Preventing a fall

Alt title: "The Harder They Fall."

“Well, I had an exciting night,” my dad said when I called on my way home from work.

“Yeah? Was there a Humphrey Bogart marathon on AMC?” I joked.

“Haha, wouldn’t that be nice? No, I got a visit from some very nice young men from the fire department around 7 a.m.”

My heart dropped.

“What? Why? What happened?”

“It was late and I was tired and I tripped on the rug in the hallway, and I couldn’t get my fat butt up,” he said.

“Oh my god, are you okay?” My tone, concerned and terrified, didn’t match his, flippant and relaxed.

“I’m fine, Lauren. Just my ego is a little bruised, that’s all.”

He had lain there for several hours before another resident of his 55+ community walked by and heard him screaming. He hadn’t broken a hip or sprained an ankle. He had just exhausted himself trying to pull his body up to the chair, over and over again.

I wish I could say I went right into problem-solver mode. Instead, when I got off the phone, I cried. I imagined him lying on the floor, maybe crying, too. The picture of my grown father crying on the floor was too much. The person I saw as basically perfect throughout my childhood, the person whose job it was to carry me from the car to my bed if I fell asleep as he drove, the person who I still cried out for when I had a night terror—imagining that person lying on the ground, unable to simply stand up, was terrifying. Whatever I had been able to tune out up to that point about my role as a caregiver, about his role as the cared-for, I could no longer ignore.

One of the times my dad fell, I was right there with the walker but just couldn’t stop it from happening. He was too heavy for me to pick up, so I brought him a pillow while we waited on the EMTs.

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Falls are a major reason older people end up leaving their homes for nursing homes, Virginia Morris explains in “How to Care for Aging Parents.” Falls are both common and devastating:

“Each year, one out of three Americans 65 years or older and living in the community (and 60 percent of those in a nursing home) has a serious fall. About 10 percent of these falls result in fractures of the hip, spine, pelvis, hand, and wrist, as well as spinal cord and brain injuries. Half of all older people who fracture a hip never fully recover—they end up needing canes, walkers, or wheelchairs for the rest of their lives. Twenty-five percent of them die within six months of the injury.”

For a lot of people, the first time their parent falls is a wake-up call they never wanted. You might think your parent is doing okay, but when they have a fall, you can’t deny any longer that they’re getting older and they might need more help.

It’s often the catalyst for an unstoppable chain of events:

A fall might lead to a hospital stay or a surgery.

Staying in the hospital can lead to infections or delirium.

Recovering and resting after the injury can leave your parent unable (or too scared) to move their body to exercise or do basic chores.

Not moving can weaken your parent’s muscles. Weaker muscles make it harder to move around, decreasing your parent’s independence.

I don’t say this to scare you. Your parent will probably fall at some point, and they may recover completely. But preventing them from having a bad fall will go a long way towards protecting their independence.

Luckily, preventing falls is one of the easiest ways you can help your parent. I didn’t think about fall prevention until my dad had fallen. If your parent is still healthy, you have a chance to think about it in time to prevent them from falling (or prevent them from having a devastating fall).

Here are some steps you can take:

Ask your parent questions.

If your parent falls, ask them why they think they fell. Their answer might not be helpful, like my dad just blaming old age, but it might reveal something you hadn’t thought of—the bed is too high, the railing on the steps wobbles, the tread on their slippers is worn, or something similar. Also ask about tasks they feel unsafe doing. Two steps on a stepladder to change a lightbulb used to be easy, but now feel impossibly dangerous. When you come by, or when you know someone steadier on their feet will be there, see what tasks can be done then.

Encourage your parent to talk to their doctor.

Ideally, your parent is willing to talk with their doctor about their fall and you can all work together to brainstorm why the fall happened and what can be done to prevent the next one. In reality, falling as an older person is embarrassing. Your parent might feel afraid that they will be told they can’t live alone anymore. They might feel annoyed that you’re fussing over them—everyone falls once in awhile, right? Gently prompt your parent to ask their doctor about their fall. Remind them that you are all on the same team, working together to keep them healthy.

Be cautious with medications.

When you (or your parent) talks to their doctor, ask about drug interactions or side effects to see if these might cause a fall. If your parent is experiencing dizziness, lightheadedness, or blurred vision, they will be more likely to fall. Be sure your parent is following the instructions on what time of day to take medications. They may have necessary medications that cause drowsiness, but your parent should probably be taking those at bedtime.

Ask if your parent ever takes anything to help with sleep.

My dad often complained about insomnia and would take various “PM” medications, and would get prescribed sedatives, only to then complain of being drowsy during the day. Drowsiness can lead to unsteadiness.

Observe your parent as they walk.

Does your parent seem off-balance? Do they “furniture surf,” holding onto a chair, a railing, a table as if riding a wave through the room? They may be afraid of their poor balance. Ask your parent’s doctor if PT or OT is appropriate, or see what’s available in your area. Google “area aging organization” and see if there’s a Tai Chi class. Or start with chair yoga on YouTube. My dad was under the impression that once he lost fitness, it was not possible to regain it. This is simply not true.

