Preventing Falls and Improving Balance for Older Individuals

Falls are the leading cause of death from injury among seniors, and the risk increases with age. Fully one third of those over age 65 fall each year, and many suffer severe or even fatal injuries. Additionally, a person who has fallen once has double the chance of falling again.  The statistics are disconcerting:

One in five falls results in serious injuries, including broken bones and head injuries.

  • Each year, 2.8 million seniors are treated in emergency rooms for falls.

  • Over 800,000 individuals are hospitalized because of falls, and at least 300,000 are hospitalized for hip fractures.

  • Medical costs related to falls are approximately $31 billion annually. Centers For Disease Control and Prevention.

Photo by Wavebreakmedia/iStock / Getty Images
Photo by Wavebreakmedia/iStock / Getty Images

There are numerous, often inter-related, conditions that contribute to falls.  They include, increasing body weakness, the effects of medicines, vitamin deficiencies, vision issues, tripping hazards, and walking and balancing issues.  Researchers at the Mobility and Brain Function Program at the Institute for Aging Research (Harvard Medical School) are concentrating on understanding what causes older adults to fall, which will hopefully lead to development of preventive measures. They have found a direct correlation between balance and reduction of fall risk in older adults.

In a recent article, Dr. Brad Manor, the program’s director, explains that as we grow older, our ability to efficiently perform multiple tasks at the same time start to slowly deteriorate. Even the simplest of simultaneous activities, such as walking and talking, can disrupt our balance and put us at risk for a serious fall-related injury.

Mobility, the researchers conclude, is both physical and mental. The physical part relies on the ability of your muscles and reflexes to create the movement necessary to help maintain balance. The mental part relies on your ability to pay attention to the world around you, your short-term memory of where your legs and feet are located related to the ground, and your ability to make the correct decision to change your movements when needed, such as when a sidewalk is wet or covered with snow.

In an effort to find ways to prevent falls by seniors, researchers at the Center have started looking at exercises that target both the physical and mental fundamentals in mobility. They found that the purposeful movements and fluid repetitious motions in Tai Chi not only boost muscle function but also stimulate the mental functions that make mobility easier. Yoga and dance also have great mind-body interactions and work well to improve balance in older adults. While walking on a treadmill, riding a bike or strength training are all beneficial exercises, they were found to not have the balance component necessary to most effectively prevent falls.

Often, older adults will fall, become injured and then be less active. This chain of events causes further balance deterioration and greater risk of suffering another fall in the future. Dr. Manor stresses that it’s never too late or too early to start exercises to help improve balance and prevent the debilitating results that can come with a balance-related injury later. He does caution that any balance-based exercise should be done in a group or with a partner for safety reasons, and to check with your doctor before beginning a new exercise.

In Cleveland, organizations such as Fairhill Partners offer programs to assist older individuals develop strategies and practices to improve balance, flexibility, and strength.

The attorneys at McFadden Bushnell are there to assist with estate planning and planning for the possible future need for Medicaid and Veterans Benefits.  Please contact our office if we can be of assistance to your family.

McFadden Bushnell LLC offers a wide variety of elder law, special needs and estate planning services in the greater Cleveland and Northeast Ohio area, including Shaker Heights, University Heights, Cleveland, Cleveland Heights, Beachwood, Warrensville Heights and throughout the area.

Article originally published February 1, 2017.

A New Year’s Resolution To Top Your List: Estate Planning

January is a time of new beginnings and of resolutions for the new year.  One resolution we all should make is to have our essential estate planning documents in place.  There are several important legal documents that all adults should have, regardless of age.  These documents include a will, a durable power of attorney, a healthcare power of attorney and a living will.  Unfortunately, only about half of Americans have any of these documents – and the number is even smaller for those under age 50.  So what are these documents?

Will – A will allows you to designate where your belongings should go after your death.  If you have minor children, you can also designate who will care for your children.  If you do not have a will, a court will make these decisions for you.  The court would choose who will be the guardian for your children, and this may or may not match who you would have chosen.  As to your assets, the probate court will rely on state rules of intestacy to divide your property, again regardless of what you would have wanted.

