This past summer I went back to my hometown in Poland to visit my family. Unfortunately, around the time that I was there, both of my grandparents suffered a fall. Fortunately they were both relatively unharmed. And they also have a physical therapist grandson that can help prevent future occurrences.
That was in the summer. Now it's winter time in Chicago, and we Chicagoans know that sidewalk conditions are abysmal. But everyone knows to be cautious when conditions are poor. So, since most of us will be spending time with loved ones in the coming holidays, I want to take the opportunity to highlight some potential fall risk factors that either aren't often thought about, or aren't so obvious.
Most of what is to follow is practical and obvious to people with a loved one they have concern for falling. However, trying to get a family member to listen, AND THEN adhere to your advice is no small feat. This way you can show them that a Doctor of Physical Therapy (who works on a daily basis with fall patients) makes these specific recommendations.
Falling in the Home
This is actually very common, maybe even more so than falling in public as people tend to get comfortable/complacent in familiar areas and will risk themselves more so than in unfamiliar situations. In addition to my outpatient clinic work, I also see home bound patients as a side gig. The patient's I often see in that setting are elderly individuals that recently suffered a fall in or near the home. Here are some simple habit and environment changes that can be made to decrease the risk of falling in the home:
Remove throw rugs. It may seem like nothing, but even the height of a rug is enough for someone to trip over if they tend to drag their feet.
Ensure all walkways are well lit - especially at night and on stairs.
Install or seek assistance in obtaining handrails on stairways and in bathrooms. Pull bars near the toilet and in the shower can make a world of difference.
Encourage the use of assistive devices. Many people view canes and walkers as an admission to being limited/weak/impaired. Shut those thoughts down! Assistive devices are named for exactly what they do - they should enable and empower the individual to move with more stability, speed, and most importantly safety.
Ensure there is adequate clearance for assistive devices in doorways, hallways, and other high traffic areas. Power cords, toys, and furniture can easily cause someone to trip or get caught, especially with a cane or walker.
In the winter - double check for any looming plumbing or heating issues. Leaks and cold temperatures. Need I say more?
Don't rush the individual, especially when changing positions (laying down to sitting, sitting to standing). A common cause of falls is syncope - which is a loss of consciousness due to a drop in blood pressure. Taking time to let blood pressure adjust may be all that is necessary to prevent some falls.
Lastly if you are worried about your parent's/grandparent's fall risk get a check up from a physical therapist!
There are many potential mechanisms for falling. Some of the most common are slipping and syncope. However, it's difficult to say what the underlying risk factor is without an examination as there are a few systems responsible for maintaining upright balance: eyesight, proprioception (sensation), and the vestibular system. We've already talked about how blood pressure can trigger a fall, but additionally these other 3 systems can malfunction or hypofunction as well. Many of these deficits are identifiable on a physical therapy exam, and can be improved upon with a course of therapy. As a Doctor of Physical Therapy, I am also trained to screen for a symptom presentation that may not be appropriate for physical therapy, or will require additional management from other healthcare providers. In those cases a referral will be made to an appropriate provider.
Thinking Long - Term Prevention
Additionally, as many falls result in fractures, strength training is a sound long term strategy on many levels. Consistent practice will increase bone density for one, which can limit damage should a fall occur. You can never go wrong getting strong either. Training just to prevent the loss of strength can make a significant difference in an individuals ability to safely and independently negotiate stairs, and transfer in/out of the car, tub/shower, bed, and lower chairs.
Stay safe out there people, and Happy Holidays!
-Dr. Piotr