I just want to share a few insights into issues related to falls among our elderly parents. I won't address complex studies or cite statistical references, but rather simply state general guidelines that are easy to understand. Hopefully they can be of use to fellow caregivers. I'll update as much as I can.
Here are some common complications resulting from falls.
Fractures. The elderly are prone to falls for a number of reasons, but one of the most common complications is fractures in the arm, leg & hip bones. Hip surgeries are common, & the recovery for an elderly person can be lengthy & costly. As caregivers, cooking healthy balanced meals together with your elderly parents can help them understand the great benefits for healthy bone & muscle. We all love our char kway teow, but with accelerated muscle & bone loss in the senior years, it is critical to consume balanced meals.
Spinal or Head Injury. The bathroom & stairs are major areas for falls. One of the great risks is getting an injury in the nervous system thru the head or spine. In our average Singapore bathroom, the toilet, sink & bathtub/shower areas are within close proximity of one another. A wide slip (where a person falls more laterally than vertically) could cause a person to sustain head or back injury on any of these hard edges. Always wipe down the entire floor surface for hard-to-notice puddles of water, & install grab bars & anti-skid tape where you can.
Psychological Trauma. Though an intangible form of injury, an elderly parent's loss of confidence & increase in fear of moving (as he/she did before) can be obvious simply by active observation. For example, she might approach the escalator/steps much more slowly & conscientiously. As a caregiver, our role is also to help encourage independence & working together. If your elderly parent has sustained a fall previously, it is likely she will try to be overly careful & restrict movement. This is may discourage her from exercise, leaving the home & maintaining independence in daily tasks like showering. Help her overcome her fear with encouragement & physical assistance where she needs it.
Feel free to let me know your thoughts.
To be continued.
Hi Devan, thanks for sharing.
Falls in the elderly are usually quite serious :
a) due to age,
b) ability or inability to heal to what it was before
c) long-er time to heal
d) for those who practise "active ageing", depending on the severity it could be a great set back because the inactivity will cause the fitness levels, muscle etc to degenerate.
Hence even when I fall ill and miss 1 week or 2 weeks of gym workout it takes significant effort and pain to get back to where I was. Imagine if this was a 3 - 6 month lay off, I feel we will never be able to get back to the same level.
In my talks to the Elderly, I try to focus on "Prevention of falls" due to the reasons above.
In talking to Physios and the patients, the time of day with the highest incidence of falls is during the night when the elderly goes to the toilet. Tyically when the elderly, wakes up to go to the toilet their bladder is already quite full and most have to rush to the toilet to make it in time.
I find that most elderly are typically NOT Incontinent but just slow in getting to te toilet due to age.
Slowness, coupled with a full bladder, being still not fully awake and moving in the dark night, the likelihood of a fall is very high.
Hence we suggest for the elderly to wear diapers, ideally PullUp panst diapers, so that they can take thier time to get to the toilet because the pullups will catch the drips (if any) and he eldery can focus on fall prevention and be confident and sure footed as the get to the toilet.
When I was caring for my Mum and Dad, they typically go to the toilet about 2-4 times during the night and hence the probability of falls increases significantly, and yes my Mum fell and fortunately only broke her arm.
Let us know your experience in Managing Falls and also share your ideas on fall prevention.
Thanks so much for posting some great points on falls. I am sorry to hear that your mum had fallen & broke her arm. As I mentioned previously, fractures from falls are avoidable but the rare occassion can arise when you least expect it. I totally agree there is a significant risk at night from bed to bathroom, so we have to address it head-on.
When your elderly parents have to go to the bathroom at night, some of the following could occur:
1) trip or slip over floor clutter on the way to the bathroom with limited light.
2) knocks & falls from walking half-awake.
3) temporary vision impairment from the sudden light in the bathroom.
The above may seem obvious & minor, but they are serious real issues experienced by our elderly citizens. As caregivers, we can mitigate the risk together with them with a few simple actions:
1) Keep a torchlight on the bedside table. It is easy to grab & turn on to light the way to the bathroom. This comes in especially handy when sharing the room with a spouse or caregiver, so as not to wake them with the main room light.
2) Installing grab bars in the bathroom. There are many types that you can find in your neighbourhood hardware shop. Always ensure they don't fall loose or have soap/water on them.
3) Tidying up the bedroom floor. Living as 3 generations under one roof is common in Singapore. Often grandchildren will leave their toys around, or perhaps there is just the random clutter from someone else in the family. We can always spend the time to ensure the floor is kept clean & clutter-free for everyone.
I understand the slowness of movement could lead to falls because of a full bladder, & using adult diapers is a great solution. I also recommend bedside urinals (there are male & female types) as a great alternative to night time bathroom visits. No situation is the same as the next, so it helps to be prepared in a few ways that your elderly parents can adapt to well.
To be continued.
Get to know your parents’ neighbours. Ask them to drop in when they can to check on your parents. A quick walk by takes no more than 30 seconds to scan what’s going on, or perhaps a 5 minute chit chat could provide some insight for their neighbours, & then feedback to you. You don’t want to trouble them of course, but approach them kindly & ask for the favour.
Ask your friends. If you have friends living in the same area as your parents, ask them this favour of stopping by every now & then if it is convenient. Many of my good friends’ parents treat us as their own, so there is trust & openness between them.
Call in. You can do this daily, weekly or as you see fit. Better yet, teach your parents to use video conferencing like Skype (other apps look too complicated). Get updates from them as frequently as you can. Whatsapp is also a great tool once they get the hang of it.
Visit as often as you can. This is obvious, but I assume you have a busy schedule. Occasional weekend trips would be good.
Employ a certified caregiver. Only if you think they need one. It could be part-time or full time if you can afford it. During the day or stay-in for the night. The important thing is to ensure somehow that the caregiver is competent & trustworthy. This is tricky.
Encourage enrolment in a community centre. If there is a community centre in their neighbourhood, it would be a great place to gather with their friends, old & new. Lifelong learning, exercise classes & events are all stimulating activities. Ensuring they have a secondary place for pleasant & joyful interaction will help put your mind at ease. Just as important, they will be under the watchful eye of the staff at the centre.
Install a monitoring system. There are numerous companies offering remote monitoring services for elderly persons. They install sensors in the home & sometimes on appliances, remotely monitor their activity & can immediately notify you if there is a pattern change (eg. getting up at night more often to use the bathroom could indicate a risk for falls & an underlying reason). However, no one likes to be monitored constantly by people they don’t know, & it is seen as an invasion of privacy. You should discuss this with your parents.
I firmly believe in aging in place, in a community of all ages, social & cultural diversity to create an atmosphere of independence & flexibility for elderly persons. We don’t want to exercise so much care that they learn to become dependent on us. We want to encourage independence so that they are in control of their lives & can find their own ways to enhance quality of life. Each person has unique needs, & so you will have to figure out the best combination of ways to “remotely” take care of your parents.
(I strongly discourage nursing homes & retirement villages as immediate alternatives, unless they absolutely necessary)
I hope this was helpful for you.
To be continued.