Fatal Falls Rising in Older Adults

The Centers for Disease Control released a sobering report on mortality due to falls and other unintentional injuries in older adults. The good news: death from motor vehicle accidents has fallen since 2000, and death from other unintentional injuries such as suffocation, fire, and poisoning remain relatively rare. The bad news: between 2000 and 2013, the age-adjusted rate of death from falls in older adults nearly doubled, from 30 deaths per 100,000 adults to 57 deaths per 100,000 adults. Among adults at the upper reaches of age, the death toll from falls is even more striking. In 2012-13, there were 226 deaths due to falls per 100,000 adults.

Figure 2. Age-adjusted death rates, by cause of death among adults aged 65 and over: United States, 2000–2013

While concerning, these numbers only scratch the surface of the total burden of falls in older adults. According to the CDC, in any given year, one in three older adults will have a fall, and 20-30% of adults who fall will suffer a moderate or severe injury. These injuries and the fear of falling can have profound impacts on quality of life and subsequent morbidity and mortality. As a results, the total mortality burden from falls likely far exceeds the immediate risk of fall-related death cited in the CDC's latest report.

Why are fall-related deaths increasing? The answer likely is complex, and includes changes in the distribution of underlying chronic illnesses as well as better reporting of falls as a contributor to death. Whatever the cause, more action is needed, and emerging initiatives and interventions - such as a falls reduction program being studied by a consortium of Pepper Centers - will be vital to the solution.

by: Mike Steinman

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Practical Advice for the End of Life: A Podcast with BJ Miller

This week we talk with BJ Miller, hospice and palliative care physician, public speaker, and now author with Shoshana Berger of the book "A Beginner's Guide to the End."

As we note on the podcast, BJ is about as close as we get to a celebrity in Hospice and Palliative Care. His TED Talk "What Really Matters at the End of Life" has been viewed more than 9 million times. As we discuss on the Podcast, this has changed BJ's life, and he spends most of his working time engaged in public speaking, being the public "face" of the hospice and palliative care movement.

The book he and Berger wrote is filled to the brim with practical advice. I mean, nuts and bolts practical advice. Things like:
How to clean out not only your emotional house but your physical house (turns out there are services for that!)Posting about your illness on social media (should you post to Facebook)What is the difference between a funeral home and mortuaryCan I afford to die? …

Improving Advance Care Planning for Latinos with Cancer: A Podcast with Fischer and Fink

In this week's GeriPal podcast we talk with Stacy Fischer, MD and Regina Fink, RN, PhD, both from the University of Colorado, about a lay health navigator intervention to improve advance care planning with Latinos with advanced cancer. The issue of lay health navigators raises several issues that we discuss, including:
What is a lay health navigator?What do they do? How are they trained?What do lay health navigators offer that specialized palliative care doesn't? Are they replacing us?What makes the health navigator intervention particularly appropriate for Latinos and rural individuals? For advance care planning? Eric and I had fun singing in French (yes French, not Spanish, listen to the podcast to learn why).
Enjoy! -@AlexSmithMD

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Eric: Welcome to the GeriPal podcast. This is Eric Widera.

Alex: This is Alex Smith.

Eric: And Alex, I'm really excited about toda…

The Dangers of Fleet Enemas

The dangers of oral sodium phosphate preparations are fairly well known in the medical community. In 2006 the FDA issued it’s first warning that patients taking oral sodium phosphate preparations are at risk for potential for acute kidney injury. Two years later, over-the-counter preparations of these drugs were voluntarily withdrawn by the manufacturers. Those agents still available by prescription were given black box warnings mainly due to acute phosphate nephropathy that can result in renal failure, especially in older adults. Despite all this talk of oral preparations, little was mentioned about a sodium phosphate preparation that is still available over-the-counter – the Fleet enema.

Why Oral Sodium Phosphate Preparations Are Dangerous

Before we go into the risks of Fleet enemas, lets spend just a couple sentences on why oral sodium phosphate preparations carry significant risks. First, oral sodium phosphate preparations can cause significant fluid shifts within the colon …

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