Fall Is A Four Letter Word

Research reveals that 90% of hip fractures are a result of falls, and most of those falls were preventable. Of the elderly fallers who require hospitalization, only 50% will survive past one year post-fall.

Our system of balance (vestibular system) is in our inner ear. It is actually part of the structure of the ear and contains three semi-circular tubes through which fluid flows each time we move. Each of these tubes is oriented in a different plane of space. The movement of the fluid over nerve endings signals to our brain where we are in space – like a small internal gyroscope. The movement of the fluid in the horizontal semi-circular canal moves in the same direction as our eyes move. (If you want to know why people throw-up on amusement park rides, send me an e-mail, snetherland@assistedca.com , and I’ll send you the details!)

Balance is defined as the process by which we control our center of mass (COM) over our base of support. There are three body systems involved in balance – an intact vestibular system, vision and proprioceptive feedback. Proprioceptive feedback is the knowledge of where your body is in space without your having to look. As you’re reading this, you can tell if you are sitting or standing. Good balance is dependent on at least two of these three systems working. So, for example, blind people can still maintain their balance.

There are several medical factors that influence a patient’s risk for falling.
1. Infections
2. Abnormal Blood Pressure
3. Thyroid Disorders
4. Diabetic Neuropathy
5. Decreased Vision
6. Depression
7. Cognitive Deficits
8. Muscle Weakness
9. Orthostatic Hypotension
10. Hearing Loss
11. Alcohol Usage
12. Number and types of medications taken:
Diuretics
Narcotic analgesics
Anti-hypertensives
Long acting sedatives

Think about advanced diabetics. The diabetes has caused visual problems (or blindness) and peripheral neuropathy (poor sensation in the hands and feet). This individual is extremely high risk for falling.

Hearing loss is usually overlooked. Remember, hearing and the system of balance are both in the inner ear. So, if there is an age related decline in hearing, there may also be an age related decline in the functioning of the vestibular system.

Cognitive deficits are also a key factor in fall risk. The automatic nature of balance diminishes in the older patient. Muscle weakness, reduced active and passive dorsiflexion and the other medical issues listed are all contributing factors. Splitting focus can also be a problem. The elderly are using all their concentration to maintain their balance in a standing position. When you add a cognitive task, such as conversation, you might compromise their balance. So, if you are grocery shopping with a individual and walking down the aisle of the market, in addition to the challenge of looking sideways while walking , if you ask the individual a question, they are now a very high fall risk.

You can get an idea if someone has difficulty with combining ambulation and cognitive tasks when you are talking with them while out for a walk. If their walking speed is reduced when they are talking, they are a fall risk.

Sadly, older adults who fear falling will reduce their activity, fostering a sedentary lifestyle, decreasing muscle strength, ambulatory confidence, and the vicious cycle of fall risk is perpetuated.

Here are a few practical suggestions:

1. Remove loose throw rugs, especially those in the bathroom.
2. Pick up things that we typically leave on the floor, e.g., magazines , shoes, articles of clothing, boxes.
3. Ensure that pathways between rooms are clear and not blocked with furniture, especially in narrow hallways.
4. Lighting should be bright.
5. At night, when going to the bathroom, patients should turn on the lights, or at the very least, have a night light, lighting the way to the bathroom.
6. Have the individual arrange for grab bars to be installed in the bathroom if necessary.
7. If the individual is frail, they need to use an elevated toilet seat or grab bars around the toilet for more leverage when standing up.
8. Put skid resistant strips in the bathtub.

If someone uses a walker or cane, how confident are they with its use. Is their equipment still appropriate for them? Is it working properly? Should their doctor arrange for a Physical Therapist to do an evaluation?

How is their standing endurance? Can they safely stand at the stove and cook a meal? Can they safely stand in the shower?

When minimal distractions are critical for fall prevention and someone with insecure balance is going to watch television, wait until they are safely seated in a chair, before you turn on the television. We don’t want Oprah to say something exciting, drawing their attention while they are in the process of sitting down, causing them to fall!

Footwear is also an important consideration. People with an unsteady gait should be wearing walking shoes or other firm soled shoe. Athletic, running type shoes, or those super-soft shoes are too soft and don’t have a firm base of support. Discourage walking around in house slippers, especially the flip-flop type and avoid a heel higher than 1 inch.

Hopefully, our awareness of someone’s fall risk will not only help you keep them safe, but keep you safe as well.