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Notes from the Floor: A Unique Perspective on Falls

My eyes were opened to a new perspective on a familiar topic today after completing a continuing education course with Michele Acorn, Nurse Practitioner at the Phillips Online Learning Center.*  Here are the highlights from her program.Falling Sign

1 of 3 persons over the age of 65 experience a fall each year.

50% of persons over the age of 80 experience a fall each year.

37% of the persons who fell and WERE NOT injured, still could not get up on his or her own.  The number increases to 61% for persons who ARE injured.

50% of older persons who experience a fall, even if they are not injured, will die within a year related to their medical condition.

And lastly, the strongest predictor for an occurrence of falling is a history of having already had one fall.

Alright, have I convinced you of the importance of taking a closer look at this issue?  I hope so!  The three P’s of fall prevention are to examine if the situation was “predictable” (were there clues that contributed to the event?), “preventable” (with factors that could be controlled?), and is there a “plan for safety” in place?  The Active Tips section of this website examines the factors in the person’s home environment that can contribute to falling and losing independence.  This blog post will focus more closely on the medical, mental, and emotional factors of prevention and a unique perspective that answers the question:  what are the ramifications of the amount of time that a person has lain on the floor after a fall?

When a fall occurs, often the person doesn’t tell anyone about it.  He or she may forget about it or fear a critical eye from a family member or medical professional.  Will it lead to suspicion that he or she needs more assistance or even lose some independence?  Research shows that most older adults prefer to stay in their own homes as they get older and rarely see themselves any differently as they age; he or she feels like the same person as when younger even if the body has shown signs of aging (from 83 year old senior Doris Lessing!).  All of these factors can actually work against the person who has experienced a fall.

So where do we start?  We already know that 1/3 of persons over the age of 65 already have these type of accidents every year.  Surely your loved one has either thought about this already or heard about someone they know who has had an injury or near-miss experience.  Casually bring up the topic.  Your loved one may feel relieved that you have cared enough to talk about it.

Ms. Acorn recommends asking the following:

If you were to have a fall here at home, how would you get up from the floor?

If you were to have a fall here in the house, how would you get help?

Have you fallen in the past 12 months?  (Then inquire further from there if any answer was “yes.”)

Considering the ramifications of a person falling and not being able to get up afterwards or “long lie times” on the floor, we want to identify if this issue as soon as possible.  What are the implications?  First there are the consequences that probably cannot be prevented:  injury to the body including fractures, discomfort and pain, and distress/fear of falling again/embarrassment.  And remember the statistics noted above that include death within the following year.  This is serious business indeed.

Second are the consequences of falling that may be prevented.  First and foremost is the ability to get help immediately after an incident has occurred, especially in the first 2 hours.  An older adult will be more vulnerable to medical complications than younger adults due to age-related changes in body composition (less water in the tissues), body size (many tend to have less body mass), thinning of the skin, muscle loss, underlying medical conditions, and more.  These changes put him or her at greater risk for pressure ulcers, Rhabdomyolysis (muscle breakdown including its constituents), pneumonia, hypothermia, dehydration, and death.  For example, a frail woman lying on a cold floor in a nightgown and in a panic can easily experience a drop body temperature to 95 degrees:  the threshold for hypothermia.

Further consequences that may be prevented are psychosocial and quality of life factors such as:  fear, emotional trauma, depression, and isolation.  Fear of falling all by itself can contribute to falls!  The person may walk more stiffly when afraid, avoid getting up and moving around as often, restrict fluid intake so he or she doesn’t have to get up an go to the bathroom as often, and so on.  An accidental fall takes a huge emotional toll on an older adult who has lain on the floor for hours and hours before being discovered by a family member.  Depression (even the use of alcohol) and isolation can begin or increase.  Remember that sadness is not a normal progression of aging and is a very treatable medical condition!

If you are the caregiver for your loved one and can help bring 1) awareness of the importance of fall prevention and then 2) all of this information with you to your loved one’s healthcare provider, you can assist in determining the best plan of care.  An encouraging report from Mary Tinetti, M.D. in 1994 identified that a fall will be prevented in 1 of 8 people treated for risk factors such as those noted above (Prevention  Medicine Vol. 23, Issue 5, pp. 756-752).  Yes, early recognition of risk factors, open communication, follow-up with healthcare providers, and intervention can save tremendous heartache and may even save a life!

For more information on fall prevention, please see the Active Tips section of this website.  Of particular assistance may be the Safety at Home Checklist to get you started.  Take care, Julie, O.T.


*Complications Resulting from Long Lie Times After a Fall by Michelle Alcorn, NP