Thursday, March 21, 2019

How to Prevent Falls

Dimensions of Dementia

Maybe you know someone who has fallen recently or have done so yourself. Falling can have minor consequences but other times, tragic ones. According to Step Smart Collier, a program endorsed by the Marco Island Fire Rescue Department, one out of three older adults fall each year and fifty percent of those who are injured from a fall die within one year. Bringing the statistics closer to home, in Southwest Florida every three days someone dies from a fall-related injury.

Grady Harrison, a fire prevention coordinator with the Marco Island Fire Rescue Department, visited the local Alzheimer’s Association support group recently after several caregivers had experienced falling. He stressed prevention of falls, and that they are not a normal part of aging. Neither is dementia a normal part of aging, so does coping with it increase one’s risk of falling?

My experience is that when stressed from the responsibility of caring for someone with dementia, a caregiver may be more susceptible to falling. The caregiver, who is overwhelmed with many things to think about and do, may not be able to focus on the present moment. Also, those with dementia may have issues with vision, awareness, and balance. A walking companion can help point out any difficulties and offer an arm when balance is an issue.

For example, after my husband, Tom, was diagnosed with Mild Cognitive Impairment or MCI, he returned home one day after getting a newspaper from the kiosk across our quiet street with a bloody cut on his leg. After I washed and bandaged the cut, he showed me where he had fallen, an uneven sidewalk with a difference sure to catch unwary walkers. The next day I visited the local hardware store, confided to the paint salesman that my intent was to highlight uneven sidewalks, and the next day all the hazardous spots in our vicinity sported a bright yellow stripe. It must have helped because Tom did not fall again because of tripping over rough pavement. You may not want to paint bright yellow, orange, or red on your steps at home, but a contrasting strip of tape could be helpful, given Tom’s experience, both for those with disability and for those without any.

While sidewalks and steps anywhere can be hazardous, it is in the home that sixty percent of falls occur, according to Step Smart Collier and the mortality rate for falls in Collier County is fourteen percent, fifty five percent above the state average.

The Marco Island Fire Rescue Department will do a fall risk assessment in your home if you contact them at 239-200-0349 or online at healthyaging@cityofmarcoisland.com. If you’d rather do it yourself, their tips for a safer home are remove all throw rugs, check lighting for proper illumination at night, ensure all high traffic areas have clear pathways, especially from bed to bathroom, consider installing motion detecting lights, remove clutter and loose wiring, keep phones with reach of the floor, and add a bell collar to your pet to avoid tripping over him.

In the bathroom install grab bars near the toilet and in the shower, add a non-slip mat to the tub, consider seating in the shower, and install a raised toilet. Other tips for the kitchen are ensure frequently used items are within reach, when accessing hard to reach areas use a step stool with handles or a reach aid, NOT a chair and clean up spills to prevent slippery floor surfaces.

Personal actions you can take are to talk with your doctor about medications that may increase your fall risk, especially sleep sedatives according to Harrison. He suggests always wearing appropriate footwear with a flat sole like a sneaker, remain physically active, have your vision checked annually, and take time waking from bed for blood pressure to normalize and legs to “wake up.”

Additional suggestions from caregivers include using chairs with arms to aid in getting up or sitting down or to keep someone from falling sideways, and in the bathroom to have grab bars professionally installed for safety as glue-on grab bars may not be sturdy.

Teepa Snow, educator and trainer, who works with the staff of nursing homes and memory units to ensure safety for their dementia residents, counsels getting a fall history on patients plus a secondary diagnosis, checking their use of ambulatory aids, gait abnormalities, and their mental status. After a paragraph about the importance of mobility is this simple message to guide caregivers in anticipating the needs of patients, “People move to meet NEEDS. People STOP moving to meet NEEDS. She also instructs professional caregivers to SLOW DOWN, to use a positive approach, to structure and monitor the environment, and check that walking aids are used correctly. For more information Google Teepa Snow on fall prevention.

Another source reached at the same search destination was the Alzheimer’s Dementia Weekly: 14 Ways to Prevent Falling at Home. The statistic given was that older adults with dementia were up to sixty percent more likely to fall, sustaining injuries that can lead to hospitalization and immobility. To prevent falls in this population they suggest moving anything that could cause someone to trip or slip while walking: clutter, small furniture, pet bowls, electrical or phone cords, and throw rugs.

Additional suggestions are to organize furniture, arranging it so there is plenty of room to walk freely, removing items from stairs and hallways, getting rid of chairs that swivel and to consistently use the handrails on stairs and when carrying an item in one hand, hold the hand rail with the other.

Lighting suggestions are: make sure there is enough lighting in each room, on stairs, hallways, and entrances, and on outdoor walkways. Lamps and lighting should be of great intensity or power so that dangers are clearly illuminated and seen. Use light bulbs that have the highest wattage recommended for the fixture. The site suggests browsing bright lamps from Amazon.com. In addition, place a lamp next to your bed along with nightlights in the bathroom, hallways, and kitchen, and keep a flashlight by your bed in case the power goes out and you need to get up at night.

These lighting suggestions are so important and brought back a difficult memory of my dementia- disabled mother. She fell down eight steps when visiting my brother’s split level home because a night light was not sufficient when she was trying to find the bathroom at night. I was awakened from sleep by the sound of her falling and crying out. She was badly shaken and broke a wrist. Brighter lighting would probably have prevented her fall and injury.

More suggestions from the Alzheimer’s & Dementia Weekly are avoid wet floors, clean up spills right away, avoid wearing socks or shoes/slippers with smooth soles on stairs or floors without carpet, and assess the safety of rubber soled shoes that may be a tripping hazard because they “catch” on flooring.

Having your eyes and hearing tested often is also suggested and always wearing your glasses and hearing aids when needed. Enough sleep is important and limiting the amount of alcohol as even a small amount can affect balance and reflexes. The sites last suggestion is keep on moving by staying physically active. For information on exercises of endurance, strength, balance, and flexibility visit www.nia.nih.gov/Go4Life. The balance exercises in particular can help us prevent falls.

So tomorrow, I’m going to concentrate on improving my balance. I plan to stand on one foot when at the kitchen counter, do the toe-heel walk with my morning stretches and maybe even revisit a tai chi class with those tough spins that challenge but eventually improve balance. On second thought, I’ll just play my tai chi DVD and practice those 360-degree turns privately before going public.

Shirley Woolaway has an M. Ed. in counseling and worked in journalism, in business, and as a therapist in Pennsylvania. She has 25 years personal experience with dementia as a caregiver for family members with Alzheimer’s disease, and nine years as the coordinator of an Alzheimer’s Association memory loss/caregiver support group, earlier in Pennsylvania and now on Marco Island. She has been leading a dementia support group for eleven years, three in PA and eight on Marco Island. We believe that Shirley’s insights will prove helpful to many of our readers.

For help on all aspects of Alzheimer’s disease and other dementias call the national Alzheimer’s Association confidential, 24/7 helpline at 800-272-3900 or the local Bonita Springs office at 239-405-7008 for care consults and support group information. Also helpful with local educational programs, workshops, and support groups, is the Naples Alzheimer’s Support Network, 239-262-8388.

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