Former President Jimmy Carter has had a bad year for falls.
He broke a hip in May after falling at home in Plains, Ga., and got a hip replacement. On Oct. 6, a few days after he turned 95, he again fell at home. This fall left him with a black eye and 14 stitches but no new broken bones. The intrepid former president still traveled the next day to a Habitat for Humanity event.
Now comes word that Carter, a cancer survivor who has lived longer than any other U.S. president, has fallen again. This time he suffered a “minor” fracture to his pelvis, according to Phoebe Sumter Medical Center, the Americus, Ga., hospital where he is being treated.
Falls are often no big deal for the young, but they terrify the elderly and their loved ones because the resulting fractures can be so debilitating. Doctors have learned that quick treatment can yield better results, but 20% to 30% of older people who break a hip still die within a year, said Samir Mehta, chief of orthopaedic trauma and fracture care at Penn Medicine. Falls and broken bones, he said, can be a “marker for declining health.”
Fractured pelvises are not as common as broken hips or wrists, but Mehta said he still sees a lot of them because people are living longer, more active lives. In the young, such fractures are often caused by serious car accidents or big falls, and they can be deadly. In the elderly, they are more often the result of small falls and fragile bones. In a common scenario, a man falls on his side from a standing position without using an arm to break the fall.
People with what doctors describe as minor pelvis fractures typically don’t require surgery. They can often soon walk again while using a walker or crutches. Still, Mehta is not a fan of the word minor when it comes to pelvis fractures. “Breaking your pelvis is still kind of a big deal,” he said. Even breaks that don’t need surgical repair are a “red flag.” As a sign of health risk, they’re much like hip fractures, he said.
Scot A. Brown, division chief of orthopaedic oncology at Rothman Orthopaedics Institute, said the biggest risk factor for a broken bone in the geriatric population is having had another broken bone. Usually it’s a sign of osteoporosis. He always recommends an evaluation for bone health. It’s also important to know whether the patient tripped or whether the falls could be related to other medical problems that could cause dizziness or poor balance.
Jason Karlawish, professor of medicine at the University of Pennsylvania and co-director of the Penn Memory Center, said this history of falls would likely prompt a geriatrician to evaluate the former president for problems with balance, vision and strength. Doctors often give patients the get-up-and-go test. They’re asked to sit in a chair with their feet on the floor and arms crossed at the chest. From that position, they stand up and walk. A doctor may also stand behind the patient, pull back on his shoulders and see how quickly he can recover. The tests help doctors evaluate leg strength, speed, gait and balance. Patients often get a prescription for physical therapy, which can be a big help.
The pelvis is a pretzel-like structure below the spine. The spine and hips are attached to it. You sit on it. “The majority of your weight bearing goes through your pelvis,” Mehta said.
Bigger breaks are usually repaired with screws implanted through small incisions. Patients with more stable fractures heal on their own in about six weeks. Mehta said doctors often prescribe vitamins C and D to enhance bone healing and tell patients to go easy on the caffeine, which Mehta said is not good for damaged bones.
Brown said some patients may need to use a walker for 12 weeks, and it can take much longer than that for the bone to heal completely. He makes sure patients are eating enough protein. The most important thing they can do for their bones is stop smoking, he said.
All the falls we’ve heard about have occurred in Carter’s home. Mehta said that “this is a very typical story” and a sign that the home should be evaluated for fall risk. Penn often sends nurses or therapists to patients’ homes to look for hazards. Rugs and carpets often trip people. Rooms should be lighted well enough for older people to see what’s on the floor. Floors should be clear. Are there small animals around? Sometimes it helps to make sure there are some big pieces of furniture that can be used for support.
It is also possible, he said, that Carter would be safer with a walker or cane or that he needs more assistance at home.
Some people become fearful and move less after a fall. That is counterproductive. “We encourage people to stay on their feet, to stay active,” Mehta said.
People with hip fractures can often have lingering disability afterward, but Mehta said many who fracture a pelvis recover well. Carter, he said, “has a good likelihood of making a full recovery from this.”
Brown agreed that Carter could do well. “As active as he is at 95," he said, "I certainly wouldn’t put full recovery past him.”