{"id":27126,"date":"2019-10-18T14:39:57","date_gmt":"2019-10-18T20:39:57","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=27126"},"modified":"2026-04-02T15:25:48","modified_gmt":"2026-04-02T21:25:48","slug":"fall-prevention-clinic-all-about-keeping-people-upright","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/fall-prevention-clinic-all-about-keeping-people-upright\/","title":{"rendered":"Fall prevention clinic all about keeping people upright"},"content":{"rendered":"<div style=\"margin-top: 0px; margin-bottom: 0px;\" class=\"sharethis-inline-share-buttons\" ><\/div><p>It\u2019s one of the most stubborn health care problems in the United States. Every year, it costs the nation tens of billions of dollars, inflicts physical and psychological damage on individuals and their loved ones, <a href=\"https:\/\/www.uchealth.org\/today\/fall-prevention-class-key-to-continued-independence\/\">robs people of their independence<\/a> and not infrequently kills them. Yet it has failed to capture the public imagination with marches, high-profile campaigns, or fundraisers.<\/p>\n<p>The problem is falls among people over the age of 65. They numbered <a href=\"https:\/\/www.cdc.gov\/falls\/data-research\/\" target=\"_blank\" rel=\"noopener noreferrer\">29 million in 2014<\/a>, leading to some 2.8 million emergency department visits, 800,000 hospital stays and 27,000 deaths. The Centers for Disease Control and Prevention calculated that in 2015, direct and indirect costs of falls totaled $50 billion \u2013 about a quarter of that borne by patients and their families.<\/p>\n<p>As the population ages, these numbers are likely to increase. So aren\u2019t there urgent calls to prevent falls?<\/p>\n<figure id=\"attachment_27133\" aria-describedby=\"caption-attachment-27133\" style=\"width: 300px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-27133 size-medium\" src=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2019\/10\/18141538\/fallprevention4tiny.webp\" alt=\"Elaine Bindel is photographed\" width=\"300\" height=\"224\" srcset=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2019\/10\/18141538\/fallprevention4tiny.webp 1200w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2019\/10\/18141538\/fallprevention4tiny-300x224.webp 300w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2019\/10\/18141538\/fallprevention4tiny-1024x765.webp 1024w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2019\/10\/18141538\/fallprevention4tiny-768x573.webp 768w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2019\/10\/18141538\/fallprevention4tiny-150x112.webp 150w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2019\/10\/18141538\/fallprevention4tiny-200x149.webp 200w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-27133\" class=\"wp-caption-text\">Elaine Bindel, shown here with husband Irvin, has worked through the clinic to reduce her fall risk. Photo courtesy of Elaine Bindel.<\/figcaption><\/figure>\n<p>\u201cIt isn\u2019t sexy,\u201d said Dr. Tyson Oberndorfer, assistant professor with the University of Colorado School of Medicine\u2019s <a href=\"https:\/\/medschool.cuanschutz.edu\/geriatrics\" target=\"_blank\" rel=\"noopener noreferrer\">Division of Geriatric Medicine<\/a>. \u201cThere is no one single thing you can do to prevent falls. It\u2019s a lot of small things, not magic pills.\u201d<\/p>\n<h3><strong>Get it (up)right<\/strong><\/h3>\n<p>But Oberndorfer, who practices in the <a href=\"https:\/\/www.uchealth.org\/locations\/uchealth-seniors-clinic-anschutz\/\">Seniors Clinic<\/a> at <a href=\"https:\/\/www.uchealth.org\/locations\/uchealth-university-of-colorado-hospital-uch\/\">UCHealth University of Colorado Hospital<\/a> on the <a href=\"https:\/\/www.uchealth.org\/locations\/uchealth-at-university-of-colorado-anschutz-medical-campus\/\">Anschutz Medical Campus<\/a>, believes the dismal statistics can be improved. He spearheaded the launch last year of the UCHealth Fall Prevention Clinic, which brings together geriatrics, occupational therapy, physical therapy, pharmacy, and social work in common cause to reduce the number and frequency of falls in the highest-risk patients. It\u2019s the first clinic of its kind in Colorado and one of only a handful around the country.<\/p>\n<p>The clinic, which presently sees patients one half-day every other week (Oberndorfer hopes soon to expand the clinic to one half-day weekly) addresses an issue that has for years hidden in plain sight. It\u2019s standard policy in outpatient clinics for medical assistants to ask patients, regardless of age, whether they have fallen in the last six months or are afraid of falling. If the answer to either question is \u2018\u2019yes,\u2019\u2019 it\u2019s recorded in the electronic health record. All too often, the information goes no further.<\/p>\n<p>That rankled <a href=\"https:\/\/www.uchealth.org\/provider\/robert-schwartz-md-geriatric-internal-medicine\/\">Dr. Robert Schwartz<\/a>, director of the Division of Geriatric Medicine at CU, who had long recognized that providers needed processes to treat patients who answered the questions affirmatively. Schwartz brought the problem to Oberndorfer and asked him to find a solution. Oberndorfer\u2019s clinical interest in frailty in the elderly dovetailed with Schwartz\u2019s determination to systematically address fall risk.<\/p>\n<p>\u201cWe\u2019ve needed a place in the outpatient setting for patients to be purposefully treated for falls,\u201d Oberndorfer said, \u201cand this multidisciplinary clinic is a venue for that.