A majority of seniors will experience a fall at some point in their lives. Sometimes, there is no way to prevent it. But in many cases, additional knowledge or a bit of advanced preparation could have made the difference between a near fall and a fall with serious consequences. Given the many complications that can flow from a fall, it’s critical to minimize the chances of one happening. Use these suggestions to set your aging patients up with the best odds to help prevent devastating falls.
It’s no secret that folks slow down and become less agile navigators of their surroundings as they age. But especially for seniors who’ve been active throughout their lives, the need to be more careful and take precautions to avoid falls may not be at the front of their minds.
A French study from 2005 identified a number of factors associated with postural instability. Among these, the authors discovered that lateral stability had a strong correlation with an increased risk of falling. Your otherwise healthy patients may report some change in their balance or postural stability. Especially in cases when they report balance deficiencies to be lateral in nature, make your patients aware that this trait has been shown to be predictive of an increased risk of falling.
Declining vision and hearing, certain medical conditions, and some medications can also increase a patient’s risk of falling. These risks can add up quickly when multiple diagnoses are present, or due to polypharmacy. Remember to cover falling as a possible side effect when discussing diagnoses and medication.
Special Case: Seniors with Diabetes
Mary Tinetti’s 2003 article in the New England Journal of Medicine found that seniors aged 65 and over with four diabetic complications have up to a 78% risk of falling compared to just a 30% risk faced by their non-diabetic peers. With almost 27% of that age group having been diagnosed with diabetes, it’s a substantial group of folks at risk of suffering a fall.
Several main complications of diabetes, including peripheral neuropathy, retinopathy and nephropathy, can work individually and together to increase falls risk. Lifeline’s ebook, Reducing Falls Risk Among Older Adults: The Correlation Between Diabetes and Falls Risk, highlights each condition and offers strategies to reduce those risks.
Home is Where the Falls Are
Though they’re often the places we feel most comfortable and safe, our homes become more and more dangerous to us as we age. The familiarity that permits us to walk around in the dark, navigate the halls from memory, and take steps a few at a time becomes the very thing that will betray us. We tend to know how to avoid areas of danger, because we’ve spent so much time in those areas previously.
But as we age, our bodies behave differently. The same 37 steps that used to get us from our bed to the bathroom in the dark may now only deliver us to the middle of the hallway. The eyes that used to adjust to permit us to see and avoid the dog toy in the hallway no longer perform as we remember, and we risk tripping. Worse, when we do trip in the dark, our balance isn’t what it used to be, and we’re unable to recover.
Admitting that we run a greater risk of falling should be all the motivation we need to make our homes as safe as possible. But that can be hard to admit, for a number of reasons. Sometimes, seniors feel that there is a stigma associated with being labeled a faller, and avoid discussing their concerns with their medical providers. We’ve previously looked at strategies for helping aging patients overcome such stigmas. Once your patients are ready to address the realities of their increased risk, it’s time to assist them in creating a safer environment. Here are some important thoughts for a few areas of the home.
Depending on the type of residence, the areas outside of the home can be the most treacherous. Seasonal conditions can create drastic differences in the reliability of the ground surface – from icy winter conditions in colder climates to extremely hot sand near the beach. Walkways on grades are especially susceptible to becoming problematic due to the weather. Steps, ramps or surfaces in poor condition that can be overlooked by more agile persons can easily become a trip hazard. Encourage your patients to have secure handrails installed along areas of frequent travel, and to ensure all entry and egress areas are in top condition.
Gardening is an enjoyable activity for all age groups, and can even improve cardiovascular health. A variety of enabling devices are available to assist even very unstable seniors in continuing to enjoy gardening throughout their lives. Garden beds can be constructed at a height to eliminate the gardener’s need to stoop or kneel. Container gardens or wall-hanging beds make the activity accessible even in limited space. Even seniors confined to a bed can enjoy cultivating window boxes or houseplants. For your patients who insist upon maintaining a traditional garden plot, make sure to remind them to stay hydrated, to rise from a kneeling position slowly and carefully, and to protect their skin and eyes from the sun.
The kitchen can be a dangerous room for even the most surefooted person. Kitchen floor surfaces are typically smooth for ease of cleaning, but this can cause slippery conditions in the event of a food or water spill. Cleaning up such a spill can require bending, reaching and wiping – all less familiar body positions that can cause a loss of balance.
Normal daily activities can present additional risks. For example, a tall kitchen garbage bag may have been easy to manage for most of one’s life, but can become a heavy and unwieldy load to lift from the receptacle and transport to the collection area when at an advanced age. Even putting groceries in the refrigerator – an activity that requires frequent bending and reaching – can be dangerous for patients with orthostatic hypertension. Be frank when addressing these risks, and help your patients adjust to these sorts of limitations by selecting smaller, easier to carry trash containers and by stocking the refrigerator while seated or by using an extension grabber claw device.
Another room with potentially slippery floor surfaces is the bathroom. As explained in Lifeline’s ebook, How to Create A Safer Home, there are four areas of the bathroom that require special attention.
Using the toilet requires a squatting motion that can challenge unsteady seniors. Secure grab bars installed near the toilet will make the area much safer. This advice works for bath and shower areas as well. If a high step-over is required to get in or out of a tub, grab bars can give your patients the confidence to bathe themselves without anxiety.
The shower and tub is a great place to consider assistive devices such as hose-mounted shower sprayers and shower seats. A seated position eliminates the need to maintain balance throughout the bathing process. With some practice, it will be possible for patients using a shower seat to enter and exit the shower without needing to step in our out while standing, by instead swinging the legs over the tub wall one at a time while seated. This practice greatly reduces the risk of a slip and fall accident.
Because seniors often need to visit the bathroom during both day and night hours, it is important to ensure the space is well lit. Counsel your patients to install a bright, light-sensitive nightlight to make using the facilities easy no matter when nature calls. An LED model will use very little energy, and will provide abundant light every time it is needed.
Even with grab bars present, getting in and out of the shower is dangerous. It’s made much more so when a bathmat is underfoot. Unlessit’s a non-slip model designed to grip the floor securely, suggest removing bathmats altogether. A uniform floor surface uncluttered by a loose bathmat will also be safer to navigate while groggily making one’s way to the bathroom in the middle of the night.
Climbing and descending steps is taxing enough to aging bodies without adding an obstacle course to the task. Fortunately, it’s easy to improve the safety of a stairwell. Tell your patients to start by removing all clutter from stair treads. Household items placed on a step to be transported up or down stairs can easily trip a less stable senior. Unsecured area rugs or loose areas of carpeting should also be addressed. Be sure your patients have handrails at every staircase, and that they are capable of supporting the weight of a fall. Finally, encourage seniors to upgrade the overhead lights illuminating the stairs. Shadows can be deceiving and often hide trip hazards. A well-lit, uncluttered staircase with a secure handrail will give your patients the best chance of avoiding unnecessary falls.
A Safer Life
Falls are frightening. But not understanding one’s risk and not knowing how to prevent a fall is much worse. Help your patients notice the changes they’re going through, and alert them to changes that may be coming due to condition or medicinal side effects. Then work together to create as safe an environment as possible. For great details on ways to optimize the safety of bedrooms, living rooms, stairwells, bathrooms and more, download the ebook mentioned above.