What are the causes of falls in the elderly population? Elderly people may have such health impediments as impaired vision and hearing which can make a fall more likely, particularly if their living quarters aren’t well lit or they have furniture or other objects which can be easily tripped over. The elderly also have a higher incidence of osteoporosis which can increase the risk of falling. They tend to be frailer with reduced muscle mass which is another cause of falls in the elderly individual. One of the most important and often overlooked factors that can increase an elderly person’s risk of falling is medications.

Is an elderly member of your family taking medications for high blood pressure? If so, he or she may be at an increased risk for falling. A Dutch study performed in 2007 showed that discontinuing certain medications in the elderly reduced their incidence of falls by half. (British Journal of Pharmacology 2007; 63:232). Medications that are most likely to increase the risk of falling include high blood pressure medications, sleep medications, and drugs taken for psychiatric problems. Since many elderly people are being treated for high blood pressure, antihypertensive medications can be a significant cause of falls in the older population.

What can be done to prevent falls in the elderly? The first step is to determine if your elderly family member is taking medications such as blood pressure pills which may increase the risk of falling. Schedule an appointment with their doctor to determine whether any of these medications could be changed or discontinued. At the same time, your doctor can check the elderly person’s visual acuity to see if this is a factor that can be corrected to reduce the incidence of falls. Any underlying medical problems that may be contributing to falling can also be addressed.

Once health and medication related causes for falling have been corrected, it’s important to do a review of the elderly individual’s living quarters. Any areas of clutter should be cleaned up and loose objects removed. Handrails should be placed in rooms so that the elderly person has support when walking. Adequate lighting should also be installed. There should also be ready access to a phone and appropriate phone numbers in case of an emergency.

Don’t let your elderly family member be a victim of a nasty fall. Understand the causes of falls in the elderly and how to prevent them and you can help your elderly family member spend their final years in a healthy and safe manner.

by Kristie Leong M.D. – Featured Health & Wellness Contributor

It is extremely important once a family member has been diagnosed with osteoporosis to help them prevent falls and further deterioration of their bones. Here is some information, I hope you will find helpful.

Does the person really understand their condition?

Make sure they clearly understand what the doctor has told them. Often they do not. Write down the doctor’s directions as simply as possible. Review the instructions daily if needed, until they are getting it correctly. The elderly person may have difficulty understanding explanations and directions because of mental or memory problems.

Preventing Falls is the #1 Goal

Vision: Make sure they get their vision tested. Bad vision causes falls.

Proper Posture: Observe them getting up out of a chair and walking. You may notice habits that may contribute to a accident in the future.

Demonstrate safe walking techniques: Explain how using the walker to pull themselves up on their feet is dangerous; instead show them how to push themselves up using the the chair arms; how to stand up slowly with their legs a few inches apart to give the body more balance; to wait for a few seconds to walk until they feel steady; to keep their head up and eyes forward; to stand tall not slouch when walking or using the walker; to bend from the hips and knees, not from the waist; when bending over to pick up an object, to not lean over if possible but lower themselves down using your thighs, keeping upright: when they lean over they are more prone to losing their balance and becoming light headed.

Take immediate steps to make their home safer: Install night-lights in each room and the hallways; remove boxes, bags, clutter from around walking areas; don’t wax floors; remove small rugs that may become a fall hazard; remove rugs that are ripped and uneven; remove all electric cords from walking areas; install handrails or grab bars on stairs, steps, bathroom, and shower; install a non-slip rubber bathmat in the shower; and make sure there is adequate lighting in all rooms. If they have a favorite chair that rocks, slips, or has narrow arms, encourage them to replace the chair. The new chair should sit higher, not rock or move, and have firm, wide arm rests. There are also chair seat lifts operated by a spring that can be placed on top of the chair seat. This makes it much easier to get up when arm strength is lacking. There are chairs that have built in, motorized seat lifts as well. The lift is controlled by a simple button control remote. You will find many of these items at a medical supply store.

