4 Reasons to Get Elders Out of the Hospital Quickly!
Your mom just had surgery and you thought she’d be in the hospital for weeks, but she’s being discharged today! You may feel as though your mother is being pushed out of the hospital door just to make space for the next patient, but there’s a lot more to it than that.
Here are four reasons why you don’t want an elderly relative to remain in hospital any longer than necessary:
1. Bedrest is TERRIBLE!
When someone is sick or recovering after surgery, it is tempting to pamper them while they remain in bed all day long, but that is actually the worst thing for recovery. For every day of bed rest, the frail elderly lose approximately 5% of their mobility. After only a week of bedrest, they could be down by 35% of their mobility—and they may not have started with 100% prior to surgery. Getting up and out of bed is crucial to retain mobility and strength. Encouraging someone to get up periodically throughout the day will prevent the 5% mobility loss that comes with complete bedrest.
2. Hospitals make you sick!
The risk of contracting an additional illness while in hospital increases the longer you remain in hospital. Those with weakened immune systems are most likely to contract superbugs such as MRSA or C-difficile which are antibiotic resistant.
These illnesses can cause severe diarrhea which often leads to dehydration, which increases the risk of delirium—the next item on the list.
3. Delirium, Dementia or Despair?
Delirium is a state of confusion that can be mistaken for a sudden case of Alzheimer’s Disease. It is NOT a form of dementia, but it can mimic dementia. The frail elderly are at high risk of developing delirium in the hospital.
Here are some of the risk factors:
Medication changes—their regular medication routine may be changed to help with diagnosis
Interrupted sleep—injections in the middle of the night, a nurse checking in, etc.
Day/night reversal—orientation to time of day becomes difficult when lights are on all night and circadian rhythm is interrupted.
Lack of social interaction—while nurses and doctors may conduct a test or provide care, they cannot remain at a patient’s bedside for hours at a time. The loneliness and sense of isolation can cause the elderly to despair. With a sense of time interrupted, someone may believe they have been abandoned for days.
4. Get back on the john!
If an elderly person is at risk of falling or they need assistance, they won’t be permitted to toilet independently. They can press the buzzer to request help, but hospital staff may not be immediately available. In many cases, it is easier to catheterize a patient to ensure that they are not attempting to get out of bed and risk falling on their way to the bathroom.
The longer someone is catheterized, the greater the risk that they will become incontinent. The catheter holds open the muscles that usually contract to block the bladder. Those muscles will essentially become lazy. The catheter might be removed, but the muscles may have lost their ability to retract and no longer be able to contract sufficiently to contain urine.
Losing the ability to hold one’s bladder has enormous ramifications. Beyond the increased care needs, someone’s confidence and quality of life can be negatively impacted by incontinence.
The hospital is the right spot for someone who is acutely ill or injured, but it’s a terrible place to recover! Returning home as soon as possible will prevent these four risks of a prolonged hospital stay. We can help your loved one remain healthy and well!
Inclusion is a hot topic and a very important one for our elderly population. It emphasizes the importance of inviting the active participation of all citizens, including our elderly population, into our social fabric.
The Canadian Network for the Prevention of Elder Abuse (CNPEA) has reported that:
Being socially isolated is a common affliction among older adults. More than 30% of Canadian seniors are at risk of becoming socially isolated.
Isolation and loneliness are as bad for your health as smoking 15 cigarettes a day.
And, social isolation can put seniors at increased risk for elder abuse.
Inviting the elderly population into social spaces is the first step, the second next step is creating an age-friendly community.
What exactly is an age-friendly community?
Being age-friendly means that there are no barriers to accessing services in the community, regardless of age or ability. A city that is designed to include and be accessible for its elderly residents is automatically factoring in the needs of its younger population.
For example, if a community is accessible for someone using a walker or wheelchair, it is also accessible to a parent pushing a stroller. The examples that we think of quickly are usually about physical accommodation such as ramps, wider doorways, longer crosswalk signals, etc. These accessibility features are certainly important, but a truly age-friendly community is about far more than just physical accessibility.
Dr. John Lewis, professor at the University of Waterloo, points out that currently, one-quarter of Waterloo Region’s population is age 55 plus. That number is only going to increase in the next few decades. It is not acceptable that there are ageist prejudices towards 1/4 of our population! If we want to have a community that is inclusive to all members, it needs to be designed to suit those who are age 55 and older.
