HOW THE NURSING HOME PREVENTS FALLS

Every year the average nursing home will have between 100 to 200 patient falls. The people who fall the most often are men, and patients who are confused. Men fall almost twice as often as women because they are less likely to call for assistance, because it is more difficult for them to admit needing help. Patients with Alzheimer’s disease or another form of dementia fall frequently, because they no longer have safety awareness.  Statistics tell us that 35% of those patients who fall are unable to walk, yet they try.

Most patient falls happen in the patient’s room, when the person is attempting something without assistance. Few falls happen in places like a dining room or at a nurses station where many staff members are available to monitor for unsafe behaviors. The majority of those falls in patient rooms have to do with needing to go to the bathroom. Being incontinent of urine, having diarrhea, and having to urinate frequently at night all contribute to the high number of falls.

Added risk factors are poor vision, going bare foot, clutter on the floor, poor lighting and possible a slippery/wet floor from the patient becoming incontinent. As well as the patient forgetting to reach for their cane or walker in their rush to the bathroom.

A nursing home fall prevention program includes assessing each and every patient for their fall risk. All of the above mentioned problems are identified. A plan of care is developed and all staff members are informed of the plan. Safety devices are put in place, most of those devices are in the form of alarms. A good web site for safety devices is -www.Rehabmart.com. Their site is very user friendly and they have a large selection of safety alarms.

Looking at the environment, follows the assessment. Are the grab bars placed correctly? If the patinet is getting out of bed, is the bed in a low position, with an alarm? Is the lighting adequate, are there motion sensors in place? Is the patient on a regular toileting schedule before bed? How often does the staff check on them during the night?

A big deterrent for falls is a busy, engaged patient, a patient who has activities to go to that they enjoy. A patient who is really tired when it is time for bed, that they enjoy a good nights sleep.

Virginia Garberding RN

Certified in Restorative Nursing and Gerontology

FALLS, SENIORS AND NURSING HOMES

Phil lives alone unless you count his dog, Clare. Phil now is seventy-three and most people would have considered him in better than average shape. He is not one for exercise but he always has watched what he eats, and was blessed with good genes. However, Phil made some very bad decisions.

It happened on a very nasty night in the Midwest. There was a ugly ice-sleet storm raging outside when Clare needed to go out. Phil did his usual thing at night he took Clare out into the backyard. Too bad his usual thing was to walk Clare in his underwear. So when Phil fell, he was too embarrassed to call out to his neighbors for help.  So there he lay with an injured leg, shoulder and arm, out there on the ice.

Because Phil didn’t want to call for help it took him two and a half hours in the cold, on the ice, to pull himself to his back door and drag himself in.   This experience caused Phil to be hospitalized for five days and is now in a nursing home due to the pneumonia that set in while hospitalized.

What seniors can do to protect against falls:

  • if you live alone (and are even if in very good condition like Phil) wear an alert button
  • think ahead, make good decisions and be proactive – is it really a good idea in any weather to be outside in your underwear
  • prepare for the weather – when in snow, ice, sleet – carry a small bag of salt, sand or gravel to throw out in front of yourself as you walk
  • for those who have to go out in all weather – consider rubber ice cleats that easily attach to the bottom of any shoe or boot – they are easy to put on and off and very in expensive

It really didn’t seem like it would be Phil who would be in a nursing home, at least not until a very old age. Bad weather got him there, and a fall, but more than that it was bad choices.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

FALL PREVENTION GUIDELINES FOR SENIORS IN WINTER WEATHER

Of course the elderly and seniors are afraid of falling, but Beth was only 31 when she fell on ice in a parking lot. Beth was late for work and walking much too fast for the slippery conditions in the parking lot that day. And the parking lot as slick as it was, made her fall even harder, resulting in a fractured wrist.

