Falling Is Serious Risk for Seniors, but Exercise Helps

The statistics about falls involving senior citizens are troubling: According to the Centers for Disease Control and Prevention, 1 in 4 adults 65 and older fall each year, and the numbers are rising.

There’s more: Every 20 minutes an older adult dies because of a fall (more than 27,000 a year), 1 in 5 falls cause a serious injury and 7 million falls required some form of medical treatment. These CDC statistics from 2014, the most recent year available, have led to the growing concern from health care providers and others who work with senior citizens.

By Liz Sauchelli, Valley News Calendar Editor and Sunday Seniors Feature Writer
Published by the Valley News on Sunday, September 23, 2018. Reprinted with permission.

Saturday was the National Council on Aging’s annual Falls Prevention Awareness Day, but it’s a topic that should be on our radar every day.

“Even though it’s very common, we know it’s under reported,” said, Dawna Pidgeon, a physical therapist at Dartmouth-Hitchcock Medical Center, during a presentation to the Aging in Community Forum quarterly meeting last week.

“We need everybody,” to help reduce falls, said Pidgeon, who is part of the Dartmouth Centers for Health Aging Falls Team.

A fall, in general terms, is described as “unintentionally coming into contact with the floor or a lower service,” Pidgeon said. Hip fractures from falls are of particular concern, because many senior citizens who have them never fully recover, according to the CDC. But it’s important to note that many of the intrinsic and extrinsic factors that contribute to falls can be addressed.

Intrinsic causes include:

  • muscle weakness
  • dizziness
  • poor vision
  • fear of falling
  • gait/balance issues

Extrinsic causes include:

  • the use of four of more medications
  • alcohol use
  • wearing poorly fitting shoes

Dizziness Is Never Normal

“Dizziness is never normal,” Pidgeon said. “If people are dizzy, we want to make sure we’re getting them help for it.”

When it comes to preventing falls, there’s one tactic that takes precedence. “Of all the things we can do, exercise is the most important,” Pidgeon said. “The exercise has to be balance and strengthening exercises.”
While people naturally start to lose muscle fiber as they age, the goal is to strengthen the muscle that remains. “We also know you can always increase the size of the muscle fibers you do have,” Pidgeon said.

She is a certified trainer for Tai Ji Quan: Moving for Better Balance, a program that studies have shown helps improve balance and prevent falls among senior citizens. “The results are phenomenal,” Pidgeon said. “They build their strength and their confidence.” Another program, A Matter of Balance, has had similar results.

One challenge is getting people to participate in the programs. Ti Ji Quan, for example, requires seniors to attend class twice a week for 24 weeks. A Matter of Balance asks attendees for two hours each week for eight weeks.

Balance Screening Can Be First Step

Another way to get people started on these courses is to do balance screenings, which health care providers and organizations can provide. DHMC’s Aging Resource Center, for example, hosts free balance screenings from 9:30 a.m. to 11:30 a.m. on the first and second Wednesdays of every month.

Other steps people can take to minimize fall risks, according to the CDC, including clearing clutter from floor, adding grab bars in bathrooms and handrails on stairs, removing throw rugs and keeping areas well lit.

Editor’s note: For more information about falls prevention, visit https://www.cdc.gov/steadi/.
Liz Sauchelli can be reached at esauchelli@vnews.com or 603-727-3221.

Hartford Community Coalition Putting the Cures Grant to Work

Submitted By The Hartford Community Coalition

Coalition Representatives attend the National Prescription Drug Abuse and Heroin Summit in Atlanta

Hartford Community Coalition (HCC) is a collaborative group of citizens designed to support and promote the wellness of individuals and families in Hartford, Vermont. This year, we received a grant as part of the 21st Century Cures Act, which allowed us to focus on preventing the opioid epidemic’s reach in our community.

A major part of implementing the Cures grant was to hire a part-time addiction prevention coordinator, who could focus on outreach and education on substance misuse prevention. Shortly after signing on with the HCC, our coordinator participated in the Vermont Department of Health’s Understanding Opiate Addiction Workshop at the Hartford Area Career and Technology Center. Also, this past spring, we sent her, as well as two other coalition members—a social worker from the Hartford Police Department and a Community Health Partnership Coordinator from DHMC—to the National Prescription Drug Abuse and Heroin Summit in Atlanta. There, our representatives learned the latest in topics such as prevention messaging, research on ACEs (adverse childhood experiences), and the developing role of recovery coaches.

