Recently I experienced my mother falling in the middle of the night and ending up in the hospital. Unfortunately she lives alone and 250 miles away in California. She has had a history of falling, but this last one was serious. Fortunately, my mother had her Lifeline personal emergency response system pendant on, pressed it, and two young handsome EMT men came to the house and saved her life.
This very personal traumatic event motivated me to explore falling among elders. Boy, did it open my eyes. Let me walk you through the fears and reality of falling.
As we all know, elders are living longer and remaining in their own homes; however, falls have become an epidemic problem that jeopardizes elders’ chances to live independently. According to Dr. Stevens in her 2005 article, “Falls Among Older Adults—Risk Factors and Prevention Strategies”, every year in the U.S., one out of three people age 65 and over will fall. This statistic translates to 13.3 million people who will fall in 2010, or one person falling every 2.3 seconds on average. Wow!
Sterling, Connor, and Bonadies in their 2001 research article discuss the fact that falls, in which the majority occurs in the home, are the leading cause of nonfatal injuries and hospital admissions for trauma, as well as injury-related deaths. Close to 50 percent of elders can’t get up from a fall without help and lying on the floor for an extended period of time can lead to serious complications, including: pressure ulcers, muscle necrosis, dehydration, hypothermia, pneumonia, and even death. The care and treatment of these potentially preventable complications are costly to the healthcare system and negatively impact quality of life for elders.
In addition to the tremendous incidence and cost of the reality of actual falls is the fear of falling. Fear is a rational response to a likely and potentially dangerous event – a fall. A cautious concern with falling could be viewed as the first step in falls prevention. I have a saying with my mother, “Be smart. Be safe.”
However, too much fear can compromise the physical and mental wellbeing of anybody; especially an older person. It can have serious negative effects, such as reducing an older person’s frequency and intensity of physical activity, which can lead to de-conditioning and ultimately increase the risk of falling. Fear of falling can also compromise social interaction, leading to isolation, depression, and anxiety. Fear of falling ranks very high among elders, 47% have those fears according to Howland, et. al. in their 1993 study. There is nothing more that contributes to falling than sitting on the couch.
Many studies have found that fear of falling is associated with a decline in health status and function, which includes lower self-rated health and a history of previous falls. It is also linked to impaired balance, inability to walk or instability in walking, and the use of walking aids. The fear might not occur immediately after the first fall, but might start after multiple falls. Lach, in a 2005 study, concludes that women with the greatest risk have impaired balance and gait issues, resulting in unsteadiness, multiple falls, and poor self-rated health. That is my mother!
Some of the questions to ask regarding the risk of falling:
Physical – Have you fallen in the past year? Do you sometimes feel dizzy, or have trouble keeping your balance? Do you have trouble walking because you feel weak, your joints feel stiff, or you have problems with your feet? Have you limited your physical activity because of a fear of falling?
Some people think that the best thing to do if you’ve fallen, or if you’re afraid of falling, is to be less active. Actually, inactivity makes it more likely that you will fall. That’s because when you’re less active your reserves of energy, muscle tone, and alertness are reduced.
That’s why it is recommended starting a regular exercise routine of any kind—even if it’s as simple as taking a walk every day.
Hazards in and around the home – Are there areas inside and outside your house that are not well lit? Do rugs and floors pose slipping or tripping hazards? Do stairways have handrails on one side only? Do you find moving around the bathroom challenging? Is there clutter in the main walking areas of your home?
As we get older, items in our home that used to be virtually harmless start to pose a greater risk. Carpets, throw rugs, stairs, floors—even pets can be dangerous. The good news is that many falls can be prevented simply by removing loose rugs, putting hand rails up, or grab bars in showers, etc.
Health and medicine – Do you take more than four medications? Do you take medication to control blood pressure, to treat depression or anxiety, or to help you sleep? Do you have a geriatric certified pharmacist or doctor to make sure that all your prescriptions are safe to use together? Do you have a history of stroke, heart disease, or diabetes?
Medications can be a contributing factor to falls. Although medications are supposed to keep you from getting sick, they can also put you at risk for falling. It is a good idea to consult a geriatric pharmacist about ALL the medications you take—including over-the-counter and/or herbal preparations that your doctor may be unaware of.
Here are some tips to avoid medication side effects that could contribute to falls:
- If possible, use a single pharmacy to fill all your prescriptions. Your pharmacist can review your medications and communicate concerns to your doctor. Ask if they are certified in geriatric pharmacy.
- Report any new symptoms to your doctor right away. He or she will help you decide if the symptoms are caused by the medication.
- Take medications as directed.
- Be alert for side effects. Even a single medication can have unintended results. After taking medicine, have you experienced any of the following: dizziness and balance problems; fatigue or drowsiness; confusion; loss of coordination; weakness? Avoid mixing alcohol and medicine, unless approved by your doctor.
- Keep a complete, updated list of the medications you take, including non-prescription medications like aspirin, cold preparations, antacids, vitamins, dietary supplements, etc.
As important to being aware of the prevention measures mentioned above, consider subscribing to a personal emergency response system device. Philips Lifeline was the first inventor of such a safety device and is the leader in the country. Philips, which owns Lifeline, just added an incredible technological advance called Auto Alert. This pendant device, which is small and worn around the neck, detects the difference between sitting or lying down and falling. If a person falls and does not press the button within 30 seconds, the program will automatically call the person. If the person does not respond to the call (which is through an intercom system), the Lifeline center will call the EMT and help will be on the way within minutes. The sense of security and safety is invaluable.
The Center for Healthy Aging recognized the value of such a service as Lifeline to keep elders in their own home or the community, therefore we now provide the service to Northern NV. The value of Lifeline has been shown repeatedly. If the person is living alone and falls, they will feel secure knowing that they will not lay there for days or until someone takes note.
For more information about this very special service, call Marta Malone at the Center for Healthy Aging at 775-848-1260. We strive to Add Life toYears.