September’s safety topic is about falls, speciﬁcally fall prevention. Falls can occur at any age and consequences may be severe at any age. Statistically however, seniors have the highest percentage of falls of any age group. One third of seniors fall annually, and 50 % of these falls represent repeat falls. Consequences of injuries can lead to disabilities and the worsening of existing health problems. It is important to note that the actual injury from a fall, such as a hip fracture, can evolve into a permanent disability and even death. Understanding general fall risk factors and tailoring these to an individual’s medical status is important. Safety at home goes hand in hand with assessment of risk factors and providing solutions.
ARE YOU VULNERABLE TO TAKING A FALL?
Here is a great resource from the CDC - Check For Safety A Home Fall Prevention Checklist For Older Adults
Every part of our bodies contributes to our ability to stay upright and walk safely.
- The Central Nervous system is the coordinator of signals from the brain, sensory organs, and response to how we adjust gait, avoid dangers such as falling oﬀ a curb, or tripping. Chronic conditions aﬀecting the Central Nervous System, also place a person at risk for falls. The Central Nervous System can be damaged by brain injuries, stroke, brain tumors, and Examples of these conditions are Parkinson’s and seizures that aﬀect response time, coordination, cognition, and concentration.
- Sensory Organs: These are eyes, ears, and proprioception. Proprioception is the unconscious ability to detect position and location of the body as well as sense movement and Lack of proprioception contributes to falls. Poor vision, and decreased hearing can prevent the brain from recognizing and thus avoiding fall risk.
- Musculoskeletal System: Conditions that aﬀect muscle strength and response time can contribute to Examples such as chronic pain, or arthritis can impair the ability to correct the joint movement or the position of hip, knee, ankle, or foot and thus avert a fall.
- Factors that act to decrease alertness and increase fatigue can contribute to a Typical examples are medication side eﬀects: Some examples of these side eﬀects are confusion, fatigue, agitation, blurry vision. sedation, and confusion.
- The natural process of aging can cause balance to decline. Dizziness when standing due to blood pressure not increasing quickly enough, can contribute to falls. Medication use is more common with aging and thus makes age a risk factor for falls. Vision changes with aging may make it diﬃcult to avoid fall hazards.
Talk to your medical team if you feel your medications are interfering with alertness, balance, or cognition. Have your eyesight and hearing checked if you feel you are not seeing or hearing well. Find out about supervised exercise programs for seniors that focus on leg strength and balance. Tai Chi has been reported to be highly eﬀective for fall prevention.
The CDC has a wonderful program you can learn more on how you can stay safe and independent. One of their videos demonstrates Chair Rising exercises that strengthens leg muscles involved in rising from a chair.
Environmental factors that contribute to falls.
Home environmental conditions can be tailored for fall prevention. A home assessment for fall prevention involves identifying and correcting conditions that increase fall risks. Statistically 25 % of all falls occur at home. An additional 25% of falls occur on the sidewalk or curb outside the home. A detailed list of environmental safety is included in a chart from the CDC at the end of this article. Speciﬁc contributing environmental risk factors include:
- Any slippery surface: Wet surfaces such as showers are Grab bars and/or shower chairs are advised to prevent shower falls. Bathtubs should have nonslip strips. Bathroom toilets seats should be high up for ease in safely getting up.
- Rugs: Rugs that are not tacked down, or are worn out, or are placed on an uneven ﬂoor need to be addressed
- Clutter is dangerous as it presents a tripping hard. If addressing clutter is not easy for the resident of the home, there are agencies that can The outside space of the home which includes the sidewalk, curbs and the walkway to the front door should also be clutter free.
- Electrical wires from lamps or appliances should be secured and not running across a ﬂoor.
- Each step of a stairway needs to be stable and Rails need to securely in place. The entire staircase should be well lit. Steps should be clutter free.
- Lighting for the entire house should h be placed for ease of turning the lights on and oﬀ. A back up source of light such as a ﬂashlight should be readily available in rooms that are frequently used.
- Look around before you rise from a seated People can trip on their pets, on magazines or anything left on the ﬂoor.
- Use your sensory aides, speciﬁcally your glasses and/or hearing aide at home when you are changing positions or walking in the house.
- Shoes are Invest in shoes and slippers that ﬁt well. Flip ﬂops and backless slip-on shoes can result in an actual ﬂop or slip.
Programs for medical evaluation, exercises to decrease fall risks, and initiating environmental adjustments to your home.
Medical Evaluations can be done with your medical team. Home evaluations for environmental safety vary from community to community. Attached to this article is a CDC questionnaire that identiﬁes fall risk.
Avenues for a home evaluation can arise from any member of a care team. Sharing your concerns with your medical providers of any specialty - Primary Care, Specialty Care, Podiatry, Physical and Occupational Therapist, a Home Health Nurse or Aide, or a Home Health Agency can direct you to local resources. If local programs are not easily identiﬁable the Pima County Council on Aging is a good resource.
A person home alone, who has fallen, may not be able to get up and answer the door. The same holds true for other medical emergencies, and for ﬁres. if the front door is locked and the person in need of help cannot open it, often the door is smashed down. A solution to prevent destroying property and a safer way to enter a home is a lock box. A secure box that is placed outside the home and a key to the home is placed in the lock box. The key that opens this box is available only to responding firefighters on duty. To maintain safety and ensure that the key in the box is always available, not even the homeowner has a key to open the lock box. Your fire district has a great lock box program with thousands already in service.
We are reminded, as we complete this article, of the Ben Franklin quote: “An ounce of prevention is worth a pound of cure”. We close with the SHIM slogan: “Stay Vertical.”