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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

Res and Rec: Toileting Accessibility Made Easy, Part 1


With the aging of the 77 million folks that comprise the Baby Boom generation, I have a feeling that I am not the only one using the more accommodating toilet in a public washroom!  Many of us are noticing our stiffening joints, have had a back injury at some point in our lives, or maybe are sensing a need for a joint replacement surgery in the future.  When there is a grab bar on the wall nearby, my observation from the occupational therapy clinic is that most folks tend to use it for light support.

My first reservation in noting this:  If you find that you are using adaptive equipment, get busy on taking care of your health and joints TODAY.  For example, strengthen your quads by practicing squatting without support if it is safe for you to do so instead of risking those muscles becoming weaker by pulling yourself up with your arms.  My second reservation is that if you are truly benefitting from simple modifications in public places, consider adding them to your own living environment.  A few changes may help you to use less effort in the bathroom (and save it for other activities), improve your body mechanics, and reduce the risk of falling in one of the most dangerous areas of your home.

In this 2-part blog, I will detail several options for improving the safety and ease of use of the toilet area of your bathroom.

Recommendations:  Part 1

Whether it’s for a powder room or an “en suite,” some basic safety strategies go a long way to aid your independence. In part 1 we will look at the toilet as is.  In part 2 we will look at the many uses of a simple piece of equipment that can help in the bathroom and in more places than you ever thought possible!

Optimal positioning for toileting has come full circle over the years. Like sitting in a desk chair, sitting with the hips/knees/ankles are at 90 degrees (think corner of a box) puts less strain on the low back and makes it easier to rise to a standing position. When the hips are lower than a person’s knees, it is harder to rise from sit to stand. However, too high of a toilet seat may decrease the relaxation needed for bowel elimination. A removable stool that can be stored out of the way such as a Squatty Potty may be the answer here.

So where is the balance?   I suggest in general avoiding low toilets and either 1) attaching sturdy grab bars to the toilet itself (called a toilet safety frame) or 2) attaching grab bars to the adjacent walls (or side of a sink cabinet) for a secure hand-hold. Frames or grab bars next to your body, on both sides of the toilet allows for better support and body mechanics when sitting down and standing up. Additionally, place NO rug or mat underneath the legs of the toilet safety frame; the footers should come in direct contact with the floor.

Most folks will use the edge of the counter or sink when needing additional support.  This awkward hand positioning often places significant strain on both the shoulder and finger joints. It’s also easy for your hand to slip while holding the smooth surfaces or scratch oneself on the rough underside of the counter as well.

Further, the sudden impact of sitting down too hard can place increased compression/pressure on the hips and spine exacerbating, even causing pain and injury.  Never allow yourself to plop down onto a toilet seat!   “Lift up” or “boost” devices exist to aid in self-lowering down or rising up from sitting on a toilet (and a chair too) if absolutely necessary. Think mechanical recliner lift chair and you have the idea of a device that is now available for toilets and commodes!

A raised toilet seat (or “toilet riser”) attaches to the toilet generally with a paddle that expands inside the inner rim of the toilet bowl. They are designed with and without attached “arms;” with arms provides the best “transfer” technique.  Please avoid using a plastic toilet riser that does not have a tightening attachment as they tend to slide around on most toilets. It is almost impossible to achieve a secure attachment to the bowl without a tightening mechanism. While a “donut” shaped riser may be the least expensive option, this sliding motion of a loosely fitting riser creates an unstable, tippy surface upon which to sit and greatly increases the user’s risk to fall!

Also assess beforehand if the toilet bowl is round or oval as this will determine the exact design of toilet riser that will fit the best and tighten the most evenly, securely. There are different designs available for each type of toilet; consider and measure what is needed for all of the toilets in the home that the primary user is likely to use during the day and during the nighttime too.

Another option to improve toileting accessibility is to replace the toilet with a taller “ADA” (Americans with Disabilities Act) toilet:  which is generally 19 inches from the floor.   The only caveat is when there are shorter family members and grandchildren using this bathroom too . . . Try to be mindful of who else in the home will be using the bathroom as you make changes. However, never assume that the person needing the riser will just apply it every time they need it and remove it after each use. In my experience, this usually leads to non-compliance and increases the risk to fall when a person in need must repeatedly (day and night) move equipment around.

Alright.  So know you know more about toileting accessibility than most people on the planet!  And that is a good thing since you never know when you or a loved one will need to know this information.  But wait, there’s more!  InRes and Rec:  Toileting Accessibility Made Easy, Part 2,” we will discover how one of the most common piece of bathroom equipment you can find at a garage sale can save you money, effort, and prevent falls too.  (See the Checklist for Used and Donated Bath Equipment before making your purchase.)

Please note that this information is intended to be a guide and not a replacement for an individual home safety assessment by an Occupational Therapist or Certified Age in Place Specialist.

Stay tuned and be sure to “FOLLOW” us as we make life easier!

Take care, Julie, O.T.