Preventing Disasters in The Elderly Part 1

by Frank A. Williams, M.D.

Protecting your loved one from a fall is one of the most important, yet difficult, tasks a caregiver can face. It requires the vigilance of the caregiver and ability to recognize when a person is at risk for injury or illness. Falls can occur unexpectedly especially when the person is going to the bathroom or waking up in the morning—times when the caregiver may not even be aware that the person is getting out of bed. It is impossible for a caregiver to be “on duty” 24 hours a day 7 days a week—yet many heroically try.

Falls are the number one risk for injury and death. Why? Because they lead to hip fractures, broken arms, and head injuries. These injuries often lead to chronic pain, immobility, malnutrition, and finally pneumonia–then death. They are often fatal when the person is on blood thinners. A fall is like getting hit by a Mack Truck for the elderly and often leads to death. Medications may contribute to falling, especially those used to treat high blood pressure. Sometimes the medications lower the blood pressure to the point where, because of poor circulation in the brain, the elderly become off balance or dizzy especially when getting up from bed to go to the bathroom at night or arising from the bed in the morning. We call this orthostatic hypotension. Diabetic medications can also contribute to falls by lowering the blood sugar too much causing weakness. Altered Mental Status, dementias, disorientation, and confusion are common causes of falls. Physical deconditioning due to illness, malnutrition, and advanced age frequently leads to difficulty with balance and walking. Refusing to use a cane or walker is often a behavior that can lead to falls.

How to prevent falls:

  • Be sure to bring all medication bottles to appointments for your doctor to review. This allows us to know exactly which medications are being taken—not guess. We can recognize and ask you for symptoms of drug interactions which your parent or patient may be experiencing.
  •   Remove all obstructions that your loved ones can trip over including shoes,  carpets, toys, and other objects.                                                                                        
  • Recognize warning signs of difficulty walking especially holding on to walls and people.
  • Install guardrails in the hallway leading to the bathroom, and shower.
  • Watch for automatic refills at pharmacies such as Longs Drugs. Stopping a medication may require that you personally call the pharmacy to notify them to stop sending automatic refills on discontinued medications.
  • Write down which issues you want to discuss with your doctor in advance.
  • Beware of coughing, sneezing around your loved ones. The common cold can lead to pneumonia.
  • Do a walk thru of your house to determine and eliminate other risks for falls—loose carpet, toys, plastic bags, water on the floor, electric cords, trash and clutter.
  • Get backup caregivers to prevent burnout.
  • Write down any questions or concerns that you have about your loved ones. This is the most effective and efficient way to communicate.
  • Be sure to call for follow up of any persistent medical problems especially infections, bedsores, laboratory results and diagnostic studies.
  • Remove sharp objects such as corners of tables or glassware that may injure your loved ones if they fall.
  • Do not let your loved ones drive if they have vertigo, dizziness, poor eyesight, confusion, dementia, serious illness, stroke, heart attack, history of falls, or seizures.
  • Do not let the elderly cook or use a stove if they are forgetful. Always make sure that burners are turned off when leaving the house or at night.
  • For those prone to falling encourage them to always use a walker. Foam hip protectors may protect them from a hip fracture if they fall.
  • Consider baby monitors, cameras, and bed alarms to alert you to when your loved one gets out of bed.
  • Physical therapy may improve leg weakness and sense of balance caused by deconditioning after an illness.