Aging Parents: Fall Prevention-- Alert Pendant/Bracelet

Why isn't this relatively inexpensive, old technology as important to older people indoors, as an umbrella is to them outdoors when it rains?

It needn't be worn continuously--as explained in my October 10th post, but can be left near the door so that when a living-alone senior enters his or her homeit's right there; and when the senior goes out, it's left right there.

Since the statistics--that people over 65 are at greater risk of falling and the risk increases with age--are widely known….

1. Is it that older people who are fit don't think they risk of falling in their homes?
2. Do they assume if they've taken or take tai chi and/or other fall prevention classes they are exempt?
3. Do they fear paramedics will break down the door to rescue them, thus causing damage to their home?
4. Is it the expense?

There are undoubtedly countless reasons older people reject a piece of "alert" jewelry.

To set the record straight:

1. Most people fall in their homes.  Denial may be at work.
2. Fall prevention classes have clearly been shown to reduce the risk; but that doesn't mean falls don't happen.
3. The alert monitoring companies give instructions for lock boxes or other ways to make keys available so paramedics can unlock, not break down, the door.
4. There is an expense, but weigh the expense vs. parental emotional as well as physical pain, suffering, and adult children's time, energy, and stress.

Fear of falling is one of older people's most prevalent fears.  Falling and breaking a hip spells trouble: a long recovery and initially--if not forever--greatly diminished independence. (No need to spell out how this impacts caring adult children's lives.)

Falling alone in one's home means needing to painfully, slowly crawl to the telephone--usually high up off the floor and thus a challenge to pull down even when one finally reaches the phone's location.

If a hip is not initially broken, but has suffered only a hairline crack, what are the odds the hip will suffer a complete break due to crawling?

We try to help our parents age well. Wearing an "alert" pendant or bracelet can clearly help maintain quality of life.  It's an invaluable gift and hopefully a thoughtful discussion will convince parents of its value.  (I'll try to compile a list of well-thought-of companies, whose alert pendants older people like, for a post next week.)

Also check out my new site" http://helpparentsagewell.com. Same post plus informative tabs and pull-down menu.

Aging Parents: Falls and Fall Prevention-Part 3

"I tell my older patients they should have a night light in their bedroom," emphasized a highly esteemed practicing physician, on the faculty of a major teaching hospital. I had asked about his experience with older people falling, which he said increased as his long-time patients aged. And he made a case for night lights as he recounted this story about an 89-year-old man in excellent health, mentally sharp, and still working part time, who had recently experienced an avoidable, bad fall.

"Even though they know their surroundings and can find their way in the dark, a night light would have prevented this," he said. Like many, the elderly man read in bed at night. On this particular night he was reading work from his briefcase which, after finishing, he place on the floor next to his bed. He got up during the night in his unlit room, stepped--then tripped and fell--on the briefcase and papers, and sustained serious bruises, but fortunately no broken bones.

Call a night light an "environmental modification;" call it a "common sense" addition; call it a "using common sense"--like changing from unstable high heels to flattering low heels or flats. There are many "environmental modifications" that can ensure--to the best of our ability-- that aging parents' homes won't invite falls. Most of us know that scatter rugs are an accident waiting to happen and that grab bars in showers and tubs and near toilets provide stability. It's also helpful to know about AARP's free booklet "Taking Steps to Prevent Falling Head Over Heels" (see Saturday's post), which provides a short, excellent, informative guide to simple adaptations that we can help our parents make.

And while it doesn't mention the pitfalls of reading in bed and placing the reading material on the floor to trip on (my helpful hit #2), it mentions the value of night lights and good lighting more than a few times.

So check out AARP's website and search "fall prevention" and "steps to prevent falling" in some of the bulletins and pamphlets (first result). ("Better Balance Prevents Falls" is an example). Also search "inner ear and balance" for more specifics on this past Saturday's post.

Additional helpful information can be found in the book, "Fall Prevention," by Gail Davies and Fran Scully (Infinity Publishing, 2006) and at: stopfalls.org. Stopfalls.org provides a "basics" fact sheet for downloading. It reminds us that a person is more likely to fall if he or she is 80 or older or has fallen in the past;

The above reinforces the importance of letting aging parents know we won't dump them in assisted living if they tell us they have fallen. Obviously we're trying to help parents age well, so it's important to gain an understanding of why they fell and possibly involve their physician-- (which shifts the responsibility from us and we avoid seeming like were meddling).

Aging Parents: Falls and Fall Prevention-Part 2

Older people and the increased likelihood of their falling has been a major concern--no doubt for decades. The drug industry has come forth with medications to improve bone density. More recently gyms and senior centers offer programs aimed at improving balance, flexibility, muscle strength, and bone strength, among other things. And in the last 10 years or so--probably because people are living longer and the likelihood of falling increases the older one gets--the subject of older people falling has spawned considerable literature with ideas for prevention.

