Did you know that one in three Canadians over the age of 65 will fall this year?
Some of these falls are life-threatening. In fact, falls are the leading cause of injury-related hospitalizations of older adults in Canada (Smith, Wager & Elliott, 2010). In 2004 Statistics Canada reported falls cost the health care system an estimated $2 billion.
In Canada, falls are the leading cause of head injury hospitalizations in adults (Canadian Institute for Health Information). Thirty-five percent of injuries from a fall result in broken or fractured bones (Statistics Canada). The cost to the health care system and to personal quality of life is staggering.
It is important to know the risks and to prevent falls from happening.
These falls happen everywhere; be it in the home, the community or in long-term care. There are some helpful online risk assessment tools and other resources to help older adults who are at risk, or who simply want to be pro-active in fall prevention. A study done in 2009/10 showed that fall related injuries from simply walking comprise forty-five percent of self-reported injury. (Statistics Canada, Community Health Survey).
Self-Assessment for Older Adults Who Live Independently
For older adults who live alone, the Staying on Your Feet website provides a self-assessment questionnaire for older adults, called Prevent Falls Check-Up. Once completed, a Check-Up report is provided which offers a variety of suggestions and tips for falls prevention. The main message here is that most falls are preventable, and steps can be taken to reduce risk.
Safety is far more important than what preventative and risk-reducing measures “look like.”
Concerns about getting in and out of the bathtub? Arrange to have grab bars installed. The Canadian Mortgage and Housing Corporation has released guidelines on the best placement for grab bars for maximum effect and ease of use. We have to get past the idea that grab bars may make us look weak or frail.
Taking medication? For those on three or more medications who are experiencing bouts of feeling light headed or dizzy, regular medication reviews are recommended. Medication adjustments may be required to help reduce unwanted and potentially harmful side effects that can cause an increased risk for falls.
Could the home surroundings be made safer? When a person has lived in a place for many years, they tend to not see where improvements can be made. If the person tires easily, perhaps a relative can help select rest areas where small chairs can be set to provide breaks. If the person tends to walk the same path through his/her home, move furniture to ensure a clear pathway. If a small pet tends to get underfoot, install a bell on its collar. Move commonly used kitchen items to easy-to-reach areas to reduce the need for step stools. For hard to reach items, never stand on a chair – always use an appropriate stool or short step-ladder made for such a purpose, and preferably one with a handle at the top to provide steady support.
Is footwear safe? Slippers or mules with no backs, overly worn soles or shoes that are too tight, can all contribute to falls. Ensure the person has a good pair of well-fitting shoes, preferably without laces that could cause tripping, and with lots of room in the toe box. Wear these shoes in the house. Shoes that move with one’s feet will help reduce falls in the home.
Problems with blood pressure? Postural hypotension, or a sudden lowering of blood pressure when changing head elevation, is common among those 65 and older. A good tip is to get in the habit of sitting on the edge of the bed for a few seconds upon awaking before standing up. This allows the blood pressure to adjust to reduce the risk of dizziness upon rising.
Overactive bladder? If bladder incontinence or urgency poses problems, rushing to the bathroom can be a fall risk, especially in the night, and especially for homes where the bathroom is not close to the bedroom. Consider purchasing a bedside commode. The commodes of today are much more user-friendly and attractive than in our grandmother’s day, and we should not be embarrassed to install one in our bedroom. Purchase a screen to hide it during the day if embarrassment is an issue.
Need to use the stairs? Falling on stairs is the third most reported reason for falls, (Statistics Canada, Community Health Survey) after walking and snow/ice slips. 12 Steps to Stair Safety at Home is a one-page checklist on stair hazards and ways to look at stair issues effectively. First and foremost handrails should be on both sides of the staircase and should be used in every instance, no exceptions.
What to Do After A Fall is a poster that can be printed off and kept in various places around the home. It is especially recommended for those who live alone and have already experienced a fall.
Personal Response System to Ensure Safety
If the risk for falls is high or family members are concerned about their loved one falling, one popular option is to get a personal response system. The Philips Lifeline AutoAlert service is a great optional feature that will automatically summon help if the person falls. There are many other such services and some of them are: ADT, Alert1, Bay Alarm, Care Innovations, LifeAlert, LifeFone, LifeStation, Medical Guardian, Mobilehelp, and RescueAlert. Some research may be needed to find the one right for the circumstances, and these may not all be available in Canada. Some people are worried about the appeal of wearing a device such as a necklace or bracelet but modern technology makes many of these devices appear as regular jewellery. In Canada, Costco stores provide two such devices – Medical Alert and Direct Alert.
Although there are reportedly only one fifth as many falls in residential care facilities as in private homes (according to Statistics Canada), it is still important to be aware of fall risks and prevention strategies in seniors’ residences.
Some seniors’ residences have a buddy system or a safety check program in place. Examples would be where the tenant puts a door knob hanger or other signal (garbage can for example) outside their doors at night and remove them in the morning to signal that all is well. Alternatively, a phone call once or twice a day can ensure one’s safety with the added bonus of social interaction.