Trust – A trust is a legal structure that permits management of your assets by a trustee on behalf of your beneficiaries. A living trust is established while you are still alive, as opposed to being created upon your death. You can be the trustee for your own living trust until you are no longer able to manage your financial affairs or pass away, at which point the responsibility for managing the trust passes to someone you designate as a successor trustee. When a trust is structured correctly with the help of an experienced estate planning attorney and properly funded, your entire estate can stay out of probate court. This process not only limits court costs, but it also maintains the privacy of your financial records while enabling your beneficiaries to enjoy the benefits of the trust without disruption or delay.

Durable Power of Attorney (DPOA) – A DPOA allows you to designate someone who can make financial decisions for you.  You can name someone to act in this position immediately, or designate that it will only go into effect upon some triggering event, such as incapacity.  Without such a document, when an  individual becomes incapacitated, be it by trauma, illness or a deteriorating health condition, it will likely be necessary to have a court name a guardian to make these decisions– a sometimes long and expensive process, where once again a court decides who will make these important decisions for you.

Healthcare Power of Attorney (HPOA) – With an HPOA, you can give legal authority to another person to make decisions about your health care if you are unable to make them yourself. This prevents the courts from getting involved if there is disagreement between family members and/or the medical community as to what actions you would want taken.

HIPAA Authorization Form - The Health Insurance Portability and Accountability Act (HIPAA), is a Federal law that requires the establishment of standards to protect the privacy of patients’ health care information.  A HIPAA authorization allows you to name individuals who can have access to your medical information.

Living Will – A living will, sometimes known as advanced directives, allows you to make your wishes known as to end-of-life medical care.  This can help your loved ones know what you would like to have happen if you are ever in a position that you are unable to express your wishes.

If you already have these documents, great!  Perhaps the new year is a good time to give them a quick review to make sure there have not been major changes and that they reflect your current intentions.

Creating these essential documents often makes us address uncomfortable topics such as health, end of life issues, and what will happen when your gone, but making these decisions will make sure that your wishes are understood and followed.  These documents can help guide your loved ones during times of extreme stress, and is actually a gift that you are giving to them.  Indeed, most people indicate relief after drafting these documents because they realize how helpful they will be to their families and loved ones.

If this is one new year’s resolution that you want to keep this year, please contact the office of McFadden Bushnel LLC in order to make an appointment.  We can help you work through the process of developing the legal documents that express your wishes.

This article was originally published on January 3, 2017. The current version includes some additional information.

McFadden Bushnell LLC offers a wide variety of elder law, special needs and estate planning services in the greater Cleveland and Northeast Ohio area, including Shaker Heights, University Heights, Cleveland, Cleveland Heights, Beachwood, Warrensville Heights and throughout the area.

The Wrong Mix of Medications Can Lead to Faulty Alzheimer’s Diagnosis

Originally Posted August 23, 2016 

Memory loss, confusion and changes in personality or mood are some of the main symptoms of Alzheimer’s disease.  However, these symptoms can also be caused by medications, supplements and vitamins, or a dangerous mix of these—often resulting in a false diagnosis of Alzheimer’s.

The elderly are especially at risk of developing dementia-like symptoms because their bodies are not able to process medications as well as a younger person’s does. A lower metabolism, less lean body mass, less water in the body, and decreased kidney and liver functions make it harder to clean out toxins. As a result, drugs can accumulate in the body.

The list of drugs that can cause dementia-like symptoms is long and includes:

* antidepressants                                 * antihistamines

* anti-Parkinson drugs                       * anti-anxiety medications

* cardiovascular drugs                       * anticonvulsants

* corticosteroids                                   * narcotics

* sedatives                                              * statins

Also, seniors are usually prescribed more drugs as they get older. Polypharmacy is the term used to describe the use of five or more medications, and it is common in people over 65. This can easily happen when multiple doctors are prescribing drugs for different ailments. The more drugs they take, the greater their risk for a damaging drug reaction.

Using one pharmacist can help provide a gatekeeper, but it is vitally important to have a primary doctor oversee the person’s complete list of prescriptions, over-the-counter medications, vitamins and supplements. Alcohol, or even taking someone else’s medication, can add to the problem.

In many cases, the cognitive symptoms vanish when medication is stopped. But don’t try to do this yourself. It is important to work with the primary doctor to determine which medications can be reduced, eliminated or replaced without adversely affecting the person’s overall well-being. Take the bottles and containers with you so the doctor can evaluate the dosages and expiration dates.

