Preventing falls is extremely important in ensuring that elderly loved ones can remain safe and at home. Falls are the leading cause of death of people over 65, resulting in over 9,500 deaths each year. One third of those 65 and older will fall each year and two thirds of those who fall one time will fall again within six months. Half of elders who sustain a fall will never return home, spending the rest of their lives in nursing care.
According to researchers at Colorado State University, some of the risk factors for falls include:
- Osteoporosis. A decrease in bone density can cause stressed bones to break and make a person fall, and brittle bones are more likely to break during a fall.
- Lack of Physical Activity. Without exercise, elders lose muscle tone, bone mass and flexibility, meaning that they’re less likely to recover from starting to fall, and are more likely to be injured in a fall.
- Poor Vision. Lack of depth perception, sensitivity to light and blurred vision can lead elders to trip over obstacles and misjudge stairs.
- Medications. The side effects of some medications impair balance and can cause low blood pressure.
- In-home hazards. One third of falls are due to preventable in-home hazards such as torn carpets, footwear without proper treads and slippery floors.
To prevent falls, the American Academy of Family Physicians offered some guidelines for the elderly, which include:
- Wearing shoes with non-skid soles
- Ensuring that a home is well-lit with lamps and night-lights
- Fix uneven surfaces, tack down carpets, remove throw-rugs, get rid of electrical cords that cross pathways and don’t wax floors
- Have grab bars installed in bathrooms and make sure there are handrails on both sides of stairways
- Ask for help reaching high places instead of using stepladders and chairs
- Have your eyes, hearing and feet checked regularly
- If you have fallen, or if you feel confused or dizzy, see a doctor right away
- Tell a doctor if you suspect a medication is causing you to feel dizzy or lose your balance
- When getting out of bed, sit on the side of the bed for a minute or two to give your blood pressure a chance to adjust so that you don’t feel dizzy
Technology can help, too. Eldergadget.com featured some innovative products that keep elders on their feet, including rolling walkers, canes that help people stand up from a sitting position, bed rails and cushioned bath mats.
When elders receive care at home, they can get help in bathrooms or navigating stairways. Loved ones can relax knowing that someone is there making sure that home is a safe place and that elders are staying in shape and taking their medication properly.
When family members choose home care for an elderly relative, it is often because they want their loved one to recover in the comfort of their own home. Since most homes are usually not designed for someone with cognitive or physical impairment, recovering at home may require some easy, simple modifications to a home in order to keep elders safe.
Recently, the New York Times’ New Old Age blog outlined some good recommendations for keeping elders safe while recovering at home. These recommendations come from the Visiting Nurse Service of New York and were compiled by case manager Cathy Castronova.
These guidelines are especially helpful for those with dementia or Alzheimer’s, but are useful for anyone who is recovering at home with some impairment:
- Create a “wander loop” in your home, a safe pathway that allows the patient to safely roam.
Use reflector tape to create a path to the bathroom.
- Cover radiators and electrical outlets with guards.
- Lock doors that lead to places like basements and garages.
- Lock cabinets that contain liquor, medications, household chemicals and any other toxic substances that could be swallowed.
- Get rid of firearms, or store them in a locked cabinet with bullets in a separate locked cabinet.
- Install safety locks and alarms on exit doors and gates.
- Cover smooth or shiny surfaces to reduce confusing glare.
- Eliminate shadows with a lamp that reflects off the ceiling.
- Cover or remove mirrors if they are upsetting to a person with hallucinations.
- Store car keys in a locked container; disable the car.
- Do not allow unattended smoking.
- Make sure an I.D. bracelet is being worn at all times.
Castronova recommends that patients with Alzheimer’s and dementia who are receiving home care should be treated by home care workers who are specifically trained to work with each disease. Most importantly, she recommends constantly re-assessing a loved one’s abilities with the help of a nurse or physician.
Recovering at home can be a comfortable way for an elderly person or a person with Alzheimer’s or dementia to receive medical care. Family members can have peace of mind knowing that the home where their loved one is recovering is a safe environment.
In this week's New Yorker, Dr. Atul Gawande addresses an important medical service that is under-appreciated by many physicians and patients.
Patients who are immobilized after an injury are at risk for pressure ulcers, also known as bed sores or decubitus ulcers. The painful sores result from pressure that restricts blood flow, causing tissue damage.
Up to 22 percent of nursing home patients and up to 32 percent of hospital patients will experience a pressure ulcer, the severity of which may range from irritated, red skin to deep craters that leave bone and muscle exposed. Patients receiving care at home are between 7 and 21 percent less likely to develop a new pressure ulcer than those in a long-term care or acute care setting, respectively, one of the benefits of receiving at-home care.
Among those at risk for pressure ulcers include those who have suffered an immobilizing injury who are unable to relieve pressure by moving themselves, and the elderly who have reduced skin elasticity. Patients who are incontinent or who have a neurological disorder such as Parkinson’s disease or Alzheimer’s disease are also at higher risk for developing pressure ulcers.
The Centers for Disease Control and Prevention (CDC) define the severity of pressure ulcers as follows:
- Stage 1: A persistent area of skin redness (without a break in the skin) that does not disappear when pressure is relieved.
- Stage 2: A partial thickness is lost and may appear as an abrasion, blister, or shallow crater.
- Stage 3: A full thickness of skin is lost, exposing the subcutaneous tissues--presents as a deep crater with or without undermining adjacent tissue.
- Stage 4: A full thickness of skin and subcutaneous tissue are lost, exposing muscle or bone.
