Falls in elderly is a common issue and we can do a lot about it, though many people do not know it.
A majority of older seniors (around 85-91%, according to different researches) would like to age in their homes, as independently as it is possible. It would be fine, but, unfortunately, many forget that they are getting older and things that were quite easy to do or even avoid before, aren’t any more. A fall can easily put an end to independent living. Half of those who fall never return to the previous level of mobility and independence. Risk of ending up in a nursing home triples to ten folds.
In this article, we’ll try to see what are the odds of having a fall, some interesting facts, the main risk factors and the ways you can improve your chances of NOT falling. We’ll still give some tips on what to do if the fall still occurs and finally, take a look at the psychological impact of a fall, occurred or not.
When you have a loved one who might be in risk of fall, your first task is to talk about it. Consider all the risks, remove those you can and improve those you can’t.
Some Facts About Falls
Accidental falls in elderly are a major source of morbidity and mortality for older people. They are also the most common cause of traumatic brain injuries and spinal cord injuries.
Every 15 seconds one American gets into an emergency department because of a fall and every half an hour one person dies as a fall result.
In UK, each year, fractures in patients aged 60 years and over account for more than 1.5 million hospital bed days.
Third of over 65 adults fall each year, while every second over 80 does.
This is the 5thleading cause of death in over 65.
10% of all falls lead to fractures, especially hip fractures, brain traumas.
60%of sufferers experience moderate, while 15% a serious decrease in social life and physical activity.
More than 95% of hip fractures are caused by falling.
However, according to KE Anderson, Consultant in Department of Medicine for the Elderly, Royal Victoria Hospital, Edinburgh, UK, a big portion of falls are generally preventable if all the existing risk factors are addressed at the same time.
Who Is in Risk of Having a Fall:
-People who have fallen before (the risk doubles after the first fall)
-People who have strength, gait and balance problems, muscle weakness, being ill for some time and losing strength, abnormal gait and balance, trouble walking, decreased functional status(the ability to take care of yourself), above 80 age…
-People with postural hypotension (a condition where your blood pressure can suddenly significantly drop if you stand up from a sitting or lying position)
-People who suffer from some medical conditions and illnesses, like sight impairment, hearing impairment, age related changes, osteoporosis, diabetes, dementia, dizziness, depression, arthritis, occasional sudden pains, incontinence (you wouldn’t think of this one, would you?)
-Fear of fall is also one of the serious risks, especially after having had one already.
There are further risks, which are somewhat easier manageable:
-Certain medications (sleeping pills, antidepressants, anti psychotics and all of those that affect the brain), or 4 or more medication of any kind. Some of these might be very much-needed, but worth of talking over with your doctor a different approach.
-Environmental, like clutter in the home, unsecured carpets, unstable furniture, slippery floors, improper footwear, poor lighting, low toilet, no rails on stairways, worn out carpet on stairs, no grabbing bars in the toilet or bathroom, or outside cluttered sidewalks, loose tiles, damaged pavements, poor lighting, poor railing, etc.
-Improper use of assistive devices also represents a risk and a not so uncommon cause of falls.
People with 4 or more risk factors have a whopping 78% chance to fall in a year.
By improving, ceasing the existence of some of those risks (changing the medication, improving balance, exercising to regain strength, your risk can be reduced to half or even less.
What Can You Do If You Are in This Group?
First, accept that you are not that stable or young as used to be and there might be a higher chance for you to fall at some point. Admit it, ask for help from your doctor and other professionals, accept the advice, take precautions and be sensible about it.
Have a plan for a possible fall, think it over. How can you get up if you fall in any of your rooms. Do you have a chair, for example, to help you. Who will you call to help you and how? Do you have a cell phone in your pocket or would you be better off with a personal alarm system? Be prepared. It will at least decrease your panicking if it happens.
Exercise is extremely important, to keep you fit, healthy and help not only prevent fall, but also help you recover if you have had a fall. You can start at any age, even if you have never exercised before. Regular exercise has been strongly proved to decrease falls in older adults. At least three times a week is the recommendation of healthcare professionals.
You should choose something you like and that will target your balance, strength, coordination, reflexes, body awareness. Thai chi, for example, walking, some strength and balance exercising would be a good choice. A physical therapist can help you find appropriate exercises.
When someone falls It is not uncommon that a person who fell starts avoiding activities-going out, walking, exercising and so on. Actually, you need to increase your physical activity after a fall, not decrease it. You need to improve your balance, regain your strength and decrease the possible fear of fall that might have appeared after having had one.
As with anything health-related, it is essential that you eat a healthy diet, here especially one that will increase your bone density and strength. It might be helpful to take supplementation of vitamin D-people falling are often deficient of it. Make sure you ask your doctor or healthcare provider about it first.
A good check-up should become your regular habit as you age (sight, hearing, blood pressure, joints, muscles, brain, heart, nervous system, feet).
