We All Fall Down

Illustration "Humpty Dumpty" by Jason Noble Hays 2012 For most people reading this, it is probably not news that falls can be very serious for older adults.  I found some surprising statistics on the Center for Disease Control and Prevention (CDC) website. Which prompted a this two-part post on balance issues, the prevalence of falls in older adults, how to reduce falls in the home, and a few Aging-Matters-Style pointers on how to do a fall prevention “sweep” in the home.

Some surprising points covered in the CDC’s fact sheet on falls:

  • Falls are the leading cause of death among adults 65 and older.
  • Over the past 10 years, fall related deaths have risen sharply among older men and women.
  • Moderate to severe injuries (ie. lacerations, hip fractures and head trauma) occur in 20 to 30% of the falls reported. Many falls aren’t reported at all.
  • Almost 20,000 fall related deaths were reported in 2008
  • In 2009 2.2 million non-fatal falls were treated in U.S. Emergency rooms.
  • Falls can be a downward spiral. Injuries and the fear that result  from falling can limit individuals’ activities. This can lead to reduced mobility and reduced physical fitness which then increases the risks of further falls.
  • Men fall more than women but women experience fractures more often then men.

For people at home with mobility issues, identifying fall hazards could stave off the potential for serious injury, hospitalization and even early death.  Any care management professional worth their salt should do a fall prevention “sweep” of the home as part of their original assessment. Below are many of the things I look for in a client’s home; it should be handy in your own home or the home of a loved one at risk for taking an unwanted trip.

But First, Talk to a Doctor …
… especially if abrupt changes occur
to one’s balance, strength, and/or a general change to the way someone normally walks (aka: gait changes). An abrupt change could be the result of a serious medical condition. What we are talking about here is a gradual decline in mobility that has probably been noticeable for some time, perhaps there is a history of falling or a recent fall. Even in the case of a gradual change, doctors may want to rule out new or undiagnosed medical conditions.

Review Medications & Supplements 
Make sure that doctors understand how side-effects and drug interactions (including over-the-counter medicines) may express within an elderly patient. Consult with or switch to an trusted doctor is a Geriatric Specialist. Consider an osteoporosis screening and consult with doctors on making sure that vitamin D and calcium levels are appropriate.  Also, talk to the pharmacist, explain mobility and balance issues and to ask for advice when introducing a new prescription or over-ther-counter medication.

Physical Therapy & Exercise
Explain the mobility and balance changes to a Doctor, once other medical conditions are ruled out s/he may offer a referral to a Physical Therapist for a balance assessment – if the doctor doesn’t offer physical therapy (PT) go ahead and ask for a referral.  A Physical Therapist can assess balance, recommend a cane or walker and devise a training and exercise plan. The plan usually consists of about three to six sessions. PT sessions are usually covered by Medicare or insurance, and Physical Therapists will often make house calls since mobility is the issue at hand.

Treatment for Balance and mobility issues generally involve a good amount of strength building in the legs; cane or walker training if applicable; techniques for getting in and out of chairs, beds and vehicles. The therapist may also recommend ongoing exercises to maintain and increase strength and balance – ask them to if they don’t.

When Jack LaLanne yelled, “use it or lose it” he was talking about balance too. Weight bearing exercise strengthens muscles and bones. Stronger legs help us recover from a misstep or stumble and, of course, strong bones protects us from fractures when a fall takes place.

Eye Glasses
Keep that eye glass prescription up to date. The CDC recommends considering a dedicated pair of single vision distance glasses used when walking outside. Check with an Optometrist about current glasses and whether they are appropriate for someone with mobility issues.

Fall Prevention Sweep in the Home
Tidy up, Rearrange & Lighting
Remove clutter! Clear walk ways and hallways. It is natural for newspapers, mail, and other items to accumulate near that favorite chair, get a magazine rack or a waste can to keep things tidy.  Rearrange and remove furniture to accommodate canes and walkers.

Make sure furniture is conducive to mobility needs – will that side table collapse if it has to be used for support in an unbalanced moment? Get rid of it or replace it with a sturdier table.  Identify potential low lying hazards in case a fall does happen. That beautiful marble fireplace hearth and that cute, crocheted brick door-stop can be lethal. Make sure rugs, mats and floor runners don’t ripple or slide easily, it is probably safest to just remove most of them.

Finally, make sure the lighting is adequate around the home. Brighter bulbs don’t have to mean new lamps and fixtures – compact fluorescent light bulbs burn brighter and cooler than incandescent predecessors.

Fall Hotspots
Bathrooms, hallways, bedrooms and of course stairways are especially tricky areas. To increases independence and decrease falls install permanent grab bars in showers, tubs and near the toilette. Banisters in hallways are very useful and don’t forget to double-check the strength of that thirty year old banister in the stairway. It is often a good idea to install a second banister on the other side of the stairway too.

If falling out of bed is a problem take a trip to the medical supply store. Half bed rails are easy to install and help people move, stand and stabilize themselves when getting in and out of bed. Special high impact bedside mats  used to soften landings. Low rise beds are available, but beds can also be lowered by removing the box spring if the bed frame cannot be adjusted.

Clothing & Shoes
While polyester is virtually indestructible, we are not.  Those rose-colored, poly knit, bell-bottoms still look fresh off the rack .. but tripping over that hem just isn’t worth the fashion statement. Check all pant hems, house coats and robes to make sure they are not too long.  A trip to the tailor could save a trip to floor.

Well fitted comfortable shoes are very important in preventing falls.  I suggest you burn loose-fitting, slip-ons, and flip-flops (or at least passionately slam-dunk them into the nearest trash can), slippers and sandals are safer with heel straps. Go to a shoe store that knows how to measure feet and fit shoes (probably not Payless or DSW). Ask a Podiatrist or Physical Therapist for referrals to good shoe stores.

Finally, reducing fall risk takes plain old observation. Watching how someone moves around their space may reveal unforeseen obstacles. Try to take a look around with fresh eyes, it is natural to miss hazards in an environment that we are accustomed to.

Illustration by Jason Noble Hayes, 2011
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One thought on “We All Fall Down

  1. I found this blog very helpful and the last paragraph was and eye opener. When a caretaker is accustomed to the living quarters of a loved one it is very easy to overlook the hazards that may be lurking.

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