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What’s up with falling down? Reducing the risk of falls for your loved one on hospice

By Terre Mirsch

I remember Jean, an elderly woman living alone with a fierce spirit of independence that was not to be reckoned with. I, and the rest of the hospice team, worried about her day and night. Despite our counsel and concerns, Jean was determined to remain in her home even with the inherent safety risks, including the risk of falls that accompanied her illness and poor home support system. Thankfully, with the support of hospice and safety interventions designed to reduce safety hazards, Jean was able to die peacefully, comfortably, and safely in her home.

Jean was not alone in her struggle to reconcile the limitations that typically accompany advanced illness. Optimal quality of life is a goal for many who face serious illness; and, often, quality of life is defined by one’s ability to maintain independence and the best possible function. Supporting your loved one during their declining health status, and finding the balance between supporting autonomy while providing the supervision necessary for safety, can be a challenge.

According to the Centers for Disease Control and Prevention, one out of three adults age 65 and older falls each year. Twenty to thirty percent of those who fall suffer moderate to severe injuries such as lacerations, hip fractures, or head traumas. The chances of falling and of being seriously injured in a fall increases with age. Hospice patients, and others with advanced illness, are frequently at even greater risk for falls. The frailty that accompanies physical decline increases your loved ones susceptibility to falls, while specific medications used to control symptoms and promote comfort add to this vulnerability. Your loved one’s risk of falling increases with the number of risk factors present. Other factors known to increase one’s risk for falls include:

  • Environmental hazards such as poor lighting, throw rugs, clutter, and stairs.
  • A history of falls. If your loved one has fallen before, their risk of falling again is greater.
  • Weakness, difficulty walking or moving around, or poor balance, including the need to use an assistive device such as a walker or a cane.
  • Urinary incontinence or the need to urinate frequently or urgently.
  • Altered mental status such as confusion, disorientation, or depression.
  • Impaired vision or hearing.
  • Taking three or more medications of any kind.

Traditional measures to reduce the risk of falls, including exercise or eliminating medications, may not be consistent with goals of care for those with advanced illness. For example, your loved one may not be able to tolerate or may not benefit from conventional exercise programs. Additionally, the medications your loved one takes are necessary for the management of pain and other symptoms and should not be eliminated.

But, there are things that you can do to promote your loved ones safety and reduce the risk of serious injury. Taking measures to reduce your loved ones risk of falling will significantly reduce the likelihood of a fall with serious injury.  As a caregiver, consider implementing the following measures:

  • Reduce environmental hazards by ensuring that your home is well lit. Use a night light during sleeping hours. Eliminate throw rugs, extension cords, and clutter.
  • Be prepared to assist or supervise your loved one, particularly in the bathroom, bedroom, and stairwell, where most falls occur. Be aware of specific hazards in the bathroom, a location where we often want to afford privacy to our loved one. The close quarters, hard tile floor and other surfaces, and sharp edges of the vanity combined with wet surfaces can cause hazardous conditions.
  • A physical or occupational therapist may be helpful in conducting an environmental assessment and making recommendations for home modifications and assistive devices. Therapists may also provide instruction regarding proper mobility and safe transfer techniques.
  • Ensure that assistive devices are within reach at all times and remind your loved one about the importance of using them. Recognize that it may be difficult for your loved one to acknowledge the need for this type of assistance. Be sensitive to these struggles.
  • Your loved one should wear footwear with a non-skid rubber sole that holds firmly on the foot. Avoid open back or raised slippers.
  • Lower the bed close to the floor if your loved one is not able to ambulate but is restless and attempting to get out of bed without assistance.
  • Use alarm systems such as bed sensors, personal emergency alert systems, or call bells when appropriate. The use of a room monitor may help you detect unexpected movement or sounds when you are in a different room from your loved one.

Preventing falls is consistent with the quality of life and comfort goals of hospice and palliative care. After all, falls can result in serious injury, which may in turn cause increased pain, significant disability and loss of independence, and even premature death. While you may not be able to prevent all falls, these simple steps to improve safety will contribute greatly to your loved one’s comfort and security.

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