In the elderly, even a slight fall can cause serious injuries. It can also be terrifying, especially if they have to wait a long time for help to appear.
Focusing on safety to prevent falls won't just lower the risk of physical injuries. It can help your elderly loved have peace of mind too.
Not all falls are going to have a big, obvious cause. And not all risks can be removed. I know someone who sneezed while walking, stumbled, and just couldn't right themselves before falling. Obviously a caregiver, no matter how vigilant, can't prevent a rare quirky incident like that!
However there are a many common risks (and some not so common) that can be removed or minimalized as much as possible. Sometimes it is as simple as moving certain items to other rooms. Other times it might mean installing hand rails.
Ice and snow of course are two of the greatest hazards. Wet porches, steps, walkways and floors can also be dangerous. You can't prevent snow or rain, but you know to dry up spills, and clear ice and snow from senior's porches and driveways.
How much safety prevention and preparation you do inside the house will depend on your loved one's needs and limitations.
So let's take a look at some ways to prevent falls, stumbles and other risky mishaps.
Environmental Hazards
These are usually the easiest to remedy. The areas most used by the elderly should be clear of hazards that can cause falls. These include:
Surprisingly, very simple things can cause someone to slip. People with poor balance or vision can slip on something as seemingly innocent as a piece of paper. Or even trying to avoid something they think they see. (For example they might mistake a patch of sunlight as a bit of paper or some other object and step over it, possibly losing balance.)
Some falls aren't caused by an object, but rather by a condition of the environment. This can include very bright or very poor lighting. Spots on the floor that are particularly slick, or that are very non-slick can both cause an equal amount of falls. Glare on floors or at eye level (such as bright uncovered windows) can be a problem too.
A person who scuffs their feet can trip when they walk across an area that does not allow them to slide their foot, taking them by surprise and upsetting their balance.
A person's health can be one of the largest culprits when it comes to falls. Conditions such as these can all lead to falls:
Less serious conditions can also lead to falls.
Temporary conditions such as surgeries or uncomfortable medical treatments can also increase the risk of falls. When in pain, the elderly may be weaker, especially after a long convalescence that caused them to lose bone or muscle strength. They may also avoid using assistive devices if they cause pain the arms or hands.
Those who take a variety of medications may have an increased risk of falls. Especially those who take anti-depressants or anti-psychotics.
Some medications have bad interactions with each other. The effects of medication can be increased if the elderly catch a cold, get a UTI, or undergo a period of stress or pain. The time period directly after new medications are introduced or increased is a very vulnerable time when the elderly may be more disoriented as they adjust.
The elderly may take these risks as a declaration of their independence. They may feel like they are justified because they have always done things the same way, without issue before. For those who are more mobile, using a device such as walker might feel like too much trouble for a few short steps to the kitchen.
In nursing facilities, many falls are caused by residents deciding not to call for help. Sometimes they just want to do it for themselves. Especially if they are still in denial that they need help at all.
As a home caregiver, you will encounter the same issues. An elderly loved one may not call for your help if they have decided they are capable of standing or walking on their own. They may also decide that since your back is turned, they can "sneak" by without using a cane or walker, or slipping on their safer shoes. (Especially for just a "short walk".)
- Rugs (At the very least they need to be slip proof and have the edges secured. )
- Loose carpeting or tile
- Cords or cables across the floor
- Areas of flooring that are slick
- Small objects and furniture
- Toys and clutter
Surprisingly, very simple things can cause someone to slip. People with poor balance or vision can slip on something as seemingly innocent as a piece of paper. Or even trying to avoid something they think they see. (For example they might mistake a patch of sunlight as a bit of paper or some other object and step over it, possibly losing balance.)
Some falls aren't caused by an object, but rather by a condition of the environment. This can include very bright or very poor lighting. Spots on the floor that are particularly slick, or that are very non-slick can both cause an equal amount of falls. Glare on floors or at eye level (such as bright uncovered windows) can be a problem too.
A person who scuffs their feet can trip when they walk across an area that does not allow them to slide their foot, taking them by surprise and upsetting their balance.
Illness, Surgery, Pain
A person's health can be one of the largest culprits when it comes to falls. Conditions such as these can all lead to falls:
- Arthritis
- Parkinson's disease
- Alzheimer's
- Dementia
- Hearing Loss
- Poor Vision
- Vertigo
Less serious conditions can also lead to falls.
- A sprained ankle can lead to a missteps
- A headache can cause blurry vision (or they might be turning their head to avoid harsh light)
- Nausea can lead to hurrying to a bathroom too fast (as well as feeling weak/dizzy)
- Sleepiness can cause stumbling
- A fever can cause disorientation
- A surprise cough or sneeze can cause a stumble
Temporary conditions such as surgeries or uncomfortable medical treatments can also increase the risk of falls. When in pain, the elderly may be weaker, especially after a long convalescence that caused them to lose bone or muscle strength. They may also avoid using assistive devices if they cause pain the arms or hands.
