Preventing falls: Milwaukee VA tackles major concern for older adults

“I needed balance,” he said, noting problems with his nerves, side effects of medication and a sedentary lifestyle brought on by the COVID pandemic. 

So he turned to tai chi, offered through the Milwaukee VA’s Whole Health program. Tai chi and qigong are low-impact exercise routines especially helpful for older folks. The classes are offered in-person and virtually a few times each week, not only in Milwaukee but also through outpatient clinics.

Bennett’s been doing the classes for a couple of years, and they’ve helped improve his balance.

“It’s made a major difference,” he said. “It’s not perfect, but if I lean over, or I feel I’m about to fall, I know how to adjust my body so I don’t fall. I’m a lot better. I’m proud of my balance.”

Realizing the dangers of falling, and taking steps to prevent falling, like Bennett has done, are major concerns for all people as they age. And preventing falls is an ongoing focus in the Milwaukee VA Medical Center.

Falls: a growing problem

According to Milwaukee VA physical therapist Melanie Schultz, falls are a big problem for the elderly. A recent article in the Milwaukee Journal Sentinel noted that 21% of all 911-related calls in Wisconsin in 2024 were for falls. And that number has been rising consistently since 2019.

The Centers for Disease Control reports that every year, 1 in 4 older adults (over age 65) experiences a fall, and that falls are the leading cause of injuries (fatal and non-fatal) among older adults.

While not all falls result in injuries, falls are the leading cause of injury-related death among older adults, the CDC said.

Falls can do more than just cause physical damage: They can reduce quality of life, put more stress on the patient and family and lead to lengthy hospital stays.

Why do so many older adults fall? There are numerous reasons, but one reason is overconfidence: A person feeling unsteady may think they can make it to the door or the bathroom, or don’t believe that a throw rug or dog toy on the ground poses a threat.

“Your balance gets worse as you get older, so it’s really important to work on that,” Schultz said. “But not everyone wants to hear that, so they don’t take the action needed to (prevent falling).”

Medications — as was the case with Bennett — can upset a person’s equilibrium or sensations in the feet and legs.

Changes in vision can also lead to a fall if the person doesn’t have the right prescription for glasses/contact lenses. Bifocal or progressive lenses can sometimes make things seem closer or farther away than they really are, according to the CDC.

Take action to prevent falls

“There are a lot of good programs out there that help with fall prevention, but you have to be willing to participate in them,” said Schultz, who will help lead a falls prevention program beginning at noon Oct. 15 in Matousek Auditorium at the Milwaukee VA Medical Center. The program will include tips for preventing falls as well as instruction in basic tai chi and qigong movements that can help improve stability and balance.

Being physically active is key to preventing falls.

“As we age, it’s important to keep moving,” said Sue Kautz, falls performance improvement coordinator for the Quality, Safety and Value department in the hospital. “The worst thing we can do is just sit in a chair.”

Kim Gebauer, safe patient handling and mobility program manager, agreed.

“One of my favorite phrases is: Movement is medicine,” she said.

And that’s where activities such as tai chi can be valuable.

During tai chi, participants work on stability and shifting their weight from one leg to the other, said Stacy Olson, Whole Health program manager.

“This helps prevent falls, with patients being more intentional and more aware of their movement,” she said. “And it helps strengthen the lower extremities and overall sense of balance.”

Being safe at home

To prevent falls in the home, Schultz recommends:

• Adding grab bars in bathrooms and railings for stairs.
• Making sure lighting is adequate throughout the home.
• Removing clutter, throw rugs and other tripping hazards.
• Placing colorful strips of fabric on the edges of stairs.
• Wearing shoes in the house because they protect the feet and give a person a better sense of landing.
• Having a chair in the bedroom for dressing

She also said older people often need more time to adjust from lying down to sitting, or from sitting to standing. Falls often occur when someone is getting out of bed to go the bathroom, she said; they may be halfway to their destination when they suddenly feel lightheaded and fall.

And it’s a good idea for people to consult with their doctor, who can screen for increased risk of falling, including a review of medications and evaluation of balance and strength.

Schultz admitted that sometimes patients can be stubborn, insisting they don’t need a walker or refusing to exercise.

“We try to educate them and give them the assistive devices to make them as safe as possible,” she said, noting that she emphasizes quality of life in her recommendations.

“If spending time with your grandchildren is important, then you need to build your balance so you’ll be able to play with them without worrying about falling,” she said.

Falls in the hospital

Patients admitted to the hospital are often at risk of falling as well because they don’t comprehend that they are “not at their normal level of function,” Schultz said.

“They’re often a lot weaker than they are at home — and they don’t realize that they’re not able to do everything they normally can — so we ask them to call for help or we make sure their walker is nearby so they remember to use it,” she said.

Gebauer agreed.

“When patients lie in bed too many days in a row, they get debilitated to the point where they’re losing muscle mass,” she said, noting that such changes start after 24 hours.

And it’s easy for patients to overestimate their abilities, said Ruth Kunich, clinical performance and excellence coordinator, who’s part of the Milwaukee VA’s falls and mobility committee.

“One day in the hospital already starts the decline,” she said. “Plus there’s a pride issue; people want control and want to be self-sufficient. They may say, ‘Oh, it’s only from here to the bathroom; I can make it,’ but they’re not the same person they were when admitted.

“But something as simple as a cold can decrease a person’s ability to get up and walk around, and that might even cause some mental decline, and then they don’t understand that they’re not at the same level as they had been before,” she said.

Keep moving

The falls and mobility group annually hosts a falls symposium, where representatives of different units share proven strategies for reducing falls. There are also demonstrations on fall recovery, assistive equipment and patient handling.

“It’s a celebration of the hard work that’s being done in the hospital,” Kunich said, noting that each unit in the hospital has at least one “falls champion.”

“Some areas have made a significant difference in decreasing their falls, and we have seen everyone rallying in this effort,” Kautz said.

The group has set goals for certain units, such as making sure patients are up for meals three times a day.

Most inpatients are encouraged to get out of bed and walk if possible, even if it’s just a few feet to sit in a chair for a while. 

“That’s one of the most beneficial things you can do for people in the hospital,” Schultz said. “By sitting upright, you’re using a lot more muscles, and that helps everything function better.”

There’s also the STRIDE program, Gebauer said, which is designed to keep patients moving so they don’t lose their strength.

“During admission, we let patients know that they need to stay up and active as much as possible,” Kunich said.

Falls have decreased in the hospital

There has been a 5% decrease in the number of falls over the past year, Kunich said. She attributed that success to more people being involved with the falls and mobility group and more awareness of the problems that falls create.

“We’ve definitely put more resources behind this as a facility,” Gebauer said.

Kunich agreed.

“You don’t have just one person looking at one thing,” she said. “You’ve got a team of people that consciously watches the projects. We give input. We give advice. We keep the momentum going. We keep our eye on the ball.”

“Falls is not a one person or one group committee,” Kautz said. “This is a system initiative. It is the duty of everyone who walks in a hall to help prevent falls. We’re not asking people to put their hands on people; we’re asking you to be aware of your surroundings and be willing to call for help.”