Whether you are a senior or you are a caregiver caring for an aging loved one, falls are concerning …

Considering that one out of every four persons age sixty-five and older falls each year, I decided to dig up some additional research for us here. Especially since it was only a few years back when I was conducting “Fall Prevention,” classes, and the ratio reported then was “one in every three persons.” Sadly, the statistics of the number of falls that occur yearly among the aging population is not diminishing- not by a long shot. Each autumn, is a great time for “Fall Prevention Awareness,” in hopes falls in the aged or chronically ill persons may be prevented, or fall risks are better monitored. It’s also good to know what to do after a fall. Soon, winter will arrive bringing with it ice and snow, which increases one’s fall risks, so preparedness is helpful, just in case a bad fall were to occur.

It is interesting to also note that while Medicare is well aware of the staggering number of aging persons who fall, healthcare reform has had little or no effect on the number of incidences of falls in the senior population for which it serves. From a geriatric care manager perspective, it is concerning that more “fallers” are being admitted to long term skilled care units, upon post hospital discharge than are “non-fallers,” adding to the fact that most thirty day hospital readmissions in the U.S. are caused by fall related injuries (FRI’s) than any other cause. Research (and common sense) indicate that prolonged hospital stays compound the risk for falls in persons over the age of sixty-five. The fall risk increases with a person’s age, severity of illness, general weakness, poly-pharmacy or medication mismanagement and a variety of other factors, such as cognitive impairment. These are the facts. Here’s the good news: Patient centered approach to fall prevention can go a long way in reducing the number of falls annually. Also falls help diagnose diseases that may have caused a fall.

According to the CDC, “Deaths from unintentional injuries are the seventh leading cause of death among older adults, and falls account for the largest percentage of those deaths. Approximately one in four U.S. residents aged 65 years (or older) report falling each year.” (A.A.R.P.)

In May of this year, JAMA reported retrospective research on the incidence of FRI’s, in that the Hospital Readmission Reduction Program, was also concerned about the “worrisome gaps in evidenced-based fall prevention in recently discharged” patients from 1994-2000. JAMA also reported “that post-hospital FRIs were a leading readmission diagnosis, particularly for patients originally admitted with a FRI or cognitive impairment. Targeting at-risk hospitalized older adults, particularly those discharged to home or home health care, is an underexplored, cost-effective mechanism with potential to reduce readmissions and improve patient care. “

In addition to gaps in the level of care transitions (going home from hospital) and gaps left wide open in the healthcare delivery system, patient’s don’t always get the right “level of care” they actually need. It’s in these gaps that a potential problem exists for patients deemed to have “fall risk potential,” are sent home; some of which are instructed to set up outpatient therapy on their own when they arrive home. It’s a well known fact that persons who fall have higher risk of falling again. Public awareness also needs to be emphasized to assist such patients since they are not “eligible” for “in-patient rehab” inside a hospital setting, as a result of managed care. These patients need more advocacy prior to being discharged from the hospital, despite the fact they may have passed an in-patient assessment. If you know of an aging loved one who has a history of falls, be sure the hospital staff (or other care level facility) is aware of this.

Some patients may however, “qualify” for skilled home health, and if so, it is recommended families discuss the care recipient’s real needs during the initial Medicare certified (skilled) home health therapy and/or nursing assessment phase to ensure all fall (and health) risks are identified and that furthermore, the therapists assist the care recipient and family to help identify all fall risk factors by conducting a “home safety evaluation,” in addition to the strength, conditioning and balance/coordination protocols. I also advise my clients to keep Medicare’s Home Health Care Agency Compare” bookmarked on their laptops or cell phones, since it’s imperative to know how well the Medicare certified (skilled) agency scores with standard regulations comparatively. Find out more (and save this site for future reference): https://www.medicare.gov/homehealthcompare/search.html

Let’s take a look at what we can do in simpler terms for those we know or care for who may have a fall risk, be it mild, moderate or severe. A fall is a fall, and in the fall time of the year, it’s the leaves we want to see falling and not our loved ones, right? What can reduce fall risks year round? Okay, so here are some simple and practical measures to help lower one’s fall risk:

1. If no physical therapist is coming anytime soon, then conduct a “Home Safety Evaluation” of your own. Look room-by-room for steps and/or walkways in need of repair, secure railings where needed and grab bars in the bathrooms, adequate lighting, open pathways- free of clutter, throw rugs (carpets, rugs and mats should all lie flat), loose electric or phone cords, no casters or wheels on furniture, non-skid floor surface on non-carpeted floors, night light, EMS activation system referred to as a Medical Alarm System, such as “Link to Life,” “The Electronic Caregiver” or “LifeFone,” which is offering fall savings!

What else can be done, you ask? Lots. Let’s look at more ways to prevent falls:

2. If you are a senior, or you care for a senior and a recent illness, hospitalization, or other event has made you weaker than usual, you may need to consult your primary care physician and discuss possible therapy options individualized for you. I believe in “two people go” to all MD appts. Interestingly falls can lead to a diagnosis that otherwise may remained silent, such as arteriosclerosis (ASHD), transient ischemic attack (TIA’s) or other illnesses. Dizziness, also referred to as “syncope” or “lightheadedness,” is a major factor in the genesis of falls that may or may not be reported. Research has indicated that many fallers have reported post fall amnesia associated with these type of falls indicating further studies are needed, and it’s a matter of public awareness and prevention.

