Falls and Fall Prevention

Falls are one of the most serious threats to an older person’s quality of life. In adults 65 and over, one out of every three fall in a year, and of those, 20-30 % have falls that cause moderate to severe injuries, such s fractured hips which will radically alter the course of life. Estimates of ability to return to previous levels of functioning after a fracture range from 45-65%. Whatever the “true” number is, a significant number of people do not. Falls are a leading cause of admission to hospitals and nursing homes, and a predictor of death within one year of up to 25 % of people who have a fracture.

There are a number of causes of falls which are preventable, although some are not. Many falls are due to spontaneous fractures that are the result of osteoporosis, cancer, or other diseases. Many are the result of decreased cognitive functioning which comes with a dementia, such as Alzheimer’s, or vascular (stroke related) dementia, or Parkinson’s. For some of the factors which lead to falls, all one can do is help the older adult stay in good physical and emotional health, regularly see a good doctor who is truly interested in the health of their elderly patients. Common sense and preventative actions can lower risks.

Here are some causes of falls and suggestions as to the precautions you can take to avoid them..

	Risk Factor	What You Can Do
1	Over or under-medication or taking medication differently from how it is prescribed	Review medications with physician. Monitor if, and how they are being taken. Ask the pharmacy to "bubble" pack medications. Use a dosette which has compartments for morning, afternoon, and evening pills. Use an electronic pill dispenser and monitor.
2	Ill fitting shoes or other clothing	Watch how shoes are fitting. Avoid high heels. Make sure that shoes can be put on easily. Wear shoes that have good traction. Clothing should not restrict movement and prevent lifting of arms or shoulders.
3	Throw rugs and non secured mats on floors	Use a two sided tape to secure rugs and mats, or remove them.
4	Poor vision, neglect to wear glasses, glasses which are not longer appropriate to vision needs	Have eyes tested on a regular basis. Update prescriptions for glasses as necessary. Put a chain around glasses so they can be carried with the person so they won’t be forgotten.
5	Weakness in the legs or upper body, poor balance	Regular exercise to strengthen and increase balance and gait. Physiotherapist assessment and development of exercise routine. Yoga or swimming. When family is visiting, do something physical instead of just sitting.
6	Depression	Ask about mood and talk about sadness, grief, loss, fears. Refer to counselling and to physician. Exercise. Remember that medication is only ONE approach to dealing with depression.
7	Poor lighting in home	Monitor day and night lighting in home. Increase wattage if necessary. Make sure that light bulbs have not burned out. Increase lights in areas of high usage or night usage.
8	Poorly fitted walkers, poor use of walkers	Have walker assessed for appropriateness by an Occupational Therapist, and train the user how to use them. Make sure the person has the adequate strength to use breaks and the control ability.
9	Malnourishment and dehydration	Monitor food and liquid intake. Use pre made foods from an agency, meals on wheels, the supermarket. Consider supplements such as Boost or Resource. Make sure there is adequate liquids that the person likes in the home. When visiting, have a snack or drink of juice or water. Ensure that the person is able to swallow safely without choking.
10	Furniture which gets in the way of walking	Re arrange furniture, discard or put in storage furniture which crowds or is no longer used. Buy furniture which is easy to get up from.
11	Alcohol use/abuse and prescription drug use/abuse	Limit alcohol. Make sure that medications being taken do not enhance the affect of alcohol. Ensure that pain or other prescription medications are not being abused.
12	Icy or slippery/wet surfaces washroom or on porches, stairs, sidewalks, and streets	Use enough salt in winter. Make sure that surfaces are sloped so that water drains. Put on slip resistant materials on surfaces. Use a low pile wall to wall carpeting.
13	Lack of grab bars in bathing area, bars around toilet, or other supports, such as adequate and safe railings on stairs.	Have a home assessment by an Occupational Therapist. Review all areas where a person may have to transfer themselves/change positions.. Review all areas of home for places bars and railings should be changed or installed. Make sure that railings can be gripped.
