Most caregivers are aware of
the importance of preventing falls. When a fall
occurs, the results can be life-changing. While we all
realize the significance of a broken bone that may
result from a fall, what we sometimes fail to
acknowledge is the broken spirit that may occur after
a fall. Many elders who fall never fully regain the
confidence in their ability to navigate around their
home or near steps. They may experience a fear of
falling again that may cause them to limit their
activity. They may have a permanent disability—not
only from the physical consequences of the fall, but
from the emotional consequences as well. What then can
be done to reduce the likelihood of falling? There are
four major risk areas to target when you think of fall
reduction: Environmental Risk, Age-Related Risk,
Health- Related Risk, and Medication Risk.
Minimizing environmental
risk would include things like providing for hand
rails near the toilet and tub to make it easier for
the individual to get up or get balanced; using
non-skid throw rugs, or better yet, no throw rugs at
all; keeping pathways to and from the bathroom,
bedroom, and kitchen free of clutter.
Reducing age-related risk
would include things like accommodating for vision
and hearing changes that make it more difficult for
the older adult to interpret their environment and
to see or hear clearly. Eyeglasses should be of the
correct strength, in good repair, and clean.
Lighting needs to be increased, but not to the
extent that it produces glare. A night light will
help reduce the dramatic and often times blinding
changes in light when going from a darkened bedroom
to a brightly lit bathroom. Hearing aids should be
cleaned regularly as wax may accumulate and prevent
them from working properly. Hearing aid batteries
should be replaced regularly to ensure good
function.
Reducing health-related risk
requires a good healthcare partner and a motivated
patient. Osteoporosis is primarily a disease that
affects older women and those who have taken
medications known as long-term steroids (often used
for the treatment of severe arthritis and asthma).
These medications cause bones to become increasingly
fragile and break even without trauma. Older adult
women should be screened for osteoporosis to
determine the density of their bones and if
medication management is required. All older adults
should get regular weight bearing exercise and eat a
well-balanced diet to maintain their bone health.
Older adults need as much calcium as pregnant women
(1200 mg/day)! Vitamin D requirements also increase
with age (400-600 IU/day) and are essential for
healthy bones as well.
The last category for risk
reduction is medication awareness. As we age, we are
at risk of taking many medications for many ailments
prescribed by many providers; a situation known as
polypharmacy. There is much research and increasing
awareness of the potentially hazardous effects of
polypharmacy. It is well documented that the more
medications an individual takes, the greater their
risk of side-effects, drug interactions, and falls.
Certain medications are particularly dangerous.
Anti-anxiety medications like Valium, Xanax and
Ativan; sleeping pills like Ambien, Restoril, and
even Tylenol PM have been implicated in increasing
fall risk. Discuss your loved one’s medication
regimen with the prescriber and focus on reducing or
eliminating those drugs that increase the risk of
falling. Should your loved one require extended care
somewhere other than home, be sure to ask what their
fall reduction program has to offer.
Fear of falling is a very
real phenomenon that is as important to reduce as
the physical consequences of a fall. Both can be
life changing and demand our attention to reduce the
likelihood of a fall occurring.
Sharon Roth Maguire MS,
APRN-BC, GNP, APNP is the Senior Director for
Healthcare and Resident Services at Alterra Health
Care Corporation and a Clinical Assistant Professor
(Adjunct) at Marquette University College of Nursing
in Milwaukee, WI.
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