Medications
Those who take a variety of medications may have an increased risk of falls. Especially those who take anti-depressants or anti-psychotics.
Some medications have bad interactions with each other. The effects of medication can be increased if the elderly catch a cold, get a UTI, or undergo a period of stress or pain. The time period directly after new medications are introduced or increased is a very vulnerable time when the elderly may be more disoriented as they adjust.
Stubbornness and Falls
It sounds mean to blame stubbornness on falls, but to perfectly blunt, the sometimes the elderly can be obstinate. When they refuse to use assistive devices such as glasses, hearing aids, walkers, canes, rails, and safe shoes...they increase their risk of falling and sustaining an injury.The elderly may take these risks as a declaration of their independence. They may feel like they are justified because they have always done things the same way, without issue before. For those who are more mobile, using a device such as walker might feel like too much trouble for a few short steps to the kitchen.
In nursing facilities, many falls are caused by residents deciding not to call for help. Sometimes they just want to do it for themselves. Especially if they are still in denial that they need help at all.
As a home caregiver, you will encounter the same issues. An elderly loved one may not call for your help if they have decided they are capable of standing or walking on their own. They may also decide that since your back is turned, they can "sneak" by without using a cane or walker, or slipping on their safer shoes. (Especially for just a "short walk".)
Memory Loss
Someone with memory loss, such as in dementia, or loss of cognitive reasoning, may simple forget to ask for help. They may not realize that they can no longer stand, walk, or even transfer to a wheelchair without assistance.
In this case, it is often very hard for caregivers to monitor, because the elder can suddenly get the idea that they need to walk somewhere and just try to stand and go. And it can be at any time of the day and night. Many caregivers use small alarms that tell them if the person is moving or shifting their weight so they can hurry over to prevent a fall.
Room monitors with video and audio can help too when you simply have to be in another room.
Falling, no matter how old or young you are, can be embarrassing. Therefore, the elderly usually don't want to discuss it unless they are in serious pain. They may feel that falling is due to their age, rather than other hazards:
"When I was younger, I wouldn't have tripped on that hose."
"I can't believe I wasn't fast enough to grab that rail."
Where as hip fractures and head injuries are the most common injuries sustained in a fall, other parts of the body are just as susceptible to breaks, bruises, and other trauma.
When an elderly person falls, witnesses will usually ask if their hip hurts, or if they can move their leg. It is very important to ask about ALL pain and discomfort after a fall. Some injuries that can occur, include:
In elders, a fall does not have to be complete to cause a fracture or dislocation. Bumping a body part against a piece of furniture, or grabbing something to stop the fall can also cause a reasonable amount of trauma.
In the medical profession terms such as "fall prevention" and "fall-free area" are used. However, most medical workers also know that not all falls can be prevented unless a person is being supervised 100% of the time. And sometimes even close supervision can't prevent a sudden accident.
It is more appropriate to say "reducing fall risks". To reduce the risk of falls, you can remove environmental hazards, and implement a few health and safety changes:
Keep calm and assess the amount of injury. Quickly.
If their is even the slightest sign or pain or confusion, or if you see blood, call the ambulance. (You should probably take them to be checked out even if they seem fine, but it might not be as urgent. You can always call their doctor and ask their opinion if you aren't sure, or just take them to ER just in case.)
Stay with the fallen person and keep them awake by talking to them. Have them tell you where they hurt, what happened before the fall...anything that you can relate to paramedics afterwards.
If the person does not seem injured and wants to get up, help them get into a chair comfortably. Keep them awake and warm and monitor them. Signs of injury may not appear for a few days, so be vigilant throughout the coming week. To be safe, go ahead and schedule a doctor's visit as soon as possible, since some injuries can go undetected.
After a fall, even if their was no trauma, the elderly may feel afraid. They may worry that it will happen again and that no one will hear them or find them.
As a consequence they might try to remain in bed or in a chair at all times in hopes of avoiding a fall in the future. This can lead to loss of strength and actually increase their risk of future falls, as well as other health related problems. Encourage exercise, but reassure them that you will be close by when they do so.
Not Wanting to be a Bother
And then there are the elderly who may feel that they are being too much trouble. They might try to do things that are unsafe rather than asking for help. They might feel that its too much to bother someone for a small matter that they used to be able to handle themselves, like leaning over to plug something in, or reaching to get something off a shelf.
Reassurances and reminders can help, as well as clearly communicating which precautions are absolutely necessary. (And which ones they can totally keep their independence on to balance things out.) For example you might say "As long as you use your walker every time you go into the kitchen, then its fine for you to do that task yourself if you want. "
Consequences of Falls In the Elderly
Falling, no matter how old or young you are, can be embarrassing. Therefore, the elderly usually don't want to discuss it unless they are in serious pain. They may feel that falling is due to their age, rather than other hazards:
"When I was younger, I wouldn't have tripped on that hose."
