Elderly Falls - a Serious Issue
We all wish to see our loved ones living in comfort even after they attain the age when they can't live by themselves. As winter is near us and the conditions become more slippery, our elderly loved ones are at a greater risk of falling.
This is true especially with our elderly loved ones who have a tendency to frequently fall. Senior fall prevention is something that we can’t joke around with, and elderly victims need a place where the best care will always be well guaranteed.
Most of us will agree that falls are serious health-related issues that hundreds of seniors face daily, particularly more so during a winter wonderland. To elaborate on how serious this concern is, our senior fallen victims may have suffered broken arms, wrists, hips, backs, as well as serious head injuries. Regardless of whether a senior citizen falls without a head injury, he or she may end up becoming nervous when he or she remembers the event. This, in turn, leads to a phobia for engaging in daily activities, such as going for walks, leaving the home, or physical exercises. As a result, senior isolation and loneliness may occur. The results of declined activities result in the weakening of their body muscles, leading to more regular falls in the future.
To understand more about how to prevent falls for the elderly, it's better to acquaint ourselves with the causes of these falls and their effects.
Dangers Related to Falls in Seniors And Elderly
- High Risks of Bone-Breaking, Bruises, And Cuts
Due to old age, most of the fragile bones and organs in the body may be at risk for becoming weak. The fall may also result in disorder, trauma, or even death due to excess bleeding due to bruises and cuts. As a result, the immune system may be compromised causing a longer wound healing time. The body may become more delicate, and a fall may cause greater damage to elderly people than younger people. Our elderly loved ones should be well taken care of to prevent the break of bones, bruises, and more severe wounds.
- Brain Damage
Senior and elderly people have a weak immune system, so a fall resulting in a head hitting the ground may result in traumatic brain injury and many other cognitive decline complications. Traumatic brain injury may result in milder concussions or more serious and permanent irreversible brain damage, even resulting in dementia, which in turn will require seeking a memory care facility.
- Breaking Hip At Old Age
As we age, we may become weaker, and more susceptible to heart disease, high blood pressure, and an array of other health concerns, for which we need to ensure we are receiving the best care. In such elders, even a low-level fall may result in a broken hip. The recovery chances from trauma of an 80-year-old senior is longer, and sometimes less likely, compared to that of a younger person.
Major Causes of Elderly Falls
The array of typical changes associated with getting older, similar to poor vision or poor hearing, can make one bound to fall. Diseases and physical conditions can influence the elderly people’s quality of life and balance. Poor lighting, unadjusted rugs, or slippery conditions from the boots you wore during a winter snowstorm or a rainstorm can also increase their likelihood of falls.
Also, the reactions of certain drugs can agitate the elderly parity and make them fall. Drugs for misery, sleeping aides for rest issues, and hypertension pills regularly cause falls. A few prescriptions for diabetes and heart conditions can likewise make a senior flimsy on their feet.
They might be bound to fall if they are taking at least four medications. They are likewise liable to fall if they have changed their medication within the previous two weeks. Generally, the following are some of the causes of elderly falls.
A. Environment-Related Risks
Due to their weak stamina and fragile conditions, seniors can easily slip and injure themselves. We should take actions to ensure our elderly loved ones enjoy a friendly environment that is free from falling risks. Consider taking off your wet boots outside of your home so that you do not bring the dripping wet inside with you. Check out your flooring to see if the ground and floors are slippery, and if you can install slip-resistant flooring.
An extrinsic risk factor includes environmental aspects that may cause slipping, imbalance or tripping. At home, seniors may trip over pets, rugs, electrical cords or other such surface objects. Tripping on stairs or wet bathroom floors that do not have handrails, is also a common occurrence. Also, a low seat toilet, poor lighting, and chairs without armrests increase fall risks for seniors at home.
Outside of the homes, inappropriate footwear, uneven sidewalks, ice, and snow can also cause falls for the elderly.
B. Weak Immune System and Drugs with Side Effects
As people get older, they're more likely to contract diseases. This causes longer healing times, and greater care should be taken to improve their immune system.
Also, as they are more prone to chronic conditions, they may be prescribed medications. Some of the medicines used to cure diseases, such as diabetes, high blood pressure, and depression may, in turn, cause side effects such as poorer eyesight. Poor eyesight results in increased fall risks as the older person cannot see clearly. Vision is a crucial element in our daily activities, thus caregivers should guide the elders on how to administer the drugs as prescribed by the doctor. Also, if you notice any unusual occurrence or if the elderly person feels a bit differently, then call or visit a doctor immediately. A seemingly minor challenge could result in or be the cause of a more serious health condition.
