Jewish World Review June 29, 2004 /10 Tamuz, 5764
Jan L. Warner & Jan Collins
Recovering confidence after a fall
Q: I read your column a few months ago about the importance of trying to prevent falls among the elderly, and it hit close to home. In the past three months, my 87-year-old mother has fallen twice. The first one occurred in her home and resulted in a fractured hip; the second at the nursing home where Mom was sent after the surgery for rehabilitation. While her hip was not re-fractured by the second fall, she did break her arm. Now she is afraid to move around much, gets very little exercise, is depressed, and has gained weight. I don't know if she will ever be well enough to go home because I don't think they are addressing the problems. Is it because she is a Medicaid patient or because this is an older facility? Is there anything I can do?
A: Her Medicaid patient status shouldn't matter since all residents are supposed to receive equal care. That said, you would be wise to schedule a meeting with the nursing home administrator and others charged with her well being to review your mother's care plan. The plan should include physical and occupational therapy, diet, exercise, medication and counseling, all specifically geared to your mother's needs.
According to the American Academy of Family Physicians, there are 12 key physical findings in elderly patients who fall or nearly fall which include: inflammation of joints or joint deformity; low blood pressure; hearing and/or visual abnormalities; tremors; balance problems; foot problems; arrhythmia; heart blockage; or heart valve disease; leg-length discrepancy; generalized weakness; illness; poor nutrition/weight loss; and gait disturbance. For these reasons, request that the facility physician give your mother a thorough physical to check for osteoporosis, impaired vision and other ailments that could contribute to her unsteadiness - and therefore her lack of confidence.
Also ask to review your mother's medications to ensure they aren't influencing her balance problems. For example, sedatives, antidepressants and certain other drugs can contribute to falls by reducing mental alertness and sometimes cause a sudden drop in blood pressure. If your mother is taking multiple medications, that also puts her at a greater risk of falling.
Take a careful walkthrough of the facility to identify possible problems that could lead to falling: For instance: Are there sturdy handrails on stairs and steps? Are doorway thresholds too high? Is the lighting adequate? Are hallways free of clutter? Do the bathrooms have grab bars on walls around the tub and beside the toilet? Are there nonskid mats or carpet on the floor surfaces that might get wet? Is the bed the right height to allow your mother to get in and out of it easily? Does the bedroom have a nightlight and a bedside light with a switch that is easy to turn on and off? Is there a telephone or lifeline within reach of the bed?
As mentioned in our earlier column, falls are the leading cause of death from injury among people aged 65 and older. Studies indicate that one-third of elderly persons living in the community fall each year, while 60 percent of nursing home residents do so. (The risk of falling increases with age and is greater for women than for men.) One fall in 10 results in a hip fracture, and two-thirds of those who experience a fall will, like your mother, fall again within six months. One-fourth of those who fracture a hip die within six months of the injury. It's estimated that close to 2 million hip fractures occur worldwide each year.
According to a two-year study conducted by Dr. Sallie Lamb and her colleagues at the University of Warwick in England, elderly people who fall on carpeted wooden floors were 80 percent less likely to fracture their hip than falls on all other surfaces. By contrast, falling on concrete floors carried the greatest risk for fracture. Because nursing home residents are "typically frail" and may have a tendency to fall, safer environments for the elderly should take into account not only the health and habits of the elderly themselves, but also the type of flooring in those environments.
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JAN L. WARNER received his A.B. and J.D. degrees from the University of South Carolina and earned a Master of Legal Letters (L.L.M.) in Taxation from the Emory University School of Law in Atlanta, Georgia. He is a frequent lecturer at legal education and public information programs throughout the United States. His articles have been published in national and state legal publications. Jan Collins began co-authoring Flying SoloŽ in 1989. She has more than 27 years of experience as a journalist, writer, and editor. To comment or ask a question, please click here.
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© 2003, Jan Warner