Walking in winter weather calls for extra diligence in:

  • Taking care of your body, for it to function as limber and flexible as possible. Warm up your legs, feet and knees before you go out in snow and possibly slippery conditions. A great way to warm up feet is with a warm water soak in Epsom salts. Difficulty walking can be due to inflammation which will make tissue painful, tight and stiff. Knees, legs and feet can be especially vulnerable to inflammation, and that inflammation can be tracked back to poor food choices. Avoid inflammatory foods; sugar, white flour, white potatoes, white rice, and pretty much anything that is white.
  • Exercising – to improve strength and balance. Maintain a regular exercise routine and on days when the elderly cannot get out, it is even more important to exercise. Stretch before going out, stretching improves circulation and limbers the joints and muscles.
  • Careful, but appropriate use of pain medications. Just as a person in a healthcare situation would take a pain medication before going to therapy, so also medicating before walking outside maybe just as appropriate. Arnica gel is a great topical for pain, swelling and stiffness. There are new reports all the time on the benefits of Ibuprofen medications for inflammatory pain relief.
  • Dressing for the weather. Now that you have those legs, knees and feet warmed up, keep them that way. Three light layers of clothes are preferred to one heavy layer. Be aware of any clothing that might be too restrictive, and actually decrease the ability to move. I personally love the new warm light weight fabrics – long underwear anyone?
  • If the elderly use a cane or walker they should also use that walking device, in winter weather. However caution needs to be taken when rubber tips on canes/crutches become wet – they can be extremely slippery on a hard surface indoor floor.

Many elderly people become isolated in winter and suffer from depression. Going outdoors, enjoying fresh air, nature and socializing is so necessary to protect against depression in winter.

Virginia Garberding RN
Certified in Gerontology and Restorative Nursing

WHEN THE CONFUSED ELDER KEEPS FALLING OUT OF BED – SIDE RAILS ARE NOT THE ANSWER

The goal in the nursing home is to never use side rails as a restraint, or to keep someone in bed. There are only a few times in a nursing home that they will give an elder side rails:

  • One side rail when the elder is in bed to give the elder something to hold on to either help him sit up or reposition in bed.
  • The elder has two side rails up but is capable of calling for assistance to get up or go to the bathroom and will not climb over the side rail.
  • The elder has two side rails up per their own request because it gives them a sense of security.
  • A person who no longer moves may have their side rails up.

When my Dad was beginning to get a little unsteady, he requested that we put some kind of side rail on his bed. This gave him a sense of security, especially at night when he got up to go to the bathroom. They were just very short rails attached at the head of the bed. This did not restrict his movement getting out, but gave him something solid to grip to stand.

THE ELDER WHO IS NOT SAFE WITH SIDE RAILS

When an elder is confused, has no safety awareness and is likely to climb over the side rails – then side rails would not be appropriate. Having an elder climb over side rails and fall from an even higher level is dangerous. In the case of an elder who exits the bed unsafely, the nursing home would place the elder in a very low bed. A bed practically to the floor and then they would place extra mattresses on each side of the low bed, in case the elder attempts to exit the bed unassisted.

Virginia Garberding R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegettoknowme.com

FALL PREVENTION – BETTER BALANCE FOR EVERYONE

Well I fell last week, off my front step. The injuries to my face and nose have prompted many people to share their stories of slips, trips and falls. One lady shared with me that she has been hospitalized 4 times for falls. Famous people have died as a result of a fall; George Burns, David Brinkley to name a couple. What I have heard tells me anyone can and does fall.

(Book excerpt – enjoy)

SIX STEPS TO BETTER BALANCE:

  1. STRETCHING IN BED – When you wake up in the morning stretching feels so good. All your joints, muscles and tendons are still warm and so much more flexible and pliable than later in the day. The bed is not only a nice warm place to stretch but also it is safe.

While you are stretching, don’t forget your neck. Remove your pillow and lay flat and with the support of your mattress turn your head from side to side. This exercise will make your neck more flexible for driving, helping your field of vision. Finish by sitting at the side of the bed and stretching your arms to the ceiling, forward and to the side.

