Concerns for Older Adults Working in Agriculture

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Hello everyone, I’m you host Carey Portell and today we are going to talk about health and safety for aging adults, since they make up a large portion of the agricultural work force. And even if you aren’t part of this population, it’s worth having a listen, because it will be relevant in the future!

Welcome back to the Talking Total Farmer Health Podcast. Today we have a wonderful guest, Dr. Ali. And we're going to start off. Dr. Ali, will you go ahead and give us just a little bit about your background and how you got into geriatric medicine?

Yes, thank you, Carey. So I started my career in medicine, family medicine, and I noticed there is an increase on the aging population and I noticed during my rotations residencies, we do not have like paying much attention to the older adult, unfortunately, because there is a lot of factors. So during my training I was introduced to one of the greatest of fellowship rotation in Toledo, Ohio, at the University of Toledo. So I was very much interested in joining the geriatric fellowship. And then I completed my fellowship in geriatrics and I joined the LSU Health Care Science Center, become an assistant professor of geriatric at LSU HSC.

Can you explain what exactly is geriatric medicine. Because there are some people out there who kind of know what it is, but maybe you can give more detail.

Sure. So geriatric is a specialty of medicine that focuses on the health of the older adults aged over 65. And the main goal of geriatrics is to promote health and maintain or improve the quality of life of the older adults.

Okay. Now, 25% of nonfatal injuries in AG forestry and fishing are categorized as slips, trips and falls. So can you give us the real definition of falls?

Sure. So fall is defined as an event that result in a person coming to rest unintentionally on the ground or at a lower level.

And we found that 6% of the fatal injuries are also categorized. That and 6% seems like a lot to us.

Correct. Correct. And I'm going to talk about those, why it's very important to talk about falls in older adult, why it's important to screen for falls, even if the older adult does not have experienced any falls in the past.

So in speaking of those older adults, how common are falls in that age group?

Surprisingly, it's very common. Every year there is more than one in four older adults over the age of 65 had falls. However, more than half of those who had fall do not report that their fall to their healthcare providers, unfortunately.

Yeah, I can definitely see that. So if an older adult fell, what are the consequences of that fall?

Yes, Falls is a very serious health threat to the older adults over 65, and it is one of the most common events threatening their independency. Falls is usually associated with decline in functional status, fear of falling, increase in emergency department visits, more hospitalization, and also it is associated with nursing home placement.

Yeah, that that is interesting. And I know around our area, like when you hear of a certain individual falling, first thing you think of is hip or shoulder. So and those are very big functional parts of your body that you need to use every day. What are some of those causes of falls in that older population?

Causes of falls is usually multifactorial, rarely due to one single cause. And the risk factor can be divided into patient-related risk factors or environmental risk factors. So for the patient-related risk factors, we have age-related decline and we have the medication use. So for the age-related decline, we have change in vision, poor balance. For poor balance. We have examples or sign of poor balance when the patient have unsteadiness or needing to support while walking, or when a person steady himself or herself by holding onto furniture when walking at home. Weakness, also another risk factor, mainly weakness in the leg muscles. And it's a major reason of fall. So for the signs of weakness, when the person need to push with their hands to stand up from a chair or when there is some trouble stepping up onto a curb depression. Also, when we have the patient have symptoms of depression such as like not feeling well, feeling slowed down, are also linked to falls. Chronic disease like Parkinson's disease, stroke, arthritis, numbness in the feet, can cause a stumbles and lead to falls. And the medication use- there are certain medications that increase the chances of falling in older adults. An example of that the medication used to help sleep, like sleeping aid medication, medication to improve the mood, or some diabetic medication, or also when there is a recent change in the dosage of the medication or when the total number of medications is more than five. The side effects from medication, including those over the counter medications, can increase the chances of falling and sometimes make them feel lightheaded or more tired than usual. And the environmental risk factors include poor lighting, no safety equipment, loose carpet and footwear. It's very important, when we have uncomfortable or ill fitted footwear, they do not fit properly. That will contribute to falls and the more risk factors we have, the higher risk for falls in those older adults.

It seems like so many things that you have to watch out for, doesn't it?

Yes.

It's like that when you list them all out like that. So when when talking about health care providers, why is it important for them to check and screen for falls in the older adults?

Because the people who have fallen, once they are likely to fall again and people who are worried about falling, they were more likely to fall. Also, it is important to check and screen for falls in older adult because complications of falls are the leading cause of death from injuries in people older than 65.