Make their house safer.

You can do this, to some degree, no matter what your parent’s age is, and no matter whether they’ve fallen yet or not. Talk to them about the dangers of falling, and remove tripping hazards, including: clutter, shoes, area rugs, brooms and mops, cords, chairs or tables with legs that stick out, trash cans, and unnecessary furniture. Install or fix treads on stairs. If that conversation feels awkward, ground it in their goals and values. “I know it’s so important to you to keep up with your volunteer work. I want to help make sure a fall doesn’t sideline you.”

Look to tech.

Consider an alert bracelet or necklace, a smartwatch, or smart home devices that could be used to call for help in the event of a fall. Your parent’s insurance may reimburse for this.

My dad wore his alert necklace religiously at first, terrified of falling again. He even pushed the button a couple of times and had the fire department come out and help him again. But over time, he got less vigilant about putting it on, and he had a fall with the alert button out of reach. The cost of the necklace we had was also high, and my dad felt guilty about me paying for it.

A different solution occurred to us eventually. My husband and I set up Amazon Echos all over my dad’s apartment, one in the kitchen, bedroom, and living room. We placed an Echo Show (the one with the big screen) next to his recliner and programmed it so it showed photos of our son, whom he couldn’t see often because of the pandemic. The Amazon devices could make phone calls, so if he fell, he could say, “Alexa, call Lauren,” and then I could call 911.¹

It wasn’t a perfect system—once, I had my ringer off and didn’t know he needed me—but it had additional benefits. One was that it was less expensive than the monthly alert necklace—after the initial investment in the devices and the Amazon Prime subscription we already had, there was no monthly upkeep. There was also nothing for him to do—the devices would always be there without him having to remember to put anything on or charge anything. The larger device, the Echo Show, also had the capability for us to “drop in” to see and hear what was going on in the room. I only used this a couple of times, as it felt like an invasion of privacy, but being able to check on him without having to drive to his apartment was helpful.

Don’t forget about the bathroom and kitchen.

Install a shower bar, shower chair, or no slip mat in your parent’s shower, and a grippy mat outside the shower in your parent’s primary bathroom. Install a toilet seat with raised handles to make it easier for your parent to stand up after using the toilet. Remove kitchen rugs. Ask or observe whether your parent is capable of mopping up a spill, and consider buying whatever cleaning tool you think would help them if not. Also, remove the need for your parent to use a step stool in the kitchen—empty the upper cabinets make sure all kitchen tools are in the lower cabinets.

See what shoes they wear.

Watch your parent as they put on their shoes. Are they easy to put on? If not, help your parent pick out new shoes that are designed for accessibility. (Google “adaptive shoes for adults.”) Also be sure your parent isn’t walking around the house barefoot, in socks, or in shoes with no tread. Something else to keep in mind is that people with diabetes or other conditions can experience numbness or tingling in the feet, which can cause unsteadiness. Ask or observe whether your parent experiences this, and encourage them to talk to their doctor if so.

Consider mobility aids.

We had a variety of mobility aids for my dad—a cane, a wheelchair, a walker, and a walker with a seat—and used each for different tasks, depending on how far he would be expected to go, how he was feeling, and who would be there to help him. Your parent may be more open to these aids if they can choose when or if to use them. If your parent’s doctor thinks a mobility aid will help, it’s likely it will be covered by insurance. If not, check your local thrift store.

Check the lighting in your parent’s home.

Are there dark spots? Are the chains or switches accessible? Tripping may more easily occur if the space is poorly lit. Consider adding lighting or nightlights if necessary.

Ask your parent when they last had an eye exam.

If it’s been a year or more, encourage them to make an appointment to get new glasses and get checked for medical problems affecting the eyes.

Don’t make fall prevention a “one and done.”

Periodically check your parent’s home for tripping hazards such as carpet coming unstuck, slippery rugs, or tread missing from stairs. Set a calendar reminder for each quarter to be sure this task doesn’t get forgotten.

Check for local programs.

Some cities and states have programs to assist the aging with home improvements. Most of these are dependent on income level, but it’s worth checking to see whether your parent may qualify. Connect with your local office of Elder Affairs or Senior Support Services to look at your options.

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Whew, that was a lot. I hope you don’t feel overwhelmed. You don’t have to do all these steps tomorrow, even if your parent has recently fallen. It’s okay to adjust one thing at a time, to start slowly. I don’t want you to charge into your healthy, 60-year-old parent’s house and demand they burn their area rugs. But preventing a fall is a key way to keep your parent out of the hospital.

And those very nice young men from the fire department probably have other things to do.

1. At that time, there was no way for Alexa to call 911 directly. Now, you can pay for Alexa Emergency Assist, which has a monthly fee, and not have to go through a family member to call for assistance.