  1. BALANCE – Stand in front of a table and with your hands on the table first raise one knee – to a count of 1-2, and then put your foot down. Repeat with the other knee. Then do the same exercise while moving your fingers on the table as if you were playing the piano. Repeat exercise while removing your hands from the table. Repeat exercise with both arms stretched out to the side.
  2. BALL HANDLING TECHNIQUES – Using a 1 inch rubber ball, slowly roll the ball from one hand to the other. Using two paper cups roll the ball from cup to cup – increasing the distance between the cups. BOUNCING – starting with a large ball (soccer) bounce and catch ball – change to a medium ball, bouncing and catching. Using a tennis ball bounce with right hand and catch with right hand, then switch to left. Progress to bouncing with right hand and catching with left. Continue until you can do activity with the 1 inch rubber ball.

(Great non-conversational family game for elders and children, is to put a 8X10 piece of paper on the floor as a target and have family members bounce the ball to each other, hitting the target on the floor)

  1. WALKING AND TALKING ON THE TELEPHONE – As you are walking and talking on the phone – switch the phone frequently from ear to ear. Also stop and sit down and then stand up – this is a great exercise for keeping those leg muscles strong.
  2. SLUMP – Standing in front of a soft, high backed chair, loosen up your knees and shake your arms slightly to loosen up – then instead of sitting down, kind of slump into the chair. This is a great way to “practice” a fall, by getting your body ready to loosen up. Having a fall when your body is loose could be the difference between a bruise and a fracture from a tense fall.
  3. DANCING WITH YOUR PILLOW – Put some music on that you enjoy and holding your pillow against your chest with your left arm and your right hand in the air slowly dance around the room. As you are dancing switch arms and hold the pillow with your right arm, then switch to holding the pillow with both arms.  Dancing gives a person the opportunity to go forward, backward as well as side to side.

These are tips from Dr. Betty Perkins-Carpenter’s book How to Prevent Falls available at Barnes and Noble as well as at: www.senior-fitness.com

 

 

Virginia Garberding R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegettoknowme.com

NANCY REAGAN FALLS AT POLITICAL EVENT – FALLS IN THE ELDERLY ARE PREDICTABLE EVENTS RELATED TO RISK FACTORS – PERSONAL AND ENVIRONMENTAL

(PART I)

This blog was first posted in April of 2010 – in the light of Nancy Reagan(now 90) tripping on the evening news last night- I thought to re-post it. Was that trip predictable? Maybe if she can no longer see tripping hazards in her path and the person assisting her is not looking as well.   

Environmental Factors

“Mom fractured her ankle in three places.”

“I didn’t know your mother was still living,” I replied to my friend. “You never mention her.”

“Well, we don’t go to see her very often,” she replied. “Why is that?” I asked.

“Because there is no place for us to sit” she said.

Now I understood, Mom was a hoarder and fell over her clutter and fractured her ankle. Yes, that’s what it was. Mom was in her early 70’s and this could have been a predicted fall because of the cluttered environment she lived in.

Personal Factors

Marge is 80 years young, lives alone and still drives. She has decreased ability to focus her eyes due to aging. It is a bright sunny day and Marge drives herself to the grocery where she walks into the store and immediately falls. With age it takes eyes longer to re-focus to different levels of light. Most falls in stores are at the entrance due in part to wet surfaces from wet feet and a , change in surfaces. (Environmental factors) But many times due to personal factors and the reduced ability for elderly eyes to adjust to different levels of light. (The elderly shopper can easily fix this by grabbing a shopping cart when they park and pushing it into the store with them. This way they have something to hold onto.)

History of Falls

In 1900 the average life expectancy was 49 years. At that time people were dying from infectious diseases; TB, pneumonia, influenza etc. Advances in public health, with improved sanitation, antibiotics, and vaccines increased the age expectancy to 68 yrs by the 1940’s.

Now that there was an older population, there also was an increase in falls. Over the years since then, the thinking regarding the cause of falls in the elderly has changed.

