Falls

Falls are a leading cause of morbidity (disease related changes) and mortality (death).   Falls are numerous and often are the cause of the senior being transferred to another living environment.  Some things that the family can observe for to proactively reduce falls include:

1.  Monitor the home for trip and fall risks.  While throw rugs are one of the known causes of falls in seniors, they may not want to remove an area rug that has been a fixture in the home for decades.  The fight with the senior over the rug may intensify into full blown war.  Consult an external expert who can help you with the communication with the senior.  An outsider is always more knowledgeable and their recommendations do not fall on deaf ears.
2. Watch for preventive maintenance issues around the home.  There are a number of reasons these fall risks do not get handled.  The senior may have vision difficulty and not be able to see the risks and the repairs that are needed.  The senior may not have the money or may feel that their money should not be spent on these things when they need medications and other items more.  Seniors know that they may be preyed upon and may not trust others in their homes to do repairs.  The senior may have cognitive impairment and may not be able to comprehend the need for the repairs.  This includes both inside and outside the home.  Sidewalks, garage doors, screen doors, back steps, step hand rails and rotted or unevenly worn front steps all can lead to falls from lack of maintenance.
3. Look at how the senior walks.  Gait is term used which describes how someone walks.  If the senior is unable to lift their feet when they walk, it takes very little for their foot to catch on something low to ground causing a fall.  Diseases like Parkinson’s have a shuffling gait or walk and the person often has poor balance.  Look to see if the senior has to grab on to walls and furniture to walk.  This is a sign of instability and fall risk indicator.   Compare their gait to how you walk.  If it is substantially different, an assessment may be necessary.
4. Monitor for forgetfulness and memory loss which are two of the key indicators of onset of dementia.  If the senior has dementia, they do not understand that they are not able to walk safely and will not be able to protect themselves.  When someone has dementia, they are often impulsive and have poor safety awareness which places them at greater fall risk because of their lack of understanding.  With the memory loss, the senior  may not remember to use assistive devices like walkers and canes.  You can lecture to them into perpetuity, but they are unable to remember it is not that they are being resistant to change. 
5. Monitor for weight loss which is a sign of failing health and wellbeing.  Weakness occurs because the body is using muscle for energy once body fat has been  consumed.  The ratio of body fat to protein changes as we age and loss of weight is often not fat tissue, but protein or muscle tissue.  Often seniors that are overweight are actually malnourished even though their weight is increased.  The excess weight comes from carbohydrates rather than protein leading to malnutrition.  The weight loss may be due to inability to purchase nutritious food or to the ease of cooking prepared foods that are not nutritionally adequate. 
6. Monitor for hygiene of the senior .  They may have been ignoring their personal hygiene because of their  fear of bathing and falling rather than lack of interest in hygiene.  Look at the bathroom to see if the senior needs assistive devices like elevated toilet seats, shower or bath chairs and the height of the sink and mirror over the sink.  If you are unable to reach items safely and are afraid of falling when you do, you will not place yourself at risk if you are a sound decision maker.
7. Medication is one of the leading reasons that seniors fall.  The typical senior is on multiple medications with multiple side effects singly and more side effects cumulatively.  The senior may be taking medications incorrectly.  They may be using over the counter medications that they do not consider medication which are leading to issues.  All medications are chemicals and they interact differently in each person whether they are an expensive prescription  or a cheap generic dime store brand.  They may be concerned about finances and are not taking their medication properly and having disease effects rather than medication effects.   Even though someone sets up their medication, they may have memory problems and forget to take their medications.  They may be getting prescriptions from a variety of pharmacies and doctors and no one is aware of the entire medication regimen leading to adverse drug reactions which will continue because no one is aware of the multiple prescriptions.  The side effects of the medication may be distasteful so the senior does not take the medication even though prescribed.
8. Fear of falling is a risk factor for further falls.  Every senior knows a friend or acquaintance that has fallen and experienced the tragic effects of the fall.  Not only are we afraid of falls because we know the potential  consequences, but even more distressing is the fear of falling again.  A fall can lead to the senior not wanting to walk or move for fear of another fall.  This leads to increased weakness, instability and immobility which are all factors for increased fall risk.  While this sounds ludicrous to the younger person, it is very real to the senior.  This is especially significant in the senior has experienced a fall and had an injury. 
9. Monitor the senior’s body for bruises and skin tears.  The normal process of aging makes our skin less elastic and thinner and increased the likelihood of these occurrences.  However, often these are signs of falls and injury rather than from the normal process of aging.  If the senior is on a blood thinner such as warfarin or Coumadin, these falls can lead to life threatening circumstances and should not be ignored.
10. Monitor the home for items that could exacerbate the fall risk.  Things like step ladders should be removed from the home.  These can include full sized ladders or two or three step ladders either of which are unsafe.  Chairs with wheels on them in the kitchen may help the senior move about, but they also provide a fall risk for the senior who has poor balance and has weak legs.  Women’s shoes with high heels and straps should be removed to prevent falls.  Assessing foot wear to assure that shoes fit properly and that they are safe can prevent falls.  Look at easy chairs to see that the height is adjusted to allow the senior to sit and rise without fall risk.  Look at the bedroom to make sure that the top of the mattress is mid level at the bend of the back of knee for optimal leverage for rising and sitting on the edge of the bed.

Falls are a major issue.  Seniors are often not honest about their falling behavior because they know that the consequences may be adverse to their wishes.  As the advocate and caregiver for the senior, it is our responsibility to maintain as safe as environment as possible.