 6,800 are hospitalized, studies from the city’s public health department show.
“Depending on the gravity of the fall, it can result in major head injuries, or fractures that lead to paralysis of the lower or upper body,” said Barbara Fillion, an occupational therapist with Montreal’s public health department and the CIUSSS Centre-Sud-de-l’Île-de-Montréal regional health authority. The injuries can require months of rehabilitation, and cause a loss of mobility, constant pain and a lack of appetite.
“Not all seniors have the reserves to get past that,” Fillion said. “It’s devastating for the patient, but also for the family and other loved ones.”
Seniors are susceptible because aging can affect mobility or balance. They have less muscle mass and their reaction times get slower. Often they are on medication that can affect balance or are suffering from issues like low blood pressure or a cardiac condition.
Among the greatest causes of falls is the worry they will happen.
“I see a lot of fear of falling,” said Daniel Badra, physiotherapist at the Institut de réadaptation Gingras-Lindsay-de-Montréal rehabilitation centre in Côte-des-Neiges, where Kaur Mudhar is being treated. “We try to teach patients not to be overly afraid, because sometimes they get too scared to go outside, they become inactive all of a sudden, and that actually increases their risk of falling in the future.
“Maintaining an active lifestyle and social involvement is much more important for their well-being than avoiding activity.”
Health experts say the number of falls likely increased during the pandemic because many seniors were not able to leave their homes or attend exercise classes, affecting their mobility and balance.
January and February see a spike in hospitalizations for hip and pelvic fractures related to outdoor tumbles, notes Dr. Élise Lapointe, a family physician at the Gingras-Lindsay rehabilitation centre. Recovering involves weeks of pain and painkillers as the bones slowly fuse together and muscles rebuild. Patients are bed-bound for weeks.
“It can change people’s lives,” Lapointe said. “Some go home but they still need help with bathing, or need prepared meals. They can’t cook as much for themselves.”
Prevention is the best cure, experts say. Decluttering homes, removing hazards like throw rugs and extension cords, and installing stability bars are recommended. Above all, seniors should try to keep moving as much as possible.
“If they can take a daily walk, that is excellent,” Fillion said. “But they can also do exercises at home to increase their strength in their legs, and to improve balance.”
One of the first things Kaur Mudhar plans to do when she returns home is install grab bars and put a chair in the bathtub. She’s scheduled to return on Dec. 1. After a month in rehabilitation she’s able to go to the washroom and shower on her own again. And put on her socks.
“I’m trying my best,” she said. “But only time will tell.”
How to prevent falls
Occupational therapist Barbara Fillion and Montreal’s public health department recommend the following to reduce the chances of a fall:
- Declutter the living space by removing unnecessary objects, throw rugs or furniture that can be tripped over.
- Install safety bars in bathrooms and in bathtubs, where damp floors are a hazard.
- Ask local health authorities to do a home safety check.
- Check the medications a senior is using to make sure they’re still necessary. Many can interfere with mobility or balance, and often seniors will take the same medications for many years without checking if they still need them.
- Provide clear lighting in all sections of the home.
- Carpet wooden stairs, that can be particularly slippery, and ensure there are handrails.
- Have a vision check done.
- Remain as physically active as possible — exercise aids strength and balance.
- Eat well — reduced consumption leads to less muscle mass, which reduces balance and makes falls more serious when they occur.
- Wear winter boots with a good non-slip sole.
- Avoid wet leaves, they can be slippery.
- In winter, walk like a penguin — slowly, with small steps, almost dragging your feet, feet slightly turned out and apart, and arms out of pockets to aid with balance. (“This isn’t just for seniors,” Fillion said. “I’m 41 and I do it when conditions are slippery. And I tell my children to do it, too.)
- Break isolation, and find community resources that can offer support.
Online resources for fall prevention tips and exercise programs
- Montreal’s public health department has its own guide on preventing falls that can be found at santemontreal.qc.ca/en/public/advice-and-prevention/seniors-fall-prevention/
- The public health department also offers the Stand Up program designed for people 65 and over afraid of falling. It includes in-person classes to improve balance and co-ordination and increase leg strength, among others. Ask at your local CLSC for local programs. The in-person program is on hold due to the pandemic, but an online version called Walk to the Future can be found, in French, at www.cnfs.ca/marche-vers-le-futur
- Physical activity for seniors — Montreal’s public health department has a series of exercise videos to improve strength, balance and mobility, designed for five different fitness levels, called Le Go pour Bouger! program. It can be found at santemontreal.qc.ca/en/public/advice-and-prevention/physical-activity-for-seniors/#c38831
- Keep On Keep Up (KOKU) — a free application developed by the University of Manchester, is a digital strength and balance program that gives different exercises that can be done each day, in a fun animated video format. The difficulty level of exercises increases as the user progresses. At kokuhealth.com/
- Parachute — This internet site developed by the non-profit safety promotion group Parachute offers several tools, videos and resources for the aged or their loved ones. It also offers aid to caregivers on how to motivate seniors to exercise. The site can be found at parachute.ca/en/injury-topic/fall-prevention-for-seniors/
Correction: An earlier version of this story misquoted occupational therapist Barbara Fillion’s advice for walking like a penguin. She said it is not just for seniors.