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Kathryn Haslanger

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As Fall Approaches, a Checklist to Keep Family Elders Steady on Their Feet

Posted: 09/11/2012 3:50 pm

The first day of Fall -- Sept. 22, 2012 -- marks National Falls Prevention Awareness Day to increase public awareness about how to prevent and reduce falls among older adults. This year 46 states, including New York, are participating in Falls Prevention Awareness Day. i Seems like a good time to talk about what family caregivers can do to help reduce this epidemic.

So many of our elderly friends and family members dread the possibility of falling, and with good reason -- it is an increasingly common occurrence among our aging population and the consequences of a fall can be quite dire. Each year in the United States, more than 11 million people over the age of 65 fall -- that's one of every three senior citizens in the country!ii Plus, falls are the leading cause of fatal and non-fatal injuries to older people, and cause more than 90 percent of hip fractures.iii Aside from the injuries and even death that might result, falling can lead to decreased mobility and even more fear of falling, which in turn can limit a person's independence and negatively affect their quality of life.

At the Visiting Nurse Service of New York (VNSNY), we have a falls prevention program called Strong Foundations that is designed to reduce a person's risk of falling and fall-related injuries or hospitalizations and maintain safety at home and in the community. Program staff also work to educate family caregivers about their family members' risk of falling, and to try to mitigate those risks as much as possible. Eileen Bach, PT, DPT, Director of Rehabilitation and Quality at VNSNY, tells family caregivers that the first thing they can do is to encourage their family member to talk with their primary care doctor about their risk for falling. Physicians can serve as an important first checkpoint for falls prevention. Asking about an individual's history of falling, and observing him or her doing specific in-office activities, such as getting up from a chair and walking steadily, helps the physician identify people who are at higher-than-average risk.

In the home, a family caregiver's watchful eye can be extremely helpful in preventing falls. Dr. Bach says there are specific risk factors for falling, listed below, that a family caregiver should consider and discuss with their physician or home care nurse:

Age: According to the Centers for Disease Control and Prevention, each year one in every three adults age 65 and older falls. Falls happen to all people, states Dr. Bach, but the older people are when they fall, the more susceptible they are to injury, and recovery becomes more challenging. In fact, people age 75 and older who fall are four to five times more likely than those age 65 to 74 to be admitted to a long-term care facility for a year or longer.v

Multiple medications: Taking four or more medications, especially those that may cause side effects or interactions such as dizziness or drowsiness, increases one's risk of falling. You should talk with your primary doctor about any side effects your family member is experiencing from medications. Taking medicine with a meal or before bed or working with the doctor to have lowest possible dosages might help ameliorate some symptoms.

Vision: Family caregivers should encourage family members to get an annual vision exam, because failing vision can go unnoticed by a person able to carry out daily activities such as reading the paper or watching television. However, vision problems can be the cause of a fall and improving vision can go a long way in preventing falls. A new study published in the Journal of the American Medical Association by researchers at the University of California, Los Angeles, showed the effect of cataract surgery on helping patients prevent falls. The study found that for the oldest patients, and those who were very ill, those who had cataracts removed sustained 16 percent fewer hip fractures in the year after surgery than those who did not. Patients ages 80 to 84 experienced the most significant benefit, with 28 percent fewer hip fractures.vi The study underscores the important role vision plays in healthy aging. Dr. Bach recommends that family caregivers help their care recipients update glasses frequently and consider getting a pair with single vision distance lenses for some activities, such as walking outside.

Home Environment: It's important to make periodic assessments of the home to reduce tripping hazards. Keep pathways clear of clutter and well-lighted, make sure floors are dry, ensure that stairs are level and evenly-spaced, and install handrails wherever there is more than one step down. Also, carefully gather wires, tape down carpets, and install grab bars in the bathroom so no one is tempted to grab on to a towel bar (which is not meant to support weight). Especially for those seniors who have some incontinence and find themselves hurrying to the bathroom, it's critical that their pathways are clutter-free, secure and well-lighted.

Footwear: Research says if you're over 65, you increase your risk of falling if you walk barefoot or with only socks. Our reflexes decrease as we age, so if your family member happens to step on something injurious, the reflex that causes him or her to hop off it may cause them to fall. Encourage your family member to wear comfortable well-fitting shoes both around the house and outside.

Assistive Devices: If your family member uses a cane, walker or crutch, make sure it fits properly in terms of height and handle grip size, and that they use it correctly. At least once a month, turn it upside down and make sure the rubber tips are in good shape and change them if they show signs of wear.

Balance: Good balance is important to prevent falls. But a person's balance may be affected by illness or medication. If you feel you have to hold your family member or they may topple, talk to your doctor. He or she may recommend a balance retraining program.

Muscle strength: Research at California State University showed that physical activity plays an important role in preventing and/or lowering an older adult's risk for falling. vii As a caregiver, you can help your family member keep up their muscle strength by reminding them, coaching them, or participating with them. According to Dr. Bach, various forms of exercise can help including walking, Tai Chi, yoga, strength training, and exercise classes for seniors.

Dr. Bach recommends that caregivers talk with family members about what they would do if they fall. "Play out this scenario: Pretend you've fallen. You should first see if you're hurt by patting yourself all over and then determine if you can drag yourself to a piece of furniture to get upright. If that is impossible, do you have a way of calling for help?" Dr. Bach says that after this discussion, many family members decide to get a Personal Emergency Response System (PERS) or "panic button" that can be worn around the neck or in a pocket.

A PERS transmitter is programmed to dial a response center when pressed. Wearing the device helps someone in trouble reach emergency assistance right away, and can prevent more serious problems from developing. According to a 1996 study in the New England Journal of Medicine, "The longer a person spends helpless, the greater the likelihood he/she will be discharged into supportive care. For elderly people who live alone, becoming incapacitated and unable to get help is a common event, which usually marks the end to their ability to live independently."viii A personal emergency response system means "peace of mind" for many caregivers and their family members.

For more information on preventing falls, visit the Visiting Nurse Service of New York's Strong Foundations website at http://www.vnsny.org/our-services/by-service/specialized-services/strong-foundations/.

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ihttp://www.ncoa.org/improve-health/center-for-healthy-aging/falls-prevention/falls-prevention-awareness.html

iihttp://www.clevelandclinic.org/health/health-info/docs/2900/2985.asp?index=10577

iiihttp://geriatrics.uthscsa.edu/tools/FallsintheElderly.pdf

ivhttp://www.cdc.gov/homeandrecreationalsafety/Falls/adultfalls.html

vhttp://www.cdc.gov/homeandrecreationalsafety/Falls/adultfalls.html

vihttp://www.nytimes.com/2012/08/01/health/research/fewer-hip-fractures-are-a-side-benefit-of-cataract-surgery-study-finds.html?_r=1

viihttp://www.who.int/ageing/projects/6.Role%20of%20physical%20activities%20in%20falls%20prevention.pdf

viiihttp://midwestalert.com/SOME_FACTS.php

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