Ways to Dispose of Unused Medications

For the past six months, the HCC has continued to work with community stakeholders to reduce substance misuse in Hartford: we’ve distributed Vermont Department of Health Twin State Safe Meds information to our local senior center, pharmacy, doctors’ offices, and libraries. In addition, we created an informational flyer about local mental health practitioners who accept Medicaid, so cost won’t be an issue to those seeking treatment. We also dispensed prescription drug lockboxes at Town Hall meetings and at our annual community block party on June 6.

Coalition Representatives participate in National Take Back Day

We’ve used social media and the Hartford Town List Serv to share Twin State Safe Meds information as well as to provide reminders about Hartford Police Department’s drop box for unused prescription medications. We were able to increase visibility for the 2018 National Drug Take Back Day on April 28 through blog and Facebook posts, by placing flyers throughout the community, and by publishing a letter to the editor of the Valley News. On National Prescription Drug Take Back Day, we worked with the Hartford Police Department to host our first two Take Back Day events at the town libraries in Quechee and Wilder to increase access to safe disposal of unused or expired medication. From these efforts, the Hartford Police Department has collected 172 pounds of unused prescription drugs since March.

HCC facilitates monthly substance misuse and mental health subcommittee meetings, and sends our Hartford liaison to monthly meetings of Green Peak Alliance (formerly Windsor County Prevention Partners), a collaboration of substance abuse prevention coalitions that includes, Windsor, Windham, and Orange counties. We believe we’re making a difference, and we’re grateful to the Cures grant for giving hope to our community.

Nursing Students Learn About Community Nursing

Laurie Harding and Bob Rufsvold (left), Co-Directors of the UVCNP, with Professor Shari Goldberg and Colby-Sawyer College Senior Nursing Students in April 2018.

Recently, a group of four Colby-Sawyer College Nursing students completed a Nursing Leadership Capstone Project with the Upper Valley Community Nursing Project.

Upper Valley Community Nursing Project

The Upper Valley Community Nursing Project helps elders receive continuity of care and remain independent—at home and in their community. The Project Co-Directors provides advocacy, training, and technical assistance to communities throughout our region who want to add a health professional to the informal network of volunteers already providing care for elders. They also facilitate the placement of a nurse in a community to address non-acute needs of elders at home. The Project is led by Laurie Harding, MS, RN, and Bob Rufsvold, MD. Ms. Harding founded the Project with Dr. Dennis McCullough using a holistic philosophy of nursing, which dates back to the mid-19th century.

As of April 2017, the Upper Valley Community Nursing Project (UVCNP) provides support and consultation to community and parish nurses in New Hampshire and Vermont towns. These towns include Grantham, Hanover, Lebanon, Lyme, Hartford, Sharon, and Thetford. Laurie and Bob are also available to work with communities who wish to add a community or parish nurse. They assist with understanding the role of the nurse, developing job descriptions, and may provide some initial funding to help the community launch a community nursing program.

Over the past year, the UVCNP has worked closely with staff at Dartmouth Hitchcock Community Health to build a database for the project. The tool will allow community and parish nurses to capture information about the people they see. Data from this tool can be used to provide important information about the value of these programs and opportunities for quality improvement.

Student Nurses Learn About Community Nursing

On April 10, 2018, students from the Colby-Sawyer College Department of Nursing presented the results of their Nursing Leadership Capstone Project to the Co-Directors of the UVCNP, and a number of community and parish nurses and community volunteers. According to Associate Professor Shari Goldberg, PhD, RN, “The year-long Nursing Leadership Capstone experience, as well as our community and public health nursing course, complement the exquisite acute care clinical experiences at Dartmouth-Hitchcock Medical Center that students complete throughout our nursing program. During their capstone experience, students examine health care at the organizational, community, and public policy levels of care, and develop a growing understanding of the social determinants of health. Many of the capstone students work with agencies that serve the needs of older adults, preparing them to care for an aging population.”