Age-friendly communities are about inclusion and a sense of belonging. It is about receiving the respect and dignity that all citizens deserve, regardless of ability or age.
Often, these issues relate directly to coping with ageism. Ageism is the stereotyping of and prejudices against someone because of their age. It might include automatically treating someone in a certain way, just because they appear to be a senior.
For example, assuming someone is hard of hearing because they have gray hair is an ageist stereotype. Another example is the way that professionals often speak about a senior to their family members, as though the senior is not even in the room! The conversation should be directed to the relevant person, regardless of age.
In addition to physical challenges, some people experience cognitive changes. These people deserve the same level of respect and inclusion as all other members of society. Brenda Hounam, dementia advocate and spokesperson, highly advises communicating about dementia itself. Rather than hiding her challenges with dementia, she has decided to be very public and make others aware of her disease.
Hounam suggests that people “open the doors for communication—just ask”. She feels that it is much better to ask for clarification and to communicate clearly with someone who has dementia; do not just make assumptions. She asks that people do more than just listen; she wants people to truly hear and validate what she is saying. Hounam’s overarching message is that “we are all unique, and we all have something to contribute until the last breath.”
Being inclusive and respectful of all citizens—regardless of age, ability, or illness—better allows us to fully acknowledge and appreciate the contributions of all members of society.
Driving is a very personal issue that involves strong emotions. For many seniors, driving is a privilege they’ve had for decades, and their personal sense of identity and independence is often linked to their ability to drive. When driving seems so second nature, it can be difficult for people to remember that driving is truly a privilege, not a right.
So, when is it time to give up the privilege of driving?
Oftentimes, the person who is suffering from dementia is the least aware that anything is wrong. They may not notice that their reaction time has changed, or that their judgment is off. The family are often the first ones to be concerned about driving, and rightfully so, as research shows that someone with dementia is eight times more likely to be in an accident than the average population.
Some warning signs to watch for if you have an elderly who is driving with dementia:
Damage to the car
Traffic tickets
Difficulty navigating familiar routes
Simple errands taking hours longer than necessary with no explanation
Mixing up the gas and brake pedals
Missing stop signs or traffic lights
Problems with lane changes and merging
Passenger input is required
Family refuse to get into the car
Consider the “grandchild question”: do you feel comfortable allowing the grandchildren to ride with their grandparent behind the wheel? If your answer is no, there are likely significant concerns about your loved ones’ driving ability.
If you are concerned about your loved ones’ driving, you need to speak to their doctor. It is ideal to attend a doctor’s visit with your loved one; you may also write letters to inform the doctor of the changes your loved one is experiencing.
The family doctor is required to notify the Ministry of Transportation, and it is the MTO who will revoke the licence (not the family doctor). After being notified by the family doctor, the MTO will send a letter directly to your loved one (not to the family doctor). The letter will state whether they may continue to drive, they need an assessment, more medical evidence is required, or the licence is revoked.
What happens when their licence is revoked?
If the licence is revoked, it is HIGHLY advised that your loved one’s car be removed from the property. Someone with dementia may no longer remember that they are not allowed to drive. Disabling the vehicle is an option, though it is remarkable how handy and mechanically-minded many seniors from that generation can be, so the simple options of unplugging the spark plugs or draining the battery may be insufficient. The most ideal solution is to have the vehicle removed from the property altogether to ensure that your loved one is safe, and to ensure that others are safe as well.
It is important to understand how devastating the loss of a licence can be for many seniors. It can result in loss of independence, reduced social interaction, loneliness, lowered self-esteem, depression, and increased stress on family and friends. For all of these reasons, family doctors do not just send letters to the MTO easily; they must have concrete evidence of imminent safety concerns. To minimize the negative impact of losing a licence, family and friends can assist by providing alternate means of transportation and socialization.
There are volunteer driving services that can be accessed through your local community centres or the Alzheimer’s Society. Taxi companies are often able to offer discounts to “frequent riders”. If your loved one drives less than 4000—5000km per year, then it is cheaper to take a taxi everywhere than it is to maintain the car. From a purely economic standpoint, driving may simply be too expensive compared to alternate options! Appealing to your loved one’s financial sense may be more effective than having them agree that their driving is no longer safe.
