Physical therapist expands practice to help those at risk prevent falls
By Kimberly Hundley
“I’ve fallen and I can’t get up” is no joke.
The line from the TV commercial for a medical-alert device has become a punch line over the years, but falling is a flesh-and-blood danger for older people. Injuries from falls rob many seniors of their independence, their mobility and even their lives.
After his own father fell three times within a week of getting out of the hospital, North Scottsdale physical therapist Sandy Goldstein was determined to create a one-stop solution for fall prevention: MEASURAbilities, his niche practice that measures people’s ability to perform and also gives them strategies and products to prevent falls.
“We are the only company that takes people all the way through. We hold their hand through identification of the problem to providing solutions, without them ever having to go anywhere else,” says Goldstein, who operates MEASURAbilities with his wife, Deena.
Though a vast amount of information on fall prevention is available, Sandy’s research revealed nobody was pulling it all together. Taking a comprehensive approach, Sandy created a nine-point, fall-risk assessment that includes a check of the home environment, where most injuries occur.
“You would be amazed at how many seniors are at home and it’s not adapted appropriately to prevent falls,” says Sandy, who poured through tons of research to make sure his programming would effectively address pertinent areas. “Those nine bullets, I didn’t invent them. This is where people are at risk.”
As part of MEASUREAbilities’ service, Sandy comes to a client’s home and screens for such factors as cognition, medication overlap, footwear and vision impairment. If someone, for example, is putting on flip-flops to go to the bathroom, the shoes are identified as unsafe, right then and there.
Balance and strength assessments are an integral part of the service because, surprisingly, people often don’t know where their impairment lies, Sandy says. “Balance problems could be related to feet, vision or the inner ear. Another area people are usually unaware of is how weak their legs have gotten. Lower-extremity weakness is a large factor for fall risk.”
When Sandy’s father went into the hospital for surgery in his late 70s, he had strong legs from years of horseback riding. But when he was released, his legs had weakened and he was given a walker to use for the first time. Like many patients, he wasn’t thoroughly trained on how to navigate with the walker and ended up falling.
“The incidents of hospital readmission post-discharge is very high,” Sandy says. “People get discharged—I don’t want to say irresponsibly, but let’s just say without a very comprehensive plan. They get home and they haven’t had proper training on how to use the walker or proper follow-through on making sure they know what to do, for example, when they get up at night [and use the walker to go to the bathroom].”
MEASURAbilities works with clients to make sure they are using their walkers correctly. Sandy, a certified disability management specialist as well as a licensed PT, also provides one-on-one physical therapy, a service that is often covered by insurance. “It’s so rare for a patient to be seen every single time by a therapist who is licensed and not be passed off to a technician or an assistant. That is one of the keys to our business,” he says.
As part of its “one-stop” solution, MEASURAbilities recommends and actually installs needed environmental modifications to make the home safer, such as grab bars, nonslip surfaces, commode lifts, transfer chairs, etc.
One of Deena’s favorite products transforms tile, travertine and marble floors into nonslip surfaces. “It’s a treatment, like getting a perm, that opens up the pores of the tile so when it’s wet, it actually has friction,” she says. “And there is no visible change to the tile. It changes on a molecular level.” The treatment can also be used on porcelain or any other hard-mineral surface, so bathtubs and showers can be made safe without the use of unsightly rubber mats.
“We have it in our own bathroom at home,” Deena says. “I was doing ‘holiday on ice’ on our tile floor after a shower, and now I can walk across the floor wet.”
The ‘Not Me’ Challenge
Once people agree to take the risk assessment, they are pleased by what goes forward, but the biggest challenge is getting them to take it in the first place, says Sandy.
When MEASURAbilities exhibits at health fairs and offers people a free fall-risk screening, those most in need of the feedback walk right by. “And the ones who don’t need it come over and show off,” says Sandy.
“It’s frustrating because we want to identify and intervene for people at risk of falling,” says Deena. “Intervention is part of prevention.”
Sandy agrees. “People have egos and don’t want to admit they are at risk. But studies show just getting a risk assessment and identifying where your risk is—just doing this one thing—is extremely effective in decreasing the rate of falls.”
The statistics speak for themselves: More than one in three adults 65 and older will fall in a given year, according to the Centers for Disease Control and Prevention. Within six months, two-thirds will fall again. To get people talking about falls, the Goldsteins frequently speak at community health events and do presentations for home-health companies and organizations like Silver Sneakers.
“Caregivers are the first ones who contact us many times for someone who is a fall risk,” says Deena, adding that falls are the leading cause of accidental death among those over age 65.
Unfortunately, individuals don’t usually take action on their own behalf until after there is a crisis, says Sandy.
“I hear it a lot. Someone is in denial, and they don’t want to pay for whatever changes they need to minimize their risk. And then, a day or two later they fall and we get a call. It happens all the time.”
Most of MEASURAbilities’ clients are between the ages of 50 to 80, and often have been recently released home from the hospital. Either they or a family member has recognized they are at risk and asked for an assessment.
The Goldsteins urge those who are at risk of falling to take proactive measures.
“People don’t realize that one fall can change the direction of your life,” says Deena. “Preventing falls is our goal. If you need someone to step in and help, that’s where we come in.”