This group of four senior nursing students they shadowed community nurses in a number of communities. They also conducted a review of the information collected to date.  According to one student, Courtney Lambert, “Working with the UVCNP has been an eye-opening experience. I feel fortunate to have been able to spend time learning about the role of the community nurse and seeing how important they are to their communities.”

Who Community Nurses Serve

The students, Emily Crow, Courtney Lampert, Emily Martin, and Ashma Shrestha, shared summary characteristics about the people served by community and parish nurses in five communities. They were able to examine trends across nearly 200 clients with records in the UVCNP’s database. In general, they found the people served were over the age of 75 and lived alone. Most clients had multiple health and safety risks. Helping clients learn to take their medications properly was a common role for community nurses. Nurses often provided reassurance  to clients or family members in cases of emergency or after returning from hospital stays. They often guided people looking for resources to help with daily tasks. Nurses also screened clients for falls and other safety risks and provided education and referrals.

The data so far, though limited, suggests these nurses often succeed in resolving or helping clients manage health concerns effectively. Most notably, of the 36 people who had been discharged by a community nurse, none reported they no longer wanted the services. Reasons for discharge included moving away, no longer requiring services, or death. The students final Capstone Presentation provides an overview of how they planned their project, what they did, and what they learned about community nursing and the participants who call upon them for support.

An Eye-Opening Experience

All the Colby-Sawyer students expressed real gratitude for the chance to learn about community nursing. The Capstone Project was their first experience in nursing outside the walls of an institution. Emily Crow shared how deeply the project has affected her: “I don’t think I truly understood the significance of community and parish nurses until I was able to see their impact through home visits and this data analysis project. Community-dwelling older adults are such a large portion of the Upper Valley’s population and the nurses working with them in their communities are truly heroes. I will carry the lessons I have learned through working with the UVCNP into my future nursing career. We didn’t choose this project. It chose us and we are so glad that it did.”

I feel lucky to be a part of this project. This project has helped me expand my knowledge about the role and the importance of community/parish nurses in improving health outcomes of older adults aging in community. — Ashma Shrestha

These Nursing students will all graduate from Colby Sawyer College in May. They have all accepted jobs at Dartmouth Hitchcock Medical Center. Based on the quality of their Capstone Project work and their genuine respect for the community and parish nurses they met, we are very lucky they have chosen to stay in our community. Emily Crow will be working in the Birthing Pavilion. Ashma Shrestha and Emily Martin plan to work on a medical specialties unit. Courtney Lampert will join the Intermediate Special Care Unit. We wish them all the best!

Upper Valley Summer Meals Evaluation Report

Summer Meals and FunDuring the summer of 2017, the Public Health Council commissioned an evaluation of several summer meals programs operating in the Upper Valley region. Today, March 1, 2018, we are pleased to release the final report of the program evaluation: “Evaluation of 2017 Summer Food Programs in the Upper Valley Region.” The evaluation sought to understand and describe how some of the meals programs in the Upper Valley operate. We wanted to understand  the programs’ benefits and challenges. We also wanted to provide recommendations that might improve program outcomes and impact. Furthermore, the evaluation was descriptive in nature and did not attempt to demonstrate the effectiveness of the programs.

Four Programs Participated in the Evaluation

The four programs included in this evaluation are: Hartford’s Take a Bite Out of Hunger, Windsor Summer Meals, Lebanon Lunch Friends, and Mascoma Seamless Summer Option. Evaluation was primarily qualitative in nature, but it also recorded the number of individuals served through the programs for the period June to August 2017. For example, the total number of meals served by the 4 programs was:

  • Hartford Take a Bite Out of Hunger: 10,643
  • Windsor Summer Meals: 1,076
  • Lebanon Lunch Friends: 6,770
  • Mascoma Seamless Summer Option: Breakfast — 3,360 and Lunch — 4,763

The PHC contracted with Jabeen Ahmad, MPH, to conduct the evaluation. She visited meal sites, spoke to staff, volunteers, and parents to understand how the programs worked and how they were received by the participants. Overall, both staff and parents perceive the programs to be beneficial in providing free and nutritious food to the communities they serve. There is interest in continuing and expanding the programs. However, there are also challenges to effective program utilization and some of those include:

  • low community awareness of programs;
  • transportation to and from programs;
  • low participation of community children who are not part of a summer school or camp program;
  • resistance from teens to participation;
  • lack of flexibility with federal (USDA) programs, especially regarding taking meals off site and menu options;
  • stand-alone meal program is not as appealing to children/families; and
  • providing meals to children only and not adults.