Just the other day, one of our caregivers had a question for us. She wanted to know what she should do when she is out in public with a client, and the clerk or receptionist directs all their questions to the caregiver and not to the client. She was particularly disturbed; the client she was serving that day needed physical assistance but is completely capable of making her own decisions. The receptionist was asking questions about the gentleman’s health—no one would know the answers to those questions better than the man himself!
It is unfortunate that this question even needed to be raised. Since when is it acceptable to speak about a person right in front of their face, without addressing them directly? Doesn’t this break all social norms?
What this client experienced and this caregiver witnessed is a case of ageism. Sadly, it is all too common. Ageism is assuming someone’s capabilities, preferences, tastes, etc. based solely on their perceived age. It is a form of discrimination or stereotyping.
It can happen to young people who might be told that only two young people are allowed to shop in the store at a time; more often though, ageism is experienced by those who are perceived to be elderly or infirm. Just because someone is using a walker doesn’t mean he can’t answer personal care questions; just because someone is in a wheelchair doesn’t mean she can’t make her own decisions.
How do we combat prevalent ageism?
We start by ensuring that we always address the adult to whom we are speaking—not their son or daughter, their caregiver, their spouse. We address the person directly, and speak to them in the same manner with which we’d speak to any other adult (ie: not using ‘elder speak’ which is akin to baby talk).
What do we do in a case such as our caregiver presented? We, ourselves, might be respectful and addressing elders directly, but someone else in the general public isn’t offering the same respect. How do we graciously handle that situation?
My recommendation is to set a good example by redirecting the conversation to the appropriate person. When asked a question that should have been directed to my client, I will respond with: “oh, I believe that question is for Mrs. Weber. Let’s ask her.” It may seem small and simple, but at this moment, we can afford dignity to the elder who deserves it and hopefully set a positive example to someone who is inadvertently being ageist.
Next time you are out in public, and you notice someone speaking past a senior or ignoring a senior, please speak up and encourage the respect and dignity that the senior deserves.
You grow attached to your residents and you hate to see them move on from your residence into Long Term Care. You wish you could keep them with you even longer! You may even feel a little torn because on one hand, you have grown fond of each resident and you want them to remain in your home, but you also see the toll it takes on your staff when care needs suddenly increase.
Warm Embrace can help you to have the best of both worlds! Your residents can remain living with you much longer, without placing an increased burden on your staff.
One of our greatest success stories was with a gentleman at a retirement home in Kitchener. When he moved into the retirement home, he had occasional nighttime urinary incontinence due to prostate issues. After prostate surgery, he became entirely incontinent and he wasn’t able to self-manage. Because of this, he was self-isolating, remaining in his room and not attending any activities or events.
He had AM/PM care from the LHIN, but many days he wasn’t ready to get out of bed when the PSW from the LHIN arrived. That left the retirement home staff to attend to his needs at the busiest time of day—the morning rush. He needed assistance numerous times throughout the day as well and it was taking quite a toll on the staff.
Warm Embrace was brought in to help support this gentleman so he could remain living in retirement and not move into long term care. We intentionally scheduled our service at the time of day that was heaviest for the retirement home team. That way, their efforts could be focused on other residents, knowing this gentleman was well-cared for.
Our caregivers attended to his personal care needs in the morning—on his schedule when he was ready to get up. Our caregivers ensured that he was bathed and dressed in fresh clothes. Each day, they changed the bedsheets and laundered them, along with any other soiled laundry. While this gentleman had weekly laundry included in his package, our team was responsible to immediately launder soiled items so they didn’t remain in his suite until laundry day.
Once he was dressed and ready for the day, we’d get him to breakfast and then take him on an outing. With a caregiver’s reassurance, he began leaving his room to attend events and activities. When he required assistance, we’d be right there to provide it. His confidence began to return!
Our morning visits thoroughly covered the busiest time of day, and the retirement home staff was able to provide the coverage for this gentleman required in the afternoon. Working together as a team, we supported this gentleman in remaining in his retirement home of choice for an additional three and a half years.
We are pleased to partner with you and your team to provide the same support to any of your residents who require it. We intentionally schedule our services at your highest need times of day to reduce the strain on your staff.
