Preventing Falls in the Elderly Simple precautions can help create a safer h o m e environment. By
ARLENE
ORHON
JECtl
growing number of elders in the United States are cared for at home by family or community visiting nurses. According to Dorothy Howe of the American Association of R e t i r e d P e r s o n s Health Services, " P e o p l e want to p r o v i d e c a r e at h o m e for frail relatives, even when faced with the p r o s p e c t of a r o u n d - t h e clock care. ''1 F o r r e l a t i v e s to c a r e safely for elders at home, the environment needs to be safe. Falls are the most prevalent home accident and are a serious health hazard among older Americans. 2 According to Robert L. Buckley, MD, associate professor at Mercer University School of Medicine, falls are the cause of death each year for 9500 people older than 65 years of age. H e also said that persons aged 65 to 74 years have three times the risk of serious falls as those younger than 65 years; by age 75 years the risk is twentyfold, and there are 172,000 hip fractures each y e a r ) Because people are living longer (the life expectancy at 65 years of age has been an additional 18 years for women and 14 years for men for the past decade), 2 failing is a serious health risk. What can be done by older people and their families to prevent falls? Some very simple things, according to Buckley. 3 (See
A
"'Creating a Safe Environnwnt For Elders.") ARLENE ORHON JECH, RN, is a head nurse in geriatrics at Laguna tlonda tlospital, San Francisco, California. 34/1/35607
Body Changes Aging itself causes changes in the body that increase the risk of falling. Vision is often worse, especially at night, making it difficult to see hazards such as stairs and telephone and electric cords that could be tripped on. Balance has deteriorated; therefore older people may not lift their feet as high when they walk. Thinning of the bones, especially in older women, makes it more likely that a fall will result in a broken bone. Home Safety aging put the older person things can be done to make n is often worse in older peorant, especially in halls and save a few cents on the electric Ulll by usmg low-wattage bulbs or may even try to navigate halls and stairs in the dark, only to fall and break a bone. The ensuing thousands of dollars in medical bills they have to pay makes this a false economy. Keep those bright lights on! At night a night-light or flashlight at the bedside would help the elder who gets up at night to go to the bathroom. Light switches should be conveniently located. Stairs, even if well lit, pose a special hazard. The older person with reduced vision may not see the first or last stair of a staircase. Stairs should always have a handrail and at the correct height. The first and last steps can be painted a different color to make them stand out from their surroundings, or a knob can be placed on the banister at the first and last steps as a signal. Stairs,
Geriatric Nursing January/February 1992 43
C R E A T I N G A FALL SAFE E N V I R O N M E N T Problems Contributing to Falls Vision Worse
Stairs Tripping on telephone and electric cords Throw rugs High-wax floors Slick file or tub in bathroom Loose-fitting shoes Medications, especially over-the-counter
Interventions~Teaching Adequate lighting, especially in halls Night-light or flashlight at night Handrails at carrect height. First and last stair painted contrasting color or knob placed at first and last stair Sand added to paint for outdoor stairs Cords stapled to floor or wall Rubber backing or tacked to floor Nonskid wax Nonskid appliques or nonskid tiles Handrails near toilet, shower, tub Well-fittlng shoes All medications, including over-the-counter, brought to family physician to evaluate safety of combinations
especially outside ones that might be wet or slick, can be painted with sand-added paint to make them slipo proof. Balance may worsen with aging. Older persons may not lift their feet as high when they walk, thereby risking tripping on objects that never would have caused a problem when they were younger. Telephone and electric cords can be stapled to the floor or wall. Throw rugs are a special hazard. They should be eliminated. If they must be used, they should have a rubber backing on the underside or be firmly anchored. Highly waxed floors should be shunned in favor of nonskid floors. The bathroom, with its slick tub and tile, can be made s a f e r w i t h n o n s k i d a p p l i q u e s p u r c h a s e d in h a r d ware stores, or nonskid tiles can be installed. Handrails should be mounted on the wall near the toilet, shower, and tub to assist the elder in getting up and down without falling. Well-fitting shoes are important in preventing a fall; loose-fitting slippers or shoes could cause elders to trip and fall. Likewise, walkways outside should be in good repair. A crack in the concrete could cause a heel to catch, resulting in a fall. Uneven walkways also are hazardous. Medications
