She was falling too often. We made the difficult decision to put her in a nursing home.

The last several posts have been about fall prevention strategies. However, there are seniors who continue to fall frequently despite interventions. Some individuals are unstable as soon as they stand up and start walking. Other “frequent fallers” have dementia, poor judgement, and impaired impulse control. An accident can happen as soon as you’re not watching.

Frequent falls can result in the decision to put a person into a nursing home. But nursing homes have limited success in reducing falls. Nursing home strategies include health assessments, medication review, exercise programs, and environmental improvements. However, falls continue to be frequent. Nursing home residents average at least 2.5 falls per year.

Frequent falls are a frustrating and dangerous problem. There are no clear solutions. These are my thoughts:

There’s no one more important than the caregiver

Attentive, Anticipate, and Assist

The one intervention that has the most impact is a skilled caregiver. They make a major difference. Skilled caregivers are attentive, anticipate problems, and  assist when help is needed. For example, mishaps commonly occur when going to the bathroom. Caregivers suggest going to the bathroom before it is urgent. The caregiver then assists and stays attentive until the person finishes. Another situation is when an older individual is restless. The caregiver suggests an activity to refocus attention. Or the caregiver goes for a walk with the person. These are simple examples. Caregivers are aware of the thoughts and tendencies of each unique individual. They know the circumstances and environments that lead to mishaps. It takes trial and error, but the caregiver learns what works and what doesn’t work.

Daycare programs often help

Many seniors resist going to a senior daycare program. A friend of mine told me that her mother was too unsafe to be home alone. She therefore left work to care for her mom. For two years, her mother steadfastly resisted trying a daycare program. But once she started she was much happier. (Be sure to visit the daycare program to make sure it is a good fit.). These programs typically have an activity room that makes supervision easier. Activities decrease restlessness and supervised exercises improve strength. In addition, some participants are very good at keeping an eye on other participants.

Slowing down a fall is helpful

Once a fall is unavoidable, slowing it down can result in less injury. A slow tumble decreases the impact when hitting the floor. It also gives a person more time to react and grab on to avoid falling all the way down. When a senior starts to fall, it’s best to hold the person under the armpit, the upper arm or around the waist. Grabbing a senior by the hand or forearm seldom stops a fall. If the fall cannot be stopped, guide the fall towards a soft landing. Be careful to avoid injury to yourself. Watch your own stability and avoid landing on top of the other person.

Do walking aids prevent falls?

Canes and walkers can help people walk. They are frequently helpful to prevent falls but sometimes they are not. Canes transfer weight from the legs to the arm. This is helpful if hip, knee, or foot pain contributes to trouble walking. Canes are also useful if an individual has poor balance. The cane adds a third point of contact with the ground, widens the base, and distributes weight. Canes are also an extension of the arm. This helps a person “feel” the surroundings. In addition, other people are more careful when they see a person with a cane.

However, canes can also contribute to accidents. This is especially true in people who lack the coordination to use a cane correctly. Walkers and rollators (4-wheeled walkers) also have benefits and risks. Each of these assistive devices can result in injury. A physical therapist is especially important. The therapist assesses the patient and determines which approach is best. Devices also need to be adjusted to the right height. The therapist then coaches a patient to use the walking aid correctly. Lastly, it is important to use walking aids consistently. Falls occur when they are not used.

Do restraints prevent falls?

A restraint prevents a person from getting up and walking. This can be by tying down or trapping the individual. This is rarely if ever indicated. Long ago restraints were commonly used in hospitals to keep patients in bed or a chair. But now, they are rarely used. Restraints resulted in anxiety, confusion, and agitation. They also resulted in functional loss, immobility, injury, and loss of dignity.

Beds with railings are controversial. In the past there was concern that railings “trapped” patients. There were examples of major injury from patients attempting to climb over railings. Bed and railing designs are now improved. But whether bed railings are helpful or harmful depends on the situation. Another practice is the use of  beds that are lowered close to the floor. These beds make it difficult to stand up. Falling from close to the floor may result in less injury. Low beds are still in use in some nursing homes. However, the data about fall prevention is unclear.

Do Monitors help?

Cameras and monitors are useful to alert people when an incident has occurred. But their effectiveness in preventing falls is not clear. Monitors are helpful if a caregiver is close and can respond immediately. Technology is also evolving. There is hope that technology can eventually prevent mishaps.

Warmest Aloha,

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PS: I say it over and over again: There's no one more important than the caregiver in the daily life of a frail person.

Attached is some information about using canes and walkers.

Using Canes and Walkers.pdf