Our Warm Embrace caregivers can support your highest-needs residents on a one-to-one basis, freeing your staff to attend to all the other residents in their care. Together, we can help your residents to remain with you for many more years to come!
When people hear the term “advanced care planning” they often think it’s about having a will or planning a funeral. While those topics are important, they are not part of Advanced Care Planning. Advanced Care Planning is all about while you’re still alive—what happens if you are unable to make a decision for yourself? Who will make a decision on your behalf?
The person to make a decision on your behalf is called a Substitute Decision Maker (SDM). The SDM should be someone you trust, and someone who knows you very well so that they can make the types of decisions that you would make yourself. It is the responsibility of the SDM to act in your best interests and to make decisions that you would make, even if they would personally choose something different.
Did you know that you already have an SDM? Even if you haven’t selected someone, there is a hierarchy that is set out and followed, in lieu of having selected your SDM. Here is the hierarchy:
1. Guardian
2. Power of Attorney (POA) for Personal Care
3. A representative appointed by the Consent and Capacity Board
4. Spouse or partner
5. Children or parents
6. Parent with the right of access (i.e. custody)
7. Brother or sister
8. Any other relative by blood, marriage, or adoption
9. Office of the Public Guardian and Trustee
If a substitute decision-maker is required, this list is consulted—starting at the top, if someone doesn’t have number one, they move onto number two and likewise until they find someone who can act as your substitute. The catch is that you might select someone who isn’t reflected on this list. For example, you might have a really close friend who has known you for 40 years but friends don’t make the list. Instead, a long-lost cousin would qualify as “any other relative by blood, marriage or adoption.” If you would like the friend to make your decisions for you, then you need to appoint that friend as your Power of Attorney for Personal Care — then they are at the top of the hierarchy should the need ever arise.
Sometimes people figure that they have lots of relatives and people who care about them, so they don’t appoint a POA. Such situations can be tricky though. For example, if someone is in their 60’s and no longer married, but they have three adult children in their 30’s as well as parents who are aged 85 and 92 — all five of these people would need to agree on every single decision. Based on the hierarchy chart, parents and children have equal ranking; one does not trump the other. As long as the children are over age 16, they can be an SDM. In this example, there are three children over age 16 and two parents who are presumed capable and a unanimous decision would be required for any medical decisions. You can imagine how complicated this situation would become!
Looking at the hierarchy, you may be content with the automatic SDM. For many people, the automatic option is number four — spouse or partner. To be considered common-law for the purpose of assigning the SDM, the couple must have been living together for at least one year prior to the SDM being appointed.
If a couple separates or divorces, they are no longer considered under option number four. An ex-spouse of decades would be overlooked as the SDM and a distant relative could be assigned instead. If a divorcing couple were amicable and still wanted to be SDM for each other, they would need to assign each other as their POA for personal care.
The safest way to ensure that your medical decisions are made as YOU would wish is to confirm your selection for SDM or appoint a Power of Attorney for Personal Care. This eliminates possible confusion or delay as people sort through the hierarchy. Appointing an SDM or POA gives you the opportunity to discuss in advance what your wishes would be. Don’t assume that someone else would know your preferences — tell them what you would like for your own personal care.
While it is always preferable to discuss your wishes with your POA, you might be surprised to know that it is possible to appoint someone as POA without their knowledge! There is no paperwork requiring a POA to accept the position. Theoretically, someone can be appointed as a POA and never be informed. They are just called upon to act as SDM when the need arises.
However, there is no requirement that someone accepts the role of Substitute Decision Maker (SDM) at any time. A spouse who is highest on the hierarchy can refuse to act as the SDM and have the responsibility roll over to the next level. Even a POA can refuse the responsibility of the SDM and decline being involved. For this reason, it is often advised that you select an SDM or POA as well as a backup — in case your first SDM is unavailable or unwilling to act as SDM.
There are a few requirements for who is eligible to be an SDM:
1. They must be capable
2. 16 years of age or older
3. Have no court orders or separation agreements in place
4. Be available
5. Be willing to act as SDM
Beyond these basic criteria, you want to select someone who will act in your best interests, so what other criteria can you use?
Here are a few important elements to consider:
Do you trust this person to make all your decisions for you?
How well does this person react in stressful times?
How well do they handle emergencies?
