It began as a casual visit. However, the situation could have been far worse. During a get-together with my mother, she tried to stand up from her chair but lost her balance and fell. Concerned, I rushed over to offer what help I could. Fortunately, Mom was perfectly fine. I helped her back to her feet and we both had a good laugh over what had just happened.
Seniors falling is not usually a laughing matter. As we age, falls can become increasingly common and risky for seniors. The World Health Organization (WHO) Global Report on Falls Prevention in Older Age states that “approximately 28-35% of people aged of 65 and over fall each year increasing to 32-42% for those over 70 years of age. The frequency of falls increases with age and frailty level. Approximately 30-50% of people living in long-term care institutions fall each year, and 40% of them experienced recurrent falls.”
What are the Facts About Fall Risk?
The Centers for Disease Control and Prevention paint a grim picture by telling us that “more than one out of four older people falls each year, but less than half tell their doctor. Falling once doubles your chances of falling again."
And unfortunately, there is more. The WHO report shares even more alarming statistics relating to elderly falls:
- “Falls lead to 20-30% of mild to severe injuries and are the underlying cause of 10-15% of all emergency department visits. More than 50% of injury-related hospitalizations are among people over 65 years and older. The major underlying causes for fall-related hospital admission are hip fracture, traumatic brain injuries and upper limb injuries.”
- “The duration of hospital stays due to falls varies; however, it is much longer than other injuries and can range from 4 to 15 days.”
- “Falls may also result in a post-fall syndrome that includes dependence, loss of autonomy, confusion, immobilization and depression, which will lead to a further restriction in daily activities.”
- “Falls account for 40% of all injury deaths. Rates vary depending on the country and the studied population. The fall fatality rate for people aged 65 and older in the United States of America is 36.8 per 100,000 population (46.2 for men and 31.1 for women).”
- “Fatal falls rates increase exponentially with age for both sexes, highest at the age of 85 years and over. Rates of fatal falls among men exceed that of women for all age groups in spite of the fewer occurrences of falls among them. This is attributed to the fact that men suffer from more co-morbid conditions than women of the same age.”
4 Long-Term Consequences of Falls Among Older Adults
There are many possible outcomes from a senior’s fall, including:
- Injury. Depending on where and how a senior falls, there is a high risk of injury. A senior’s brittle bones can easily become his or her broken bones.
- Reduced Independence. Even the smallest fall can result in uncertainty in the mind of a senior. A senior can put up a brave front and appear to be healthy and robust. He or she may even say that the fall is nothing to worry about. However, there may be a lingering doubt about what he or she is capable of doing. After a fall – or a series of falls – a senior may think twice about heading outside for fear of another fall.
- Multiple Falls. A single fall can begin a chain reaction of more falls. These continual falls are often the result of a senior’s lack of confidence. Reduced eyesight can result in a senior reaching for a caregiver’s supportive arm or a handrail but missing their target. While a senior or a family caregiver may dismiss a fall as not being serious, this could be completely wrong. A senior may sustain more serious injuries or even die. Let that single fall serve as a red flag of warning.
- Further Family Impact. Falling doesn’t always just affect the senior. It can also affect the senior’s family. Family caregivers may have to rush away from their workplaces following a phone call alerting them of such an accident. Repeated phone calls may result in a complete departure from the office. Excessive chatting on the phone can be deemed unnecessary and a distraction from the job at hand leading to job dismissal. A caregiver may also decide to quit a job to be available for their loved one after a fall and tend to any needs that may arise. Or they may wish to be there to help prevent a fall in the first place.
15 Ways to Reduce Fall Risk and Help Prevent Falls
While you may not be able to always stop a senior from falling, you can take some steps to help reduce the risk. There are many reasons for falls in the elderly, so make sure to look at the whole picture. Use these precautions to take care of your loved one and their home to prevent falls:
- Begin with the bathroom. Wet surfaces (on the floor or counters) can be very dangerous. Seniors lack the balance and reaction time needed to avoid a fall. While it may seem easy to step out of a shower, an unsteady senior may slip and come crashing to the floor. To help, provide non-slip mats in the bathtub and shower. Install grab bars in strategic points around the bathroom. Towel bars are not sufficient because they will collapse under someone's full body weight. Grab bars can be attached inside the shower stall or just above the bathtub to help a senior with lowering or standing up.
- Provide a shower seat. Seniors can be far more secure when they are seated when showering.
- Replace the shower head with a hand-held nozzle. Seniors can become more confident with showering with a nozzle. The nozzle can be easily turned away in the case of sudden water temperature changes. In addition, it can result in a much more thorough cleaning. Long-hoses are now available, which are far easier to use for someone seated in the shower.