C. Visual Impairment
Visual impairment is considered one of the most common chronic health conditions in elderly seniors. This critical factor has been found to increase with age and contributes to greater risks of falls and fractures in seniors. Visual impairment comes in various visual aspects, such as visual fields, visual acuity, depth perception, color perceptions, and contrast sensitivity. However, it’s still unclear which of these aspects constitute the greatest role in the risk of falls in the elderly.
Elderly Fall Prevention Checklist:
Given the causes of senior falls and their related injuries, one can employ various fall prevention strategies to mitigate these risks. There are detailed guides for home safety assessments to establish and modify environmental risk factors. However, it’s important to note that curbing the environmental risk factors isn’t enough, as there are numerous intrinsic factors causing falls in seniors. Since some factors, such as gender, age, and history of the senior's previous falls may not be modified, other interventions have been put in place to target other intrinsic factors, such as vitamin D supplementation, medication reduction, exercise, and correcting visual impairments. The following are detailed strategies that can be used to prevent elderly falls.
1. Help Your Loved One Take Simple Steps to Stay Safe:
Most of our seniors aren’t concerned about falling. Many recognize falling as a serious risk, but they never think that it can happen to them. Besides, they believe that even if they fall, the chances of getting hurt are minimal. To minimize their fall, share some of the myths regarding older adult falls. If the seniors express some concern about falling, balance, or dizziness, encourage them to discuss these concerns with their physicians who will then assess their fall risks and suggest services and programs that may help.
2. Evaluate the Seniors’ Health Conditions:
Evaluate and find out whether your aged loved one is finding it difficult to manage his or her own health. Do they remember to take the correct dosage at the current timing for the correct duration to mitigate diversion? Do these medications have adverse side effects that are being monitored? Do they find it difficult to engage in activities they could easily do in the past?
It is important to ensure that they take advantage of the various preventive services available, such as those offered by Medicare or your local health department. Such benefits include annual wellness visit and fall prevention workshops. Encourage the importance of openly discussing their health conditions with health care providers.
3. Take Them for Regular Eye Check-Ups:
As our vision declines, we may need to wear glasses. However, you need to make sure that these glasses are the ones prescribed, are adjusted as needed, and are the ones advised by the opticians.
It’s important to note that using tint-changing lenses is risky, especially when moving from bright sun into darkened homes or buildings. Sometimes, you may need to switch or adjust lenses after you enter dark buildings after spending time out in the daylight; or if you enter your home after spending an evening out and about.
Also, keep a watchful eye if your loved one is using bifocals, as this is hazardous especially when moving up or down the stairs and can result in a fall. It’s therefore important to take caution when using these bifocals. If the senior is struggling with poor vision, encourage them to consult an optician.
4. Visit a Trained Physical Therapist to Improve Their Balance:
Find out if your loved one is holding onto furniture, someone else, or walls when walking. Notice if they’re having difficulty walking or getting up from a chair. If these signs are evident, it’s the right time you consult a physical therapist. A professional physical therapist can greatly help vulnerable seniors improve their strength, gait, and balance through regular exercise. They might also recommend using a walker or a cane, and offer guidance on how to make the best use of these aids. Strictly follow the therapists’ advice. Poor walking aids or not correctly abiding by the physical therapist’s recommendations can greatly increase falling risks.
5. Conduct a Thorough Walk-Through Safety Assessment in Their Homes:
Caregivers should always commit themselves to make the aged senior's homes safer. There are numerous simple ways to ensure this safety. For expert assistance, consult occupational therapists.
Regarding lighting in elderly houses, increase the lighting to ensure the rooms are clean and free from obstacle courses. This especially refers to checking that the stairs are free and there is sufficient lighting as the bottom and top of the stairs, as these are the most likely sources of tripping hazards. Also, ensure that lighting is available, even if they happen to wake up and wander around late in the night.
6. Ensure That the Bathrooms Have Rails:
Check to see if the bathrooms have grab bars installed in the showers and tubs, as well as near the toilet. Ensure that these rails are strategically located for the senior to be able to easily identify and use them, even if the senior forgot to turn on the bathroom lights. To improve safety, order shower chairs and install handheld showers.
