Health Matters: Intervention options for elder prone to falling

Q: My elderly grandmother has been having trouble with falls. I'm concerned that she's going to injure herself. Can anything be done?A: You are quite right to be concerned. As we age falls become a major hazard. They are the major cause of seriou...

Thinkstock / Special to The Forum
Thinkstock / Special to The Forum

Q: My elderly grandmother has been having trouble with falls. I'm concerned that she's going to injure herself. Can anything be done?

A: You are quite right to be concerned. As we age falls become a major hazard. They are the major cause of serious injury in the elderly, and a bad fall can start a downward spiral from which the patient may not escape. But the good news is that there are interventions that we can take that have been proven to be helpful for seniors like your grandmother.

A recent review of the available medical evidence confirmed this. The three most important interventions are to encourage her to exercise, to have her vision tested and corrected if needed, and to institute therapy for osteoporosis if appropriate.

Other interventions may be helpful as well on an individualized basis, such as assessing the subject's environment for identifiable fall risks like scatter rugs. Seniors who seem to profit most from an exercise program are, not surprisingly, those who are sedentary or debilitated. It is important that any exercise program be started slowly and carefully, as some patients may overdo it and actually increase their propensity for falling. And convincing a deconditioned and chronically sedentary person to engage in routine exercise can be a major challenge for caregivers. But the benefits of a carefully instituted and appropriately monitored exercise program are unequivocal and real. So now is the time to intervene with your grandmother; don't wait for that dreaded phone call.

Q: I am 45 years old and need a valve replacement for a leaking heart valve. My heart surgeon said I can get my valve replaced with either a plastic mechanical valve or a tissue (pig) valve. Which is better?


A: There are advantages and disadvantages to each type of valve. The major advantage of the tissue valve is that you may not have to be on a blood thinner like warfarin (brand name Coumadin) to prevent blood clots (as you would with a mechanical valve). But tissue valves can wear out over time, and the need for reoperation is higher with them.

On the other hand, the risk of bleeding (and stroke in some age groups) is higher in those who have a mechanical valve and thus require the blood-thinning medication. So the choice between the two valves traditionally has been one of balancing the risk of bleeding (with mechanical valves) with the need for reoperation (with tissue valves).

But a recently announced major investigation has made the argument for mechanical valves much stronger, especially in younger patients like you. In a study of more than 25,000 patients who received a valve replacement, subsequent 15-year mortality was higher for those patients who received a tissue rather than a mechanical valve. This was true for patients less than 55 years of age getting a new valve to replace their damaged aortic valve, and 70 years for those getting a mitral valve. So since you are only 45 years- old, I'd really think very seriously about a mechanical valve, even though it means you'll be on a blood thinner forever.

Wynne is vice president for health affairs at UND, dean of the School of Medicine and Health Sciences, and a professor of medicine. He is a cardiologist by training.

Submit a question to Health Matters at or Health Matters, 1301 North Columbia Road, Stop 9037, Grand Forks, ND 58202-9037. Remember, no personal details, please. The content of this column is for informational purposes only and does not substitute for professional medical advice or care. Never disregard professional medical advice or delay in seeking it because of something you have read in this column.

Thinkstock / Special to The Forum
Dr. Joshua Wynne, Health Matters columnist

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