Why do Seniors fall?

The answer to this seemingly simply question is very individualized and very complex.  The easy answer is:  it depends....

I'll touch on some of the more common causes - but be aware, this list is by no means exhaustive.

First there are the true accidents; missing a stair on the way down the staircase, tripping over a toy left by a child in a hallway, slipping on a slick wet floor in a grocery store...these are all scenarios that we have seen in cases where seniors have fallen.  Although the cases that we have seen have resulted in serious injuries, like fractures, these kinds of "accidents" have been the exceptions.

Most of the falls that we see are related to impaired mobility, sensory changes, balance disturbances, medication influences, blood pressure fluctuations, dehydration, confusion, agitation, disorientation etc.

There's enough material available to write volumes on each of these causative factors, but in the interest of being useful, each day for the next number of days, I'll touch only on some important highlights.

You might receive guidance to wear "appropriate footwear".  What does that actually mean?
Proper footwear may include shoes or slippers with non-skid soles, that are closed back, that have either no heel or a low (1") heel. I have noticed that most styles of slippers, worn by Clients, do not have support around the heel and often do not have non-skid soles. (Socks should also be non-skid).

While we're in the region of the foot in our discussions, other foot related issues include foot and nail care that allow for comfort and fit in the shoe. A podiatrist or foot care nurse might be needed to assist with this. For those with longstanding diabetes, neuropathy may be a contributing factor to falls.  A person with neuropathy in the feet cannot feel their foot in their shoe or striking the ground. Swollen extremities caused by poor circulaton, edema, heart failure, infection are problematic because sensation in the foot and leg may be impaired.  Also the added weight of edema in the legs, makes it difficult to move the legs normally and easily during walking. Any kind of pain will interfere with a person's gait-and this may be due to arthritis, osteoporosis, fracture, intermittent claudication, knee pain, side effects of medication, poor circulation etc.

Some solutions may include; regular exercises, analgesics, pressure stockings, orthotics, weight loss, leg massage, proper footcare, diabetic control, reduction of edema, etc.

Helpful people may include a physiotherapist, a chiropodist, a footcare nurse, a doctor or specialty footwear professional.

Home Safety - general considerations

There are so many elements to consider in a home safety assessment.  The priority will always depend on the abilities and the wishes of the individual Client.  Below are some commom themes and issues that need to be addressed in any home safety assessment. Also, a long distance home safety assessment is not ideal.  This is the kind of exercise that needs to be accomplished onsite.

The issues that are addressed will vary depending on whether home is a house, apartment, condominium, bungalow or multi-storey dwelling.

Challenges in balance, gait and the need for assistive devices such as a walker or wheelchair need to be taken into consideration. A stairlift, handrail or ramp may be needed for those with strength, balance and other mobility impairments.  The width of doorways, hallways and stairways may have an impact.

For all rooms of the house it is advised to reduce clutter and remove throw rugs.  Smoke detectors should be present.  If the resident smokes, are they doing so safely? If there are pets in the home, can the resident ake care of the needs of the pet such as litter box changes, daily walks, feeding, provision of fresh water, fish bowl cleaning etc?

Memory affects safety.  Will the resident remember to eat and drink adequately? Can they safely manage the stove?  Can they learn how to use a microwave?

How are medications organized?  Perhaps a blister pack would be appropriate, or a dossette.  Meals on Wheels delivery might be helpful for some -  for others, a visit from a caregiver or companion each day might be suitable.

These are some general thoughts with regard to home safety. The abilities, personality and wishes of the individual will dictate which ones are the best choice.

Home Safety in the News and always on our minds

There's a terrific series in the paper this week that brings to light the huge number of seniors experiencing falls.  Falls experienced by seniors are important and often life threatening events.  I am always amazed when someone casually mentions that a senior has had a fall.  To me it's a tragedy, a red flag, a message that there are already a number of risks that need attending. 

Falls are rarely an isolated event.  They are almost always the outcome of a long series of events, that culminate in a fall. We should take it as a given (and we do in other age groups) that it is not normal to be falling down! It's dangerous and painful, debilitating and inconvenient and puts one at risk for all sorts of other related negative events.

Falls may happen anywhere and there are a great number of possible contributing factors. One place that we can hope to reduce the incidence of falls is the Client's home.  A home safety assessment, conducted by a knowledgeable and experienced care provider, is the first step to improving safety at home for seniors.

Over the next number of days I will publish aspects of a home safety assessment commonly used to improve safety in the home. I'll share some creative and uncommon strategies that we have used to improve safety and I will provide practical advice and give examples from the homes of Clients that we have visited.