\u201d<\/p>\n<h3><strong>Comprehensive assessment<\/strong><\/h3>\n<p>Patients referred to the UCHealth Fall Prevention Clinic by their primary care providers or by specialists first get a medication review from a pharmacist who specializes in geriatrics, including the use of multiple medications, an important contributor to fall risk.<\/p>\n<p>\u201cWhen somebody has had a fall, the first thing that any physician should do is look at their medications and ask which ones may have contributed to that fall,\u201d Oberndorfer said.<\/p>\n<p>Patients meet face-to-face with an occupational therapist and physical therapist, each of whom assesses their fall risk. After the assessments, the team gathers to review each case and craft a personalized care plan. Oberndorfer then discusses the plan with each patient, gives them a copy, and sends another copy to their primary care physician.<\/p>\n<figure id=\"attachment_27129\" aria-describedby=\"caption-attachment-27129\" style=\"width: 200px\" class=\"wp-caption alignleft\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-27129\" src=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2019\/10\/18104937\/Fall-Prevention-Clinic-3-Tyson-Oberndorfer.jpgtiny.webp\" alt=\"Dr. Tyson Oberndorfer of the UCHealth Seniors Clinic serves as geriatrician for the Fall Prevention Clinic.\" width=\"200\" height=\"300\" srcset=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2019\/10\/18104937\/Fall-Prevention-Clinic-3-Tyson-Oberndorfer.jpgtiny.webp 600w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2019\/10\/18104937\/Fall-Prevention-Clinic-3-Tyson-Oberndorfer.jpgtiny-200x300.webp 200w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2019\/10\/18104937\/Fall-Prevention-Clinic-3-Tyson-Oberndorfer.jpgtiny-100x150.webp 100w\" sizes=\"auto, (max-width: 200px) 100vw, 200px\" \/><figcaption id=\"caption-attachment-27129\" class=\"wp-caption-text\">Dr. Tyson Oberndorfer of the UCHealth Seniors Clinic serves as geriatrician for the Fall Prevention Clinic.<\/figcaption><\/figure>\n<p>This process takes time: Oberndorfer, for example, schedules 40 minutes for his patient visits but he builds in extra time to accommodate more complex cases. The team approach is critical, he added, because evidence shows that while falls may be caused by a single event \u2013 tripping over a rug, say \u2013 they are nearly always the result of multiple factors. For example, that trip could be attributed not only to an area rug, but also to poor vision, weak physical condition, harmful medication interactions or side effects \u2013 or a combination of all of these things.<\/p>\n<h3><strong>Practical prevention<\/strong><\/h3>\n<p>The strategies for preventing falls are low-tech but carefully considered. The team\u2019s occupational therapists, for example, interview patients and their caregivers to understand the layout of their homes, the routine tasks they perform, and the seemingly harmless items \u2013 like that area rug \u2013 that present risks.<\/p>\n<p>\u201cWe look at how a person fits into the physical and social environment, based on their current abilities, and how we can sometimes tailor that to keep them safe and engaged,\u201d said Marie Andrews, lead occupational therapist with the clinic, who also specializes in geriatrics.<\/p>\n<p>The protections against falls might be grab bars and no-skid strips for the shower; pads to give height to toilet seats; contrast tape on the stairs to aid vision; recommending eye exams and medication reviews; or shoes that fit firmly to prevent trips. Andrews also recommends community resources that help patients with tasks like yard work or transportation.<\/p>\n<p>There are no cookie-cutter solutions, she said. \u201cThere are a lot of questions around literally the structure of the home, such as how the bathroom is set up, socially who is available to assist you, which tasks seem to be the most challenging and demanding,\u201d she said. \u201cThe clinic is a forum for patients to talk and problem-solve.\u201d<\/p>\n<h3><strong>Physical findings<\/strong><\/h3>\n<p>Physical therapy is another key component of the clinic\u2019s fall-defense approach. It stands to reason that building physical strength is a bulwark against falls. But Oberndorfer also points out that poor conditioning often traps people in a \u201cvicious cycle\u201d that steadily increases fall risk, he said.<\/p>\n<p>\u201cIf you don\u2019t exercise, you get deconditioned,\u201d he said. \u201cThat weakness further increases your risk of falls. And then, after that first fall, you\u2019re afraid of falling and avoid exercising even more than before.\u201d<\/p>\n<p>Jessica Elliott, a board-certified specialist in neurologic physical therapy and lead physical therapist for the clinic, uses a battery of tests to assess each patient\u2019s mobility, strength, endurance, and balance. She then gives patients specific recommendations for how to exercise, modify their homes and use equipment, such as walkers, to reduce their fall risk. The clinic\u2019s physical therapists also help to coordinate follow-up therapy or community classes and resources to decrease fall risk, she noted.<\/p>\n<p>\u201cWe\u2019re trying to give people tools to be more active and figure out how to maximize their quality of life and minimize their risk of falling over time,\u201d Elliott said.