While more than 70 percent of Stage 2 ulcers heal within six months, only 50 percent of Stage 3 and 30 percent of Stage 4 ulcers heal within half a year. Patients with a pressure ulcer can develop blood and bone infections and can suffer from low blood pressure, fever, a fast heart rate and confusion. Serious infections are often fatal.
The National Institutes of Health offers recommendations for health care providers to prevent pressure ulcers in at-risk patients. These recommendations include conducting a full daily assessment of a patient’s skin, changing a patient’s position every two hours, exercising a patient ever y day, keeping skin clean and dry especially after a patient goes to the bathroom, and using special medical supplies such as foam cushions and sheepskin blankets.
Patients who have limited mobility or who are recovering from an injury that leaves them with restricted motion can benefit from in-home care providers who will ensure they have a lower chance of developing a pressure ulcer.
Patients who are hospitalized for surgery or who become incontinent will often receive a urinary catheter. While many catheterizations are unavoidable, studies show that up to 50 percent of catheterizations are not medically necessary. Further, a new survey shows that fewer than half of health care facilities are following recommended guidelines to decrease catheter-associated urinary tract infections (CAUTIs).
One in four patients who enters a hospital will receive an indwelling catheterization, the kind of catheter that is inserted into and remains in the bladder for an extended period of time. Unfortunately, nearly the majority of those catheters are unnecessarily placed and many catheterizations can last longer than medically necessary. According to Infection Control Today, that’s in part because of overworked hospital staff who may not have the time to respond to complex care needs.
As a result, urinary catheters are the most frequent cause of hospital acquired infection (HAI) in the United States. According to an article published in the Annals of Internal Medicine, infection frequently occurs after the placement of a catheter, and the presence of bacteria in the urine increases five percent every day a patient is catheterized. With proper infection control measures, between 17 and 69 percent of CAUTIs could be prevented. That translates to the prevention of up to 380,000 infections and 9000 deaths each year.
To decrease the number of CAUTIs, in 2009 the Centers for Disease Control and Prevention (CDC) adopted guidelines that health care facilities should follow. The guidelines addressed who should receive catheters, how they should be cared for, when they should be removed, and surveillance strategies to ensure the guidelines are followed. Unfortunately, a survey conducted last week showed that fewer than forty percent of health care facilities report that at least three quarters of their providers are applying CDC guidelines.
Patients and their loved ones can do their part to decrease the chance of contracting a CAUTI. While in the hospital, patients are advised to ask their health care provider every day if the catheter is still necessary. The CDC also has guidelines for patients, and recommends that patients do the following when coming home from the hospital with a catheter still inserted:
- Make sure to ask questions so as to understand how to care for a catheter once home from the hospital
- Contact a doctor or nurse immediately if any symptoms of a urinary tract infection develop, such as a burning pain in the lower abdomen, fever, or an increase in the frequency of urination
- Always clean hands before and during catheter care
- Keep urine bags below bladder level
- Do not tug or pull on the tubing, or twist or kink the tubing
While a catheterized patient is recovering at home, highly-trained health care providers will be able to monitor a patient’s catheter, preventing infection and giving peace of mind to patients and their families.
After an injury or illness, patients are often told they need peace, quiet and relaxation. Unfortunately, the activity in a modern hospital can keep patients up all night listening to staff pages, alarms and blaring televisions. In addition to interrupted sleep, noise can cause stress and anxiety in patients who are already suffering from confusion and pain. In some situations, extraneous noise can even lead to staff errors.
Recovering at home is one way for patients to receive care while avoiding the loud noise that is often present in a hospital setting.
A Johns Hopkins study found that the average noise level of a hospital was equal to that of a sporting event or busy freeway, with sound levels rising from 57 decibels to 72 decibels over the past 50 years. A British study found that peak noises – a dropped tray or a doctor being paged – could exceed 108 decibels, more than a chainsaw or a car horn.
Unfortunately, environmental noise is a fact of life in most hospitals. Alarms alert staff to the conditions of multiple patients on a floor, doctors and nurses conference in hallways and at nurses’ stations and laundry and food carts rumble by. Worse, sometimes food trays are dropped, doctors are paged in the middle of the night and urgent alarms pierce the usual din of beeping and whirring machines. These noises are often magnified when they bounce off linoleum floors and bare walls.
All of these sounds are vital to the operation of a hospital, but taken together can also delay a patient’s recovery. Environmental noise can disturb a patient’s sleep, leading to increased anxiety and fatigue. Loud, unexpected noises can startle a patient, increasing blood pressure and heart rate. Long-term exposure to noise levels found in most hospitals can actually induce stress-induced symptoms such as altered memory, increased agitation and lower pain tolerance. All these problems are of special concern for elderly patients.
Hospital staff members are not immune to the problem of environmental noise. At the very least, a noisy hospital makes staff members speak more loudly and feel more stress. Sensitive patient information is often shared in less-than-hushed tones, potentially breaching patient privacy. At worst, extraneous noise can lead to misunderstood directions and even medical errors.
Hospitals are working to reduce noise by installing new ceiling tiles that dampen sound, decentralizing nurses’ stations and fixing squeaky wheels on transport carts. Still, it’s impossible to completely eliminate noise from a hospital environment.
Recovering at home allows patients to relax in a quieter setting, undisturbed by late-night alarms or a roommate’s loud television. Patients are able to sleep without unnecessary interruption, and natural noise barriers such as carpeting and curtains reduce the impact of noise while patients recover at home.
Hospitalization for an acute event can be disruptive enough to a patient’s life without the added stress and missed sleep of a noisy hospital room. Recovering from a medical event in a more peaceful setting such as one’s home can reduce the amount of noise a patient experiences during the recovery process.