Walking Aids: Suggest they use a walker instead of a cane for more support. Many elderly people hate to use walkers because it makes them feel they are becoming more feeble. Impress them with the fact, it is much better to use a walker than end up in the hospital. If they won’t use a walker, encourage them to buy a safer cane. There are safer designed canes with secure grip handles and three prongs that allow them to stand up on their own.

Alter Clothes and Shoes: People cling to their old, familiar clothes and worn out shoes. If they use a full length robe or nightgown that is too long, alter the hem, so they don’t trip on it. Make sure their slacks don’t drag the floor either. You must make them understand how important it is to get rid of sloppy, loose house shoes and bedroom slippers; They must discontinue wearing shoes with heels that are unstable; Take them shopping to buy new shoes that are supportive and have soles with traction.

Consider Hip Pads: Encourage them to wear undergarments that are padded over the hip areas. Help them purchase the hip pads from catalogs that specialize in aids for the elderly. You may have to show them how to use them as well. Research has shown they help in the reduction of hip fractures.

Discuss Dietary and Life Style Habits:Smoking and Alcohol: Encourage them to give up smoking and drinking. Drinking is responsible for many falls. Most elderly people develop a decreasing tolerance to alcohol and their balance is affected more quickly.

Increase Calcium Rich Foods: Help them improve their diet with healthier foods including calcium rich foods and Vitamin D. If they will not eat correctly, make them realize how important it is to take 1000 mg of a calcium supplement including 600 mg of Vitamin D if they are under 50; If they are over 50, they should take 1200mg of Calcium with 800mg of Vitamin D. Vitamin D helps your body to absorb Calcium. Vitamin D should be in the range from 600 to 800mg according to the Institute of Medicine.

Protein Requirements: Protein is needed to maintain strong bones but too much is not good either. Too much protein causes more Calcium to be eliminated in the urine. The suggested protein intake for women is 46 grams and 56 for men. I have not seen many elderly patients eating too much protein. Most often elderly patients are low in protein because of appetite loss, poor food selection, and the inability to swallow and chew their food.

Decrease Salt Intake: Sodium increases the rate at which you eliminate Calcium in the urine: The typical American diet is packed with snack foods, canned soups and TV dinners loaded with salt.

Eating problems in elderly patients: Bad teeth, missing teeth, and plates that hurt their mouth often prevent the elderly patient from eating their food properly. These problems also prevent proper digestion and utilization of the nutrients. Most elderly patients are undernourished in every respect. When they are home, often they don’t eat because they are depressed, lonely, sick, or incapable of fixing much. Even though meals for wheels and senior center lunches encourage appetite, most meals are over cooked as well. Many times the elderly fail to eat them or only eat the dessert or parts they like. In Osteoporosis and most ailments of the elderly, nutrition is a main contributing factor to their condition or disease.

Help them start an exercise program: The majority of the elderly can start a exercise program. The exercise program will depend on the age and physical abilities. Get direction from their physical therapist or doctor. There are exercise sheets for different kinds of situations. Go over the exercises with them. Have them do the exercises with you there, to make sure they perform them correctly. Do the exercises with them. Post a weekly exercise schedule where they can see it. Check weekly to remind them.

If they are in a nursing home, get them involved in the physical activities offered by the home. If there are no activities offered, do exercises with the elderly person yourself when you can.

Medication confusion: After their diagnosis, discuss with them the suggested treatments which could be Fosamax, Actonel, or Boniva; Miacalcin, or Fortical; parathyroid medications such as Forteo; or hormonal therapy; All that information may be completely overwhelming and unclear. They may have difficulty making a decision. If you feel the medication is not appropriate, and the doctor is wrong, try to persuade them to get a second opinion.Disclaimer: This article is not intended to replace the recommendations or suggestions of your medical care provider. When ever in doubt please contact your loved ones care provider and ask them for tips and suggestions.

References:
http://www.netwellness.org/healthtopics/osteoporosis/default.cfm#Symptoms%20and%20Tests
http://www.nof.org/osteoporosis/faq.htm
http://www.nof.org/prevention/calcium2.htm

http://www.nlm.nih.gov/medlineplus/osteoporosis.html

By Christine Cadena

Diabetes in the elderly is expected to rise in the next several decades as the baby boomer population begins to enter retirement. For many elderly adults, diabetes will be a lifelong health battle and will require the attention and support of family members to ensure compliance is treatment is maintained. If you are caring for an elderly adult that is living with diabetes, is it important to understand not only what treatment is available but also what effects can arise when burnout occurs.

