The Problem
Many seniors and their families do not realize that there are many components which come into play to contributing to the high risk of falling. Often it takes a crisis to occur-which can result in hospitalization and or placement in a long term care facility for the family and the senior to realize a change must be made. A geriatric care manager/gerontologist is often hired on a case after a fall as the family becomes concerned that their loved one can no longer live without support at home or question whether the current living environment supports their loved ones changing health status.
Dementia, multiple medical issues, poor eyesight, depression, and medication side effects are just a few factors that come to mind. Families and or a professionals, need to educate mom and dad that as their physical and or mental condition changes, environmental adjustments as well as the incorporation of assistive devices are needed.
The National Safety Council estimates that persons over the age of 65 have the highest mortality rate (death rate) from injuries. Among older adults, injuries cause more deaths than either pneumonia or diabetes. Falls account for about one-half of the deaths due to injury in the elderly. Several epidemiological studies have looked at the rate of falls in the elderly at home, in outpatient settings and institutions.
- Among 65 year-old women nearly one in three (30 percent) will fall; after age 85, over half of women will suffer a fall.
- For men, the proportion who fall increases from 13 percent in the 65 to 69 age group to a peak of 31 percent in the 80- to 84-year age group. For those over the age of 85 there is a slight decrease.
- It appears that for the elderly living at home one-third to one-half tend to fall or do fall.Those who are more aged, female, single, divorced or widowed have an increased rate of falling.
- In the younger, healthier elderly, environmental factors are more important, with stairs and floor obstacles being common causes of falls.
- For the older, sick elderly, falls are often associated with dizziness and syncope (brief loss of consciousness; “passing out”), cardiac and neurologic disease, poor health status and functional disability.
Functional Ability
If a senior has poor balance, how can they function in the home properly? Tasks of eating, bathing, dressing, toileting and even driving are impacted. If the senior does not have a caregiver and or does not use assistive devices, the chances of falling multiple times trying to fulfill every day tasks of functioning increases. Safety issues of ambulation, transferring from bed to standing or chair to standing can become a risk each time. Instrumental tasks of daily living such as managing finances, driving to the bank, shopping, and cooking can all be impacted if the senior’s balance is in question and perhaps they do not do many tasks for fear of falling again.
Home modification
When ever I enter into the seniors home I assess their medical and cognitive condition and then I look at all rooms they primarily function. Do they now need a walker, cane or wheelchair for transferring? Does their bathroom have multiple scatter rugs which can contribute to falls. Could a grab bar or shower chair in the bathroom help the senior steady themselves while bathing? Do they have an emergency response system if they live alone? These are important factors to consider. If a fall has become severe enough sometimes the senior will need 24 hour monitoring to ensure that they can function in their home.
Solutions
Falls are usually multi-factorial in nature, involving many different factors. Exercise/balance training, physical therapy, incorporating adequate social supports, proper diet/hydration, and checking with medical doctors about side effects of medication are just a few. A geriatric care manager can often attend medical appointments with the senior to discuss with the MD how new medications/doses may impact balance. They are also good detectives in assessing whether or not neurological and or emotional issues may be contributing to falls. A professional assessment is often needed to ascertain which factors are at play and what professional/interventions are needed for the senior.
Hiring a professional such as a geriatric care manager to do an assessment can be worth its weight in gold and save the family and senior unwanted pain and suffering that may otherwise be costly to the seniors health, quality of life and overall independence.