Last October, Jeanette Mariani was an independent 87-year-old, living alone in Dallas and getting around with a walker. Then one night she switched off the light and tried to make her way into bed. A chair was in the way. And she fell.
"There I was, lying on the floor," she recalled. "I pulled down one of my pillows. I didn't reach very high, just pulled it down, put my head down on it and thought: 'Well, I'll wait until morning.' "
The next day, she called for help.
A fall from a chair or a bed may not seem like a death sentence — but for an older person it can be. Falls are the leading cause of death from an injury for older Americans. For women, it's especially bad: Three quarters of those with hip fractures are women. For many, the broken hip starts a chain reaction — usually because older people also suffer from underlying conditions such as diabetes, arthritis, hypertension or dementia.
Every moment counts after a fall, says Dr. Amy Moss, an assistant professor of geriatrics at the University of North Texas Health Science Center in Fort Worth. When you're bedridden or hospitalized, your odds of developing everything from bed sores to pneumonia increase dramatically.
Studies show that delaying surgery after a fracture for just 24 hours increases the chance of complications and death. "The most common scenario is they die of pneumonia after a hip fracture," Moss says.
After spending the night on the floor, Jeannette Mariani called her daughter Janet, who took her to the hospital.
"After her fall, I knew that she was going to decline," Janet said. "You had that sixth sense, you know."
That sixth sense is backed up by real numbers. Almost 1 out of 10 people over the age of 50 will die within a month of surgery for a broken hip. That rises to 1 in 5 if the patient already has an acute medical problem.
Jeanette worked hard in rehab to become stronger, but underlying health problems caught up with her. Previous lung problems got worse, and her lymphoma returned.
"After she left the hospital, she died within a month," Janet said.
More than 90 percent of hip fractures are caused by falls. But falls can be prevented. Common-sense steps like removing rugs, installing better lighting, and getting an updated prescription for your glasses are a good start. So is addressing the physical and psychological side to falls. It might sound silly, but it turns out that people who are afraid of falling are actually more likely to fall.
Nine years ago, Joyce Powell was in hospital, on her way to the bathroom, when she fell and broke her hip. She recovered, but she hasn't gotten over the fear of falling.
"It stays with you," says Powell, who is 80 and lives in Arlington, Texas. "You're aware that you can't function like you once did."
That's why Powell attends a fall-prevention class at the University of Texas, Arlington — not just to get stronger but also to face her demons. Participants are in their 70s, 80s and 90s, and their workouts involve everything from balancing on exercise balls to playing Wii games.
"The greatest predictor of a future fall is a previous fall," says Chris Ray, director of the Center for Healthy Living and Longevity at UT-Arlington.
The greatest risk for older people who've fallen is that they'll simply stop exercising, Ray says.
One of the keys to preventing a fall is improving balance. As we age, Ray says, natural changes make it hard to stay upright: changes in hearing, vision and proprioception — the awareness of where one's body is in space. If seniors can learn to use these senses better, they will be less likely to fall.
To help them learn, Ray tests them using something that looks like a photo booth at an amusement park. The machine assesses how well someone can use the senses to maintain balance. The walls shift, the screen changes, and the floor tilts.
"In daily life, when we see seniors who fall, it's usually during multitasking," Ray explains. "We pipe in loud noises, city sound or music, pipe in visual distractors on the screen or a test on the screen, as they're trying to maintain their postural control while the walls are moving in concert."
The goal, Ray explains, is to identify the best intervention for each individual. For some, a regimen of tai chi might be enough. For others, it might be weightlifting or even practicing walking with their eyes closed.
For Joyce Powell, the exercise classes have made her more confident in getting around and traveling. Still, she's cautious. "When I walk, I look to see where I am, particularly if I'm on uneven ground," she says.
Freedom from falls is never guaranteed. But dedication to an exercise program can help seniors keep their balance without giving up the activities they love.
"It's one of the things I've learned you just have to do in order to protect yourself to remain upright," Powell says. "I guess I could use a walker to do it, but I don't want to. I want to be free."
STEVE INSKEEP, HOST:
Today in Your Health, 1 of every 5 people who breaks a hip after age 50 dies within a year. It's not the fall that kills people. It's the complications that come after. We have the stories this morning of two women who broke their hips - one who died and another who recovered by facing her fears. Lauren Silverman, from our NPR member station KERA in Dallas, has the story.
LAUREN SILVERMAN, BYLINE: Last October, Jeanette Mariani was an independent 87-year-old, living alone in Dallas and getting around with a walker. Then one night she switched off the light and tried to make her way into bed. A chair was in the way and she fell.
JEANETTE MARIANI: And so there I was, laying on the floor. I pulled down one of my pillows - I just pulled it down and put my head down on it and thought well, I'll wait until morning and ask for help.
JANET: Can you imagine? It's every nightmare.
SILVERMAN: That's Jeanette Mariani's daughter Janet.
JANET: Your mother lays on the floor all night and doesn't push her button (laughter). Who would've thought, my mother?
