Step Smart Naples Program Rolls Out
by Sandra Lee Buxton
Fall Prevention Coalition with representation from a cross section of community leaders has been meeting for months in order to formulate a safety awareness program. Coalition members are moving forward making our safety a priority and here’s why: Falls are not a normal part of aging but they are a symptom of a problem and shockingly most falls are preventable. Falls are the leading cause of trauma injury and death, so it is important to determine the genius of the fall. By doing so the problem can be eliminated or the risk minimized.
One in three seniors fall each year, half of those hospitalized die within the year from complications of that fall. Most falls occur in our homes which we generally regard as our safe haven and most are preventable.
There are three risk factors which contribute to fall injury 1) Physical, 2) Behavioral and 3) Environmental.
The Physical factors to name a few are cardiovascular such as unstable blood pressure or even a stroke. Visual and auditory deficits complicate safety and need to be acknowledged. Neurological disorders such as Dementia, Parkinson’s, and Neuropathy’s are significant as risk factors as well. These disorders are usually accompanied by an unsteady gait (walk) increasing the risk of a fall even more. The complications from polypharmacy should not be minimized. Drugs with side effects such as confusion, vertigo or drowsiness play havoc when combined with memory disorders and processing issues.
It is also important that the primary care physician (PCP) be aware of all medications that the individual is taking, especially those prescribed by other doctors including specialists. Many over the counter (OTC) drugs should not be taken unless the PCP recommends them as they can be contraindicated with some prescribed medications. During the annual physical ask the PCP if there are any medications in your profile that can safely be eliminated.
As a professional nurse, falls related to Behavioral factors feel tragic since they are all preventable. Pride contributes to a fair amount of injuries since the individual refuses to accept a deficit and chooses not to use the recommended cane or walker.
If someone has experienced a fall and does not change habits or the contributing factors then a second fall is inevitable. Those that live a sedentary lifestyle lose strength and endurance which moves towards an unsteady gait. Most individuals can do some simple exercises especially walking or ask the PCP for a physical therapy evaluation and get a personal plan. A good reminder is to move slowly from a laying to standing position or surface to surface in order to avoid a rapid blood pressure change. In other words, from a lying position sit a moment before you stand and stand a moment before you walk. Risky behaviors also include combining alcohol with medication, poor selection of footwear and getting on a step stool or chair to accomplish a task. Items that you use most frequently should be within arm’s length in kitchen cupboards so that the temptation to climb is avoided.
Obtain assistance before repurposing cupboard space, it should not be done when alone. Those with memory disorders are especially challenging to work with related to poor processing and lack of safety awareness. Hopefully they have an advocate who can guide them with
their decisions which will be ongoing since their disease is progressive.
Environmental risk factors occur within our home and the community at large. Let’s start with the home: poor lighting presents a trip hazard even when the surface is clear, obtain the services of an electrician who can illuminate dark corners or at minimum obtain motion activated night lights. The cost is about $13 a piece for the night lights and once activated they stay on about 90 seconds before growing dim. As long as there is movement however the light remains on. Kohler makes a LED nightlight toilet seat which is marvelous in ensuring the bathroom is well lit without turning on a light at night, cost is about $76. Most falls occur in the bedroom and bathroom so these simple solutions could save a life.
Ensure that showers and tubs have non slip surfaces and professionally installed grab bars, a small expense considering the cost of an injury.
The light on the bedside table needs to be within easy reach or a tumble can result. Check all rooms for electrical cord safety which if not secured to the floor or wall, present another risk factor. The contents of a home needs to be streamlined. Remove clutter and assure that the placement of furniture enables an individual to walk with or without with canes, walkers, or wheelchairs unimpaired. Decluttering a home is not an easy task and may need careful negotiations if you are advising another.
Most of us feel that we have our homes just the way we want them and are not open to change, even for the sake of safety. Throw rugs and large rug overlays may seem sensible and look beautiful but for the sake of safety they all need to be removed or ensure that they are firmly tacked down. I worked with a woman who was so adamant about keeping her oriental rug in place that she stated she would risk a fall. The fall happened and she hit her head on the corner of a table and subsequently died. Tragic is an understatement in a case like this.
We all love our pets but having them weave in and out of legs while walking is a risk for all of us let alone those with an enabler (cane/walker) or a gait imbalance. Bumps on the floor between room surfaces and unchecked spills are also a danger. We can all agree that removing a spill from the floor is important, however that presents a risk of its own. The change from a stooped position to a standing position can result in vertigo and then an imbalance. Consider removing the spill from a seated position like using a kitchen chair.
When out in the community be mindful of curbs, speeds bumps and the cement stops in front of most parking spaces. Safety takes awareness, the willingness to change, coach, cue, educate and to be a role model.
Are you up to the task? To become involved contact Mike Reagen at firstname.lastname@example.org.
Sandra Lee Buxton RN BSN MA is a Licensed Healthcare Risk Manager and Medical Legal Nurse Consultant and Chief Nursing Officer
McKenney Home Care.