Falls risky for elderly, caregivers

Physical therapist Joan Levis helps Neri into chair, grabbing waistband if needed.
Physical therapist Joan Levis helps Neri into chair, grabbing waistband if needed. (MICHAEL S. WIRTZ / Staff Photographer)
Posted: July 08, 2013

'So you fell and you couldn't get up?" I asked.

It took my 83-year-old mother a second to get my reference to the alarm company's infamous TV commercial, but, luckily, she often shares my dark sense of humor.

She was in her yard feeding birds when her four-footed cane tipped on uneven ground and she toppled over. She's grown more frail of late and couldn't stand back up. My brother, who lives near her, insists that she carry a cellphone. She summoned him.

That's when her story took a surprising turn.

My brother, who is 6-foot-1 and built like an ox, had trouble getting our petite mother on her feet.

"I was dead weight," she said.

"I was afraid I'd hurt her," he said.

The story brought back memories of my own experience caring for my husband as he was dying of brain cancer. His balance was affected, and one day he teetered and began slowly falling. I was shocked to discover I was helpless. Our athletic teenage son helped me get him up, but it was hard work. Until my husband became too weak to get out of bed, I lived in terror that he would fall again.

I assumed the problem was that he was a fairly big man, and that, like thousands of caregivers, I was a smaller woman. But here was my brother struggling with the woman he used to teasingly call "little mother." It made me wonder what caregivers should do in such cases.

If your loved one can't get up, how do you lift him? What do you do to protect your back?

This time, I did what I didn't do when my husband was failing. I called some experts. Here's what I learned:

First, falls are a big problem and are getting bigger.

David Brown, deputy director of Montgomery County Emergency Medical Services, said his agency gets about four to six "lift assist" calls a day, often from people living alone. He says it's a big help if callers can tell dispatchers where they are and if all the doors are locked.

Demographics are driving this.

"People over the age of 75 are much more likely to fall, and that age group is one of the fastest-growing age groups in the country," said Jeremy Walston, professor of geriatric medicine at Johns Hopkins University.

Each year, one in three people older than 65 falls, said Brooke Salzman, medical director of Jefferson Family Medical Associates in the Philadelphia Senior Center. Half of people 80 and older fall each year.

About half of falls result in injuries. They cause 90 percent of hip fractures and are the leading cause of head injuries. They're a major reason people are hospitalized or move into nursing homes.

Older people are more likely to get hurt, Walston said. Their bones are more fragile, and many take blood thinners, which make head injuries especially dangerous.

This is why preventing falls is crucial. Most caregivers probably know to keep walkways clear and get rid of throw rugs. Older people should wear shoes or socks with treads. Dogs and cats are a tripping hazard. One big thing you can do is exercise. Get physical therapy. Tai chi, a form of exercise that emphasizes balance, is especially helpful.

Fraught with the emotions that decline and dependence can cause, falls are tough on the psyche for patient and caregiver.

My mother "cried like a baby" as she waited under a tree at dusk for my brother. "I was weak, and I was helpless," she told me.

She gets physical therapy now, but she's afraid to go out alone. This fear keeps many people from the very thing that might help them: exercising.

Many factors common in older people increase risk. A previous fall is a big one, Salzman said. Then there are problems with gait and balance, muscle weakness in legs, vision, feet or footwear, taking too many drugs, age over 80, cognitive impairment, depression and arthritis.

If you care for someone with those risks, experts said you'd do well to get training from a physical or occupational therapist.

When your loved one falls, have them lie still and calm down. When they are injured, call 911. Otherwise, see whether you can get him or her up.

Even if you're much bigger, don't try to pick them up like a sleeping 6-year-old. You don't need two injuries in the family.

"It doesn't matter the size of the caregiver," said Jennifer Keal, director of nursing for Holy Redeemer HomeCare. "When somebody falls, it's difficult to get them up."

Experts use the patient's strength. They don't try to do it all themselves.

"We're training them to help the person up, not lift the person up," said Heather Cianci, geriatric team leader for the Dan Aaron Parkinson's Rehabilitation Center at Pennsylvania Hospital.

Holy Redeemer's Joan Levis, a physical therapist, and telephone triage nurse MaryLou Neri showed me how to do this in a model apartment at the system's Villages at Pine Valley in Northeast Philadelphia. Neri, 65, with bad knees, "fell" in the bedroom, a common accident site.

Neri pushed herself into a sitting position. If necessary, Levis could have helped her from behind. They made sure nothing was twisted or bleeding, then Neri scooted backward toward a chair. This was hard work for her.

A weak or demented patient "is going to have a helluva time," she said.

When she reached the chair, she turned and used it to pull herself onto both knees. Then she lifted one leg in front and put her foot flat on the floor so her shin and thigh formed a right angle. She used her arms and that leg to help push herself up. Again, Levis could have helped her move the leg if necessary.

As Neri rose, Levis - keeping her stance wide and her knees bent - grabbed Neri's waistband from behind and steered her into the chair. If Neri had needed more support, Levis could have grabbed the waistband with one hand and wrapped the other around her arm at the armpit or she could have used a gait belt with built-in lifting loops.

Never pull an older person by an arm or leg. Don't wait until someone is up to figure out where you want to put them. Steer toward heavy furniture, if possible.

This will be harder with weaker and heavier patients and those with cognitive problems.

When experts do this, they often work in pairs. A single caregiver may need to call a relative, neighbor, or paramedic.

Meryl Comer, chief executive officer of the Geoffrey Beene Foundation's Alzheimer's Initiative, said most people, and policymakers, underestimate how demanding caregiving can be. In 2006, PBS's NewsHour chronicled her difficulty lifting her 6-foot-2, 200-pound husband with dementia after he rolled out of bed. Her frustration was palpable as she tried to help. Finally, she gave up and called the fire department. It took two men to get him off the floor.

"I always felt ashamed or upset that I couldn't do it, and I'd have to call a paramedic," Comer said. She still cares for her husband, but now has a Hoyer lift. "They're needed for real emergencies, and I can't get my husband off the floor."

Audrey Fatula decided she and her husband, John, had to move the last time he fell. He has Parkinson's disease, which puts him at very high risk for falls, and Fatula, 64, a retired nurse, knew she couldn't get him up. They moved into a senior living facility in Center City where the "wellness team" can help if he falls again.

The two work hard on exercises to prevent falls. Because he reacts badly to many drugs, Audrey worries it would be disastrous if he hurt himself badly enough to need surgery.

"We are more than aware of the fact that he cannot fall," she said.


Contact Stacey Burling at 215-854-4944 or sburling@phillynews.com.

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