You know, when I thought about it, my mother just doesn't inconvenience others. She thinks about others before she thinks of herself.
SILVERMAN: A fall from a chair or a bed may not seem like a death sentence, but for an older person it can be, especially for women, and for many, the broken hip comes on top of other health problems.
AMY MOSS: Someone in their 30s and 40s that breaks their arm or breaks their ankle really has the ability to overcome that. As we age we don't have that, you know, store of ability to overcome that injury because we have other diseases and things that have happened to us that make it much more difficult.
SILVERMAN: Dr. Amy Moss is an assistant professor of geriatrics at the UNT Health Science Center in Fort Worth. She says every moment counts after a fall.
MOSS: They're losing muscle strength every day. It's estimated that for every day they lay in bed they lose three days of function. So you have someone who's been virtually bedbound for seven to nine days, you know, we're half a month in of loss of function.
SILVERMAN: When you're bedridden or hospitalized your odds of developing everything from bedsores to pneumonia increase dramatically.
MOSS: The most common scenario is they die of pneumonia after a fall with hip fracture. And even though we know that and we do our very best to implement preventative strategies, many patients will succumb to that.
SILVERMAN: Jeanette Mariani died in December, just to two months after she fell, and that didn't really surprise her daughter Janet.
JANET: After her fall, I knew that she was going to decline. You had that sixth sense.
SILVERMAN: Mariani worked hard in rehab to become stronger, but her previous lung problems got worse, her cancer returned and she became a statistic.
JANET: After she left the hospital, she died within a month.
SILVERMAN: More than 90 percent of hip fractures are caused by falls, but falls can be prevented. Common sense steps, like removing shag carpets, installing better lighting and getting a new pair of glasses are a good start. So is addressing the physical and psychological side to falls...
UNIDENTIFIED WOMAN: All right, so now what we're going to do is a toe touch.
SILVERMAN: ...Which is what this group of Texans in their 70s, 80s and 90s are doing at the University of Texas at Arlington. Their workouts incorporate everything from balance balls and yoga stretches to Wii games.
JOYCE POWELL: I'm Joyce Powell from Arlington, Texas.
SILVERMAN: Powell was 71 when she fell and broke her hip on the way to the bathroom. She was inside a hospital. And although she recovered, the fear of falling never left.
POWELL: It stays with you once you've gone through something. The memory of it sort of keeps pegging away at you and you don't risk things like you used to.
CHRIS RAY: The greatest predictor of a future fall is a previous fall.
SILVERMAN: Chris Ray is leading efforts at UTA's Center for Healthy Living and Longevity. He says for older people who have fallen, the greatest risk is they'll still stop exercising altogether.
RAY: You know, as we age, if we were walking out on an icy sidewalk, we decide we're not going to walk out on icy sidewalks anymore. And that's a very appropriate selection, but if we don't replace that then we see a decline of strength, neurological, eventually cardiovascular, pulmonary, you know, all these systems start to decline. And eventually that has a very compounding effect.
SILVERMAN: One of the keys to preventing a fall is improving balance. As we age, Ray says, natural changes make it hard to stay upright, changes in hearing, vision and proprioperception - that's what you feel in your hands and toes. If seniors can learn to better use these senses they'll be less likely to fall. [POST-BROADCAST CORRECTION: we refer to proprioception as what you feel in your hands and toes. It's actually the body's sense of where it is in space.]
RAY: If we line them up appropriately on this force plate and then what happens is...
SILVERMAN: Ray is standing in what looks like a photo booth, except there's no seat. Your feet are on a square, metal plate that looks like a bathroom scale. The walls shift, images flash on a screen in front of you, the floor tilts. Think of it as something you might find in a carnival fun house, only with sensors to record your balance and stability.
RAY: In daily life, when we see seniors that fall, it's usually during multitasking. And so what we'll do in here is we'll re-create that, so we can either pipe in loud noises, city sounds or music. We can pipe in visual distractors on the screen. Or we can even have them take, like, an IQ type test or a distractive type test on the screen as they're trying to maintain their postural control, potentially with the walls moving in concert.
SILVERMAN: The goal, Ray explains, is to identify what makes someone unsteady and then select the best physical exercises to counter that. For some, it might be a regimen of tai chi, for others, simply walking or practice standing on one leg. Studies show exercise can prevent falls in older people. And Joyce Powell, who fell almost a decade ago, says she's felt more confident getting around since she started classes. Still, she's cautious.
POWELL: I have to be very, very careful, particularly when I get up from being seated. I have to stand for a few minutes to get balance. When I walk, I look to see where I am, particularly if I'm on an uneven ground. And that's one of the things that I have learned that you just have to do in order to protect yourself to remain upright. I guess I could take a walker and do it, but I don't want to. I want to be free.
SILVERMAN: Freedom from falls is never guaranteed, but exercise programs can help seniors keep their balance without giving up the activities they love. For NPR News, I'm Lauren Silverman in Dallas. Transcript provided by NPR, Copyright NPR.