The Prevalence of Falls in Long-Term Care and Residential Facilities
Some people who live alone move into long-term care settings because of their complex medical needs and increased risk for falls. Nursing Home (NH) residents who fall are at risk for injury such as a fractured hip or other bones. Sometimes a fall results in death.
The Winnipeg Regional Health Authority listing of Critical Incidents Reported to Manitoba Health from October 1, 2013 – December 31, 2013 identified 34 NH resident falls over the three-month period. One of these falls resulted in death. Seven of the falls were witnessed by a staff member, and 27 were unwitnessed. Of these unwitnessed falls, 16 resulted in a fractured hip and a trip to the hospital for surgical repair.
According to a 2008 Winnipeg Regional Health Authority publication, the Personal Care Home View, 18,868 falls were reported in nursing homes in Winnipeg in one year. Most falls occurred in residents’ rooms on evenings and weekends.
Falls Risk Assessment Tool for Long-Term Care Facilities
The Johns Hopkins Falls Risk Assessment Tool (FRAT) helps identify the level of risk in NH residents, based on the following criteria:
- Recent falls
- Psychological factors
- Cognitive status
If a person has had recent falls, it increases the risk for a repeat occurrence. Certain medications, such as sedatives, antidepressants, antipsychotics, anti-Parkinson’s, antihypertensive, diuretics or hypnotics can also increase risk. Psychological factors such as dementia, anxiety, depression, decreased cooperation, impaired insight or judgment (esp. re: mobility) also increases risk for falls. Finally, the higher the level cognitive impairment, the higher the potential for an incident.
The overall FRAT score is out of 20, with a higher score indicating increased risk. A low, medium or high Fall Risk Status is identified on the resident’s care plan. For those with identified risks, intervention strategies can be formulated, and referrals to other specialists may be initiated. For example, a geriatric psychiatrist or pharmacist may be consulted to review medications. Additionally, an occupational therapist may be required to assess mobility to determine the need for mobility aids and appropriate footwear. For example, hip protectors may be recommended. Also, anti-slip etching can be applied on the floor around the bed and most certainly should be in the bathroom in the shower area.
Identify, Prevent and Reduce Risk
Most falls can be prevented, and education is key. If You Fall is a guideline that can be kept on hand regarding what to do if a person has a fall including “How to get up” and the importance of “Telling the doctor.”
Regular exercise can help strengthen muscles and keep the body limber. It can also help with balance issues. Seek out the help of a qualified professional such as a physiotherapist for a tailor-made exercise program.
A healthy balanced diet and regular doses of sunshine (or Vitamin D) are also important to help keep bones and muscles strong and healthy.
Whether the older adult is living independently or in a long-term care setting, education and assessment can help identify, prevent and reduce the risk for falls. If you are keen on the subject, consider holding an awareness month, week or day like the Fall Prevention Awareness Month promoted in British Columbia and consider what kinds of activities you would like to include.
Angela G. Gentile, MSW, RSW
August Janice Bailey, Dip. Herb, HCA
Angela G. Gentile, M.S.W., R.S.W. is a clinical social worker and author of the book, “Caring for a Husband with Dementia: The Ultimate Survival Guide”, “A Book About Burnout: One Social Worker’s Tale of Survival” and the “Dementia Caregiver Solutions” app for iPhone and iPad. She lives in Winnipeg, Manitoba with her husband and two adult children. For more information, visit: www.AngelaGGentile.com
Government of Manitoba (2014). Critical Incidents Reported to Manitoba Health. Retrieved from http://www.gov.mb.ca/health/patientsafety/docs/ciq31314.pdf
Preventing Falls in Older Adults – Winnipeg Regional Health Authority, Manitoba, Public Health Resources http://www.wrha.mb.ca/community/publichealth/PREVENTINGFALLSINOLDERADULTS_000.php
Partners Seeking Solutions with Seniors and Manitoba Pharmaceutical Association. Date Unknown. Fall Prevention: How does what I take or what I drink affect my risk of falling? Retrieved from http://mpha.in1touch.org/uploaded/web/Legislation/Practice%20Resources/PSSSFallsPreventionPamphlet%20Updated%20Nov2014.pdf
Scott, V., Wager, L. and Elliott, S. (2010). Falls and Related Injuries Among Older Canadians. Retrieved from http://www.hiphealth.ca/media/research_cemfia_phac_epi_and_inventor_20100610.pdf
Statistics Canada (2014) Seniors’ Falls in Canada: Second Report. Retrieved from http://www.phac-aspc.gc.ca/seniors-aines/publications/public/injury-blessure/seniors_falls-chutes_aines/index-eng.php
Winnipeg Regional Health Authority (2008). Personal Care Home View, April 2008. 5:4. Retrieved from http://www.wrha.mb.ca/ltc/pch/files/PCHView_Apr08.pdf