Previous thinking on the cause of falls in the elderly:

  • The first thinking was “this is an act of God” a chance event with no explanation
  • That turned into “Falls are purely accidental” it happened to you, so you had some bad luck.
  • Then, its “normal” to fall,” look at your age, what can you expect?”
  • Falls are a matter of personal negligence – “You should have been more careful.”

Falls Today

Now falls are no longer considered normal or just part of aging. They are considered to be predictable events related to environmental and personal factors.

 

Virginia Garberding, R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegettoknowme.com

WHAT TO DO WHEN THE CONFUSED ELDERLY FALL IN THE NURSING HOME

This is one of the most dreaded calls from the Nursing Home. “You’re Mom fell.” You’re first reaction is natural, whether you say it or just think it. “Why do I have her there, isn’t that what you people are supposed to be doing, keeping her safe and off the floor?”

Supporting the confused elderly’s right to walk includes, however strange it may sound, the right to fall.

What to do after the elder falls.

When a family member learns of a fall the first question should be:

Ÿ  “Did anyone see the fall?”

Ÿ  “Did she hit her head?”

Ÿ  “Does she sound like she is in pain?” (A groan for example)

Ÿ  “Are there any outward signs of pain?”

There are many benefits from walking if elders are able to do so. Yet too often families want elders forced into wheelchairs prematurely to keep them “safe” after a fall. Elders want to remain as independent as possible. Even those who are demented but still able to walk can experience opportunities for interaction while “ wandering” the community. When wandering, they have opportunities for social interaction, such as when staff personnel greet them by name.

The elder can remain strong. They may wander, but they also maintain the ability to walk. As an added benefit, it enables them to work up an appetite, breathe deeper, and it supports the process of elimination.

General guidelines for families

When you have identified a change in the elder’s usual condition:

Ÿ  Don’t hesitate to voice your concern to the nursing staff.

Ÿ  Identify and talk to staff that may be more pro-active in problem solving.

Ÿ  Establish yourself as part of the team caring for the elder.

Ÿ  Be willing to participate as part of the solution.

Ÿ  Realize that seeing an unaddressed change in condition can be stressful. Try to communicate your concern without becoming overly emotional.

Ÿ  Pray for your loved one.

Excerpt from: Please Get To Know Me – Aging with Dignity and Relevance

By: Virginia Garberding, R.N. and New York Times Best Selling author Cecil Murphey

Available at: www.pleasegettoknowme.com

PAST HISTORY OF FALLS WILL PREDICT FUTURE FALLS WHEN ELDERLY REFUSE TO BE ACTIVE

(Part III)

When an elderly person falls it creates fear in the elder, resulting in a decrease in activity. Just the opposite should be the reaction. The elder should instead do more; get out more and joining exercise groups that focus on strength and balance.

Everyone wants a magic pill – the magic pill just might be exercise

It might not come in an easy to swallow capsule, and might require self-discipline and effort. But the benefits of exercise can seem like magic for the elderly. How does reduced risk of heart disease, lower blood pressure, reduce risk of osteoporosis, better sleep, and reduced risk of falls and injury sound? These are all documented benefits of exercise in the elderly. And it doesn’t seem to matter how old you are when you start. Every one, no matter what age can improve their strength and endurance through exercise.

There are so many opportunities for the elderly to join exercise classes at their Church, local Senior Center, Health and Fitness Centers even some Libraries offer programs. Balance programs combined with strengthening are the best. For the person that wants or needs to exercise at home, The National Institute on Aging offers some great exercises for balance and increased strength.

Go to: www.nia.nih.gov/healthinformation/publications/exerciseguide/chapter04.htm

A Prescription for exercise

For the elder who needs a little extra convincing that exercise would be good for them and help them reduce the incident of falls. It will help to have the physician write a “prescription” on a regular prescription pad. A prescription for walking could be – Take a walk every day for 20 minutes, seven days a week.

