The high costs of falling

Prevention and education can significantly reduce the risk of falls

A single fall can derail a carefully planned retirement. Advisors can learn the facts about seniors and falling, and how to make their offices — and their clients’ retirement plans — more resistant to falls.

Dawn Hawley was working closely with a client on the cusp of retirement. She had helped him with the sale of his business, where he stayed on for a year after the sale to manage the transition. He and his wife had just purchased an RV, and were looking forward to a retirement filled with travel.

And then, a few months before he was set to retire completely, the client fell down the stairs of his two-storey home and broke his back.

“He was home alone, and he fractured a couple of vertebrae, and he lay on the floor at the bottom of the stairs for 17 hours until someone showed up,” recalls Hawley, a CFP and RFP at the Angus Watt Advisory Group at National Bank Financial in Edmonton. Although the client was supposed to be on the benefits plan of his company’s new owners, the forms had never been filled out: “He had no disability insurance, no accident insurance and no benefits.”

The man became a quadriplegic. His home had to be completely renovated, with a ground-floor bedroom and a wheelchair-accessible shower installed. Neighbours and friends held fundraisers to help the couple purchase a new vehicle and other equipment. “There was so much difficulty, not to mention financial strain, in adjusting to this new way of life,” says Hawley. “Their dreams just fell apart in the split second it took for him to fall.”

Hawley’s story is extreme, but it drives home an important point: falls are a significant health risk for seniors, with potentially devastating financial, emotional and practical consequences. In its second report on Seniors’ Falls in Canada, the Public Health Agency of Canada reports that:

• Between 20% and 30% of seniors fall each year, with a higher prevalence of falls among older (80+) seniors.
• 215 older adults are hospitalized every day because of falls.
• Falls are the leading cause (approximately 85%) of injury-related hospitalizations among Canadian seniors.
• A senior hospitalized for a fall remains in hospital on average nine days longer than seniors hospitalized for any other condition.
• Seniors’ falls cost the economy an estimated $2 billion each year (3.7 times greater than for adults aged 25 to 64).
• More than one-third of older adults will be admitted to long-term care after being hospitalized for a fall.
• More than one-third of fall-related hospitalizations among seniors are associated with a hip fracture: falls are the direct cause of 95% of all hip fractures, leading to death in 20% of cases.

Falls can be caused by a variety of interrelated physical, environmental and behavioural factors, says Shirley Lee, a registered occupational therapist (OT) at Baycrest Health Sciences in Toronto. She’s part of a multidisciplinary team that works with seniors in the community to assess risk and minimize chances of falls.

As people age, says Lee, hearing and vision loss, as well as decreased strength and balance, can put them at increased risk for falling, as can several medications (and their interactions with each other). Environmental factors include trip hazards (like the edges of rugs, loose wires or electrical cords), staircases, inadequate lighting, clutter, wet or slippery floors, or snow and ice. And then there are the behavioural elements: maybe a senior doesn’t like to use a mobility aid like a walker, or risks climbing a step ladder to reach something on a high shelf rather than delegating the task.

Fear, says Lee, is a significant behavioural factor: one fall creates a fear of falling, so people will balk at doing an activity that they probably could do. This creates a vicious cycle where seniors become more isolated, less fit, less independent and more depressed, all of which, ironically, can put them at greater risk for falling.

The good news? The personal and economic costs of seniors’ falls can be greatly reduced through fall- and injury-prevention activities. Seniors can be referred by their doctors to programs like the one Lee works in, and can take steps (on their own and with caregivers and family members) to minimize the chance of falling. The Canadian Fall Prevention Curriculum website provides links and resources.

Likewise, says Lee, advisors can take these steps to reduce the risk of falls in the office (and at home):

• Make sure that hallways and high-traffic areas are free of clutter and trip hazards like scatter rugs or electrical cords.
• Ensure that corridors, doorways and paths to seating are wide enough for mobility aids like walkers and canes. Make it easy for all clients to walk directly to meeting areas and chairs.
• Ensure that walking areas are brightly lit; replace dim or burnt-out bulbs.
• Fall-prone seniors can struggle to get into and up from lower chairs: offer standard-height or slightly higher (at least 18”) chairs with arms, which provide extra leverage and support.
• Similarly, consider installing a higher toilet, or a riser for your office’s existing toilet, and make sure that bathroom floors are dry.
• Install a grip bar in the office washroom.
• Install handrails on stairwells; consider installing a stair glide or wheelchair lift if no elevator is available.
• Ensure that snow and ice are cleared from the outside entrance.

For Hawley—who in 2015 suffered a fall at the Toronto airport that resulted in a missed flight, a hospital stay, a broken ankle and a couple of months in a wheelchair—falls highlight the need for retirees to have an emergency fund of available capital to deal with the repercussions of unforeseen events, and for planners to build flexibility and adaptability into their clients’ plans. “Retirement planning doesn’t stop once you’ve retired.”

At a personal level, she now takes more time (“I was in a rush the day I fell”) and makes sure that she wears good footwear, especially when she’s travelling. “There’s no such thing as ‘a simple fall,’” she says. “They have profound consequences.”