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The Connected Caregiver

How to Avoid a Fall

I get a chill thinking about elderly people falling. Some 12 years before her death in 2008, my mother fell down a flight of stairs while alone in her home. She managed to crawl into bed where a concerned neighbor found her unconscious 18 hours later. She had suffered a subdural hematoma, and nearly died. Tough woman that she was, following brain surgery she recovered to have many more good years.

Want to avoid falls? Read on for some expert guidance.

One in every three adults age 65 and older falls each year, according to a recent report from the Centers for Disease Control. These falls are largely preventable. Falling can result in everything from minor bruises to hip fractures and head traumas. From the CDC come the following grim statistics:

• Among those age 65 and older, falls are the leading cause of injury and death.
• In 2009, 2.2 million nonfatal fall injuries among older adults were treated in emergency departments and more than 581,000 of these patients were hospitalized.-
• In 2000, direct medical costs of falls totaled a little over $19 billion—$179 million for fatal falls and $19 billion for nonfatal fall injuries.-

I asked physical therapist Robert Murdocco, co-owner with his wife Jackie of Impact Rehab in Miami Beach, for advice for family caregivers in the prevention of falls. Here’s what you need to do to make the home safer:

Create a clear path. “One of the biggest problems is throw rugs,” says Murdocco, who’s been conducting site-safety visits in people’s homes for 16 years. If a rug has always been there, it may seem innocuous, but “loose rugs or carpeting are the most common cause of tripping,” he says. “Older people have trouble lifting their legs, they drag their feet, and they can easily trip over a loose rug.”

Remove kitchen hazards. Start by looking for loose electrical wires. Next, rearrange small appliances so the older person won’t have to lean over things to reach what they need. “If someone has poor balance and has to reach over sink to get to medication or to grab a heavy pot, that can lead to a fall,” says Murdocco. Just as important is to make sure that no kitchen activity requires climbing on a footstool. “Even if it’s been the person’s lifelong habit to use a stool to get to certain utensils, you can help by rearranging the kitchen so climbing is no longer required.”

Make bathroom trips safer. “The most common fall occurs while going to the bathroom at night,” says Murdocco. There needs to be a clear, well-lit path to the bathroom with an easily accessible light right directly at bedside—not two feet away from the bed—with an easy on-off switch that the resident is very comfortable using, and night lights along the way.

Create a safe “landing zone.” Place chairs along the route to the bathroom, so if the person does feel dizzy or unsteady, they’ll have a place to sit and rest along the way. Similarly, if the walk to the bathroom requires passing through the dining area, leave one of the dining room chairs turned out. Obviously it’s critical that these chairs don’t themselves become hazards, so take practice walks with the person you’re caring for in order to help them get accustomed to the locations of their safe landing zones.

Make telephones accessible. There should be phones at waist height in the bathroom as well as close to the bed in the kitchen, and en route to the bathroom if the bathroom is far from the bedroom. “In case of a fall, the phone needs to be at a level that’s reachable from a kneeling position,” says Murdocco.

Create a safer bathroom. If you haven’t done so already, install grab bars in the bathroom, says Murdocco. “Grab bars are needed by the toilet, but also near the sink and in the shower.”

Check the flooring. “There should be non-slip surfaces throughout the house, but especially in the bathroom in and around the shower,” says Murdocco.

Check the stairs. If you have a staircase, make sure the stairs themselves are smooth and even. Make sure the banister or a grab bar extends all the way to the bottom step.

Make traveling safer. Special precautions need to be taken with frail people for those trips outside the home to the doctor’s office or senior center. “You need to consider, if this person hasn’t walked 700 feet in a month, how difficult it is going to be to make it down a walkway, into a car, out of a car and down a corridor of a medical building,” says Murdocco. He suggests the following:

• Know their limits. Plan the walking route ahead of time and, depending on the person’s strength, be sure there are places to sit and rest along the way.
• Give support. In walking down a pathway or corridor, support the patient on their stronger side, says Murdocco.
• Enter a car safely. In getting into a car, the elderly person needs to turn away from the car, point their rear toward the seat. Next, they should place a hand on the seat behind them so they’re not falling backward into the seat, but “guiding” their way into the car. Finally, once seated, they should push as far into the car as possible before turning their legs in.
• Exit a car safely. The biggest mistake, according to Murdocco is pulling on the open car door—which is unstable—in order to stand up. Instead, they should scoot across the seat so their legs are as far out the door as possible while remaining seated. Then, with feet on the ground, they should use one hand to push up from the seat, while pulling up on a stable part of the car’s frame with the other hand.
• Don’t rush! “When you’re rushing, that’s when accidents happen,” says Murdocco. “Don’t rush for an elevator. Don’t try to make a bus. One fall sets you back six months.”

It’s essential to think of the above as guidelines, rather than hard and fast rules. “Every person is different, and has different strengths, weaknesses and needs,” says Murdocco. For a proper survey of the home, you should arrange for a site visit from a physical therapist or another qualified professional in the eldercare field.

–Steve Slon

Steve Slon, the former Editor of AARP Magazine, blogs for “The Connected Caregiver” at http://www.beclose.com.