<\/p>\n<p>The exercises to reduce fall risk might include slow marching, standing with feet apart and together with eyes open and closed, and standing on one foot. These might sound simple, but for patients at risk of falling, they can be dangerous without proper precautions, like standing in a corner against a wall, Elliott explained.<\/p>\n<p>People can have trouble accepting recommendations, like the necessity of using a walker, Elliott conceded. She counters by describing the long-term benefits.<\/p>\n<p>\u201cJust because we recommend a walker now, it isn\u2019t necessarily forever,\u201d she said. \u201cIt\u2019s to be safe in the short term while we address these other factors that contribute to fall risk. And a lot of the physical things, like strength and balance, can really improve with exercise.\u201d<\/p>\n<h3><strong>Downward trend<\/strong><\/h3>\n<p>Count Elaine Bindel among those who had some trouble with the notion that she needed a walker to get around outside the home. Bindel, 81, overcame a childhood bout of osteomyelitis in her hometown of Akron, Ohio, and worked straight out of high school as a dental assistant and in other jobs in the medical industry, including a stint as a certified nursing assistant at Craig Hospital in Denver. Along the way, she raised four kids.<\/p>\n<p>Falling wasn\u2019t a concern for Bindel until 2003 in Montrose, Colorado, where she and her husband had settled. Walking their dog, Bindel crossed an innocent-looking patch of water running across the sidewalk. It concealed slippery mud, and she went down heavily, shattering her left elbow.<\/p>\n<p>\u201cIt was really a horrible break,\u201d said Bindel, who also broke her left wrist in the fall. \u201cIt really scared me from then on.\u201d<\/p>\n<p>Several years later, Bindel said she suffered another nasty fall during a restaurant stop with her husband on their way back from Arizona. It had snowed, but the wooden steps she mounted to a porch were clear. When she reached the top step, though, she lost her balance and grabbed for a heavy trash can that fell on and bruised her left side. A year or two later, Bindel, now living in Denver, was walking the dog when she tripped over a raised piece of sidewalk and tumbled onto a patch of grass, unharmed but shaken up again.<\/p>\n<h3><strong>Reducing the risk, facing fear<\/strong><\/h3>\n<p>Bindel\u2019s geriatrician, <a id=\"\" href=\"\/provider\/hillary-lum-md-phd\/\">Dr. Hillary Lum<\/a>, with the UCHealth Seniors Clinic, referred her to the Fall Prevention Clinic. There, her occupational therapist recommended installing grab bars and non-skid strips in the shower and tub, improving lighting in her apartment \u2013 Bindel was recently diagnosed with age-related macular degeneration \u2013 and discarding throw rugs. Her physical therapist provided exercises, with pictures, designed to improve her balance. She also uses shoes that provide traction to guard against slipping if she has to walk across snow and ice.<\/p>\n<p>Oberndorfer incorporated these and other suggestions in Bindel\u2019s treatment plan and also caught another potential problem: a periodic fast heartbeat. He referred her to a cardiologist who had her wear a heart monitor and is continuing to evaluate her condition.<\/p>\n<p>\u201cI appreciated so much their input about what I personally need,\u201d Bindel said of the clinic team. \u201cDr. Oberndorfer looks you straight in the eye and tells you everything he wants.\u201d She said the clinic team has helped to reduce her fear of falling.<\/p>\n<p>But about that walker. Bindel cheerily admits to being vain and confesses she only reluctantly stowed her \u201cbeautiful high heels.\u201d She initially resisted her physical therapist\u2019s advice that a walker was her best protection against another fall.<\/p>\n<p>\u201cI didn\u2019t want to give in to that,\u201d she said. \u201cBut my physical therapist told me a cane is no help for someone with a balance problem like mine. I discovered I felt more secure with a walker and could walk a little bit faster.\u201d<\/p>\n<p>For Jessica Elliott, stories like Bindel\u2019s can dispel misunderstandings about falls.<\/p>\n<p>\u201cPeople see falling as a normal part of aging,\u201d she said. \u201cIt\u2019s common, but I don\u2019t want people to think of it as normal. People think of it as something that just happens as you get older and there\u2019s nothing you can do about it. I want to let people know that there is a lot that you can do to prevent falling.\u201d<\/p>\n<p>UCHealth also offers an evidence-based fall prevention program called <a href=\"https:\/\/www.uchealth.org\/services\/community-health\/stepping-on-program\/\">Stepping On<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>It\u2019s one of the most stubborn health care problems in the United States. Every year, it costs the nation tens of billions of dollars, inflicts physical and psychological damage on individuals and their loved ones, robs people of their independence and not infrequently kills them. Yet it has failed to capture the public imagination with [&hellip;]<\/p>\n","protected":false},"author":2143,"featured_media":27133,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[5],"tags":[708,9171],"class_list":["post-27126","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-innovative-care","tag-adults-65-plus","tag-senior-care"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.4 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Fall prevention clinic all about keeping people upright - 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