Recently, I was on a ladder when I lost my balance and almost had a very bad fall. Although I dodged a bullet that time, “old man” problems are beginning to mount up and it made me think about the trauma associated with falls and how best to prevent it.
Emergency departments are often faced with the management of fall victims, which accounted for three million ER visits in 2021. You might also be surprised to learn that falls among adults 65 and older caused over 38,000 deaths that year, making it a leading cause of trauma mortality in that age group.
The elderly can easily hurt themselves in falls, not just from heights, but from walking on the ground due to losing balance or consciousness. This may strike the young, healthy medic as unlikely, but many medicines for chronic illness have dizziness and loss of balance as a side effect. It’s important to have a strategy to decrease the risk of falls.
Dealing With A Fall
In normal times, if you witness a fall and there’s an injury or the victim is unresponsive:
- Call 911 immediately.
- Check for breathing. If not breathing and you’re trained, start CPR
- Do not move the victim, especially if they hit their head or complain of neck/back pain.
- Keep them still, warm, and comfortable, placing a blanket or clothing over them to stay warm.
- Apply pressure to any bleeding wounds with a clean cloth (and gloves, if you have them), but avoid pressure if you suspect a head fracture.
If the person is awake, alert, and wants to get up:
- Stay calm and reassure them, they’ll probably be anxious.
- If possible, bring a sturdy chair and place it in front of them.
- Help them slowly get to a kneeling position on the chair.
- Guide them to sit back into the chair using their arms and legs. Don’t manhandle them.
- Once seated, check for pain or injuries.
- Offer a drink or snack if they seem dizzy but are otherwise alert.
- Call their doctor even if no serious injury seems apparent.
FALL PREVENTION
Fall injuries are treated like other (usually) blunt trauma, which I have written about in the past. It’s even more important to improvise strategies to prevent falls. Some is going to be common sense, like wearing reasonable shoes. Sporting high heels, shoes with slick soles, or walking around in socks on smooth floors can be a big mistake. Wear properly fitting, sturdy, flat shoes with nonskid soles. Other strategies:
Scan The Home For Hazards
A serious look around your home can identify a surprising number of hazards. Consider:
Removing obstacles from areas of high traffic in the house. That obstacle may be just a kid’s toy, but can include problematic furniture like coffee tables.
Remove loose area rugs or secure them with double-faced tape or a slip-resistant backing .
Repair loose, wooden floorboards and areas of wall-to-wall carpeting.
Store clothing, dishes, food and other daily necessities within easy reach. Decrease the need to use ladders or stepstools.
If there’s a spill, don’t wait for it to dry. Immediately clean it up.
Add nonslip mats in the bathtub or shower. If there’s space, use a bath seat to sit while showering or remodel the shower to accommodate older folks.
Add More Lighting
Some people prefer to keep the home dark, but this can be a recipe for a fall. Keep the place brightly lit to avoid tripping.
Place night lights in the bedroom, bathroom and hallways.
Keep a lamp within easy reach of your bed, perhaps on a small table.
If your light switches are right at the room entrance, clear a path to them.
Consider glow-in-the-dark or illuminated light switches.
Turn on the lights before going up or down stairs.
Store flashlights in easy-to-find places (maybe that night table) in case of power outages.
Consider Medical Assistance Devices
Although some find them embarrassing, canes, or walkers keep you steadier and help prevent serious injury from falls. Other assistive devices can help, such as:
- Handrails for both sides of stairways or automatic chairlifts.
- Nonslip treads for bare-wood steps
- A higher toilet seat
- Handrails in the shower and by the toilet.
- Hand-held shower nozzles (easier for bathing sitting down)
Physical Fitness
If you’re on a lot of meds and have noticed some dizziness, numbness, or balance issues, make sure to discuss them with your health provider. Lot of drugs increase the risk of falls. An occupational therapist can help you brainstorm fall prevention strategies.
Speaking about therapy, physical activity can strengthen muscles needed to keep your walk steady. Even gentle exercise like Tai Chi or water exercise (sometimes available through your municipality) reduce the risk of falls and improve balance, flexibility, and coordination as well.
None of us likes getting older, but physical changes, health conditions, and the meds to treat them, make falls more likely. Realize this and be serious about making the home safer. Having seen elderly relatives take nasty falls, you won’t regret making changes to avoid them.
Joe Alton MD
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