Medications can increase the risk for falls. Elders may take many medications, both those prescribed by their physician and over-the-counter medications for pain, colds, and sleeplessness. Combinations of some of these medications can be very potent and not what the elder expected, making the person drowsy and at risk for falling. Sedative hypnotics, antidepressants, and vasodilators are associated with twice the risk for falls) The family physician should know all of the medications the elder takes to properly evaluate the safety of the combinations. It is a good idea to bring all the medications to the physician's office for such an evaluation. With these simple precautions, many falls with their
44 Geriatric Nursing January/February 1992
FOR ELDERS
accompanying suffering and pain for the older person can be avoided. Then home truly becomes the best, and safest, place on earth. REFERENCES I. Newsbreak. AARP Bulletin 1991;32(10):3. 2. Schuster C, Ashburn S. The process of human development. Boston: Little, Brown and Co, 1986:794, 806. 3. Buckley R. Anticipation and prevention of falls in the elderly. Pacific Presbyterian Medical Center Teleteaching Conference. San Francisco, Dec 4, 1990.
MOVING? GIVE US YOUR NEW ADDRESS SIX WEEKS AHEAD To ensure prompt service when you change your address or whenever you write us about your GERIATRICNURSING subscription, please include your address label from a recent issue of GERIATRICNURSING. Address your correspondence to GERIATRICNURSING, Subscription Services, Mosby-Year Book, Inc., 11830 Westline Industrial Dr., St. Louis, MO 63146-3318. Affix address label here when sending address change. Clearly print NEW address. The expiration date of your subscription is toward the right end of the upper portion of the label. Name
Address City State
ZIP
ARLENE
ORHON
JECtl
growing number of elders in the United States are cared for at home by family or community visiting nurses. According to Dorothy Howe of the American Association of R e t i r e d P e r s o n s Health Services, " P e o p l e want to p r o v i d e c a r e at h o m e for frail relatives, even when faced with the p r o s p e c t of a r o u n d - t h e clock care. ''1 F o r r e l a t i v e s to c a r e safely for elders at home, the environment needs to be safe. Falls are the most prevalent home accident and are a serious health hazard among older Americans. 2 According to Robert L. Buckley, MD, associate professor at Mercer University School of Medicine, falls are the cause of death each year for 9500 people older than 65 years of age. H e also said that persons aged 65 to 74 years have three times the risk of serious falls as those younger than 65 years; by age 75 years the risk is twentyfold, and there are 172,000 hip fractures each y e a r ) Because people are living longer (the life expectancy at 65 years of age has been an additional 18 years for women and 14 years for men for the past decade), 2 failing is a serious health risk. What can be done by older people and their families to prevent falls? Some very simple things, according to Buckley. 3 (See
A
"'Creating a Safe Environnwnt For Elders.") ARLENE ORHON JECH, RN, is a head nurse in geriatrics at Laguna tlonda tlospital, San Francisco, California. 34/1/35607
Body Changes Aging itself causes changes in the body that increase the risk of falling. Vision is often worse, especially at night, making it difficult to see hazards such as stairs and telephone and electric cords that could be tripped on. Balance has deteriorated; therefore older people may not lift their feet as high when they walk. Thinning of the bones, especially in older women, makes it more likely that a fall will result in a broken bone. Home Safety aging put the older person things can be done to make n is often worse in older peorant, especially in halls and save a few cents on the electric Ulll by usmg low-wattage bulbs or may even try to navigate halls and stairs in the dark, only to fall and break a bone. The ensuing thousands of dollars in medical bills they have to pay makes this a false economy. Keep those bright lights on! At night a night-light or flashlight at the bedside would help the elder who gets up at night to go to the bathroom. Light switches should be conveniently located. Stairs, even if well lit, pose a special hazard. The older person with reduced vision may not see the first or last stair of a staircase. Stairs should always have a handrail and at the correct height. The first and last steps can be painted a different color to make them stand out from their surroundings, or a knob can be placed on the banister at the first and last steps as a signal. Stairs,
