As people age, they tend to fall and as we’ve discussed many times, it’s important to both exercise to avoid falls while also fall or slip proofing your home. There can be many complications from falling as well as from lying there, unable to get up (e.g. dehydration, pressure sores). As well, once a person falls, there is a tendency to become afraid of falling again, which increases the chances of falling in the future. For example, by staying in your chair all day, which results in lack of exercise, which can lead to a fall next time the person moves.
There are a number of courses starting to appear, to teach older adults how to fall properly, if it does happen. These are excellent. it is also important to know how to get up from a fall, so that you don’t aggravate the problem even more.
Here’s a short video from Care Givers on how to react once you have fallen and how to safely get back up from a fall. Useful and timely given the season of winter here in Toronto!
Fall prevention is a big part of what we do and I often write about it and provide various resources for more reading. I think I’ll do it again this time! Winter is in full swing right now and some winter specific ideas for fall prevention is always a good idea. So, for you caregivers out there or for seniors who want to get through the season healthy, have a read!
Keep the walkways, stairs and sidewalks free of ice. This may sound like common sense – because it is! However, there’s two reasons for it. Firstly, ice and snow are obvious contributors to slips and falls and therefore some solid shoveling and sand/ice salt over everything makes sense. Secondly and perhaps just as important, is the fact that many seniors tend to stay inside too much in the winter, fearing slips and falls. This can lead to muscle and equilibrium loss, which are the two other factors which can lead to slips and falls. Therefore, in the winter, if you can’t do it yourself, hire someone or ask a neighbour to clear things up for you so that you can get out safely and continue to exercise all year round.
Wear proper footwear. Old boots tend to have old rubber bottoms, which harden over time and become a lot slippier than when they were new. Replace those boots with something new with flexible rubber bottoms. Check the boots out online or at the store to see what their slip rating is. How often should you change your boots? I would think at least every two years. You can get a good pair for $100 or less and that is a lot cheaper than several weeks in the hospital!
Get some ice traction cleats for your boots and leave them on. I first saw these type of cleats in Europe but they are becoming more common here in Canada. I love them. The hardest part of them is putting them on so I recommend having a pair of boots that they stay on permanently. Anytime it looks a little snowy or icy out there, that’s the pair of boots you use. Here’s a link to a good article on them and some suggestions on buying them.
Keep up that exercise and balancing regime. Falls are usually caused by loss of muscle and/or balance. Neither is necessarily inevitable and older adults can reduce their chances of a fall dramatically, by doing more leg and balance exercises. So, during the winter, if you are stuck in the house, now’s the time to do some exercise and get off that chair!
It’s a tricky step to start talking about home care or other services to your parents, as it is a major change from the status quo. Many factors are involved and each case is completely different. However, here is a list of ideas for you to consider prior to taking that step!
Keep them involved. Autonomy is not a minor point for anyone and particularly for people who have run things their own way up to this point. You may prefer safety. They however prefer autonomy. Tread lightly and make sure you get them involved in the discussions at the start and throughout the process.
Do a thorough and slow assessment of their needs. Initially, you can do this by yourself but you may request an OT, family doctor or other health care professional to step in as well. Understand that these needs will change over time. Write everything down in a notebook and don’t do it all at once and then make decisions unilaterally. There are usually some pretty good reasons why your parents are doing things a certain way and understanding those reasons are important. For example, it may seem silly to you that they are doing their laundry down in the basement. However, that may also be a way they get exercise and is part of their daily routine. Therefore, instead of putting the washer and dryer upstairs, perhaps add some railings to make it safer for going downstairs.
Do a thorough and slow assessment of your needs and resources. What are you doing for them and what are you doing for yourself? How much money is available for home care? How much do you save by not having them move out? How much time do you have to assist? Is it better for you to be involved or is it better for a professional to step in? Lots of good questions to think about before you decide to jump in!
Explore all the options. There are many ways for people to age gracefully and safely. I prefer people to stay in their own home because that is what they are used to and normally what they prefer. I tend to find it easier, cheaper and better socially. However, other options like moving to a smaller apartment or condo; assisted living; group living; etc. are all possibilities that can and should be explored. Make sure you talk over all the options with them and remember – it’s their choice!
The Centre For Disease Control and Prevention out of the US has published an excellent pamphlet on fall prevention and has cited four basic ways to prevent falls. As well, this excellent checklist has ten questions which are quickly and easy to review, to start to understand your chances of falling and how to prevent it.
1.Speak up. Talk to your doctor or health care providers about falls and get them involved. Ask about your prescriptions and whether they can result in dizziness or possible falls.
2. Keep moving. Exercise is a critical piece of fall prevention. By staying strong, you lessen the chances of falling. Balance is also very important and doing balance exercises helps as well.
3. Get an eye exam. As people age, their vision deteriorates and this can result in balancing and vision issues which can lead to falls. Get an eye exam on a regular basis (yearly) and get your glass prescription updated.
4. Make your home safer. This means getting rid of the clutter and all the various tripping hazards. Install handrails in bathrooms and throughout the house. Eliminate step thresholds into rooms. Lots of things to do here and we can come and do a thorough check of your house to suggest many ideas.
