Why is preventing falls in seniors such a major concern?
Recently former first lady Nancy Reagan and Democratic presidential candidate Barack Obama's grandmother have suffered recent pelvic and hip injuries. Author Studs Terkel died, following reports that a fall two weeks ago had hastened his decline. Such news, experts say, should be a reminder to all of us about the need to help the elderly protect themselves against their increased risk of falls and bone injuries. If a senior falls and is injured; his or her ability to live independently decreases.
What are the major causes of falls?
The four major factors to consider in the prevention of falling in our aging population are indoor environment, outdoor environment, physical changes and chronic health conditions:
1. Indoor Environment:
Potential causes of falls include:
Tripping on Extension Cords
Lack of safe handrails
Loose Scatter rugs
Tripping over Pets
2. Outdoor Environment:
Potential causes of falls include:
Lack of handrails
Uneven walking surfaces
Mother Nature (Ice, snow, rain)
3. Physical Changes Associated with Aging:
The following conditions contribute to an increased in the incidence of falling:
Degenerative changes of the spine and other musculoskeletal structures
Decreased strength and flexibility
Changes in sleep patterns
Increased use of alcohol
Increased use of prescription and OTC drugs
4. Chronic Health Conditions:
These conditions may also lead to an increase in the incidence of falling:
High blood pressure
Diabetes ( blood sugar)
To demonstrate that increased incidence of falling in seniors involves a multitude of factors, I will use a case history of a patient named Fred. Fred is a 73 year old fiercely independent retired engineer. He lost his wife two years ago and is having a tough time managing without her companionship. Fred enjoys hiking, yard work and his new hobby is carpentry.
Fred hurt himself in a fall and decided to visit his friendly neighborhood chiropractor. Fred's medical history reveals that he was in excellent health until age 65 when he suffered a myocardial infarction (heart attack). He states that he has had two ear infections in the last year and has also experienced dizziness and problems with his balance. On further questioning, Fred admits to having four falls in the last few months and says that, "I haven't eaten well since my wife died." He usually rushes through one to two fast food meals every day. He also drinks five to six cups of coffee with sugar each day "to help keep me going." After further prodding, Fred reluctantly admitted that he drinks a case of beer every weekend since his wife died.
What is Fred falling?
The four possible reasons include:
Diabetes/ hypoglycemia caused by a poor diet and increased alcohol consumption.
Inner Ear Infection may be causing his poor balance.
Possible home Hazards? (See indoor and outdoor environment headings above)
Since Fred had several possible disease processes, he was referred to his medical doctor for investigations. The treatment recommended by the DC and MD included:
Proper diet to stabilize blood sugar
A referral to an ear nose throat specialist to rule out an inner ear problem
Chiropractic treatment to restore proper mechanics of the spine
Limit alcohol intake to 1 beer a week
In addition to the above, Fred also promised to fix all the home safety hazards with his son.
I am happy to report that after a 1 year follow-up visit; Fred had followed all of our recommendations, feels great and has not fallen again. However 2 weeks after that visit, he stepped on a rusty nail that required a tetanus shot!
The important facts to remember about falls in the aging population are that 250,000 fractures occur annually among older people who fall. Of this group:
20% never walk again
33% require institutionalization
Today's action step is to go through your household and check all potential hazards for your floors, lighting, bathroom and kitchen.
Floors Checklist - Answer Yes or No:
1. Do your carpets and mats lie flat without any wrinkles or curled edges?
2. Do loose mats have a slip-resistant backing?
3. Do you clean up spills as soon as they occur?
4. Are floors free of clutter?
5. Are all cords stored safely away from walkways?
6. Are floor surfaces non slip?
You are less likely to slip on surfaces such as carpet or unglazed tiles. These surfaces are preferable to polished floors which can be very slippery.
Remove all loose mats or ensure they are firmly secured and have non-slip underlay.
Make sure all your carpets are kept in good condition.
Always wipe up spills as soon as they occur. Some floor surfaces are particularly slippery when wet.
Lighting Checklist: Answer Yes or No
1. Are your lights bright enough for you to see clearly?
2. Are stairs and steps well lit?
3. Are light switches easy to reach and near each doorway?
4. Can you easily switch on a light from your bed?
5. Is there good lighting where you keep your medicine?
Nightlights are an inexpensive way to provide light to dark passageways at night.
Consider installing movement activated or photo electric lights to illuminate passageways.
Have extra lights installed or place lamps in dark areas.
Allow time for your eyes to adjust when going to and from light and dark areas.
Bathroom Checklist: Answer Yes or No
1. Do you use slip-resistant mats in the bathroom?
2. Are the soap, shampoo and towel within easy reach so you don't have to bend or reach too far?
3. Are you able to get out of the bath or shower without holding onto taps or towel rails?
4. Do you have handrails in the bath and shower?
5. Are you able to easily get on and off the toilet seat?
6. Are you able to walk directly into your shower without stepping over a raised edge?
Wet areas are more likely to be slippery and therefore hazardous. Take extra care when on a wet surface.
Non-slip flooring is recommended for bathrooms.
Paint on or self adhesive non-slip strips are advisable in the shower and bath.
Handrails are recommended in all positions around the bath and toilet where you need something to hold on to.
Occupational Therapists can advise you on hand rails and other equipment for modifications to your bathroom to ensure your maximum safety and independence.
Kitchen Checklist: - Answer Yes or No
1. Can you easily reach kitchen items you use regularly without climbing, bending or upsetting your balance?
2. Is there good lighting over work areas?
3. Do you mop up spills immediately?
4. Is there good ventilation to reduce the risk of eyeglasses fogging?
Arrange your kitchens so the most frequently used items are easy to reach.
A trolley or tray mobile allows you to transport more items with increased safety.
Counters and tables should be sturdy enough to support your weight if you lean on them.
Range hoods, vents or exhaust fans can be installed to provide better ventilation when cooking.
If possible install a wall oven in preference to a low oven.
Use a broad based, sturdy and secure ladder if it is absolutely necessary to reach high places.
If you answered no to any of the above questions, there are simple and easy actions you can take to make your home safer. Most changes are easy to make and are relatively inexpensive. Many of the items you may need such as paint, hand rails, slip-resistant strips and lighting are available from your local hardware store. Support groups or local service organizations will usually be able to help arrange installation of items when necessary.
Remember, it's up to you to take steps to prevent a fall.
Dr. Larry Smith Chiropractor and co-author of Inside the Minds: The Art and Science of Sports Medicine
Dr. Larry sees his mission today as one of living and promoting the tremendous benefits of chiropractic, health and fitness for the whole family. He uses his diversified life experiences to help his patients reach their maximum healing potential.
Also see Unintentional Death from Bed Falls