Go through prescribed (and over the counter) medication you take with your doctor and see if there are some that can be omitted or the dose changed, or some other type prescribed. (In one study, lessening gradually and finally stopping the use of psychotropic medications like sleep medications, sedatives, anti psychotics and antidepressants, over a 14- week period were associated with a 39 percent reduction in the rate of falling, however, it was also stated that permanent withdrawal is very difficult to achieve)
Get home safety risks evaluated-an occupational therapist can give advice on “fall proofing” your home. There are, however, some improvements you can already do on your own.
Risks You Can Take Care of on Your Own:
-cords in way at walking areas (remove along walls, or get cord covers for them)
-carpets and rugs loose (tack down the carpets and only use rugs with non-skid backing)
-Insufficient lights in dimly lit areas and at the top and bottom of stairs (change bulbs or add some lights)
-weak or no nightlights in bedrooms, halls, and bathrooms (consider getting motion-activated lights)
-clutter in the house, at areas you walk, especially near staircases (declutter all the areas you might be going through)
-lack of grab bars near the toilet and bathtub, and no non-slip rubber mat in the tub or shower (check if you could install some, do not rely on the vacuum grab bars and find a good quality rubber mat)
-inappropriate, soft, open, loose slippers, or even socks only (start wearing firm house shoes with a back and a good grip on the bottom)
-You can read more about home modification in a previous article here
Using a device, such as a cane or a walking frame may be repulsive to many people, as they think they will look old, incapable, vulnerable. But, try thinking of someone who needs a walking device without it compared to someone with it, and you’ll find out they actually look more confident, more capable and less vulnerable. Consider using that device, because it can make all the difference between going out and falling or going out and doing what you want to do.
Ideally, we strive not to have any falls, ever. But, more likely, we can achieve fewer falls, and no falls with serious injuries.
Now you have a rough idea about your fall prevention concept (identify risks, minimize them, remove hazards, focus)
What If You Fall Anyway
-Take a moment before you try to move. Avoid panicking. You will get up eventually, one way or another.
-Make sure you’re not injured by slowly trying to move your legs, ankles, your arms, wrists…
-Look for something stable you can hold on to, like a piece of furniture, chair, bed, or a sink or a toilet in the bathroom, then roll on your knees and hands if you can.
-Slowly try getting up holding on to the stable thing you found.
-When you managed to get up, sit there for a while and rest.
There might be situations when you simply can’t get up-you don’t have the strength or there is nothing to hold on to, or you are in an awkward position and can’t reach anything:
-make some noise to attract someone’s attention- hit the radiator or some other metal object close to you, or any glass you can reach or whatever else is usable around you. If nothing is there, use your voice -shout!
-if you have a personal alarm, use it, even if it is middle of the night! People on your contact list would rather be there for you than not be bothered at night.
When none of these is possible and the chances are you are going to stay there until someone comes and finds you:
-Make sure you stay warm-cover yourself with whatever you can reach-a coat, blanket, towel, rug…
-keep moving those parts of your body you can, as the circulation may slow down if you don’t.
-try not panicking, but keeping your mind busy by anything you can think of, besides the fall.
Dr. Mary E. Tinetti, from the Departments of Internal Medicine and of Epidemiology and Public Health, Yale University School of Medicine says in one of her publications:
“The person at risk and his or her family members should be educated about the multi factorial nature of most falls, about the specific risk factors for falling that are present, and about recommended interventions. Persons at risk for falling who live alone or who spend large amounts of time alone should be taught what to do if they fall and cannot get up, and they should have a personal emergency-response system or a telephone that is accessible from the floor”
The Psychological Impact of a Fall
Research by the American Journal of Epidemiology shows the fear of falling in seniors will have a significant impact on their quality of life. Among those who haven’t fallen yet this fear is present in about 30%, while among those who have already had a fall it is present in even 60%.
Serious falls are serious because they influence, both emotional and functional well-being of a person, a senior in our case.
A fall can be serious even if there is no significant injury as a result. The fact itself that the fall occurred may come as a shock and make a senior realize he/she has not longer that level of control over own life, as before.
This might trigger a feeling of helplessness, frustration and even anger, but most frequently-fear. Fear of having much more serious consequences at the next fall, fractures, long or no recoveries, potential disability. The need to make great adjustments, slow down in order to avoid it.
This fear may cause someone to lose partly or often even completely the confidence to leave the home, not going out as often or not going anywhere alone, not crossing the street alone. He/she becomes dependent on others, while isolating more and more.
Social connections will decrease, eventually causing loneliness. Any physical activity will be significantly decreased by the fear of falling while doing so, which in turn causes muscles to weaken, which again can lead to more falls or to increased fear.
Actually, you need to increase your physical activity after a fall, not decrease it. You need to improve your balance, regain your strength and diminish the possible fear of fall that might have appeared after having had one.
We discussed the basic facts about falls and the basic reasons someone might have one. We went through your possibilities to improve your chances of avoiding it and talked about some things you should do and not do if that fall still occurs. We discussed also the significant psychological impact of this occurrence.
I hope this gave you enough material to think about your health and about maintaining your independent life, consciously preventing even the smallest risk of a fall.
If you have any experience in your surroundings with falls in elderly, I’m sure we’d all like to read about it in the comments. As always, should you have questions, feel free to reach out and I’ll be happy to answer to the best of my knowledge.
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