- Stairs. Whether inside or outside the senior’s home, stairs can be major concerns. I recall my parent’s first retirement home in Victoria, British Columbia. This was a beautiful two-bedroom condo with a view of the ocean but outside access proved to be too much. I often saw my mother grabbing the handrail and pulling herself up the stairs to get inside. If a senior does have stairs, there are plenty of precautions you can take.
- Clear the stairs. Whether it is a few dropped clothes or a grandchild’s toy, anything left on the stairs can become a tripping and falling hazard.
- Differentiate between the stairs. Aging eyes may not always be able to separate one step from the next. To help, you could try replacing the carpet on each step to make the steps easier to spot. In the case of bare steps, try painting each step a different color. Other options include adding safety tape or removing carpeting and adding stair treads. All flights of stairs should also have handrails on both sides of the stairs.
- Consider a stairlift. These mechanisms can safely take a senior up or down a flight of stairs. The senior will sit in a comfortable chair without having to climb up or down the stairs. A colleague of mine used this with her father. This enabled her and her family to turn the basement into a fully-furnished suite for him and his caregiver.
- Shovel snow and chip ice off stairs in the winter. This work can be too much for a senior to handle. So why not delegate the job to a younger family caregiver or hire a neighbor? This task prevents slipping and falling outside the home.
- Tighten stair handrails. A loose handrail is of little good to anyone grabbing for it. Secure these handrails both inside and outside the senior’s home.
- Tuck away extension cords. Are there any power cords stretched across a senior’s floor? Tape them down or slide them underneath or behind furniture.
- Remove excess furniture. A more mobile senior may be able to sidestep a footstool or a coffee table but not all seniors can do this. Remove unneeded furniture to give the senior more room to maneuver and help to create a safer living environment. Also, a deep plush armchair may look comfortable but the senior may become trapped if he or she lacks the body strength necessary to push up and out of the chair.
- Get a cane or a walker. A doctor can best advise if the senior will need a mobility aid. This could be a wheelchair, a walker, a cane, or a motorized scooter. As with any mobility aid, make sure that is properly fitted for the best and easiest use. Reducing or eliminating the walker stigma that often exists may be a little more difficult to do. However, seniors may find that using a walker increases their own freedom, independence, and quality of life. Be aware that an occupational therapist needs to train the person to use these properly. For increased convenience, choose a wheelchair, walker, or scooter that can collapse and fit easily in a car’s trunk or back seat. Be mindful of the size of mobility aids. A wheelchair or walker may be too wide to fit through a senior’s doorways. A four-wheeled scooter will be better for outdoor use and will provide more stability. A three-wheeled scooter can be far more maneuverable inside the home.
- Evaluate a senior’s footwear. Shoes need to fit well and have non-slip soles. Shoes with Velcro straps can be easier to tighten or loosen. They also remove any risk of tripping over long laces. Do not choose senior’s shoes based on how easily they can be put on and taken off. I’ve heard from at least one person whose father wore loose shoes and she had to buy all new shoes for him.
- Install better, brighter lighting. Seniors cannot always see that well in a dark or shadowed room. Better, brighter lighting can help to light the way. On this same subject, assess the location of light switches. These may be out of reach for someone in a wheelchair.
- Keep a senior active. Whether through regular walking or light exercising and stretching, an active senior can remain more stable than a sedentary senior. Exercising can help prevent falls by keeping stabilizing muscles strong.
What to Ask the Doctor After an Elderly Person’s Fall?
Family caregivers need to understand that falls in the elderly, whether just once or repeatedly, can be a serious matter. Among the first steps for caregivers is to schedule a doctor’s appointment. Accompany your senior loved one into the examination room. Make sure to share the details of the fall and to ask the doctor questions.
What types of questions should a caregiver ask? Leslie Kernisan, MD MPH outlines her recommended medical checks in her article, “8 Things to Have the Doctor Check After an Aging Person Falls.” Make sure to ask for:
An assessment for an underlying new illness. "Just about any new health problem that makes an older person weak can bring on a fall. Some common ones include:
- Urinary Tract Infection
A blood pressure and pulse reading when sitting, and when standing. “This is especially important if you’ve been worried about falls — or near falls — that are associated with light-headedness, or fainting.
If your older relative takes blood pressure medication, you should make sure the doctor confirms that he or she isn’t experiencing a drop in blood pressure when standing. (Note that tamsulosin — brand name Flomax — is a popular prostate medication that also causes drops in blood pressure.)”
Blood tests. "Falls can be worsened by problems with an older person’s blood count or by things like blood sodium getting too high or too low. Generally, a complete blood cell count (CBC) and a check of electrolytes and kidney function (metabolic panel, or “chem-7”) are a good place to start.”
Medications review. “Many older adults are taking medications that increase fall risk. These medications can often be reduced, or even eliminated.”
Gait and balance. “Simple things to do, if gait and balance don’t seem completely fine, are:
- Address any pain or discomfort if that seems to be a cause of problems. Many older people are reacting to pain in their feet, joints, or back.