Is this person willing to be your SDM? (remember—just because you appoint them, doesn't make them willing to act as SDM!)
Express your wishes to them; communicate your health care goals and preferences so they can be confident in making decisions on your behalf.
If there is ever a situation when you are unable to make your own health care decisions, you want to be certain that you have the right person in place who will make decisions that you would make for yourself — this is what Advance Care Planning is all about.
The quick synopsis of what to do for Advanced Care Planning:
Select and confirm in writing your selection of SDM or legally appoint a POA;
Ensure that person/those people are informed that they have been listed;
Provide them with information about your wishes so they can confidently decide on your behalf.
When families are seeking companionship for their loved ones—especially within retirement homes or long term care centres—some families are surprised that the minimum companionship visit is three hours. The reason we have minimums is to fulfill our mission and philosophy of care. Within the context of long term care, there is another element that is also crucial and that is providing your loved one with one-on-one undivided attention.
One-on-One Undivided Attention
One of the reasons that companionship services are so beneficial within long term care homes is your loved one receives one-on-one undivided attention. Of course, there are wonderful staff members in the long term care home who are providing various types of care and assistance, but their attention is not undivided. They are typically rushing off to attend to the next resident because there are so many people who are in need, all at the same time. Your loved one can feel this. They can feel the sense that someone is hurrying along, or watching the clock, or checking a pager or other device. While completely unintended, your loved one might not feel important at that moment.
Our companionship services are an antidote to the rushing around and unfocused attention they’re receiving. Our caregivers slow right down and sit with your loved one. They’ll exude a sense of peace and calm that says “I’m here for you, and I’m not rushing anywhere else.” Because they have the luxury of time (at least three hours), they are not watching the clock, they are not rushing off to attend to other residents. They are focused entirely on your loved one giving much-needed undivided attention for hours on end.
We have served many clients in long term care who are in the very late stages of dementia. In many cases, these clients have very little verbal communication left. Many would say that they are past being able to recognize faces, and certainly beyond knowing names.
We served one such lady at a long term care home in Kitchener. She was non-verbal and most of the time her head hung low. She rarely made eye contact and only groaned occasionally. When family enlisted our help, many others wondered why they even bothered having a caregiver visit. Others assumed this woman could not benefit from a companionship visit since she couldn’t converse.
We paired this woman with a caregiver who had a particular knack for connecting with people who are non-verbal. The caregiver spent hours with this woman, slowly getting to know her and understand her body language. She developed trust and rapport with this woman. Before long, the elderly woman was responding to the caregiver’s voice.
The woman could be sitting in her wheelchair, slumped over with her head drooping, but at the sound of the caregiver’s voice, she would suddenly open her eyes and lift her head. When the caregiver was within sight her eyes would sparkle. She knew that the caregiver was there to see her personally. That caregiver wasn’t there to help everyone; she wasn’t there to do activities with or entertain the whole crowd. She was there for the sole purpose of being with this particular woman, and the woman knew that and responded to that individual attention.
This woman—who many might have disregarded as being unresponsive or too progressed with dementia to bother providing companionship—clearly benefitted hugely. We’ll never know how much she comprehended the caregiver’s one-sided conversation, but we know that she comprehended the feelings elicited by the caregiver. The woman felt noticed and appreciated, she felt valued and she recognized that the caregiver was there for her alone.
That is why we provide companionship to clients regardless of their physical or mental diagnoses or conditions. Making that woman’s day, providing her with a sense of joy and moments of contentment and fulfilment are what it’s all about. Would you like to have the same for your loved one?
In the world of homecare, terms like ‘minimum’, ‘maximum’, and ‘eligibility’ frequently arise.
When arranging publicly-funded homecare through the LHIN, the first concern will be eligibility—is your loved one eligible for LHIN homecare? If they are, the next question will be “for how much homecare?” Publicly-funded homecare is all about eligibility and maximums—the maximum amount of service that can be provided based on eligibility.
Privatehomecare is exactly the opposite. There are no eligibility criteria, and there is no maximum amount of service. We gladly provide as much service as a client needs or wants. In fact, to ensure that clients truly are well-served, we have minimum service provisions rather than maximums.
Why do we have minimum service provisions?
