A fall is when a person loses balance or unintentionally drops from a secure position to a lower surface. It means that a fall can happen from standing, sitting or even laying down.
Falls happen very often among the elderly. They might have an injury or not . Physical injuries might be as minor as a bruise but it could also be a fracture, joint or tissue damage. Mentally, a fall decreases their confidence.
A lot of the falls happen at home. Whether they fall from standing going back to the recliner, bed or even down to the floor. They will either be able to get up or they could also be unable to. It is very important for us therapists to teach our patients how to get up.
There are several ways to prevent falls at home. First you can improve their physical abilities. Second, environmental modifications. And lastly, improving their confidence and safety in standing, transferring and ambulating.
Improving their physical abilities includes improving their visual perceptual skills, improving their strength, and improving their vestibular system.
It is important to know what visual deficits are present. The common impairments are cataract, macular degeneration, glaucoma, and diabetic retinopathy. Vision impairment might be blurry vision, loss of central vision, loss of peripheral vision, fluctuating vision, presence of floaters, partial and total blindness. For stroke patients, hemianopsia is common which is loss of vision over the half field. Consulting an optometrist is necessary to find out what type of vision impairment the patient might have. However, let us not forget that it could be as simple as cleaning the glasses that the patient is wearing that could improve their vision thereby improving their balance.
As therapists say, movement is medicine. Regular and purposeful exercises is highly recommended. The arms are needed to push or pull. Pulling from a grab bar of pushing a walker, the arms are needed to be strengthened. The legs needs to be strengthened for stability in standing and walking. Often, the core and the back muscles are neglected. These muscle groups keep the torso upright.
Though exercise is important, rest and proper nutrition is also necessary in improving strength. When the patient does not get enough rest, cannot recover and rebuild. If the patient does not have enough and proper calories, the body is like a car running on fumes. There is nothing to fuel and build the muscles necessary for balance.
Most elderly patients have vestibular system disorders. This is because of less activity and not because of old age. They have less reasons to get up and move compared to when they were working. The vestibular system or what is often referred to be located in the inner ear plays an important part in balance. The common vestibular disorders are non-specific dizziness, unsteadiness, movement intolerance, Meniere’s Disease and vestibular neuritis.
Consult your doctor first to know the underlying problems and to find the best solution. Just like improving the muscular strength, movement is also medicine to the vestibular problems. First, moving the head side to side and up and down, around 20 repetitions, while in sitting position and while maintaining gaze to a stationary object. When perceived dizziness is less, you can have the patient stand up while holding on to a walker or the sink and moving the head side to side and then up and down again. Then you can walk with or without an assistive device while moving the head, scanning the environment. Since most of the elderly patients are sitting and watching t.v. most of their waking hours, just standing up during commercial breaks is also a good strategy.
Improving the patient’s environment is the most modifiable strategy to decrease falls. Add night lights in strategic areas where the elderly usually goes at night like the hallway to the bathroom. Using a clear shower curtain to let more light in the shower is also a brilliant idea.
To add more feeling of security and safety while taking a shower, install grab bars and hand held shower. Use a shower chair or bench as well. This way, when the patient needs to wash the back or legs, he does not have to stand up and turn around. Standing and turning around on a wet tub or shower increases the risk of falling. Use non-skid mats or tape on the tub or shower floor for added grip. Tape or paint the grab bars and the edges of the tub or shower chair with contrasting color to the wall specially for patients with poor vision. Falling also happens a lot when the patient needs to pick up or reach for object out of reach. A reacher or some call it picker upper is something cheap that they can use. However, let us not forget about decluttering and re-arranging the furniture. Make a unobstructed path to the different areas or rooms in the house. Make sure that things don’t pile up and easily falls, blocking the pathways.
Incontinence also increases falls. When the patient is unable get on the toilet or bedside commode in time, the chances of falling is higher. This is due to difficulty going to the bathroom and the embarrassment of voiding accidents. The floor gets wet and slippery when the patient voids accidentally on the way to the toilet. Kegel exercises is an effective exercise to strengthen the pelvic floor muscle. Just imagine interrupting the flow of urine. Hold the contraction and repeat a few times. Progress with longer holds and increased repetitions. If the patient is unable to do Kegel exercises, squeezing a throw pillow of rolled towel between the legs will indirectly help strengthen the pelvic floor muscles. Bladder retraining is also important. This means having a schedule for voiding such as doing it first thing in the morning and on specific times during the day. You can progress this by increasing the time between voiding. Use a portable urinal in the process of decreasing incontinence. Just remember, there is a male and female portable urinal. You can also place the bedside commode as close as the possible to where the patient usually stays the most during the day.
Improving their confidence and safety in standing and ambulation includes the proper use of assistive devices such as canes, walkers or rollator. The height of the assistive devices needs to be adjusted accordingly and to their comfort. Usually, measure from the wrist to the floor while standing. This will be the height of the assistive device for walking. You can also estimate it by subtracting an inch from the half of the patient’s height. For example, if the patient’s height is 76 inches, his cane will have a length of 37 inches (half of 76 is 38, subtract 1 inch= 37 inches).
The ability to get up from falling also improves their confidence. Practice with them how to scoot to a sturdy chair, couch or the wheelchair (make sure the brakes are locked). Then, instruct or show them to get on their hands and knees and pull up facing the chair or couch or to put their back against it and push up with their elbows and then their hands.
If the inevitable happens, the patient falls and cannot get up, the ability to call for help becomes very important. Having a medical alert is convenient. It can be worn like a necklace or a bracelet. Choose one that is water proof, long lasting battery life, has fall detection and GPS enabled. Another way is to have a cellphone with the patient at all times. Getting to the patient and helping them get up is very important.
Falls can be prevented. Our goal for the patients is to avoid keep them well and mobile without fear of falling.