Ms. Ahmad reported some of the recommendations to increase program viability and success include:

  • Work more closely with community representatives, especially for site selection, expansion, and outreach efforts;
  • Increase communication and coordination among program sponsors, sites and community stakeholders; and
  • Communicate with state leaders about barriers created by federal regulations.

Working Together to Strengthen Summer Meals Programs

As these and other summer meals programs begin to plan for the summer of 2018, we hope this report will prove useful. Therefore, the PHC will share the report with the summer meals program planners in our region and others interested in food insecurity. We will also provide the report to policymakers so they may better understand the strengths and challenges of the federal programs that support most of these meal programs.

Finally, the PHC thanks the many program staff, volunteers, and parents who shared their information and feedback with Ms. Ahmad. We also thank the following people for helping to shape the evaluation and their input into the final report Nancy Bergin DuMont, Director, Department of Community Health, Alice Peck Day Memorial Hospital; Alice R. Ely, MPH, Executive Director, Public Health Council of the Upper Valley; Barbara Farnsworth, Manager, Community Health Improvement, Dartmouth Hitchcock Medical Center; Debra S. Ford, Business Administrator, Mascoma Valley Regional School District; and Jill Lord, RN, MS, Director of Community Health, Mt. Ascutney Hospital and Health Center.

Tobacco and Alcohol Environmental Scan

A map of the area where the environmental scan occurred. Blue pins denote retail stores. Red pins denote schools.

Observations from a Community Tobacco and Alcohol Environmental Scan: Advertisement and Sale Practices in the Upper Valley of New Hampshire

This article was written by Bryan L’Heureux, MPH Candidate, University of New England, describing the study he conducted on behalf of ALL Together in the Fall of 2017.  Full Environmental Scan Report.

Background and Methods

There exists an interconnectedness between our environment and our health. In many cases, things that we are exposed to every day, such as the air we breathe or the water we drink, can directly affect our health. However, our environment can also influence decisions we make and the behaviors we participate in, which can then indirectly effect our health. This type of environmental influence sometimes occurs through the sale and advertisement practices we are exposed to within our communities and surroundings. With stricter restrictions on the ways tobacco companies are allowed to advertise via radio and television, it is not surprising that over 92% of tobacco advertising occurs at the point-of-sale within the retail environment1. That being said, one of the most vulnerable populations to advertisements are our youth and adolescents, who, conveniently, are also potential new customers in the eyes of tobacco manufacturers2. Keeping that in mind, when looking at retail density as it relates to the location of schools within the population of interest, the Upper Valley of New Hampshire, it is curious to note that there are clusters of retailers selling and advertising tobacco and alcohol in these areas. For this reason, in an effort to decrease tobacco initiation and alcohol misuse, it very important to be aware of practices used within our community that can influence behaviors related to negative health outcomes, such as tobacco initiation and alcohol misuse.

Conducting an Environmental Scan

In an effort to become more aware of the sale and advertisement practices used to sell tobacco and alcohol in the Upper Valley region of New Hampshire, I conducted an environmental scan of retailers in the community with the support of Upper Valley ALL Together and Dartmouth-Hitchcock. ALL Together, which is the Substance Misuse workgroup of the Public Health Council of the Upper Valley, is a community resource for prevention, intervention, treatment, recovery, and advocacy around substance misuse and suicide prevention. The goal of this scan was to identify practices that have the potential to influence initiation of tobacco use and/or alcohol misuse in an effort to make a collective change toward heathier advertisement and sale methods in our community’s retail environment.