Burnout in any type of treatment of a chronic health condition is quite normal. In fact, when forced to manage diabetes with medications, diet and exercise, most elderly adults will simply throw their hands up and give up the realm of their diabetes regimen. For diabetes, however, treatment is vital to ensuring long term health and to prevent other health conditions from developing. For this reason, burnout must be identified early.

Non-compliance in diabetic treatment is the first sign of burnout. While it is normal for a diabetic adult to be relaxed with diet and exercise, if there are signs that medications for diabetes are not being taken or diabetic injections are not being administered, this could be indicative of far greater complications. Burnout is common and must be accepted as part of the diabetic patient’s treatment profile. Managing and minimizing burnout can be challenging.
As a loved one, caring for an elderly adult with diabetes, you will want to speak with a healthcare provider about the elements of burnout. Because diabetes is a chronic condition that required three levels of care, when burnout arises, there is usually one element of treatment that is given way. When this occurs, most healthcare professionals will recommend boosting the other two elements to ensure that the diabetes is managed as effectively as possible.
Burnout of diabetes treatment can be challenging to control and manage in the elderly. Because the elderly often become non-compliant with treatment, the tendency for burnout is not only stronger but can also be challenging to control. As a caregiver of an elderly adult, if you find that burnout is an issue, be sure to address the diabetes treatment options with a healthcare provider and boost up the other two forms of treatment when the third has reached burnout levels. In doing so, you can ensure your loved one is given the best opportunity to manage not only the diabetes but to also overcome burnout by choice and not by force.Sources: Geriatric Patients Today, 2007: 6:78-82.

Use the following checklist to assist you in assess nursing homes. If possible, both the caregiver and care recipient should be involved in the decision making process. The more an older person participates in the planning process, the easier it will be to adjust to the new environment.

The Facility

• Are there handrails along the walls?
• Are the doorways wheelchair-accessible?
• Does management take safety precautions to prevent residents from falling down stairs?
• Is the floor kept dry and free of litter?
• In case of fire, can the facility be easily evacuated?
• Are fire extinguishers easy to locate?
• Does the facility appear clean?
• Are there lingering odor?
• Do the faucets, call buttons, telephones, and television sets work?
• Are heating and cooling adequate?

Staff and Care

• Is the atmosphere pleasant?
• Do staff seem to genuinely enjoy working with the residents?
• Do staff appear to care about and respect residents?
• Are residents treated as individuals?
• Do the staff appear interested in the residents?
• Do staff seem interested in speaking to visitors or residents?
• Are your questions answered clearly, frankly, and in sufficient depth?
• Do any other residents have conditions similar to your elderly relative’s?
• Are residents clean and adequately dressed?
• Do staff appear to refrain from making unrealistic promises or predictions?
• Are the rights of the residents clearly posted?
• Is the food hot, attractive, and tasty?
• Are special diets available? What kinds?
• Does a resident have plenty of drinking water easily available?
• Are planned, posted, and varied recreational and social activities available?
• Do the listed activities seem interesting and appropriate?
• Do most of the people at an activity program seem to be participating?
• Are religious services held weekly?

Administration

• Is the facility in good standing with the state inspectors?
• Are fees competitive?
• Have fees increased significantly in the past few years?
• Is the structure easy to understand and reasonable?
• Does the institution readily reveal what service are covered in the quoted fee?
• What services are extra?
• Is Medicaid accepted? Is Medicare accepted?
• Are billing and accounting procedures understandable and acceptable?
• Is transportation of patients provided?
• Does a resident advisory council exist?
• Are visiting hours reasonable?
• Are therapeutic services available? (Speech, physical and occupational)
• Are social work services or other mental health services available?
• Are community organizations (library, church group, volunteers) involved?
• Do the charge nurses, social workers, department heads, and top-level administrators have geriatric experience and/or education?

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