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News and analysis on caregiving topics in MetroWest and beyond.

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Caregiving Chronicles will present news and analysis on caregiving topics in MetroWest and around the world, in-depth Q&As with experts in fields related to caregiving and updates and announcements about caregiving resources available in MetroWest from CaregivingMetroWest.org Program Director Douglas Flynn.


Caregiving Chronicles Q&A: Preventing falls in and around the home
By Douglas Flynn / February 18, 2015
Editor’s note: The Caregiving Chronicles blog has partnered with Century Health Systems to bring additional expert information and advice to the MetroWest caregivers we strive to serve at CaregivingMetroWest.org.

Century Health Systems, the parent corporation of Distinguished Care Options and the Natick Visiting Nurse Association, has allowed Caregiving Chronicles to get some valuable insight from its staff for our ongoing series of Q&A sessions with caregiving experts. In this entry, we cover what caregivers should know about preventing falls in and around the home with Judith Boyko, MBA, MS, RN, who has served as  the CEO of Century Health Systems since it was established in 2001.

Boyko holds a Bachelor of Science degree in Nursing from the University of Pittsburgh, a Master of Science in Public Health from the University of Massachusetts, Amherst and a Master of Business Administration from Clark University. She has been recognized by the Home & Health Care Association of Massachusetts as Manager of the Year in 1997 and received the Deborah Blumer Community Health Leader Award from the MetroWest Community Health Care Foundation in 2007.


Caregiving MetroWest: Why is it so important to safeguard against falls for older adults?

Boyko: Falls are the leading cause of accidents for people over the age of 65, and nearly one-third of this population experiences a fall each year. Caregivers and family members of individuals in this age range who are living on their own should take the proper precautions to ensure that their loved ones are as safe as possible.

Believe it or not, falls can be considered a public health issue. The Centers for Disease Control and Prevention (CDC) says that “among older adults, falls are the leading cause of both fatal and nonfatal injuries.”

When older adults suffer from a fall, there are myriad issues that can result: debilitating fractures; head injury; mental health issues; and even isolation due to fear of falling again. In fact, just one fall increases a person’s risk of another fall.

CGMW: At this time of year, ice and snow can make for very dangerous conditions, even for a short walk to the car or to get the mail. How can you help prevent falls in the winter?
Boyko:
There are some safety measures that may minimize the risk of falls outside of the home. The first is to ensure that, if there are any steps outside of the home, there are sturdy railings on both sides of the steps. Secondly, walkways and sidewalks should be cleared of ice and/or snow and should be level and smooth – a walkway in disrepair is dangerous, even in the warmer weather. And, motion sensored outdoor lighting ensures an easier view of the stairs and walkways.

Finally, a product like Yax Trax, an ice-traction device for shoes or boots, provides better stability when walking in the snow or ice.

CGMW: What are some of the danger areas for falls inside the home?
Boyko:
Eighty-five percent (85%) of falls of the over-65 population occur at home. Most often, they happen on stairs, walking to and from the bathroom and in the bedroom.

Good lighting is the first factor to address. Be sure that each room in the home has adequate lighting. Light switches should be easily accessible and situated at the bottom and at the top of all stairways in the home. Additionally, night lights with sensors can help people navigate a dark room at night.

Second, store electrical and phone cords out of the way of where anyone will walk. Tools like wire tacks or ties can be very helpful in bundling cords, as can running wires along a baseboard or on a wall.

As with the outside of the home, stairways within the home should have railings on both sides and stairs should be in good repair.

Finally, clutter. Clutter creates a huge risk for falls – both outside and inside the home. Be certain to clear any clutter that may cause someone to trip or fall.

CGMW: Let’s go room by room for some tips to make the home safer for your loved one. What are the best ways to help prevent falls in the kitchen?
Boyko:
First, remove scatter rugs. While they may look nice, they can move easily and cause a person to slip. All rugs, mats, etc. should be securely fastened to the floor with a non-skid mat underneath or with tacks.

Second, place frequently-used items like plates, bowls and glasses in an easy-to-reach cabinet. Store heavier items like pots and pans where they can be accessed without having to use a ladder or step stool. A grabber can be helpful to get small, light items that are high on a shelf as well as items that may have fallen to the floor.

Finally, when not using major appliances – a dishwasher, fridge or oven – keep the appliance doors closed.

CGMW: The bedroom?
Boyko:
Keep a clear, well-lit path to the bathroom from the bedroom. Add a bed transfer rail to the bed, which fits snugly under the mattress and can help a person to get in and out of bed with greater ease and safety. If an individual is unable to access the bathroom during the night, a bedside commode can be a great solution.

While fluffy bedspreads may look nice, they are also bulky and may cause someone to fall. Eliminate anything on or near the floor that puts someone at risk.

CGMW: The bathroom?
Boyko:
There are myriad tools that can be used in the bathroom to help reduce the risk of falls.

First: the toilet. Many older adults have problems getting on and off the toilet. A raised toilet seat, which can be purchased at a medical supply store, gives some added support to an individual who utilizes one. Some raised toilet seats have grab bars, which further increase the ease of getting on and off a toilet. Also, consider installing a grab bar on the wall near the toilet; this adds another means of fall prevention.

Second: the shower. A tub transfer bench is a wonderful tool. When getting into or out of the shower, an individual simply sits on the bench outside of the shower stall or tub, swings his/her legs over to the tub and stands up in the shower/tub. It eliminates the need for people to raise one leg at a time to get into a shower - which can be difficult for some and dangerous for most. Grab bars on the shower/tub walls add another layer of insurance against falls.

Additionally, while powder, oil or cream may feel nice on the skin, all of these products are also slippery when they’re on the floor. Try to avoid using them when possible. Place shampoo, soap and towels in easy-to-reach spots to eliminate having to stretch or reach to get them. Finally, a non-skid mat on the shower floor minimizes slippage.

CGMW: Are there any other areas in the home to consider?
Boyko:
Generally, we suggest that all clothing be properly hemmed; that an individual use a walker or cane to further support him/her physically; that couches be raised, if  too low; and that individuals rise slowly from a sitting or lying position, to help avoid dizziness, which often contributes to falls.

CGMW: What other factors contribute to the risk of falls?
Boyko:
While the aforementioned risk factors are considered extrinsic (outside the body), there are intrinsic factors (within the body) that also add to the risk of falls. They include vision, cognitive impairment, neuromuscular disease, stroke (residual weakness) and a previous fall, to name a few. A previous fall contributes to the risk of experiencing another fall, and certain medication combinations as well as the use of psychoactive medications are also significant risk factors. Caregivers must ensure that their loved ones are taking medications properly, as prescribed by their doctors.

Finally, if an individual has a somatosensory issue, he or she has a misconception about the feelings they have in their nerves, including those in the feet. A proprioception issue creates confusion regarding where the body is in relation to the space it’s in. Musculoskeletal issues such as a slow gait, decreased lower extremity strength, or decreased range of motion, also contribute to one’s risk of falls.  

CGMW: Are there ways to learn more about fall prevention?
Boyko:
Natick VNA has a program called “Balance Matters,” in which one of the VNA’s Physical Therapists addresses the very issues presented in this article. Those interested in learning more about this can call Natick VNA at 508-653-3081. Other resources for fall prevention include:

- American Physical Therapy Association (APTA)
- National Council on Aging’s National Falls Prevention Resource Center
- National Institute on Aging – Falls and Older Adults


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