Geriatric Nursing January/February 1992 43
C R E A T I N G A FALL SAFE E N V I R O N M E N T Problems Contributing to Falls Vision Worse
Stairs Tripping on telephone and electric cords Throw rugs High-wax floors Slick file or tub in bathroom Loose-fitting shoes Medications, especially over-the-counter
Interventions~Teaching Adequate lighting, especially in halls Night-light or flashlight at night Handrails at carrect height. First and last stair painted contrasting color or knob placed at first and last stair Sand added to paint for outdoor stairs Cords stapled to floor or wall Rubber backing or tacked to floor Nonskid wax Nonskid appliques or nonskid tiles Handrails near toilet, shower, tub Well-fittlng shoes All medications, including over-the-counter, brought to family physician to evaluate safety of combinations
especially outside ones that might be wet or slick, can be painted with sand-added paint to make them slipo proof. Balance may worsen with aging. Older persons may not lift their feet as high when they walk, thereby risking tripping on objects that never would have caused a problem when they were younger. Telephone and electric cords can be stapled to the floor or wall. Throw rugs are a special hazard. They should be eliminated. If they must be used, they should have a rubber backing on the underside or be firmly anchored. Highly waxed floors should be shunned in favor of nonskid floors. The bathroom, with its slick tub and tile, can be made s a f e r w i t h n o n s k i d a p p l i q u e s p u r c h a s e d in h a r d ware stores, or nonskid tiles can be installed. Handrails should be mounted on the wall near the toilet, shower, and tub to assist the elder in getting up and down without falling. Well-fitting shoes are important in preventing a fall; loose-fitting slippers or shoes could cause elders to trip and fall. Likewise, walkways outside should be in good repair. A crack in the concrete could cause a heel to catch, resulting in a fall. Uneven walkways also are hazardous. Medications
Medications can increase the risk for falls. Elders may take many medications, both those prescribed by their physician and over-the-counter medications for pain, colds, and sleeplessness. Combinations of some of these medications can be very potent and not what the elder expected, making the person drowsy and at risk for falling. Sedative hypnotics, antidepressants, and vasodilators are associated with twice the risk for falls) The family physician should know all of the medications the elder takes to properly evaluate the safety of the combinations. It is a good idea to bring all the medications to the physician's office for such an evaluation. With these simple precautions, many falls with their
44 Geriatric Nursing January/February 1992
FOR ELDERS
accompanying suffering and pain for the older person can be avoided. Then home truly becomes the best, and safest, place on earth. REFERENCES I. Newsbreak. AARP Bulletin 1991;32(10):3. 2. Schuster C, Ashburn S. The process of human development. Boston: Little, Brown and Co, 1986:794, 806. 3. Buckley R. Anticipation and prevention of falls in the elderly. Pacific Presbyterian Medical Center Teleteaching Conference. San Francisco, Dec 4, 1990.
MOVING? GIVE US YOUR NEW ADDRESS SIX WEEKS AHEAD To ensure prompt service when you change your address or whenever you write us about your GERIATRICNURSING subscription, please include your address label from a recent issue of GERIATRICNURSING. Address your correspondence to GERIATRICNURSING, Subscription Services, Mosby-Year Book, Inc., 11830 Westline Industrial Dr., St. Louis, MO 63146-3318. Affix address label here when sending address change. Clearly print NEW address. The expiration date of your subscription is toward the right end of the upper portion of the label. Name
Address City State
ZIP
