By Mary Davies, an RN at Caregiver Homes.

When evaluating the potential for falls on a home visit, professionals ask themselves a few important questions that shape the consumer’s care plan. What are the biological and behavioral risks? What environmental factors might lead to falls? Has the individual fallen in the past? If this person were to fall, how severe might the injury be?

A consumer who suffers from chronic pain was unfortunately experiencing many falls. She struggled to get out of bed: she would manage to get up, stand, and then she would fall. Her medicines also made her very dizzy. I determined that a hospital bed could be a good solution. A hospital bed allowed her to adjust the position of the bed, put the head of the bed up, and then her caregiver could ease her out. The two of them worked as a team to transfer her out of bed. The hospital bed allows her to take her and time and control her position, and this device has saved her from many falls.

In order to make this recommendation, I had to observe and consider several risk areas:

Biological Risks:

• Mobility problems due to muscle weakness, age or underlying diseases
• Arthritis
• Vision
• Sensation in our feet. Many elders have neuropathy, and their feet can become numb or tingle.

Behavioral Risks:

• Inactivity: Inactivity can be the result of pain from the above biological risks.
• Medications: We caution people about the risks of prescription pain medication. Sometimes these medications can be extremely sedating, and that can make people not aware of their surroundings.
• Alcohol: There are some consumers who enjoy a glass of wine with their meal. We want consumers to enjoy full and healthy lives, and part of that means understanding how alcohol may impact safety risks.

Environmental Risks: 

The most preventable fall risks are environmental. Care Managers conduct a home assessment to make sure these areas are explored and the issues are addressed.

• Clutter. Many elders are not able to lift or pick up after themselves as they used to, so the clutter can build.
• Visibility. Poor lighting can compound already failing vision.
• Clearance. Evaluate whether there is enough space for the individual to travel with their cane, walker or wheelchair. Pay special attention to exits and entrances, making sure that in the event of an emergency, those pathways are clear.
• Floors. If scatter rugs do not have rubber backing on them, they can fly out from under you. Also, be careful with the type of floor cleaner you use.
• Lack of safety equipment: Care managers might make recommendations for replacements of items like grab bars, railings, rubber bath mats or shower chairs.

There are many considerations when managing fall risks, so it is important that the care team, caregiver and consumer work together. When all these pieces are in place, the falls risk is reduced. At Caregiver Homes, we assess these fall risk factors, develop ways for prevention, educate the caregiver and consumers about the risks, and then integrate that information into an individualized care plan.