Trip to Nursing Home a blessing in disguise

When the elder has a fall that sends them to a Nursing Home to recover, this is an opportunity for the elder to have evaluations and assessments done.

See Blog: July 28, 2009 – Caregiver Tips: When Seniors come into the Nursing Home, get better and go Home

Virginia Garberding, R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegettoknowme.com

FALLS IN THE ELDERLY ARE PREDICTABLE EVENTS – RELATED TO FEAR OF FALLING

Fear is your enemy, not the floor

Fear of falling can keep you from thinking clearly. Fear of falling can cause you to over react to a slight difficulty, stiffen your body and lose your balance. Fear of falling can make you walk in an un-natural way, more hesitant and irregular. Fear of falling can make you walk contantly looking at the floor and shuffling your feet.

Fear of falling can make you tighten your muscles and joints and make contact with the floor ever so much more jarring.

Falling could be embarassing – fear of making a scene

Falling may mean injury,making a scene in public, being on the floor and unable to get up. Falling in public could require someone helping you up and then they getting hurt themselves. Elderly people are very concerned about causing problems or difficulties for others.

Fear of falling causes an elderly person to restrict their activities

Betty is a 83 year old woman with diabetes, she fell outside six months ago and and she has subsequently fallen multiple times since. Betty has restricted her outside activities because of her fear of falling.

Since becomeing housebound Betty has developed muscle weakness from disuse. Due to Bett’s muscle weakness she has now begun falling from the toilet and she is becoming depressed.

Fear of falling usually leads to decline in function and strength

Living with fearfulness causes feelings of dissatisfaction with life, a depressed mood and increased frailty.  As the elder experiences decreased mobility and participates in fewer social events they become more frail. Diminished agility, muscle strength and balance often contribute to more falls and related injuries.

Increase activity not decrease (Part III of Predictable Falling)

Virginia Garberding, R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegettoknowme.com

FALLS IN THE ELDERLY ARE PREDICTABLE EVENTS RELATED TO RISK FACTORS – PERSONAL AND ENVIRONMENTAL

(PART I )

Environmental Factors

“Mom fractured her ankle in three places.”

“I didn’t know your mother was still living,” I replied to my friend. “You never mention her.”

“Well, we don’t go to see her very often,” she replied. “Why is that?” I asked.

“Because there is no place for us to sit” she said.

Now I understood, Mom was a hoarder and fell over her clutter and fractured her ankle. Yes, that’s what it was. Mom was in her early 70’s and this could have been a predicted fall because of the cluttered environment she lived in.

Personal Factors

Marge is 80 years young, lives alone and still drives. She has decreased ability to focus her eyes due to aging. It is a bright sunny day and Marge drives herself to the grocery where she walks into the store and immediately falls. With age it takes eyes longer to re-focus to different levels of light. Most falls in stores are at the entrance due in part to wet surfaces, change in surfaces. (Environmental factors) But many times due to personal factors and the reduced ability for elderly eyes to adjust to different levels of light. (The elderly shopper can easily fix this by grabbing a shopping cart when they park and pushing it into the store with them. This way they have something to hold onto.)

History of Falls

In 1900 the average life expectancy was 49 years. At that time people were dying from infectious diseases; TB, pneumonia, influenza etc. Advances in public health, with improved sanitation, antibiotics, and vaccines increased the age expectancy to 68 yrs by the 1940’s.

Now that there was an older population, there also was an increase in falls. Over the years since then, the thinking regarding the cause of falls in the elderly has changed.

Previous thinking on the cause of falls in the elderly:

  • The first thinking was “this is an act of God” a chance event with no explanation
  • That turned into “Falls are purely accidental” it happened to you, so you had some bad luck.
  • Then, its “normal” to fall,” look at your age, what can you expect?”
  • Falls are a matter of personal negligence – “You should have been more careful.”

Falls Today

Now falls are no longer considered normal or just part of aging. They are considered to be predictable events related to environmental and personal factors.

Virginia Garberding, R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegettoknowme.com