Dad Fell Again

Linda Yuhas

"Your Dad fell again," declared the emergency room physician as I answered the 2 am phone call. The words made me cringe as another fall caused an emergency room visit for my aging father. My robust and energetic father was slowly becoming a frail older man. A recent CT scan showed evidence of dementia, confirming his increased cognitive decline. Dementia and other ailments contributed to my father's unsteady gait and subsequent falls. According to the CDC 2020, falls among adults over 65 accounted for more than 36,000 deaths in 2020, making it the leading cause of injury death for that group. The US census reports that 16.9 % of the US population is over 65 increasing by over 30% since 2010. As a hospital, home health care, and hospice nurse, I was familiar with the medical ramifications of falling patients. My siblings and I persuaded our father to transition to a safer environment. However, after more than 50 years in our family home, my father adamantly refused to leave his house regardless of the opinions of his adult children. Forbes magazine reports 90% of older adults do not want to leave their homes as they age. Therefore, our family agreed "aging in place" was the best solution for our father. As a certified case manager, implementing a safe discharge plan for my father was my nursing career's most critical discharge plan.

Creating Safe Home Environment

Here is the action plan the medical team and our family established to create a safe home environment for my father, which may also assist your patients and their families.

Obtain a medical alert system. Medical alert systems support active and homebound individuals with various devices, such as waterproof help button pendants or wrist bands, two-way speaker base stations, and global positioning system (GPS)-enabled mobile units. Some services furnish smartwatches and touchscreen tablets with built-in monitoring tools. A few vendors offer mobile apps, biometric tracking, and medication reminders. Apple Watch has a FallSafety Home – Personal Alert app using intelligent fall detection and automatic alerts for up to 5 emergency contacts. The medical alert systems include multilingual support as well.
Discuss ordering home health care with the patient's physician. Most patients with a history of falls benefit from intermittent home nursing and physical and occupational therapy services. In conjunction with the ordering physician, the nurse will initiate a treatment plan, provide an ongoing review of physical status, and report any changes in the patient's condition. The nurse provides oversight to all other disciplines in the home. The physical therapist will assess the patient's gait, position changes, and stair climbing. Activities of daily living, along with the use of adaptive equipment, is the area of expertise for the occupational therapist. Medicare provides coverage for skilled home health care with a homebound patient requirement. Additionally, requesting a home social worker consult connects the patient with community services, transportation, and other social programs for enrichment. Each discipline creates a treatment plan with interventions and goals.

Interventions

Additionally, the home healthcare team may recommend one or more of the following interventions:

Install grab bars in the bathroom and shower, a raised toilet seat, and add stairway rails and night lights in the hallway and bathroom. Also, ensure light switches are reachable in hallways and stairs, and installing a phone with big buttons or pictures promotes patient safety.
Purchase a bed assist rail product. Bed assist side rail(s) provide stabilizing support allowing individuals to sit and stand up independently with greater ease, minimizing the risks of falls. Insert the bed assist side rail between the mattress and box Spring or attach it to the bed frame. 30% of elderly adults living in homes without stairs fall in the bedroom.
Invest in a medication management system. Diverse medication management systems are plentiful, from electronic pill reminders to automatic medication dispensers with light and sound systems. The appropriate medication management system is ideal for remote caregivers and families.
Contact your local township for the medical lending closet in the patient's home area. Medical lending closets are independent organizations that offer used walkers, wheelchairs, and other mobility and home healthcare equipment for individuals to borrow or rent at a reasonable cost.
Insert a lockbox near the main door entrance. First, always verify the installation requirements with the local fire/police department. The lockbox secures property keys inside the box and provides an alternative to forced entry preventing damage to your patient's home. Educate the patient's family to disclose the lock box passcode to their local fire department, facilitating rapid access into the patient's home during an emergent event. Lockboxes limit entry to only authorized personnel into the house.
Remove clutter and extra papers, and throw rugs. Clutter throughout the house may increase patient confusion and cause a fall while reaching for a dropped item. Throw rugs are notorious tripping hazards and are reported as the leading cause of falls more than snow or ice.
Create tasty, nutrient-dense microwavable meals. Patient access to favorite foods and drinks with sturdy utensils and dishes promotes nutritious intake. Chronic disease, inactivity, and medications may contribute to sarcopenia (skeletal muscle wasting) and dehydration, all worsened by poor nutrition and diminished fluid intake.
Reach out to your local Aging and Disability Resource Centers (ARDCs). The ARCDs serve as single entry points into the long-term services and support system for older adults, people with disabilities, caregivers, veterans, and families. The Aging and Disability Resource Center streamlines access to long-term care. Perform an internet search for the ARDC in your patient's county or search "Eldercare locator." Meal delivery, transportation, and social companionship programs may be available.

Plan

Consult an elder law attorney to map out future healthcare requirements and asset guarding. Health care and durable power of attorney documents will eliminate the patient's family from court proceedings if the patient is incapacitated and unable to make proper health care or financial decisions for themselves.
Locate a senior living advisor. When living at home is no longer viable, a senior living advisor provides invaluable information regarding the complicated process of selecting an appropriate facility and patient care options within the local community. The senior living advisor offers a tailored directory of senior living communities that fit the patient's specific situation. Every patient has different needs, interests, activity levels, and budgets. Anticipate waiting lists for particular types of rooms or facilities.

These strategies benefited our family in managing our father's functional status and security in his home. Hopefully, these healthcare interventions will also help manage your patient's independence and home safety.

References/Resources

Older Adult Fall Prevention: Centers for Disease Control and Prevention

65 and Older Population Grows Rapidly as Baby Boomers Age: United States Census Bureau

Population Ages 65+: America's Health Rankings

Stubborn Aging Parents Who Want To Age In Place At Home: What You Need To Consider: Forbes

Aging and Disability Resource Centers: eldercare locator

Throw Rugs Are Big Fall Risks: Elderly Fall Prevention

The Most Common Places You're Most Likely to Fall Around the Home: Medical Guardian

Malnutrition in Older Adults—Recent Advances and Remaining Challenges: National Center for Biotechnology Information, National Library of Medicine