7. Encourage Sufficient Vitamin D Supplementation:
Senior adults are at a higher risk of Vitamin D deficiency. Vitamin D is clinically known to promote calcium absorption, and promote normal bone mineralization by proper maintenance of sufficient phosphate and serum concentration. Vitamin D is essential for bone development and maintenance. Vitamin D supplementation greatly improves muscle strength and functioning, and thereby reduces fall risk by about 20%.
8. Join Them for Regular Physical Exercise:
Encourage your loved one to keep moving, and join them so that they are more interested in physically exercising. Physical exercise is known to go a long way to prevent falls in seniors. If your elderly loved one possesses the capacity, then encourage them to participate in water workouts, walking, and dance-like movements. Some of these activities are known to greatly curb the risk of falls in the elderly by improving balance, flexibility, coordination, and strength conditioning.
However, some seniors are afraid of physical activities, as they feel that these activities will increase the chances of falling. In such a case, contact their healthcare providers or physical therapist. These specialists have the training and skills to recommend better-monitored exercise programs or to consult about creating custom programs aimed at improving their balance, gait, muscle strength and flexibility.
9. Get the Right Shoes for Them:
As long as caregivers are committed to establishing fall-prevention plans for the seniors, they should also consider monitoring for appropriate footwear. High heels, floppy shoes, non-skin boots, and slippers with slick soles may seem fashionable, but it won’t be all that fashionable and pleasant for a fall to occur. To manage this risk, help the elderly wear properly fitted sturdy footwear with non-skid soles. They will be less likely to fall and their feet and knees will not be as painful.
10. Remove All Home Hazards:
Seniors may fall and get injured from various home hazards. Caregivers should look around their houses, living rooms, bedrooms, kitchen, hallways, stairways and bathrooms to remove all tripping hazards. Clear away any newspapers, boxes, phone cords and electrical cords from the senior’s walking path. Coffee tables, plant stands, and magazine racks should also be removed from high traffic areas. Also, loose rugs should be removed, as slipping on them can result in serious body fractures. To fall-proof floors in showers and bathtubs, install nonslip mats. Also, take bath seats into the bathrooms to allow the seniors to sit while taking showers.
11. Keep Track of The Senior’s Health and Appointments with Their Doctors:
Perhaps one of the most essential steps to start the fall prevention plan is to make sure that your senior loved one visits their doctor and other health professionals as scheduled.
When keeping tracking of doctor appointments and advice, consider the medications being taken by your loved one. Write down all the dosages and timing for when your loved one takes medications and over the counter prescriptions and supplements. Bring this list to the doctor and remind them to review the patient's medications for possible side effects that may increase the elderly falling risks. To assist in fall prevention, the health provider may choose to wean off all the medications with side effects or those that may affect the senior’s perceptions and moods, such as antidepressants and sedatives.
It is important to take note of the number of times that your loved one has fallen before. List down every detail, including the time, the place, any obstacles that may have caused the tripping hazard, and how he/she fell. It is also important to discuss near-miss fall instances when the elderly almost fell but was caught by someone or grabbed onto something that prevented them from falling. These details will play a critical role in helping the doctor establish specific fall prevention techniques.
Also, the caregiver needs to establish if the elderly’s health condition may have links with the falls. For instance, certain ear and eye disorders may result in increased fall risks. Discuss these health conditions and explain how comfortable the elderly may be when walking, for example, do they complain of dizziness, shortness of breath, numbness and joint pain?
Elderly Fall Prevention in Senior Homes
Preventing falls in senior homes, such as an adult family home or assisted living facility poses an ongoing challenge to the whole interdisciplinary care team, especially when providing care for elderly with disabilities.
These senior care homes first conduct a thorough assessment on the first day of admission. This is followed by the implementation of proposed fall prevention strategies and an individualized care plan to mitigate any established fall risks. However, despite the best efforts by senior caregiver experts, some falls may still occur. This, therefore, calls for a comprehensive root cause analysis that investigates beyond the most obvious causes for falls. These facilities use these reviews to develop sustainable and effective fall prevention strategies and programs that generally promote the safety cultures of vulnerable seniors.
Learn more: Assisted Living vs Home Care
When a fall has occurred at assisted living facilities, experts assess and mitigate risks that may have led to the elderly falls. The senior home’s interdisciplinary care team begins the falls prevention process by identifying both the risk factors and the senior’s fall history, including any falls that may have occurred prior to the transition to assisted living. Experts conduct a thorough multi-factorial risk assessment to establish if the falls occurred as a result of medications, health status, or physical conditions. The assessment includes a focused history review that studies the patient's fall history, medication use, and comorbidities. The holistic process also involves a comprehensive psycho-social evaluation, and physical evaluation of mobility, neurological function, joint function, visual acuity, muscle strength, and functional assessment. This, therefore, means that careful examination of all relevant medical, social and psychological history that may boost the risks of falling is conducted.