Okay. Now what should older adults expect from their health care providers when they are screening for those falls?

So the health care provider will ask the older adult about any falls within the past year. Also, they will check out for any modifiable risk factors and then they do a full fall history by asking about their activity at the time of fall, what they were doing at the time of fall. And they ask about their medication history and it changes in new medicine. And also they will ask about their environmental risk factors checking about lighting, and furniture or footwear.

So if that adult did fall. So besides the screening, is there anything else that they should expect their health care provider to do?

Sure, so when an older adults fell, the health care providers first, they will take a good history from the patient. They ask in about their circumstances, what where they are doing, the activity, location, time, and they will ask about any associated symptoms like lightheadedness or racing heartbeat or joint pain, foot pain. Also, they will ask about any chronic health condition like prior stroke, Parkinson Heart disease, diabetes, arthritis. And next, the health care provider will review their medication, including all those over-the-counter medications. They will ask them about their alcohol use. And they will also ask if. There is any recent changes in their medication. Then the health care provider will do a physical exam. They will check for their vision. They will check for their vital signs. They will check for for their joints, for any limitation in the joints. They will check for their muscle strength, feet problem. After that, they will do neuro exam checking for gaze and balance, and if there is any tremor and they will examine the heart for if there is any irregular heartbeat. Next they may require some blood work for those who are at risk at risk to exclude any anemia, dehydration, or there's any high blood sugar. They will also check for their vitamin D and B12 deficiency, and they may require also some imaging, if the falls associated with head injury, or there is any new neurological finding on exam, they may request echo for their heart if there is dizziness or lightheadedness or irregular heartbeat. And finally, the health care provider, they will refer the older adult to physical therapy for gait and balance evaluation.

I feel like our farmers and ranchers should really take note of everything that you just explained to us, because a lot of times they'll think, Oh, I just slipped. But honestly, it could be an underlying condition that caused them to slip. So instead of saying, Oh, it was just just a little slip or a trip and I don't need to go to the doctor, really, they should go and just get a full workup to see if anything else is going on that caused them to get in that situation.

Correct, I agree.

Yeah. Now, is there anything that the older population can do to prevent the falls from happening?

Sure, they can do five things to prevent their falls. First number one, speak up. So, talk openly to your health care provider, about any falls or like slipping or risk factor and prevention. Ask your doctor and pharmacist to review your medication. Number two, keep moving. Begin an exercise program to to improve your leg strength and balance. Number three, get an annual eye exam. Replace the eyeglasses if needed. Number four, make your home environment safer, so remove any clutter and tripping hazards. Number five finally, manage any foot problems - make sure that you have a comfortable footwear, and you have well-fitting footwear.

I feel like those are great tips for everyone.

Yes.

Now, how can our audience learn more about these falls?

So they can learn more about fall prevention by first contacting their local community or senior center for information on exercise, information on fall prevention programs, and information on options for improving their home safety. Or they can visit www.stopfalls.org. Also, the CDC had study program for older adults for fall prevention and stay independent and for more information they can visit www.cdc.gov/steadi (S T E A D I).

Alright we will be sure to include those links in our show notes so that our audience can just go right there and click on them and get the information that they need. Now, before we close, is there anything else that you can think of that you'd like to share with our audience?

So I just want to summarize in general, falls by older adults are common. I just want to stress on this point, it's very common and usually multifactorial and falls can be associated with functional decline and screening and preventive intervention are most effective. So prevention is better than treatment.

Wonderful, wonderful, wonderful. Dr. Ali, we appreciate you granting us your time and your knowledge today with here us at Talking Total Farmer Health Podcast and all of our audience. We enjoyed you so much and can't wait to get this out. Thank you.

Thank you very much. My pleasure.

All right, everybody, that’s all for today. If you’d like to hear more from Dr. Ali, checkout the link in our shownotes to her webinar on fall prevention! Thank you again for tuning in to another episode. Be sure to subscribe to this podcast to hear more from AgriSafe on the health and safety issues impacting agricultural workers. If you’d like to suggest topics, or have a story you’d like to share, contact us by email at INFO AT AGRISAFE DOT ORG, and title your email “T T F H Podcast.” To see more from AgriSafe, including webinars and our newsletter, visit www.agrisafe.org. This episode was created by AgriSafe Network. Script arranged by Laura Siegel and Dr. Lobna Ali, hosted by Carey Portell, edited by Joel Sharpton, with special guest Dr. Lobna Ali.