Preventing the Elders You Love from Falling

Our 90-year-old mother fell and broke her arm. Now we're on a mission to prevent another fall. Photo: Joe Hennager

Two weeks before my mother’s 90th birthday, she fell. She stubbed her toe on the carpet while reaching for a light switch, lost her balance and, Bang! She broke her right wrist.

I hustled over to my trusty computer for a little research. Yep. According to the National Security Council, the older you get, the more likely you are to end up in an emergency room from an accidental fall. Each week, more than 30,000 Americans over the age of 65 are seriously injured by falling, and nearly 250 per week die from their injuries.

And this is from the Centers for Disease Control (CDC): “1 in 3 seniors fall every year, resulting in 90 percent of senior hip fractures. Of these seniors who fall” — and this is the scary part — “60 percent of them die from complications (Murphy 2000).”

In 2006, the Centers for Disease Control and Prevention reported that unintentional falls were the “#1 reason adults over 45 visited the emergency room.”

According to the CDC, here’s how falls in the United States broke down by age group that year:

Ages 45-54:         817,043
Ages 55-64:        633,428
Age 65+:           1,840,117

Following are some more interesting stats from “Preventing Falls in the Elderly,” by K. R. Tremblay Jr., and C. E. Barber (2005).

• The risk of falling increases with age and is greater for women than for men.
• Two-thirds of those who experience a fall will fall again within six months.
• A decrease in bone density contributes to falls and resultant injuries.
• Failure to exercise regularly results in poor muscle tone, decreased strength, and loss of bone mass and flexibility.
• At least one-third of all falls in the elderly involve environmental hazards in the home.

Preventing Future Falls

After our mother’s fall, my brother, sister, and I began to analyze all that we have to do to make sure she does not fall again.

We had eliminated all of the obvious trip potentials years ago. She has no steps to go up or down. We have hidden all loose electrical cords and gotten rid of her step stool and her throw rugs, and made sure no pets were underfoot. We put a nonslip surface in her tub, and got her to buy shoes with tread on the soles.

About a year ago, Mom traded in her cane for a good, solid walker. This one has a seat she can use when she gets tired. Aside from wrapping her in bubble wrap, we thought we had her well guarded. Still, she fell.

Risk Factors for the Elderly

In the trial-and-error process of learning how to care for Mom after her fall, we discovered several factors that made her unsteady on her feet. If you are caring for an elderly person, you might want to consider these factors, too.

Eye Glasses: Older people sometimes forget to put their glasses on. And they may not notice just how dirty their lenses are. That’s what happens with our mom. And even though we all pitch in to clean them for her, they’re dirty in no time.

Vision Checks: For most people, vision rarely gets suddenly worse. Most of the time, an elderly person will slowly lose visual acuity — so slowly that they may not always notice that their prescription is out of date. Getting regular eye exams and updating their eyeglasses is especially important for older folks.

Lighting: Dim lights hide all sorts of things, not the least of which are small items on the floor that an elder can easily trip over. Increasing the lumen level in your loved one’s living space might just save their life.

Medications: Check all medication labels to see which ones indicate the possibility of causing drowsiness. You’ll be surprised how many do. The American Academy of Family Physicians provides a list of Drugs that May Increase the Risk of Falling. Another good resource is WorstPills.org, which provides essential information about drug reactions. You might also look up your elder’s medications in the Physician’s Desk Reference. Talk with your elder’s doctor or pharmacist if you have any concerns.

Poor Sleep Cycles: Many elderly folks develop poor sleep patterns, waking frequently to go to the toilet or to get a drink of water. Whatever the cause of a broken sleep pattern, the result is often increased drowsiness. By early morning, when an elder feels the urge to urinate, they may collapse from weariness.

Sleeping Pills: To combat this lack of sleep, their physician may prescribe sleep medication. The positive effect is often sufficient rest. But the side effects may include an increased likelihood of dizziness, disorientation, sleepwalking, and falling.

Dry Air: If a dry mouth is one of the reasons your elder gets up at night, consider using a very good humidifier, especially during the winter months. Keeping the bedroom humidity at about 80% will reduce the dry-mouth symptom. Be sure to use an anti-bacterial agent in the humidifier water. And check the water filters frequently to evaluate the need to replace them.

Urge to Pee: If an urge to urinate is the deciding factor for interrupted sleep, limit liquids after dinner to keep the bladder as empty as possible. This may eliminate half of those toilet runs.

Even a simple family birthday party can add to an elder's stress. Photo: Joe Hennager

Caffeine: If caffeine keeps your elder awake, eliminate it from their diet after lunch. This includes all caffeinated sodas and chocolates.

Supplements: Some dietary supplements can also excite the metabolism. Most vitamins and supplements are taken in the morning to reduce the chance of a raised metabolism at bedtime. If you have questions, check with your doctor or pharmacist.

Fiber: Eating enough fiber during the day regulates bowel movements, another of those urges that may catapult your senior out of bed.

Calcium: Calcium is necessary for bone strength. Milk, cottage cheese, cheese, white and navy beans, tofu, soy beans, oats, cereals, grains, nuts, almonds, sesame, broccoli, okra, oranges and orange juice, fish and turnip greens all are rich sources of calcium.

Make sure your senior (and you) get the proper dose of calcium to build and maintain strong bones that aren’t as susceptible to fracture.

But be forewarned: calcium supplement pills can cause constipation. Irregularity is another reason elderly folks get up at night. It may be less stressful for your elders to get their calcium via food rather than dietary supplements.

Exercise: If your senior citizen is not getting enough exercise — if they’re sitting all day, as our mother prefers to do — they’re losing muscle tone and may be lowering their total blood pressure and heart rate. Extremely low blood pressure can cause dizziness upon standing. The heart is a muscle that needs to stay active. It is incredibly important to maintain a regular pattern of movement and exercise throughout one’s whole life.

An age-appropriate exercise program will help build physical strength. Consult your loved-one’s physician about the advisability of a regular physical therapy program. Building strength and stamina will decrease the likelihood of falls. Physical training also helps improve coordination and balance. The Oregon Research Institute found that “a Tai Chi program based on a randomized controlled trial … reduced the frequency of falls by 55 percent” in people aged 65 and older.

Stress: Don’t underestimate the stress that even seemingly small changes can cause — let alone major events like a 90th birthday party. Our mom finds every trip to the doctor exhausting and nerve-wracking. She was apprehensive for a full month before her 90th birthday party — though it went off without a hitch, and she reported having a great time. When an elder is stressed, this too can lead to poor sleep patterns, which then can result in tiredness, dizziness, and possible falls. (And, as if you don’t have enough to worry about, don’t forget that every trip to a doctor’s office is another potential exposure to H1N1 and the regular flu.)

The Child Becomes the Parent

So, here we are, making sure our mother has someone with her every time she stands and walks. We have begun to adjust her diet, her supplements, and her medications, including trying different sleep meds. We are working with her exercise program, getting her to walk a few laps up and down the hallway every day. She is getting stronger, and with better sleep, she’s less disoriented. We’re hoping that, together, we can help to prevent a second fall.

We feel blessed that Mom only broke her wrist and not her hip. According to the AMA, 24 percent of all people suffering a hip fracture die within a year of falling, and another 50 percent never return to their prior level of mobility and independence; they never get out of their wheelchair. Mom is not ready to live in a wheelchair, and none of us is ready for her to die. So our vigil continues.

If your elder loved one is in danger falling, assess their surroundings, their diet, their medications, and their sleep. Falling is one disaster you may be able to prevent.

And while you’re caring for your parent, don’t forget to take care of yourself.

Joe Hennager

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