14	Pain	Make sure pain is adequately controlled, and that the pain medication is appropriate to the type and level of pain. Review pain levels and management with physician. Look for non-medical ways to control pain.
15	Delirium from Urinary tract infections, chest infections, hormone and vitamin imbalances, and others	If you note unusual behaviour which has started suddenly, and fluctuates during the day, and that seem to be affecting memory, judgment or behaviour, have a full exam by physician, with blood tests, urinalysis.
16	Poor judgment or decision making due to dementia	Where this may not be controllable, following the other guidelines will help. Try to anticipate what the person may do. Have help around. Monitor them with in home help, alarms, or distance monitoring. Block off stairs.
17	Diabetes and uncontrolled sugar levels	Regularly test for sugar levels, monitor diet, make sure person is not “sneaking food.” Adjust medication, and see doctor regularly.
18	Decreased oxygen intake	Supplementary oxygen, lose weight, have oxygen saturation levels tested regularly.
19	Reaching for containers or food in the kitchen	Modify or renovate kitchen so that everything is accessible or within reach. Remove footstools, etc.
20	Fatigue and poor sleeping habits	Nap during day. Review sleep pattern with physician. Watch for sleep apnea or other sleep disturbances.
21	Getting up to use the washroom at night when one is not fully awake.	Commode near bed. Adequate lighting. Night light or light that is activated by movement. Bed alarm to alert caregiver if someone is getting out of bed.
22	Uneven surfaces at home, in the yard, on sidewalks, or transitions between surfaces	Make sure all surfaces have the same facing, e.g. wood, or low pile carpeting. Removed metal or other connecting pieces. Fill in and repair gaps in side and front walks, and driveways.
23	Getting in or out of cars	Use aids such as special handles, swivel seats, transfer belts.
24	Use of stairs	Block off stairs, move bedroom down or up. Put washing machine/dryer on same level. Install stair elevator/lift.
25	Fear of falling	Encourage exercise with trained professional to decrease fear. Use cognitive behavioural techniques to address anxiety such as controlled breathing, relaxation, visualization.
26	Low Blood Pressure	Monitor by physician. Review medications. Pay attention when going from sitting to standing and use something to stabilize while changing position.
27	Wires and cords on floor	Use wireless where possible. Make sure cords and wires are taped down out of walking area.
28	Decreased vision from Cataracts or Macular Degeneration of other eye diseases	Referral to Optometrist and regular review by physician.
29	Strokes or TIA ( Transient Ischemic Attacks—small strokes which are often undetected)	Ask physician for a scan of the brain which may show if there is any damage.
30	Osteoarthritis	Exercise, vitamins, pain relief, medication to treat or prevent further bone loss.
31	Unknown	Ask physician for further review. There may be underlying issues such as cardiac problems or cancer which are causing changes in the body which will lead to falls.

As can be seen, many of the causes of falls are preventable by assessing a person’s physical and emotional health, by assessing and modifying their environment, or meeting needs. Seniors should have regular assessments by their physicians, and reviews of their medications, preferably by a pharmacist.

It is important to work with the older person in helping to modify homes and make decisions regarding safety, walking aides, and other issues. Making changes in habits is not easy for any of us; when it is imposed we all may become resistive. Changes due to aging and frailty can cause grief and denial as people struggle to maintain their sense of independence, self worth and dignity.

If a fall does occur, try to get or remember as much detail as possible. Where, when, how. What else was going on? What was the person doing? What had they just done—medication, or bath, etc.? Ask what they were feeling, or if they felt anything. Talk to a physician, and if there is more than one fall, begin to keep a record so that you can recognize a pattern, if there is one.

If and when a fall happens, you can ask them to slowly move and see if there is pain. Call an ambulance if the person appears to be in or describes pain. The ambulance people will want some basic information about the person. Fill out and keep updated and handy the Diamond Geriatrics Emergency Information Document. View it at http://diamondgeriatrics.com/pdf/EmergencyInformationDocument.pdf

Peter S. Silin, MSW

(Statistics from the U.S. Centre for Disease Control)

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