The environmental scan itself consisted of a survey meant to identify risk factors as well as protective factors for tobacco and alcohol initiation as they pertain to advertisements at the retail level. For the purposes of this scan, only retailers on the New Hampshire side of the Upper Valley were observed. This scan consisted of nine towns; Lebanon, West Lebanon, Hanover, Canaan, Enfield, Grantham, Orford, Piermont, and Plainfield. I spent approximately 5-10 minutes in each retailer, simply making observations pertaining to location and types of products/advertisements in

each store. For example, in each store I tried to observe if there was tobacco on counters, near candy, toys or energy drinks, if there is alcohol in the same cooler as non-alcoholic beverages, if there are advertisements with cartoons or celebrities, if there are themed displays, or if alcohol is displayed with items that would promote binge drinking. In all, forty-five stores were observed, providing meaningful data about the environment of tobacco and alcohol advertisements/sales in the Upper Valley.

Snapshot of the Region: Alcohol

Through the observations made during the survey, it is clear there are a number of things our community is doing right in terms of selling and advertising alcohol. For example, out of the stores that sold alcohol (n=41, 91%), 59% of those stores kept alcoholic beverages either in a different cooler or out of eyesight from the non-alcoholic beverages. With only 41% of the stores keeping alcohol in the same cooler as non-alcoholic beverages, it is clear that while there is some room for improvement, our community is doing relatively well in this area. Furthermore, in terms of

An alcoholic beverages case with ping pong balls hanging on the door.

advertising these products, only 7.3% of the stores sold items that promote drinking games/binge drinking (such as red solo cups and ping pong balls) with alcoholic beverages. A number of stores did however have displays for alcoholic beverages that could be confused as non-alcoholic or utilized themed displays in their advertisement practices (31.7% and 19.5%, respectively). Working with these retailers to make small changes in these areas would be small changes that may have a large impact on the way youth perceive alcohol and the culture around drinking in general.

Snapshot of the Region: Tobacco

In the Upper Valley, of the stores surveyed, 90% (n=40) sell tobacco. The chart below delves into the various types of tobacco that are sold in the region, however, it does not distinguish between the various types of smokeless tobacco, such as snuff, snus, chew etc. due to the similar appearance in the products making it difficult to differentiate between the products when completing the scan.

A number of things are important to point out in terms of the placement of tobacco products in the retail environment as well. For the most part, tobacco products were kept out of reach from the customer, behind the point-of-sale (48%). However, there were also a number of instances where tobacco products and/or advertisements were placed near candy, toys, or energy drinks (17%), or were placed on counters, within reach of the customer (35%). This is an area that can easily be targeted for improvement; store owners can easily and cost effectively change the placement of these products to promote a healthier environment and help mitigate normalcy of these tobacco products for our youth.

Finally, a number of different, common, advertising practices for tobacco products can be observed in the Upper Valley. Cross promotions (a discount/promotional effort meant to get individuals to try different types of tobacco) were seen in 10% of the stores. More commonly were price promotions in general (77%); these advertisements offer a “special price” or utilize mobile coupons. Placement of tobacco advertisements is also an area of concern; as was mentioned above, ensuring that advertisements are not placed in the faces of our youth is important in prevention efforts. 27.5% of the stores in our community place advertisements at or below three feet, showing that while many stores are following good practice, there is still room for improvement. Furthermore, 35% of the stores that sold tobacco had advertisements for these products, including cigarettes, smokeless tobacco, and e-cigarettes, from the road.

Advocating for a Healthier Retail Environment

After collecting this information, I sent a letter specific to each store celebrating what they were doing well, as well as giving them some tips and tricks for ways that they could change the environment of their store to promote a healthier community. This letter called for collective action and change, rather than placing the burden on any one retailer or individual. The hope was that framing the letter in this way would allow the retailers to feel empowered to have a positive effect on the health of the community that they live and do business in.

As a community, we can advocate for limiting retail tobacco/alcohol advertisements, both inside retail stores and at the point-of-sale, as well as advertisements that are visible from the road. Furthermore, we can work with retailers to promote practices, such as keeping these products away from items that are geared toward children and adolescents, such as candy and energy drinks.

Making these small changes can have a large impact on the overall environment of our community and the perceived culture around these products, showing that as a whole, we value healthy decisions and want to do what we can to help young people make the decision not to use tobacco or misuse alcohol.


  1. https://www.ftc.gov/system/files/documents/reports/federal-trade-commission-cigarette-report-2012/150327-2012cigaretterpt.pdf
  2. https://www.surgeongeneral.gov/library/reports/preventing-youth-tobacco-use/index.html