April 14--Dorothy Smith's walker was propped against the kitchen wall, right by the cluttered table where she pays her bills and eats her breakfast.
"I don't use the walker in the house," said Smith, who celebrates her 100th birthday on Saturday. "I use it outside, because my doctor says he doesn't want me falling again."
On a cool November day in 2007, Smith went to Mass and returned home to the cozy River Park house where she's lived since 1955. And then she fell, sprawling in the backyard for several hours until a woman passing on the street heard her calling for help.
She had a badly broken femur. Not surprisingly, her close-knit family feared the worse.
Not that long ago, a broken leg or hip in someone in their 70s, 80s or beyond was an all-but-certain death sentence. The equation was simple and brutal: A fall meant a fracture, and a fracture meant death.
But today, thanks to surgical advances and an emphasis on aggressive rehabilitation, an increasing number of older adults can rebound successfully from broken femurs, hips and other major fractures.
Even the very old are considered potential candidates today for hip replacement surgery and surgical bone repair involving rods, plates and pins.
"In the 1970s, fractures were treated much more conservatively," said Dr. Greg Le-Bleu, Sutter Rehabilitation Institute medical director. "The old days of bed rest are over. Bed rest causes pressure wounds, blood clots and pneumonia, all of which can lead to increased mortality."
After all, it generally wasn't the bone fracture itself that killed but rather the complications that set in later while the patient languished in bed.
Yet real risks remain. Even now, according to the Journal of the American Medical Association, an elevated chance of death remains for another five to 10 years for older adults recovering from a major fracture.
And as UC Davis Medical Center geriatrics specialist Dr. Michael McCloud points out, nearly half of older people do not return to their previous level of independence after breaking a hip.
"Age itself is not the strongest predictor of who will do well," he said. "Associated health problems, the number of medications taken and pre-injury fitness are better predictors."
Each year, 1.5 million people 50 and older suffer broken bones, costing the country $17 billion, says the National Osteoporosis Foundation.
The culprit? Osteoporosis.
"Even in terrible accidents, we see that people with better bone density are less likely to have bone breaks," said the foundation's health educator, Judy Chandler, "while people with weak bones are more likely to fracture."
In light of statistics on falls -- one in three older adults will suffer a fall each year, say the Centers for Disease Control and Prevention -- keeping bones strong is especially crucial for people 65 and older.
Measures to prevent osteoporosis include a daily dose of calcium with vitamin D, plus a regular exercise regimen. Not smoking also counts, as does not drinking to excess.
From decades of watching loved ones die from complications of hip fractures, the elderly know the risks too well and can fear that a broken bone inevitably signals the end of life.
"That was true in the past," said LeBleu. "They've seen it happen. The hip fracture disrupted older people's lives, and they seriously declined after that.
"But today, for someone who's very active and independent, the huge psychological blow is having to depend on others. It's a huge challenge early in recovery. Once they're up and walking and bathing and dressing themselves, they regain their independence. Their mood goes up."
Dorothy Smith played tennis until her late 80s and bowled well into her 90s.
After a two-month stay in a skilled nursing center, she returned home in early 2008, resuming her daily routine of crossword puzzles and neighborhood walks. And now, edging toward age 100, she's still going strong.
"I had no intention of giving in and never walking again," she said. "People give up. They stay in bed."
"They think, 'What's the point?' " said her granddaughter, Kathy Strickley, 44.
"I didn't ever think that," said Smith.
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Call The Bee's Anita Creamer, (916) 321-1136.
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