"I can't believe I wasn't fast enough to grab that rail."
Or they can blame others. "Are you sure you didn't just move that table there? I could swear it wasn't there yesterday."
Denial about falling, or embarrassment can lead to undiagnosed injuries that can have major health implications. According to the CDC, falls are the leading cause of injury-related deaths in older adults, and the most common cause of traumatic brain injury.
Statistics reveal that men are more likely to die from a fall related injury, but women are more likely to suffer a hip fracture.
Denial about falling, or embarrassment can lead to undiagnosed injuries that can have major health implications. According to the CDC, falls are the leading cause of injury-related deaths in older adults, and the most common cause of traumatic brain injury.
Statistics reveal that men are more likely to die from a fall related injury, but women are more likely to suffer a hip fracture.
Where as hip fractures and head injuries are the most common injuries sustained in a fall, other parts of the body are just as susceptible to breaks, bruises, and other trauma.
When an elderly person falls, witnesses will usually ask if their hip hurts, or if they can move their leg. It is very important to ask about ALL pain and discomfort after a fall. Some injuries that can occur, include:
- Broken or sprained arm or wrist
- Dislocated or broken elbow
- Sprained or broken knee
- Sprained or broken ankle
- Fractured pelvis or pubis
- Concussion
- Mouth injuries (from biting the soft tissue during impact)
- Sprained, dislocated or broken fingers
- Fractured spinal column
- Damage to internal organs
- Internal bleeding
- Fractured or dislocated tailbone
- Torn muscles or ligaments in any part of the body
- Cuts, bruises, soft-tissue damage, scrapes, punctures, infections
In elders, a fall does not have to be complete to cause a fracture or dislocation. Bumping a body part against a piece of furniture, or grabbing something to stop the fall can also cause a reasonable amount of trauma.
Preventing Falls
In the medical profession terms such as "fall prevention" and "fall-free area" are used. However, most medical workers also know that not all falls can be prevented unless a person is being supervised 100% of the time. And sometimes even close supervision can't prevent a sudden accident.
It is more appropriate to say "reducing fall risks". To reduce the risk of falls, you can remove environmental hazards, and implement a few health and safety changes:
- Have all medications reviewed by a doctor of dizziness, vertigo or stumbling occurs frequently
- Make sure that eye care and glasses are up-to-date when applicable.
- Insist on moderate amounts of exercise to maintain strength, coordination and balance
- Make sure meals and snacks are eaten regularly to prevent hunger weakness and low blood sugar
- Monitor conditions such as diabetes and blood pressure
- Install safety devices such as grab rails, shower stools, and toilet risers to assist with daily activities
- Make sure that non-skid slippers or sturdy, rubber-soled shoes are worn.
- Keep items that are accessed frequently in areas that can be reached without climbing or bending
- Remind them to use canes and walkers
Try to look at all areas from your loved one's point of view. Is sunlight blinding them when they walk towards a certain room? Is there enough light in rooms to show where all furnishings are? Is there room to maneuver canes or walkers without bumping something?
Handrails and grab bars are of course a great way to securely help support the elderly when they are walking. However its not usually possible to install them everywhere in a house. In places where you cannot have rails, look closely at furniture. Is it sturdy enough they can use it to support and guide them as they walk? If not, please anchor it to walls. If they DO grab un-sturdy or top-heavy furnishings to stop a fall, the injuries can be far worse.
If you have anything on wheels, like portable kitchen islands, make sure the wheels are safely locked so it wont roll if someone leans on it. And while it seems strange...make sure doors open easily. Having to use a lot of force to yank doors (even cabinet doors) open can cause someone to lose their balance.
In Case of a Fall
Keep calm and assess the amount of injury. Quickly.
If their is even the slightest sign or pain or confusion, or if you see blood, call the ambulance. (You should probably take them to be checked out even if they seem fine, but it might not be as urgent. You can always call their doctor and ask their opinion if you aren't sure, or just take them to ER just in case.)
Stay with the fallen person and keep them awake by talking to them. Have them tell you where they hurt, what happened before the fall...anything that you can relate to paramedics afterwards.
If the person does not seem injured and wants to get up, help them get into a chair comfortably. Keep them awake and warm and monitor them. Signs of injury may not appear for a few days, so be vigilant throughout the coming week. To be safe, go ahead and schedule a doctor's visit as soon as possible, since some injuries can go undetected.
After a fall, even if their was no trauma, the elderly may feel afraid. They may worry that it will happen again and that no one will hear them or find them.
As a consequence they might try to remain in bed or in a chair at all times in hopes of avoiding a fall in the future. This can lead to loss of strength and actually increase their risk of future falls, as well as other health related problems. Encourage exercise, but reassure them that you will be close by when they do so.
Preventing falls is not always possible, but you can greatly reduce the risk. It is also something of a team effort, between you, your loved one, your other family members, and your loved one's doctor. So make sure there are clear plans and be firm on the rules that matter.
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