Here at Warm Embrace Elder Care, we have service minimums as a way of ensuring that we always provide service in line with our philosophy of care. Here are a few important ways that minimum service provisions contribute to the fulfillment of our mission and our philosophy of care:
Promoting Abilities
Our philosophy of care is about promoting abilities and never doing for a client what he or she can manage independently. It takes significantly longer to support someone in doing a task slowly, at their ability level, than having caregivers just rush through a task on a client’s behalf. What is best for the client though? If caregivers always just do the task because it’s faster, eventually, the client will lose the ability to manage that task independently. Promoting abilities—even though it may take much longer and requires more support—is better for clients, so we allow enough time to support independence and not just do tasks ourselves.
Dignified Care
Part of dignified care is ensuring that we match each client’s individual pace. Being rushed through your daily routine, especially with something as intimate as personal care, can feel very dehumanizing. Our clients deserve the dignity of taking time and lingering over their personal routines and not being rushed by an artificial deadline imposed by a one-hour visit.
Building Rapport
Companionship is an essential element of our service. Our clients and caregivers establish a special bond, and this bond is developed by sharing quality time together. If caregivers simply rush in the door hurrying to complete a specified task in less than an hour and rush back out the door, it is difficult for rapport to develop. Slowing down and getting to know each other as human beings first, before jumping into tasks or personal care, puts the focus where it should be—on the people first and not on the tasks alone.
Comprehensive Services
When a caregiver is paired with your loved one, that caregiver is prepared to assist in numerous ways. Caregivers are able to help with numerous tasks in the time they are present—they might do some laundry, wash dishes, make dinner, help your loved one to shower and get dressed, and then run errands. The benefit of this model is that you don’t need a separate person for each task—you don’t need a driver who only does errands, and someone else who only assists with personal care, and someone else who only does laundry, etc. It’s a more comprehensive approach where all the different elements of daily life can be seamlessly woven together—the same as you weave numerous elements throughout your day. Because we’re aiming to assist with so many different elements of daily living it takes more than an hour or two to effectively assist with each.
Living and serving by our mission and our philosophy of care is what makes our service exceptional. Minimum service is the first step to abiding by our mission. Beyond the minimum, the sky is the limit! Clients don’t need to worry about exceeding the maximum or being capped at a certain level. Instead of feeling limited by caps, maximums or restraints, clients can know that we’ll be there to assist as needed.
You have a resident, Henry, who insists on “going home”. Henry is adamant that he is “getting out of here” and that you can’t stop him. As the afternoon progresses, he becomes increasingly agitated and more insistent. Henry’s agitation is contagious; other residents are upset that he is upset.
Of course, logic won’t be helpful at this point. Reminding Henry that this is his home and he has lived here for months now is not effective. In fact, the more you try to reason with him and explain that this is his home, the more upset he becomes and the more he wants to leave.
“Going home” is not about the location. It’s moreabout the feeling Henry is experiencing. Henry is trying to communicate how he feels. He wants to go home because home is a place that represents feeling safe and secure, feeling in charge, feeling productive and knowing what to do. He wants to “get out of here” because he isn’t feeling safe, in charge or productive. He’s not sure what to do, so he figures he should go home where everything will make more sense.
Answering Henry’s emotional plea with logical answers won’t work. Explaining how long he’s lived there or which city he’s in, or the fact that he chose this home when he toured with his son—none of these explanations will be helpful. Instead, he needs someone to address his emotional needs.
The challenging part is that it takes a lot of time, a lot of patience, and a lot of one-on-one focused attention to effectively help Henry. It may take more individual time than your staffing allows, and other residents may have more pressing needs. This is where Warm Embrace comes in. Our caregivers provide one-on-one support to help redirect Henry when he wants to go home.
Better yet, our caregivers proactively address Henry’s needs. Since we know that Henry is more likely to want to go home as the afternoon progresses, we schedule an afternoon visit that starts before he typically becomes agitated. We keep Henry engaged in activities and provide positive reinforcement that confirms for Henry that he’s in the right place and he belongs. When Henry is busy working on a puzzle with his caregiver, or he’s in the courtyard enjoying the sunshine, or he’s joining in the sing-a-long in a chapel, he is less likely to focus on going home.
One-on-one companionship meets Henry’s needs in a non-pharmacological way. We can help to reduce his agitation and no medication is required. Other residents are also relieved when Henry is content and not agitated. Your staff is then free to attend to the needs of all the other residents in their care, knowing that Henry is in good hands.
