Autumn or “Fall” is Fall Prevention Awareness time. The internet has numerous checklists, videos and charts about fall prevention. In my experience working in a rehabilitation center many of the patients admitted there have had a fall.
Often the fall caused a fracture or other serious injury. Someone’s life changed in the flash of a second. Below are several overlooked aspects of fall prevention.
Falls can signal or start a decline in function.
Unfortunately once someone has a fall, they are likely to have another one. Unless the reason for the fall is understood and rectified another fall is likely to occur. Falls cause fractures, fractures cause pain and pain is debilitating. Prevention is the best way to approach the problem.
Fear
Fear of falling is real. It intensifies anxiety. It makes people afraid to move. They lean back in fear and plop down. Anxiety about falling results in less movement which causes weakness which contributes to the vicious cycle of falling. Falling backward is unprotected falling and can cause a head injury.
If you are caring for someone who is fearful be calm and reassuring, stand close by when they are standing up. It’s recommended to stand close to the person, off to the side and slightly behind. You can hold onto the back of their pants to assist if there’s a loss of balance
Footwear
Footwear style is important in fall prevention. For footwear to be effective it has to be supportive, comfortable and the wearer should ideally be able to put the shoes on by themselves. Elastic shoelaces may be helpful so a favorite pair of sneakers can be converted into slip ons that never need to be tied. Foot deformities like bunions and hammer toes make it challenging to find a well fitting shoe. Take your time with shoe buying. Some brand names like Merrell and Life Stride are popular with the careful shoe buyer. Adjustable shoes for swollen feet are found with an internet search.
Fasteners
Fasteners are an important part of footwear. Often people choose no fastener, slip-on shoes, which can also slip off. Some think velcro fasteners are the key to easy on footwear which is often untrue. If the Velcro color blends closely with the shoe color it’s difficult to see the edge of the fastener. Velcro is strong and can be difficult for arthritic fingers to pry apart.
Think about elastic shoe laces that never get untied therefore changing the shoe into a slip on. Find a long shoe horn to slide the heel into the shoe. Loosely pre-tie the laces to allow slipping in and out without tying and untying. Find a pair of pliers to pull the tongue up.
Stairways and Bathrooms
Falls happen in predictable places at home, such as on stairways. and bathrooms. A fall down stairs is terrifying! Be sure the stairway has good lighting, the treads are in good repair and there are adequate handrails preferably on both sides and at the top.
See previous posts about bathroom safety for details. Knowing that bathrooms are a common site for falls, take all available precautions. Although the patient might not want you there, promise to leave as soon as they sit down. Observe how the patient manages in the bathroom. I do a lot of peeking through the partially open door.
Do not carry anything on stairs
You may need to have both hands on the same railing at one time if there’s only have one rail. Have two walkers, one at the top of the stairs and another one at the bottom. Don’t try to carry a walker on stairs! If you are helping someone navigate stairs always stay below them when they are going up or down. Watch their foot placement. Be sure their foot lands squarely on the tread and doesn’t hang off at all. Add lighting to a stairway with …Add contrast to a stairway with colored tape on the leading edge of each step
Falls frequently happen in the bathroom
Bathroom surfaces are often shiny and can be slick with water. Grab bars are essential for stepping into and out of a tub or shower. A non slip tub mat is also essential. Don’t chase a dropped bar of soap around the bottom of the tub. Instead use liquid soap on a body sponge.
A seated shower is a must for anyone with pain, low vision, limited mobility, cardiac or breathing issues. There are hundreds of variations of bathroom safety equipment. If stepping over the tub edge is frightening then sit on the outside edge of the tub seat first. Remove your shoes then swing your legs over and into the tub. If the person has heavy or weak legs then the tub wall can be cut out with a special kit for that. See other posts for how to adapt a bathroom for safety.
Do you wear bifocals?
Bifocals have been shown to contribute to fall risk. As you descend a stairway or step you are looking down through the reading lens of the bifocal glasses. That distorts your view of the area below. Tape or paint a contrasting color on the leading edge of a stair to increase visibility of the drop off point.
Fall Prevention has many nuances
Awareness of home hazards is important for taking preventative steps. Don’t get caught up in the stigma that we have in the USA about having assistive devices in our homes or sensible shoes on our feet. That’s what Aging in Place is about…understanding the trade off between the risk of having a fall and the reward of staying home safely and independently. A fall can change a life in the blink of an eye. A fall can cause a fracture. Home safety measures are good for everyone, especially if they prevent a fall and the functional decline that generally follows.
Visit the National Council on Aging at ncoa.org for high quality information on fall prevention including an assessment of your personal fall risk for a fall.
