Preventing Falls In The Elderly

Falls are the main cause of accidental injury in adults over 65 years old and account for 85% of hospitalizations1. Falls can lead to head injuries, bone fractures, and pain that can last for more than 6 months (also known as chronic pain). Not only do falls usually take time to physically recover from, but they may also affect the person’s confidence and make them more afraid to move around their home or climb stairs. Overall, falls can significantly reduce a person’s quality of life and their ability to live independently. This article will explain why falling is more common in older adults, identify risk factors for falls in the elderly, as well as discuss what to do if a loved one experiences a fall.

Why Are The Elderly At Increased Risk For Falls?1

There are common behaviours and health changes that happen after age 65 that make falling more likely. They are:

Common behaviour: older adults tend to develop a fear of falling, which makes them tenser when walking and therefore, more likely to fall. They also tend to overestimate their abilities and to not ask for help when they need it.

Changes in health: weakness of muscles and bones, unsteady walk/poor balance, poorer vision, decreased ability to see in darkness, and increased use of medication tends to occur with older age, and increases chances of falling.                                                                          

Is My Loved One At An Increased Risk For A Fall?1

Which medication(s) and how many medications are they taking? Simply taking more than 5 medications can put them at risk of falls. Do they take medication for blood pressure or certain medication to help them relax (also known as benzodiazepines)? Ask them if they feel dizzy after taking these medications, especially if they have been newly prescribed. Important: if you are concerned about a medication they are taking, please speak to their doctor or pharmacist before stopping any of them.

Do they have any medical conditions? Certain illnesses affect balance on their own (e.g. Parkinson’s disease). Conditions that cause pain and weakness (e.g. arthritis), or that affect their movement of a limb (e.g. stroke), would make it more difficult to walk and make falls more likely. Confusion, often caused by dementia, may cause them to overestimate their limits or affect their judgement about what is safe. If they are incontinent (meaning they are unable to make it to the bathroom) or if they get up often to urinate during the night (known as nocturia), falling may be more likely.

How do they walk? Do they have balance difficulties? Look for signs such as grabbing onto furniture when they walk, being unsteady on their feet or needing to use their arms to push themselves up from a chair. Consult a qualified healthcare professional to determine whether or not your loved one may need an assistive device such as a cane or walker.

Have they fallen in the past? Having experienced a fall in the past increases the risk that your loved one may experience another fall.

Do they have vision problems? 

If you answered yes to one or more of the above, then your loved one may be at an increased risk of falling in their home. If you are concerned about their safety, we encourage you to discuss these concerns with a qualified healthcare professional health. See below for simple ways to prevent falls!

How To Prevent Falls In The Elderly?1,2,3

Here’s what you can do at home to help make falls less likely:

Home safety:

  • Floor: avoid clutter on the floor and make sure rugs won’t easily move.
  • Lighting: put light switches at the top and bottom of stairs. Install night lighting in hallways and stairs that does not need to be switched on.
  • Stairs: permanently mark the bottom stair, since most falls happen because of not knowing when the stairs end. Ensure the hand rails are solid, that they extend the full length of the stairs and beyond, that there is no break in the hand rail and there is some indication of when the stairs are coming to an end (e.g. a bend). Don’t forget to evaluate the safety of your front and back steps as well. See the Canada Mortgage and Housing Corporation recommendations for safe stairs and how to go about making renovations. Speak with their doctor to see if stairs should be avoided altogether.

Home Adaptations: Speak with your doctor and inquire to see if an occupational therapist can evaluate the safety of the home and make specific recommendations.

  • Bathroom: a toilet seat riser and grab bars can be added next to the toilet and in the bathtub. Using non-slip bath mats, and even a shower seat can be a good idea.
  • Bedroom: side rails can be installed if they have difficulty getting out of bed.

Clothing/footwear: wear clothes that are not too long (i.e. that they won’t trip on and that won’t get caught in doorways) and footwear that fits properly, has a back support, and is not slippery.

Medications: Instruct them to review their medications with their doctor, mention if any make them feel dizzy, and ask if vitamin D supplements to strengthen bones are appropriate. If a medication makes them feel lightheaded when they stand (called orthostatic hypotension), instruct them to get up slowly and in steps: 1) sit up from lying down 2) slowly go from sitting to standing 3) wait a few seconds before beginning to walk.

Alcohol use: Alcohol may change the effects of medications or cause them to have extra difficulty with stairs, so alcohol may need to be kept to a minimum.

Exercise: Speak to a doctor or physiotherapist so that they may give you exercises that will strengthen their muscles and improve their balance.

Assistive devices: walkers or canes are available at your local pharmacy. Discuss with a health care professional (doctor, nurse or physiotherapist) if you are uncertain if this is necessary, or which to use. If they have difficulty getting up, remind them to ask for help.

Personal emergency response system: especially if they are living alone, installing an emergency button that they can use if they do fall may be important for their safety.

What Do I Do If They Have Fallen?

Depending on how severely injured they are, they may require immediate medical attention.

Take a deep breath. Call 911 if they have hit their head, lost consciousness, may have broken a bone, are suddenly confused, or are bleeding (especially if they are taking a medication to thin their blood). If they are injured, they should not try to get up themselves. If they feel strong enough to get up, they should follow these steps.

Figuring out what caused the fall is important, so you can address the cause. For example, if it was due to the stairs, reassess the safety of the stairs in their home. Make an appointment with their physician or nurse to tell them about the fall.

If the fall has caused them to be afraid of walking or climbing stairs, make sure this is addressed. Not walking at all will only make them weaker and in turn, further increase the chances that they will fall again.

Written By:
Palmina Montanaro BScN
Nursing Student

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If you have any questions or concerns regarding the content of this article post, you may contact us directly at infophysiotherapy10@gmail.com.

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DISCLAIMER: This blog is not meant for diagnostic or treatment purposes. It should not substitute for professional diagnosis and treatment. The content of this blog is a resource for information only. This blog was created to serve as an information resource for both the general population and health professionals. For any further questions or concerns regarding concern for the safety of a loved one, please consult your doctor.

References

1. Kozier, B., Erb, G., Berman, A., Snyder, S. J., Buck, M., Yu, L., & Stamler, L. L. (2014). Fundamentals of Canadian nursing: concepts, process, and practice (3rd ed.). ON: Pearson Canada Inc.

2. C. (2016, July 05). Preventing Falls on Stairs | CMHC. Retrieved May 10, 2017, from https://www.cmhc-schl.gc.ca/odpub/pdf/63637.pdf

3. UpToDate. (2017). Patient education: Preventing falls (The Basics). Retrieved May 10, 2017, from https://www-uptodate-com.proxy3.library.mcgill.ca/contents/preventing-falls-the-basics?source=see_link

4. American Academy of Orthopaedic Surgeons. (2007, October). Getting Up From a Fall. Retrieved May 11, 2017, from http://orthoinfo.aaos.org/topic.cfm?topic=A00098

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