Working Caregiver- Preventing Falls for Texas Seniors
Falls are a critical health issues for Texas Seniors
Falls Are a Major Risk for the Elderly
By Samantha Young- Practical Care Continuum
Falls are a critical health care problem for elderly people, surpassing car wrecks as the leading cause of death from trauma for adults 65 years and older. 40% of elderly people age 65 and above fall every year. Falls can result in medical problems such as fractures, incontinence, painful bruising, and depression. Perhaps one in 10 falls results in serious injuries, with up to 1% of falls resulting in a broken hip and a further 5% resulting in other broken bones (75-80% of all hip fractures happen to women). Fear of falling can result in isolation and limited activities, which can lead to a reduction in quality of life. Finding ways to prevent falls is of paramount importance.
Falls happen for many reasons. Age alone does not determine if an older adult is at risk for falls. Health problems such as poor vision, impaired gait, slowed reaction time, decreased muscle strength, use of psychoactive medications, and orthostatic hypotension can increase the risk of falls. Environmental factors such as poor lighting, uneven or wet floors, and shelves at too high or too low levels are also factors in determining fall risk.
Ways to Prevent Falls
The first step in reducing the risk of falls in the home would be to assess environmental hazards. The more obvious ones include loose rugs that can slide or pose a tripping hazard, electrical cords in traffic areas, and bathrooms that do not have safety bars. A simple home safety checklist can help catch potential hazards. Many home health care agencies provide a home safety check as a part of their initial registration or look on line at the Centers for Disease Control website cdc.gov/ncipc/pub-res/pubs.htm for a home safety checklist you can do on your own.
A second step would be to have the elder examined by their physician to rule out any medical causes for the falls. A recent study from Newcastle General Hospital in England found that more than a third of the people who experienced a fall for an unknown reason had a problem called "carotid sinus hypersensitivity" (CSH). CSH is a common medical problem in the elderly. It occurs when a receptor located in the neck that helps regulate heart rate is overly sensitive. It causes the heart to slow down to the point that adequate blood and oxygen can't get to the brain, leading to fainting and falls. A simple test of taking a persons blood pressure while massaging the neck can diagnosis the problem and the condition is treatable with a pacemaker. There can be other medical causes for falls that only a physician can determine which is why a full history and physical is very important.
Medications which can cause dizziness, drowsiness, or delirium can be adjusted to assist older adults increase their functional abilities. Physicians can assist with medication adjustment, pain control, and education. Physical therapists can assist with improving or maintaining strength and balance. Staying active can help prevent problems with reflexes, balance and movement control. Regular weight-bearing exercises and weight training can build and tone muscles even in very old people. An added benefit is a reduction in depression. A recent study on the effects of exercise on falls in elderly patients in the Journal of the American Medical Association showed that Tai Chi appeared, on small numbers, to be a great exercise intervention with about a 35% reduction in fall incidence.
Education and communication also play a big part in the reduction of falls. Older adults can be taught how to use equipment properly, to rise slowly to prevent dizziness, the importance of exercise, and ways to call for help. A high percentage of falls occur when patients don't lock their wheelchairs causing the chair to scoot out from under them when they try to sit down. Families and health care providers should communicate with the patient to help minimize the risk. If a family member suddenly decides that the area rug in grandmothers house, which she received as a wedding present 50 years ago, needs to go without first consulting her, you will have a fight on your hands and a very unhappy grandmother.
Fall interventions must be customized for each individual. Each person will have different risk factors based on their condition. For example, people with Parkinsonÿs disease can be at higher risk for falls in the morning because the affects of their medication have worn off. They will need more help in the morning than someone with Alzheimerÿs, whose condition can be worse in the evening. A toileting program may help prevent falls too. If there is someone with the elder every two hours assisting them to the restroom the risk of falls can be minimized. Diuretics, caffeine, and alcohol intake often result in an increased urgency to void, causing the elder to rush to the toilet. Changing medication and avoiding excess fluids before bed can reduce this risk.
If you or someone you know is having problems with falls, see a physician immediately. Considering that 25% of elderly people who have hip fractures die within six months following their injury, it is a call well worth making. And don't forget simple preventative measures such as exercise, calcium and vitamin D, proper footwear, and home safety checks.
Reference:
MA Province, ED Hadley, MC Hornbrook et al. The Effects of Exercise on Falls in Elderly Patients. Journal of the American Medical Association 1995 273:1341-7.
The Encyclopedia of Elder Care. Mathy D. Mesey, Springer Publishing Co. New York 2001.
Fals cause serious health risks in elderly, marshfieldclinic.org/cattails/01/novdec/exercises.asp
Common Heart Problem Causes Many Falls in Elderly. Michael Smith, MD WebMD Medical News. 10/31/2001 my.webmed.com/content/article/1728.92531