Additionally, more than 100 other conditions, from vitamin and hormone deficiencies to rare brain disorders to depression to urinary tract infections, can mimic Alzheimer’s disease. Some are readily treatable, so it is important to see a doctor when concerns about memory arise.

It’s important to know the person, be aware of medications being taken, and watch for changes in behavior. If a loved one has started exhibiting dementia-like symptoms, act quickly. Insist on an evaluation of their medications and eliminate other conditions. If dementia does exist after addressing these other health issues, it is critical to start treatment as soon as possible.

Some helpful Alzheimer and Dementia resources in the Cleveland area:

If you are helping a loved one who has been diagnosed with Alzheimer’s, advanced legal planning is important because it allows the person with dementia to have his or her wishes for future care known and documented.  For assistance in developing a plan that addresses the long-term care needs of a loved one and other elder law needs, please feel free to contact the office of McFadden Bushnell.  We would be honored to assist you with this or other legal issues related to aging.

 McFadden Bushnell LLC offers a wide variety of elder law and estate planning services in the greater Cleveland and Northeast Ohio area, including Shaker Heights, University Heights, Cleveland Heights, Beachwood, Warrensville Heights and throughout the area.


Care Options for Adults with Special Needs

There are numerous care options available for adult with special needs. The options available range for those with special needs who are able to be more independent to those who need advanced medical care. It is important to match the person’s needs and desires with the best possible living option or combination of options.


Family is the first care option that most people consider. For some adults with special needs, family is a great option. Parents often care for their special needs child until they are no longer able to and then other family members, such as adult siblings, take over the care of the special needs adults. Caring for a special needs family member can be very rewarding, but can also add a lot of stress for family members.  If family members choose to care for their special needs loved one, they may want to do so in combination with respite care or day program options.  However, family may not always be the best option or may not be an option at all. Some special needs adults are able to be more independent and may wish to have living arrangements that allow for more independence.

Independent Living

Independent living is for those special needs adults who are able to complete many tasks on their own with only minimal help. Personal care professionals can come into the home and provide the assistance that may be needed. A special needs adult may have a personal care professional come in and assist for a few hours a day or more. This helps the special needs adult to be able to live on their own. There is also assistive technology available that help people with disabilities to maintain their independence. Transportation can be a limitation for those with special needs living independently. Many organizations provide for transportation to appointments and jobs to help the special needs adult maintain their ability to live independently.

Group Homes

Group homes can be an excellent option for special needs adults who do not wish to live with family, but are unable to live independently. Usually those living in group homes do not need advanced medical care. A group home is staffed with professionals who manage the home and provide assistance for the special needs of the adults living there. A group home usually consists of four to six special needs adults living together. The benefits of a group home are socialization for the special needs adults and learning to work together with others. It also allows them to still maintain some independence.

Day Programs

Day programs provide options for families who want to keep their loved one living with them, but need care during the day while working or who need respite care. Day programs are offered through independent agencies and also through some long-term facilities. Day programs are a great option for working caregivers, while also providing socialization and activity for the special needs adult. Special needs children can continue to go to public school until they are 21, but after finishing school a day program can help to continue routine and structure in the life of a special needs adult.

Long-term Care Facilities

In some cases, the special needs adults do not have family members who are able to care for them or the person may not have the means to pay for other care options. Living in a long-term care facility may be a good option for those with advanced medical care needs. These facilities are able to provide care for more extensive needs. Some higher functioning adults with special needs may also live in long-term care facilities, but there are generally other options that allow for those who are able to live more independently.

It is important to plan for the care of adult children with disabilities. Planning should include the needs of the special needs adult, the resources available, and the best options to meet those needs. Getting input from the special needs adult can make transitions to new living situations go more smoothly for everyone involved.

Milestones Organization has a helpful resource page ( that includes resources for families exploring residential options in Northeast Ohio.

If you have any questions about something you have read or would like additional information, please feel free to contact us.

The attorneys at McFadden Bushnell are there to assist with special needs planning, estate planning and planning for the possible future need for Medicaid and Veterans Benefits.  Please contact our office if we can be of assistance to your family.

McFadden Bushnell LLC offers a wide variety of elder law, special needs and estate planning services in the greater Cleveland and Northeast Ohio area, including Shaker Heights, University Heights, Cleveland, Cleveland Heights, Beachwood, Warrensville Heights and throughout the area