In my hospital, many of our patients come to us for rehabilitation after an elective surgery such as a knee or hip replacement (arthroplasties). For the most part, these patients have carefully chosen their surgeon, rehab setting, and procedure date and have been educated about what to expect from surgery through recovery. When the elderly experience a fall inside (or outside) their home, it is sudden, traumatic, and deeply unnerving to both themselves and their loved ones.
According to a meta-analysis review (sixty two trials involving 21,668 people) done by the Cochrane Collaboration Institute; Interventions for Preventing Falls in Elderly People it was found that approximately 30 percent of people over 65 years old experience falls, and approximately 20 percent of those who fall require medical attention. Additionally, of those 20 percent, approximately 10 percent result in fractures. Thus, fall-associated fractures in older people are considered to be a significant source of morbidity (Gillespie LD, Gillespie WJ, Robertson MC, Lamb SE, Cumming RG, Rowe BH, 2003).
According The New York Times (Section D, 8/16/11), each year over 3/4 of a million people visit the ER secondary to falls in the bathroom, with more than a third of these falls happening specifically while bathing/showering and 14% while using the toilet. Individuals over the age of 85 acquire their injuries near the toilet, with the overall bathroom injury rate for women being 72 percent higher than for men. They conclude that the most high- risk activities of daily living are bathing and showering, specifically getting OUT of the bathtub.
In the hospital, I have treated individuals whom have fallen in the bathroom and kitchen, getting in and out of bed, down the stairs, getting out of chairs or couches and potentially worse – slipped on the ice as the weather hardens. Other risk factors I’ve encountered have include overall fitness level, medication symptoms and side effects such as syncope (fainting), dim lighting, decreased vision, floor clutter, pets, throw rugs, fatigue and dementia.
Each fall is unique and a result of a specific confluence of circumstances, but there are some general precautions that can be implemented to reduce the risk of falling in ones home.
BATHROOM: Grab bars by the toilet and in the bathtub or shower. Replace towel racks with grab bars. Shower chair or Tub transfer bench. Non-slip mats in and outside of bathing area. Commode or raised toilet seat. Long handled sponge and bath mitts, soap on a rope. Bright lighting.
BEDROOM: Bedside commode, reduce height of bed (remove box spring), bed rail, remove throw rugs, clear pathway to bathroom, nightlights.
TRANSFERS: Use surface to push from when standing, use chairs with arms. Use DME (canes, walkers…) as suggested by a health care professional and only when trained.
DRESSING: Adaptive Equipment such as: long handled shoehorn, reacher, dressing stick, sock aid, elastic shoelaces.
KITCHEN: Use mid-range shelving space, avoid heavy pots and pans, reduce bending over, remove/reduce cords and wires of appliances, bright lighting.