3. New prescriptions or polypharmacy issues (too many meds) and not enough information on side effects such as dizziness, weakness, etc.? Then it’s time to get to know your pharmacist and better yet, know the side effects of your meds. It may be that you no longer need some of the current meds prescribed, especially if there are multiple prescribers. Its time to connect your primary care physician and your pharmacist and make them a part of your health care team. Many meds have side effects that cause falls.

4. Orthostatic hypotension is a culprit of many a preventative fall. Some diseases, medications and aging itself will cause your blood pressure to drop dramatically upon standing or changing your position from sitting to standing too rapidly. Try instead to gradually stand up and remain standing until head is clearer. When getting out of bed, try sitting at bedside for a few minutes, stretching arms as much as range of motion allows and go to standing position gradually or as slow as possible before beginning gait.

5. Uneven ground, unfamiliar places, dark areas, stressful public crowding, transferring in and out of chairs, etc., all contribute to falls. People under the age of sixty-five have succumbed to falls from uneven ground. It would be nice if we all had robots to scope out the terrain of unfamiliar places we must tread, but we’re not that advanced yet, so we must proceed with caution. Failure to be cautious is probably one of the most dangerous of all fall risk factors. It’s time to call a care manager when an aging loved one needs some assistance at home to lower their fall risk, and more so if your aging loved is in denial that they need some extra help! Call a local care manager for further assistance about how to deal with an aging loved one’s denial of needing extra help or who refuses to have help. This is a very sensitive issue but the dialog always needs to be focused on safety first.

6. Visual problems such as glaucoma or cataracts can cause falls. It is reported that “patients who use eye-drops for glaucoma have a three-fold increased risk of falling; those with cataract are more at risk of breaking a hip” (JRSM, Apr. 2001). Increased lighting may help, as well as uncluttered pathways, but it is difficult to determine one’s visual impairment without a proper eye exam followed by a concurrent plan of care to decrease falls.

7. Foot problems, and unfit shoes cause falls too, in the elderly or chronically ill population. Also, elderly women who prefer heels, even low heels have an increased risk when the foot has decreased function and heel-to-toe stride is impaired. Loose fitting footwear is also likely to cause falls. Neuropathy can cause falls to occur, as well as other foot conditions such as gout, or lower extremity edema secondary to cardiovascular impairment such as congestive heart failure or ischemic heart disease, which brings us to the next causative factor for falls in seniors.

8. Comorbidity- this is term that means there is more than one health issue, diagnosis, physical or cognitive impairment such as an aging loved one who is a Type II Diabetic with diabetic neuropathy and a recent new diagnosis of end stage renal failure, along with progressive macular degeneration who is severely depressed and who also has had a significant decline in mobility and independence. This person’s fall risk has more than quadrupled. Add to this category, dehydration and malnutrition, which are both commonly unreported and are serious underlying issues in the origin of one’s fall risk.

9. The “I-Think-I-Can,” or “I-thought-I-could,” are some of the more sad reasons older people will fall. It is not easy telling a parent or aging loved one, that they are too old to do this or that or that they are deemed “unsafe” at home alone. This really gets sensitive and should be handled with care, as in “family meeting” time! In working with seniors, they prefer adult children not “snitch” on them to their primary care physicians who may start an inquiry in regard to current level of functional capacity or actual level of independence at home. This is where tough love is advised, and the issue of “safety first” needs to well established and agreed upon or if needed, prompted by professional help. As stated, always keep the focus of dialog about a senior’s current functional capacity on the safety issues.

10. Lastly, but not the last reason, since there are many- Older people will fall because they are in pain, they are weak, they do get dizzy spells associated with comorbidities mentioned, or they have incidental physical events that may go “undetermined.” We are all going to age if we live long enough and if and when we do, we will have aches and pains and decreased sensorium (decline in seven God-given senses) that will caution us as to how much, how long, and how mobile we actually are, or what we ought to and ought not take on. We too, may need assistive devices as directed by a physical rehabilitation, internist, orthopedic surgeon or geriatric specialist and the like. (I always recommend our aging loved ones get/know/visit a good registered physical therapist!) The truth is, falls happen, but what we know is that we can all know more to help those that are aging know more to fall less! So, let’s get moving!

After a fall, stay calm. Here are some more insights from the Mayo Clinic:

• Don’t get up right away or let anyone help you up immediately; this avoids the potential of causing further injury. Don’t worry about feeling embarrassed. Rather, take your time, lie there for a moment and assess how you are feeling.
• After making an assessment of your injury status, if you can get up, roll to one side. Bend your knees toward you, push up with your arms and then use your legs to stand up the rest of the way.
• If someone assists you to your feet, ensure that he or she doesn’t get hurt, too.
• Use your cellphone or mobile medical alert device if you need assistance getting up from a fall. In many communities, fire departments are available to help citizens get up from falls, even if no injury is present.
• Call 911 or emergency medical help if the fall has led to an emergency situation.

Extra Helps:

https://www.foundationforpn.org/wp-content/uploads/2015/12/PreventingFalls.pdf

https://www.cdc.gov/HomeandRecreationalSafety/Falls/index.html

https://www.cdc.gov/steadi/pdf/Steadi-Coordinated-Care-Final-4_24_19.pdf