family matters | With care and attention, many falls can be preventedby rita clancy
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My 88-year-old mother has dementia and lives at home. She fell recently and ended up in the emergency room. Luckily, she didn’t sustain any fractures. However, this was not her first fall. I live out of town. Is there anything I can set up or do for her so she doesn’t have another fall. Is this the time to move my mother into a facility? — P.T., Berkeley
Falls affect both physical and emotional health and often precipitate severe declines in our aging loved ones. While we can’t completely prevent falls, understanding the risk factors is key to decreasing their incidence. A combination of many factors — cognitive, physical, environmental — contributes to how likely an older adult is to experience a serious fall.
According to research, the incidence of falls in older adults with cognitive impairment and dementia is more than twice that of cognitively intact older adults. Impaired cognitive abilities can reduce attention and compromise posture and gait stability. Older adults with dementia may have perceptual deficits, making it more challenging to negotiate things like changes in floor surfaces. Dementia may also cause wandering, emotional distress and impaired decision-making, all of which increase fall risks. Certain types of dementia, such as Lewy body dementia and dementia related to Parkinson’s disease, have been specifically associated with higher fall rates. For these reasons, people experiencing dementia must be closely monitored for fall risks.
Physical risk factors that can predispose someone to falls may include cardiac arrhythmias, changes in blood pressure from sitting to standing position, arthritis, and neuropathy. Low physical activity, impaired balance, muscle weakness, cataracts and visual impairment, urinary incontinence, osteoporosis, low vitamin D, dehydration, and frailty are additional variables that may increase risk. The use of multiple medications is another culprit. Even over–the-counter medications can contribute to falls as some can cause dizziness, confusion and sedation. All of these physical and medication-related factors should be discussed with your mom’s physician.
Environmental factors are some of the biggest culprits for falls. Examples include poor lighting, wet or shiny floors, loose rugs, unsafe stairs, lack of banisters, and inappropriate footwear (walking around barefoot or in socks causes almost 50 percent of falls in the home). In addition, dangers lurking outside the home may include uneven walkways or porch steps without a handrail.
Because anything from this long list of cognitive, physical, and environmental factors can set up a cascade of events leading to a fall, it is essential for your mother to be monitored, and for her physician to be aware of her history of falls. Previous falls are a strong predictor of future falls. In fact, fear of falling can cause severe loss of function, with feelings of depression, helplessness and social isolation.
Moving your mother into a care facility is not necessarily the answer to prevent future falls. In fact, although only 5 percent of adults aged 65 years and older live in nursing homes, this population accounts for approximately 20 percent of the age group’s fall-related deaths, according to the CDC and Annals of Internal Medicine. And according to the Annals of Long Term Care, 50 to 75 percent of nursing home residents fall annually, which is twice the rate of falls in community-dwelling older adults.
An important first step is a comprehensive fall-risk assessment for your mother. Done with an interdisciplinary approach, the goal of the assessment is to create safety while maintaining your mom’s autonomy as much as possible. A geriatric care manager or a social services agency can perform this assessment.
Once the assessment is complete, a family member or care manager can oversee any recommended lifestyle or home adjustments. This may involve physical therapy, installing grab bars, improving lighting, adding exercise to the daily routine, closer monitoring of medications and so on. A care manager can also be key to ensuring that your mom’s preferences and values remain part of her everyday life.
Everyone involved in your mother’s care should be trained in the daily interventions to ensure her safety. This includes making sure that caregivers understand emotional factors and triggers that could upset your mother. Good sleep hygiene and plenty of fluid intake are important as well. Getting your mother engaged in physical activities can be an important risk reduction strategy, as well as ensuring some social interaction.
Despite the wide range of factors that can contribute to falls, the good news is that many falls are preventable with careful monitoring of our aging loved ones.
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