A Major Fall Waiting to Happen

Yikes, my 93-year-old Mom fell. Fortunately, it wasn’t serious, and I only heard about it the next day. Help arrived promptly since it happened outside. She was taken to the Emergency Room for evaluation and triage. They made the initial determination that she was stable enough to wait. After 8 hours of waiting, she decided she felt just fine and left. She’s not looking forward to going to the ER again.

I’m not at all surprised that my Mom fell. That’s because it’s not the first time. A previous fall is the highest single predictor of a fall within one year. The other strong predictors of falls are 1. Worry about falling and 2. Feeling unsteady when standing or walking. My mom is indeed increasingly worried about falling. She’s steady but I notice she holds on to me when we walk.

Why is my Mom falling?

I know why my mom is falling. Although she has been incredibly healthy, her legs aren’t as strong as they used to be. On top of that she has pain in her feet and walks gingerly. She has episodic vertigo and dizzy spells. She’s careful now and I trust her judgement. But every once in a while something upsets her and that makes her feel dizzy.

Living alone, she leads an active life. But her living situation presents some challenges. There is a steep slope up to her house. In addition, she needs to climb a flight of stairs to reach the front door and another flight up to her bedroom. Her hallways are clutter-free and safe. But there are photos, memorabilia, and old furniture in otherwise empty rooms. She is now thinking back and forth about the pros and cons of moving at her age.

What Reasons Stick Out for You?

There are three common reasons falls occur in the aging population: physical impairment, errors in judgment, and fall-prone environments and situations. A combination of all three of these factors is common.

1. Physical Impairment

Watch an older adult get up from a chair and walk. As we grow older, balance, mobility, muscle strength, vision, and hearing all decline. A slow or tenuous gait is a sign that falls, and injury, are more likely.

The Timed Up and Go (TUG) Assessment is a useful tool to evaluate mobility and the risk of falling. Weakness resulting from medical conditions or frailty can result in a slow gait. Arthritis and foot problems can lead to pain while walking. Neurologic conditions often result in decreased strength, and agility. Loss of balance is common in Parkinson's Disease, dementia, and other neurologic conditions. Long-term diabetes also damages the nervous system. In addition, severe hyperglycemia or hypoglycemia results in dizziness.

Lightheadedness upon standing up or getting out of bed is fairly common. This can result in a fall. The lightheadedness occurs when there is a temporary drop in blood flow to the brain. Orthostatic hypotension means that the blood pressure suddenly drops when changing positions. Straining during urination or bowel movements can also trigger a drop in blood pressure and heart rate. This is known as a vasovagal response and leads to accidents in the bathroom. A large meal can also lead to a drop in blood pressure when standing. The stomach empties more slowly with age. As a result, the circulatory system pools around the stomach. Then the blood pressure drops when standing up.

Taking five or more medications increases the likelihood of falls. Substance abuse or excessive alcohol consumption also raises the risk. Some medications have side effects such as orthostatic hypotension, sedation, and confusion. There is a comprehensive list of these medicines at the end of this post.

2.  Errors in Judgement

Does the person make good decisions? Poor decision-making significantly increases the risk of mishaps.This can occur in different situations. For instance, an individual develops Alzheimer’s Disease but refuses help. The person forgets or denies that certain activities are unsafe.

Anxious or depressed individuals also fall more often. Poor decisions are made in response to surroundings and situations. Lifestyle choices also have the potential to result in falls. An elderly person may be fearful of falling and ends up walking less. Strength and balance then decline. Osteoporosis worsens. Stumbling becomes more likely, not less likely. These types of situations are common. Dementia diagnoses come with a 50% risk of falling within a year.

 3. Environmental and situational factors

Does the environment or situation increase the risk of falling? Most accidents are at home. Ten percent of falls happen on stairs, and more than 30 percent occur in the bathroom. Tripping is responsible for over half of all incidents. This is often due to stumbling over cords, loose rugs, or excess clutter on the floor. Oversized clothing, slippery footwear, and inadequate lighting contribute to the problem. While a person can walk without falling for months, it only takes one misstep to result in a fall.

Circumstances also have the potential to result in accidents. I have seen many different scenarios. A big dog abruptly chases a cat while on a leash. An elderly individual is pushed on a busy street. A person stumbles on an uneven sidewalk or while walking in bad weather. A cat lover trips over one of many cats. A senior is found on the floor. It turns out that the patient has a fever and is acutely ill. Last, but definitely not least, a frail person is left at home alone and slips.

Bottom Line

The Three Key Questions that predict risk of falls:

  1. Have you fallen in the past year?
  2. Do you feel unsteady when standing or walking?
  3. Do you have worries about falling?

The Three Reasons falls happen:

  1. Physical Impairment
  2. Errors in Judgment
  3. Environmental and Situational Hazards

The next post will be about what we can do to prevent falls.

Warmest Aloha,

[email protected]

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.

Posted in Caregiving, Dr. Warren, Geriatrics with Aloha and tagged , , , .


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