- Consider a physical therapy referral for gait and balance assessment. A physical therapist can often recommend suitable strengthening exercises, and also can help fit the older person for an assistive device (e.g. a walker) if appropriate.”
Vitamin D level. “Studies suggest that treating low vitamin D levels might help reduce falls in older adults. Low vitamin D levels can also contribute to fragile bones."
Evaluation for underlying heart or neurological conditions. "An older person may be falling because he or she has developed a chronic problem with the heart or blood pressure system or Parkinson's disease.”
Vision, podiatry, and home safety referrals. “Could your loved one be in need of a vision check, podiatry care, or a home safety evaluation? If you’ve brought an older person in after a fall, it’s a good idea to talk to the doctor about whether these services might help.”
Eyesight’s Impact on Fall Risk for Older Adults
It’s been said that our eyes are the windows to the world. But if those windows are dirty or blocked, we cannot properly see people and things around us. Seniors may experience this happening as they lose their eyesight resulting in in significant problems:
- Focusing difficulty
- Poor depth perception
- Trouble balancing
Fortunately, options exist to correct poor eyesight. These include the following:
- Properly prescribed glasses can sharpen vision (attach a strap between the earpieces to help keep glasses on the face and to reduce the chance of loss)
- Surgery may clear up glaucoma, macular degeneration, and cataracts
- Eye drops or medication may soothe eye dryness, watering/tearing, or itchiness, or remove “floaters” (spots which appear in a senior’s line of sight and impede vision)
Diagnosing the nature and scope of the problem is best done by an optometrist during a complete eye exam. Caregivers may find accompanying the senior into the eye exam may reduce the senior’s anxiety and better allow them to listen to the doctor’s report or ask questions.
Strategies to Support Seniors After a Fall
Preventative measures to help reduce fall risk in seniors is always the first step, but if a fall does happen, supporting seniors who have fallen takes two approaches. A caregiver must provide physical support to help a senior safely stand upright again. A caregiver may also provide emotional support to help a senior regain any lost confidence or composure. Helping a senior up from the floor is the first step. Remember these recommendations:
- Calm down. Seeing a senior fall can result in panic or worry. Seniors may mirror these reactions and respond in a similar manner.
- Check for injuries. Resulting injuries from a fall can vary from slight bumps and/or bruises to more serious fractured ribs. Cuts and/or blood flow can be conspicuous.
- Resist rushing. Family caregivers looking for injuries and seniors trying to stand again should proceed gently. Hurrying the process may result in further damage.
- Offer help – but don’t get too close. Extending a hand may seem like the simple reaction. But lifting a senior takes strength, balance, and experience. Even well-meaning caregivers may risk strain and undue harm. Encourage the senior to use a chair to pull him/herself to a standing position.
A Longer-Lasting Problem of Falling
A fall may lead a senior to adapting a “once-bitten, twice-shy” mindset and becoming extremely nervous about even standing up out of bed in the morning. It may take time for the senior to regain his or her personal trust. Physical reactions can be accompanied by emotional problems:
- Increased fear. Even with offered help, a senior may become tentative about standing or walking. After falling, a senior may take slower and smaller steps.
- Anger. Typically stubborn loved ones may greatly dislike knowing of or having a family caregiver’s help. Losing one’s independence can be a difficult thing to accept. Imagine being unable to do something that you could do previously with great ease.
- Depression. They have lost their purpose and may simply give up. Family caregivers may also see their loved one withdraw, become sadder, or show severe mood swings.
- Denial. Seniors who have fallen may casually dismiss the problem, refuse to talk about it, or conveniently forget about it entirely.
Addressing the emotional impacts of a fall can prove to be trickier for family caregivers. Try these recommendations:
- Recognize the senior’s emotions. A senior who has fallen may become increasingly frightened, confused, and even resistant to talk about the experience. Family caregivers can help them by showing understanding, support, and patience.
- Appreciate the risk. Unfortunately, a senior who has fallen is, typically, more likely to fall again. When walking with Dad in his later years, I worried about him stumbling. A support belt – which fit snugly around Dad’s waist – was advised. I was shown how I could grab onto this behind Dad’s back and help to keep him upright. I was not, however, completely confident though that I could safely catch Dad if he tripped, or be able to lower him to the ground, so I kept our walks shorter or borrowed a wheelchair for Dad’s use. If precautions need to be clarified with a loved one, explain why they are necessary for the senior’s safety.
- Offer encouragement: A reassuring smile, comforting pat on the back, or positive feedback can greatly help a senior who has fallen. Understanding falling has occurred is simple to understand but accepting falling has happened is a much harder thing to ask for. Respond positively, reassure, and help the senior in any way possible. Remember to work within the senior’s capabilities.