Which of your residents would benefit from the same support as Henry?
Do you know a senior who has suffered a serious fall? Likely you do, since approximately 30% of seniors who live in the community suffer a fall each year. The consequences of a fall can be quite serious—injury, hospitalization, even death from complications.
Did you know that falls are the cause of 90% of all hip fractures, 50% of all injury-relatedhospitalizations in seniors, and the 5th leading cause of death in the elderly?! These numbers also double when a senior has dementia. So, it is extremely vital in keeping seniors strong and steady on their feet.
Why do seniors fall in the first place?
“Falling isn’t as much about slips and trips. It’s about the failure to recover. Slips and trips happen at all ages” (Dr. George Fernie). There are various external factors at play that contribute to slips and trips; such as:
Loose carpets/rugs
Poor lighting
Unstable chairs
Steep stairs
Poor footwear (e.g. slippers)
While some falls can be attributed to tripping—such as tripping over floor mats, pets or curbs—other falls seem mysterious. The person will report that they just went down and we're not sure why. In many of those mysterious cases, the fall is due to internal factors such as:
Visual and hearing deficits
Vestibular dysfunction
Cognitive impairment
Neuropathy (abnormal sensory feedback)
Low blood pressure
Edema/swelling
Pain and foot drop
Weakness and tightness
Decreased flexibility
Slowed reflexes and balance disorders
What can we do to prevent falls?
1. Get rid of all the external factors that cause slips and trips!
Ensure that your living space has no loose carpets or rugs, the lighting is bright for increased visibility, all chairs are sturdy with armrests, everything needed is on the main floor (no stairs), and that proper footwear is worn in the house.
2. Improve balance and stability!
“She says she wants to keep living in her home. We say it starts by keeping her on her feet” (American Academy of Orthopedic Surgeons). The number one key to fall prevention is staying active! Physical activity has shown to mitigate the deathly consequences of falls – just walking, gardening or housework is enough for an elderly loved one.
However, when your elderly loved one refuses to do regular exercise the best option is to increase their base of support.
To remain balanced, there must be a stable base of support—the wider the base of support the more stable it becomes. The base of support is the invisible box that can be drawn around your feet when you are standing. Added to this is our centre of mass—which is approximately where our belly button is located.
When someone’s centre of mass is in the middle of their base of support, they are perfectly balanced. When their centre of mass begins to reach the outer edge of their base of support, they are more prone to falling.
For example, a ballerina narrows her base of support to be only one square inch when she is en pointe. Her balance is quite precarious because her base of support has been reduced. The only way that she remains upright is by perfectly hovering her centre of mass over her base of support. She is constantly adjusting to ensure that her centre of mass doesn't sway too far aware from her base of support.
In contrast, a football player crouches low and spreads his feet wide so that he has a wider base of support than he normally would. He may even put one hand to the ground adding a third point of contact and expanding his base of support further. He has a stable base of support, and his centre of mass is positioned in the middle of his base.
In the case of a frail senior, their feet may ache or have bunions, causing that person to only walk on the edges of their feet, which reduces their base of support and their balance. Instead of using the full surface of their foot, they have reduced their base of support more like a ballerina. As well, the senior’s posture may be more forward-leaning, pushing the centre of mass to the outer edge of the base of support, causing instability. A senior will not likely be crouching down to touch the ground for support, the way a football player does.
The best way to create a strong base of support is to use a walker. The four wheels of the walker expand someone’s base and provide the necessary support. Much like a football player, a well-balanced senior using a walker is less likely to fall than a senior who is precariously balancing on sore feet. If their posture is forward leaning then the walker extends the base of support ensuring that the centre of mass remains in the middle of the base of support.
Encourage the seniors in your life to carefully assess their centre of mass and base of support to ensure that they are as safely balanced as possible. Every fall that is prevented is a great success and ensures a longer and healthier life for that senior!
For example, a ballerina narrows her base of support to be only one square inch when she is en pointe. Her balance is quite precarious because her base of support has been reduced. The only way that she remains upright is by perfectly hovering her centre of mass over her base of support. She is constantly adjusting to ensure that her centre of mass doesn't sway too far aware from her base of support.
