Notes from the Floor: A Unique Perspective on Falls

My eyes were opened to a new perspective on a familiar topic today after completing a continuing education course with Michele Acorn, Nurse Practitioner at the Phillips Online Learning Center.*  Here are the highlights from her program.Falling Sign

1 of 3 persons over the age of 65 experience a fall each year.

50% of persons over the age of 80 experience a fall each year.

37% of the persons who fell and WERE NOT injured, still could not get up on his or her own.  The number increases to 61% for persons who ARE injured.

50% of older persons who experience a fall, even if they are not injured, will die within a year related to their medical condition.

And lastly, the strongest predictor for an occurrence of falling is a history of having already had one fall.

Alright, have I convinced you of the importance of taking a closer look at this issue?  I hope so!  The three P’s of fall prevention are to examine if the situation was “predictable” (were there clues that contributed to the event?), “preventable” (with factors that could be controlled?), and is there a “plan for safety” in place?  The Active Tips section of this website examines the factors in the person’s home environment that can contribute to falling and losing independence.  This blog post will focus more closely on the medical, mental, and emotional factors of prevention and a unique perspective that answers the question:  what are the ramifications of the amount of time that a person has lain on the floor after a fall?

When a fall occurs, often the person doesn’t tell anyone about it.  He or she may forget about it or fear a critical eye from a family member or medical professional.  Will it lead to suspicion that he or she needs more assistance or even lose some independence?  Research shows that most older adults prefer to stay in their own homes as they get older and rarely see themselves any differently as they age; he or she feels like the same person as when younger even if the body has shown signs of aging (from 83 year old senior Doris Lessing!).  All of these factors can actually work against the person who has experienced a fall.

So where do we start?  We already know that 1/3 of persons over the age of 65 already have these type of accidents every year.  Surely your loved one has either thought about this already or heard about someone they know who has had an injury or near-miss experience.  Casually bring up the topic.  Your loved one may feel relieved that you have cared enough to talk about it.

Ms. Acorn recommends asking the following:

If you were to have a fall here at home, how would you get up from the floor?

If you were to have a fall here in the house, how would you get help?

Have you fallen in the past 12 months?  (Then inquire further from there if any answer was “yes.”)

Considering the ramifications of a person falling and not being able to get up afterwards or “long lie times” on the floor, we want to identify if this issue as soon as possible.  What are the implications?  First there are the consequences that probably cannot be prevented:  injury to the body including fractures, discomfort and pain, and distress/fear of falling again/embarrassment.  And remember the statistics noted above that include death within the following year.  This is serious business indeed.

Second are the consequences of falling that may be prevented.  First and foremost is the ability to get help immediately after an incident has occurred, especially in the first 2 hours.  An older adult will be more vulnerable to medical complications than younger adults due to age-related changes in body composition (less water in the tissues), body size (many tend to have less body mass), thinning of the skin, muscle loss, underlying medical conditions, and more.  These changes put him or her at greater risk for pressure ulcers, Rhabdomyolysis (muscle breakdown including its constituents), pneumonia, hypothermia, dehydration, and death.  For example, a frail woman lying on a cold floor in a nightgown and in a panic can easily experience a drop body temperature to 95 degrees:  the threshold for hypothermia.

Further consequences that may be prevented are psychosocial and quality of life factors such as:  fear, emotional trauma, depression, and isolation.  Fear of falling all by itself can contribute to falls!  The person may walk more stiffly when afraid, avoid getting up and moving around as often, restrict fluid intake so he or she doesn’t have to get up an go to the bathroom as often, and so on.  An accidental fall takes a huge emotional toll on an older adult who has lain on the floor for hours and hours before being discovered by a family member.  Depression (even the use of alcohol) and isolation can begin or increase.  Remember that sadness is not a normal progression of aging and is a very treatable medical condition!

If you are the caregiver for your loved one and can help bring 1) awareness of the importance of fall prevention and then 2) all of this information with you to your loved one’s healthcare provider, you can assist in determining the best plan of care.  An encouraging report from Mary Tinetti, M.D. in 1994 identified that a fall will be prevented in 1 of 8 people treated for risk factors such as those noted above (Prevention  Medicine Vol. 23, Issue 5, pp. 756-752).  Yes, early recognition of risk factors, open communication, follow-up with healthcare providers, and intervention can save tremendous heartache and may even save a life!

For more information on fall prevention, please see the Active Tips section of this website.  Of particular assistance may be the Safety at Home Checklist to get you started.  Take care, Julie, O.T.

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*Complications Resulting from Long Lie Times After a Fall by Michelle Alcorn, NP

Res and Rec: Pet Care

Here’s a Sneak Peak on Pet Care from my upcoming eBook, Two Step Solutions:  Making Life Easier for Everyone.

Reservations

We love our pets and they provide comfort when no one else is around.  Remember that for your pets to be loved well, you and your health must come first!  Pets cannot live without your assistance at some level so you gotta be first, they are second.  Now ask yourself how many do you really need right now and can you adequately care for them?  If your answer is “well, maybe not,” can your loved ones adequately care for them and you too?  Is there any risk that their presence (for example severe allergies) poses to your health?  Can you train them to obey you to avoid behaviors that might be increasing a risk to for you to fall?

Recommendations

If all of these factors are not o.k. then making their care as convenient and safe as possible is important.  For example, consider keeping the food and water bowls near the area where food is stored and water is easily accessible.  Can an automatic feeder or fresh water bowl save you time and energy?  Is there any way to simplify their clean-up such as an automatic pooper scooper in the cat box to a large tray underneath the bird cage to catch the seed shells?

