Falls At Home

May 25, 2021 Jessica Kluetz

Falls at home.

If I were to review my list of current patients in my acute rehabilitation hospital at any given time, it would be a safe bet to say that I am treating at least one patient in rehabilitation due to injuries from a fall at home. Falls are all too common in the senior population. The rate of falls in those greater than 65 years of age is 30-40%, and half of those falls result in injury. Of those injuries, 10% are serious. The rate of injuries increases as the age increases.

While the fall itself can lead to a decreased quality of life, just the fear of falling at home can also lead to decreased quality of life. It is very common for those that experience a fall to develop a strong fear of falling, which in turn leads to self-limiting of their activity. This creates a vicious cycle in that by limiting one’s activity, it leads to further debility and, thus, a greater risk of fall.

(Related blog post: Managing Quarantine Debility)

Elderly fall risk.

I thought it would be good to talk about the risk factors for falls and then spend some time talking about how to mitigate those risks. It is important to note that there are risks specific to the individual and those specific to the environment.

Let’s look at individual risks first. Some of the risks are just age related changes, often things we cannot control. For example, worsening vision. While we cannot necessarily stop vision from worsening, it is possible to help correct the vision with appropriate glasses. Another risk factor is sensory deficits. Some of these deficits are a result of chronic illnesses such as diabetes, which leads to neuropathy. Sensory deficits can also be due to vitamin deficiencies, such as deficiency in Vitamin B12.

While impaired sensation from chronic diseases may not be able to be corrected, it can at least be slowed by ensuring that the chronic illness is being appropriately managed. Impaired sensation from certain vitamin deficiencies can be corrected if the deficiency itself is corrected. In addition, acute illnesses such as urinary tract infections or illnesses that lead to dehydration and electrolyte imbalances can lead to falls.

And finally, behaviors and choices can lead to falls. If one chooses to remain sedentary rather than stay active, loss of muscle mass occurs. Many of the factors I listed can be treated and caught early if the individual maintains regular check-ups with their primary care physician.

Fall prevention at home in elderly.

Now I will move on to the environmental factors that can lead to falls. The first is medications. I cannot tell you how many patients I have who arrive on multiple medications that can each increase the risk of falls, and then combined, magnify that risk even more. This especially happens when multiple physician specialties are involved in the treatment of a patient. As a specialist myself, I will admit that we can all get tunnel vision when treating a patient and forget to see the big picture on how a medication we see as necessary might affect another aspect of a person’s function. Again, I want to reiterate the primary care physician and her importance in overseeing the big picture for each patient.

(Related blog post: Options For Medication Management)

Another environmental factor is assist devices (or the lack thereof). I have written about obtaining the needed home medical equipment for the bathroom. This equipment is important, as is mobility equipment (walkers, rollators, canes, etc). Almost as important as the equipment itself is making sure that your loved one is using the appropriate equipment. For example, the rollator is not a good fit for everyone. They can actually be a fall hazard for some people who cannot appropriately operate the brakes or for someone who needs to walk with the device closer to their body rather than it being in front of them. This is when an initial evaluation by a physical therapist can really pay off. A couple of physical therapy sessions are worth the time if it avoids a fall and subsequent fracture.

(Related blog post: Home Medical Equipment)

An additional environmental factor is the home features. Are there throw rugs around? Is there a lot of clutter around the home? Both of these are major tripping hazards, but can be easily changed. Are there steps that your loved one has to navigate to get into the home? Does she have to climb up stairs to get to her bedroom? Oftentimes, modifications to the home can be made to allow your loved one to more safely stay in the home. Sometimes, there are just too many structural hazards for the home to really be safe, possibly necessitating a move to a safer environment.

(Related blog post: Elderly Home Modifications)

Finally, another environmental factor is support from caregivers. There are some things that just become too risky for some loved ones to do. For example, I had a patient who really wanted to stay in her home, but her laundry room was in her basement. Everything else was on one level, and she was managing great on that one level. Her daughter took over the duty of laundry so that her mom would not have to worry about that. Cooking can pose a fall risk for some. I have multiple patients receive services from organizations such as Meals on Wheels that provide meals for the elderly, eliminating the need to be moving around the kitchen with big pots and pans just to make a good meal.

There are many factors that can lead to falls at home. While not every fall is preventable, there certainly are steps that can be taken to lower the risk of falls. Let me encourage you to be proactive now to possibly avoid a fall for your loved one, or you, down the road. If you are not sure how to go about making those adjustments, I would be happy to give personal guidance on how to make the necessary adjustments to prevent falls at home.

What steps have you taken to prevent falls at home? Share your questions in the Comments section. Or reach out to me directly.