Upon the completion of the fall risk assessment, the team strategizes and identifies care interventions to address or reverse each individual risk that was identified on the falls evaluation instrument. Effective manipulation of risk evaluation tools solely depends on the identification of each risk factor that may have caused the fall.
However, various conditions may compound the risks of falls and make it more difficult to identify and effectively intervene. For instance, poor oral health may lead to hydration and nutrition deficits that can cause poor healing of infections, weakness, and cognitive changes. An oral hygiene concern may be a bit more challenging to identify as the stem for a fall. However, the assisted living facility caregivers are trained to constantly observe for any unusual occurrences so that they intervene as soon as possible, to ensure the senior has the greatest care outcomes and maintains proper health.
The Doctor’s Checklist When Considering Elderly Falls
When an elderly person falls, we need to concentrate our efforts to prevent injuries. The caregiver needs to be proactive in getting the right medical assessment to the doctor who will then make decisions based on the available information.
After the fall, caregivers should accompany their loved one to a medical visit to have doctors address any potential injuries that may have resulted from the fall. To prevent future falls, ask the doctor to check on all probabilities that could have led to that single fall. Even if you’re sure whether your loved one just slipped or stumbled, it's important to conduct a proper evaluation to uncover aspects that may make him or her stumble again.
The doctor will consider the following factors to create an appropriate fall prevention plan for your loved one:
1. Deep Evaluation of Any Underlying Illness
Specialists check for any underlying illnesses or comorbidities that may have contributed to the fall. The doctor will examine if the patient has wooziness, dizziness, or poor wellbeing indicators. Be sure to discuss any side effects you've detected, and let the doctor know how rapidly the disease's progression may have escalated.
2. Blood Pressure Examination
This is particularly significant in the event that a senior elderly has been stressed, falls frequently, often has near-miss falls, experiences hypertension or any other heart-related condition.
In case your loved one takes a blood pressure prescription, you should ensure the medical specialist affirms that the individual in question isn't encountering a drop in blood pressure.
3. Blood Count Test
Checking the elderly person’s blood tests regularly is a smart thought after a fall or a near-miss fall. Falls can be compounded by issues related to an individual's blood count, or by aspects like blood sodium becoming excessively high or excessively low.
For the most part, a total platelet count (CBC) and a check of electrolytes and kidney work (metabolic board, or "chem-7") are a good spot to begin.
Ensure that you’ve requested that the specialist clarifies any abnormalities found in the blood components, regardless of whether they may be identified with the falls. Ask the specialist how they intend to address these concerns.
In case your elderly loved one has diabetes and takes insulin or different prescriptions to lower glucose, ensure you acquire the glucometer or a glucose log. Scenes of low glucose (hypoglycemia) are a significant hazard factor for elderly falls, yet a lab blood test doesn't indicate snapshots of low glucose.
Your Senior Loved One Falls Frequently. What Are the Next Steps?
It's important to note that falls are a common phenomenon for seniors. However, most caregivers know that this condition can be frightening. Once this sign starts to show, family members are left wondering how to get their old loved ones back on their feet. However, positive minds and positive affirmations can help ease and improve the situation. If you are concerned about falls, then the best strategy to minimize falls is to contact health providers and let them examine the general health of your loved ones. Start the prevention plan by ensuring that the home itself is safe and habitable. By removing all hazardous objects from the house, you will minimize the chances of injuries resulting from falls. If you are concerned that you may be unintentionally neglecting your elderly loved one and that may be the reason for their falls, then an assisted living facility may be the best option to consider for you as the caregiver and your elderly loved one.
About the Author:
"Elderly Fall Prevention & Causes of Elderly Falls" is authored by Anisha Rao, MPP, Healthcare Consultant, Certified Lean Six Sigma Green Belt Healthcare Professional. Anisha holds a Master of Public Policy from the University of Maryland, Baltimore County, as well as a Bachelor of Arts in Health Administration and Public Policy, a Bachelor of Arts in Psychology, and a Minor in Management of Aging Services. Anisha has extensive experience in Healthcare Services and Aging issues, including dementia care, senior health, and nursing home care. Anisha is passionate about ensuring seniors receive the best care possible and empowering seniors to become more involved in their care planning decisions.