For dogs, many cities now have pooper scooper services available for outside of the home.  Long-handled scoopers are available in larger pet stores that eliminate the need to bend over to clean things up.  Further, is there a groomer who will pick up and deliver your best friend?  Ask your local pet store staff for ideas or check online forums with a “Google” search.  Sometimes rubbing your furry friend with a damp towel sprayed with a very weak solution of pet shampoo provides a nice touch up, extending time between grooming appointments.

One of the biggest helps at our home with a beloved, larger pup was to simply place the food and water bowls in an area with a ceramic tile floor.  No matter what method I tried, I could not stay ahead of the water and mess on the kitchen floor:  a large plastic tray, large plastic mat, rubber-backed rug, or big towel either became soaked over the course of the day or wicked the water underneath it.  When I was sick for a few years, I simply could not keep up with cleaning the floor multiple times per day.  And the risk for either mold growth or damage to the floor as water seeped near the baseboards was of concern as well.  Yes, I know that most dogs don’t eat and drink in the bathroom!  Well  in our situation we are grateful that the floor is tiled in our bathroom and Elle didn’t seem to mind after that first treat that lured her in there to make the change.  My hubby and I just keep a small dog towel hung out of the way for quick clean ups as needed when using the bathroom.  Done!

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Our German shepherd Elle as a pup!

For more tips on pet care, chat with the owner of your local pet store or ask in pet-specific groups in your favorite social media.  People love to talk about what works for them and share resources on Facebook, Yahoo Groups, breeder websites, etc.

Before you go, Gentle Reader, hit the “FOLLOW” button for more Active Tips and a special offer when the full book is released later this Spring.  In the meantime,

Take care, Julie, O.T.

From Dawn to Dusk

Here’s an excerpt from my upcoming eBook entitled, Two Step Solutions:  Making Life Easier.  The intended audience is the person facing a temporary setback who might not normally think about fall and injury prevention when he or she is used to living life independently.  Everything can change, including the way we do everyday tasks and activities.  In this eBook I will take a tour with the Gentle Reader through a typical home whether it is a house or an apartment, examining simple strategies, tools and equipment to make life easier until he or she gets back on one’s feet again.

From the moment you open your eyes in the morning until the moment you close them again at night, some things very likely are different for you than for the typical person. Let’s take a closer look at the daily routine of an atypical person: the one with a temporary or ongoing disability.  We are living a “new normal” for a time and this is what our world might look like with a few adaptations to make it work more smoothly for us. Take what fits for you and pass on the rest to someone else who may benefit too! Now it’s time to start as you wake up at the beginning of your day . . .

Bedroom, Hughes House from Pond5

Bedroom, Hughes House from Pond5

The Bed

How are you positioned in bed? If you wake up in pain, take a closer look at the shape of your pillow, the firmness of your mattress, and the positioning of your physical frame. Keeping our head/neck, torso, and hips/knees/ankles in what we call neutral alignment is a consideration here. Try to avoid twisting, pushing one body part forward from this alignment or bending anywhere but at the hips/knees/ankles. For example, is your rib cage twisted? Sleeping with an anatomical-type pillow that cradles your head with a dip in the center can help if your neck is stiff and sore. Placing a pillow under your knees when lying on your back or placing it between your knees when lying on your side can: 1) ease stress on the low back and 2) reduce the risk of pressure sores when the knees rub together. Exceptions: persons with a history of hip or knee replacements/arthritis might want to avoid the pillow as it can increase joint stiffness and decrease available range-of-motion over time. In the latter case it might be better to have the legs straighter. Also if you are using pressure relieving garments or bedding, check first with your healthcare professional before markedly changing your sleeping position.

Check the height of your bed. If your feet don’t hit the floor when sitting squarely at the edge, it’s too high. This poses the risk of falls when getting into- or out of- the bed. Do what you can to lower the bed height even if it means having someone saw off a couple of inches off of the wooden legs or adding a low/secure stepstool.  If when sitting at the edge of the bed your knees are higher than your hips then the bed might be too low. This requires extra effort when rising to a standing position and increases the distance when lowering yourself from a standing position. Increasing this distance poses risks for a fall and for spinal compression if you sit down to hard on a repeated basis.  Adding bed risers that securely to each leg underneath may be needed.

If you are moving (or “transferring”) from a wheelchair or walker to the bed, try to have the height of the bed match the height of the wheelchair seat. Removing the wheelchair armrest and scooting across the two level surfaces is ideal. Replace the wheelchair armrest once safely in the chair. (This applies to any type of chair too: moving across level seat heights can increase safety and reduce effort.) Adding a one-half bedrail or a floor-to-ceiling transfer pole may provide additional handholds needed to perform the transfer safely.  

Typical bed rail that slides between a mattress and box spring.

Typical bed rail that slides between a mattress and box spring.

Transfer Pole with accessories can be rated for bariatric use too.

Transfer Pole with accessories can be purchased in a version that is rated for bariatric use too.

Moving around in the bedroom

First, have someone else take a look at the layout of your bedroom. If you do your own analysis, you might not see the obstacles lurking there or be willing to change them! In working with hundreds of home health care patients I have noticed that folks usually see the way things have been for a long time and have a tough time visualizing it any other way. Having “fresh eyes” look at the bedroom in addition to other rooms of your living space can be quite valuable. Your independence and prevention of injury might be enhanced by a few simple changes so it helps to have another pair of eyes to help identify them.

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Julie, O.T.