The first time I show up at a senior’s home to do work, particularly if I’ve been asked to come by one of the children or a caregiver, it’s always awkward. Normally, the home owner or senior doesn’t really want me there, feels that the job could be done by themselves, isn’t that important, or simply doesn’t trust me. All of which makes the situation tricky to deal with. How to get around this if you are the caregiver or the person doing the work? Here’s some ideas.
Say it’s for yourself, not them. In most cases, they’re your parents and they respond well to your needs and fears. Just tell them it will make you feel better and this tends to get the door open. Or, say you just don’t have the time to do it all yourself and you would rather do positive things together as opposed to running around cleaning the house and fixing stuff. After the first job or two is done, it gets a lot easier.
Tell them about me. I personally don’t like people coming into the house if I don’t know them. Neither do your parents. Give them some background on the handyman or other person coming in, what they do for a living, what their objectives are, etc. Give them my phone number as well and get them involved. After all, autonomy is not a minor issue here and everyone wants to feel in control! Then, introduce them properly. Let me have a moment to chat with them and hear their thoughts. Ultimately it will be the two of us working together and knowing a bit about each other makes it a lot easier.
Say it’s doctor’s orders. This should be used as a last resort but seems to work better for some people than others. Some folks tend to respect doctor authority (not all do that’s for sure!) and they will allow me to come in to put up some bars or other devices if that’s required.
Be clear that it will allow them to stay in their house longer. In the majority of my cases the senior person feels that this is the first step in getting them to move into another form of care. They often complain to me that “she just wants me to go into a senior’s home.” Explain that that is just not the case. Be clear that having help at home will allow them to stay longer. Make the financial case to them as well. If they fear that you are using up the inheritance, tell them honestly that every day they spend at home makes the inheritance all that much larger. In short, be honest and blunt.
Those are just a few methods that work. Each person is different of course but if you follow some of these ideas it might work out a lot better than most cases I see!
Embracing Aging 2020 is an upcoming free series of presentations to help people going through this process to better equip themselves for the inevitable changes. All of the presentations are at Eglinton St. George’s United Church. There are a number of topics that are to be discussed including:
Feb. 2: Aging-in-Place: Growing Older, Staying at Home. This is all about staying safe and independent in your home or condo as well as how to make it free of barriers and adaptable to your changing needs. Carried out by Margot McWhirter, an Occupational Therapist and specialist in the field of aging-in-place.
Mar. 29: Scam Alert! Presented by Patrick McKeen of the Better Business Bureau. This is all about how consumers can protect themselves from the most significant scams out there.
Apr. 19: Coming of Age. Presentation by Dr. Samir Sinha on Ontario’s and Toronto’s Senior Strategy, how it was carried out and other progress to date.
Accessibility is the ability of the person in the household to move about (e.g. through doorways, down stairs) or do daily household chores (e.g. make dinner, do laundry). Visitability is achieved when someone is visiting your home and through some modifications or just forward thinking, they have no problems accessing certain rooms (e.g. bathroom) or moving about. Both of these objectives can be partially achieved through the addition of threshold ramps.
Threshold ramps are generally placed at the point of transition between two rooms, where there is often a currently existing transition strip or a short step-up. These changes in height can prove troublesome and even dangerous (due to trips and falls) for people who have mobility issues.
Installing permanent or temporary threshold ramps at these points in the home can make it much more accessible for the home owner and a much friendly environment to visit for friends and family.
As we age, we lose our balance, which can lead to falls and all the nasty things that falls can do. However, it is possible to lessen the chances of falling and one of them is through regular balancing exercises.
This video, by two physiotherapists (Bob and Brad) is both funny and quite useful. Do the exercises and avoid falls. Seems simple to me! They even have a good YouTube website which is worth looking at for more exercises.
We all know that exercise is good for you but did you know all the various forms that are good for seniors? The positive effects each one can have? The following is an excellent article from McMaster Optimal Aging Portal that outlines five major categories (walking, yoga, HIIT training, strength training, aquatic exercise) and various options for each. Well worth reading and we’ll let the experts speak for themselves!
Falls are the number one issue with most older adults. Not because of the fall itself, but from all the various complications that result from falls. A big part of our work at HSS Toronto is involved with preventing falls through a number of interventions. Here’s a quick list of possible things to consider if you want to prevent yourself from falling; or, if you want to mitigate the chances of your loved ones from falling.
Review medications and your overall fall risk with your family doctor. Lots of medications can cause dizziness or balance issues. Eye examinations on a regular basis can also be useful so that your eye doctor can advise on needed prescription changes. By just being aware of these causes or modifying behaviour around their use can lessen the chances of a fall.
Clean up and remove clutter in the house. Sometimes this is as simple as getting rid of piles of stuff near doors or entrances; or moving furniture and tables around so that they are no longer in the way. Tacking down (or removing completely) loose carpets and looking for changes in floor heights from room to room is also very useful.
Exercise. I’m a big proponent of exercise for a number of reasons. Strengthening legs allows for more walking and reduced risk of falling. Balancing exercises ensure better balance overall. Exercise can also reduce fatigue during the day, making falling less of a risk.