Even a dog dish or newspaper can cause a fall
Donna Hardy has a job to do: keep her patients out of the hospital and thriving at home. Her success increasingly depends on making sure they don’t fall.
Hardy, a physical therapist who works for the Visiting Nurse Association of Cape Cod, travels from Falmouth to Provincetown teaching high-risk patients, as well as their friends and family, how to avoid an accident.
That’s where her shopping bag comes in.
“I will visit individual homes or speak in front of larger groups and take out my bag. Inside are many of the objects that have actually led to unnecessary – and often severe – falls. It’s a great way to get everyone’s attention, and it leads to action on their part,” she explained.
Hardy’s props are seemingly innocuous, but they could be life-threatening in the wrong moment. Here are some her examples:
- A LEGO piece. “One woman was taking care of her grandchildren who were playing with LEGOs. She stepped on a sharp piece, fell and broke her arm.”
- A dog dish. “A friend’s father tripped over his dog’s water dish, which was in the middle of the kitchen.”
- A newspaper. “One gentleman went out to get the newspaper. It was at the bottom of his front steps. He bent down before descending all the steps, lost his balance and fell head first.”
- A lap blanket. “A woman was sitting in a chair with a blanket over her lap. The telephone rang and she rushed up to get it. She immediately tripped over the blanket, and landed on her face.”
- A new pair of sneakers. “A patient of mine put on a brand new pair of sneakers that had thicker soles than her previous pair. She was tired while climbing the stairs and did not pick up her foot enough to compensate for the thicker soles. She fell and broke her neck.”
- Silk pajamas. “One patient slid right out of bed trying to turn off the lamp to go to sleep. It wouldn’t have happened if she was wearing cotton pajamas.”
- Flip-flops. “These slippers did not have backs on them. As this patient was walking, she accidentally placed one foot on the back of the other slipper and immediately fell to one side, injuring her shoulder and knee.”
Carrying Groceries Can Be a Risk
Hardy continued to take out other “weapons,” including magazines that people tend to leave right on the floor by the bed or chair, throw rugs without rubber backing or adhesive strips; and even grocery bags.
“They’re culprits for another reason,” she said. “I encounter so many situations where someone is carrying too many bags in from the car and then tries to open a door. That’s a scenario for a potential disaster.” More than the groceries will fall, she said.
Hardy strongly recommends that you keep one arm and hand always free. Even if you fall, you can brace yourself to avoid the worst possible fall, hitting your head.
Hardy’s cautions also go to making sure that good intentions are backed up by good execution.
“A lot of fall prevention is about education,” Hardy emphasized.
A physical therapist for 30 years, Hardy has worked for the VNA of Cape Cod since 1993. Many of her patients have recently been released from the hospital, and she visits their homes and helps make them as safe as possible.
Other clients are elderly and need to develop new, safer behaviors. This entails a constant journey across the Cape, often visiting five or six patients a day in their homes, she explained.
“I will evaluate their home for risks. I will observe the client in his or her home, paying special attention to their mobility. I will test their range of motion, their balance and their overall coordination,” she said. “We take all these elements into consideration and then develop goals for the client.”
There Are Two Causes of Falls
There are two causes of falls – intrinsic and extrinsic, Hardy explained.
Intrinsic has to do with the client’s health habits, mental status, vision, flexibility, strength and balance. It also includes issues of circulation and sensation, especially in the feet as one gets older. Neuropathy, which is numbness in the feet, is a significant cause of falls. So is blood pressure, which can cause dizziness if not controlled, and irregular heartbeat from conditions such as atrial fibrillation.
While all those require medical attention, the extrinsic causes of falls can be controlled by individuals themselves with these precautions:
- Don’t rush.
- Don’t get up quickly.
- Don’t walk with your hands in your pockets.
- Don’t carry too many objects at the same time.
- Drink plenty of liquids so you don’t get dehydrated.
- Manage your medications carefully. Some medicines, or combinations of them, can make you sleepy or dizzy.
- Keep your home uncluttered.
- Keep outside pathways clear.
- Pets can contribute to falls by being under your feet or jumping on you when you aren’t prepared.
- Control your blood pressure.
- Place grab bars in the bathroom, by the toilet and in the shower.
- If you need a cane or walker, use it.
- Improve lighting in your home and use nightlights.
- Avoid going barefoot or wearing slippery slippers or flip flops.
- Have your eyes checked annually.
One of the biggest challenges Hardy encounters is the reluctance of many people to share their concerns about falling with their doctor.
“Less than half the people who do fall or fear falling will not say anything,” she said. “For some, they are afraid they will lose their independence – driving the car, or even being encouraged to go into assisted living. They are afraid to show their vulnerability.”
“That’s exactly the wrong thing. The key is to tell your doctor so you can be provided with ways and resources – including the VNA – to prevent falls and maintain your independence,” she emphasized.