To say that older women suffer more fractures than older men probably comes as no surprise. But the statistics may surprise. After age 50--and increasing with age as just indicated-- up to one out of four women and one out of fifteen men can anticipate breaking a bone. Is this because: a) women outlive men; b) their bones are less strong; c) all of the preceding? No matter. If we have aging mothers we must be proactive (if they aren't) in our quest to help them age well. And let's not slight aging fathers. Bone density is also a problem for some men, so it may bear checking out in older men with slight frames.

It seems obvious that there is proactive prevention--to ward off problems before they become problems ; and reactive prevention--to deal with immediate problems. Of course, the proactive is easier. The reactive is difficult to begin with, but is made more difficult because many parents don't tell when they fall (see October post).

Starting with the proactive: When aging parents aren't already taking measures to ensure--to the extent possible--that they will not fall, what can be done that is effective, respectful, and supports self-esteem and competence. Note: I didn't write "confidence." Parents may think they have will never sustain a fall, or may be in denial, because they consider themselves healthy (they are) and "in charge."

It's best to begin this conversation before it's needed. Don't put it off if you think your parent is presently at risk of falling. If a friend should fall, this news usually travels quickly among older people and is sobering. It also provides a natural opening to suggest certain check-ups and provide some information--"some" information because we don't want to sound like "know-it-alls" (even when we think we do) or cause overload. 

The following are often associated with risk of falling, so check-ups to rule them out or identify them before they become problems makes sense.

Vision--Natural aging may cause problems distinguishing shades of dark colors that could result in missing a step at, for example, a curb or on uneven pavement on cloudy days or at night. (A small flashlight is a good gift.) Cataracts at a certain point may make night driving NOT advisable, but shouldn't affect daytime driving, until they worsen. And outdated prescription-glasses pose obvious risks.

Hearing--if balance seems to be a problem, rule out inner ear problems.

Balance, dizziness, falling asleep at the wheel (yes, it happens). Check with pharmacist to rule out medication reactions and/or contact doctor. An exam may be in order.

Proactive prevention:

Bones weaken, which makes falls more dangerous, thus becoming familiar with bone density medication, vitamins, and certain kinds of exercise (ie. walking, dancing, tai chi) to strengthen bones makes sense.

Muscles weaken, flexibility lessens, and reflexes can slow down. While this occurs naturally to some degree with aging, these changes become more pronounced for inactive people because of the "If you don't use it, you lose it" truism. 

An awareness of the above has led to fall-prevention offerings at senior centers and gyms.  Example: tai chi, a gentle but proven effective exercise for balance.  No doubt this is why these classes are popular and offered at senior centers, as are yoga and chair yoga (the latter for the less physically able). Check out "Silver Sneakers" (www.silversneakers.com), a nationally-offered exercise program designed for seniors, given at fitness centers, and covered by insurance companies (which vary by state).

Lastly, one of my two fall-prevention tips (tip 2 next post). An octogenarian tells me, that--at least with women-- vanity enters into the falls and fractures discussion. How? By the shoes women wear, that can make good balance very "ify" and perhaps even more worrisome if it's your aging mother who is teetering in them. This fall prevention "head's up" will probably be met with resistance. Indeed, this kind of discussion may be better coming from a physician. I'm not ready to give up my shoes yet and perhaps will never think I should. What about you?

"Fall Prevention" continues on Tuesday.  In the meantime, you might want to order a free copy of "Taking Steps to Prevent Falling Head Over Heels" using AARP's "Home and Community Booklets Online Order Form."

Aging Parents: Falls and Fall Prevention

Older people fall a lot. A researcher on a 2008 Oregon Research Institute study to prevent falls among older adults says "falls are a leading cause of mortality and morbidity among adults age 65 and older."*

Over the weekend I learned via email that two pioneer teachers from the early days of our high school, now in their 90's or nearly 90, had suffered broken hips. Mailing/email addresses, and telephone numbers were included so we could contact them. The email also suggested contacting Mr. W. (see my jump start post), who I visited while on vacation last month, and who the email said had fallen several times but suffered no injury. I share, in part, my email to the classmate:

I did see Mr. W and his wife. Hadn't planned to stay more than 15 minutes, but ended up staying 2 hours. It was a good stay--talked about old times, some of our class members, I provided a bit of sworn-not-to-tell gossip and left with the satisfaction of seeing two 87-year-olds who have been through a lot together and are wonderfully grounded emotionally...each in his or her own way. I guess there have been more letters, cards, etc. than they can count. And with that, I think, comes reaffirmation of a life well lived, a life of purpose and contributions.....

On that visit I too learned that they fell "a lot." Their home is well carpeted and "nothing broke." I remember a friend of my mother's in her 90's telling me a similar story. This aging--no old, but young at heart--parent fell a lot on carpeted floors and "nothing broke." She admitted she should use a cane but kept losing it in her home--"and I keep 3 canes and can never find a one," she giggled.

It drove her adult children "crazy," but they were firm in their conviction of empowering aging parents and not undermining confidence. They also knew that continued discussion on the subject of falling accomplished nothing. But they succeeded in having her wear a pendant with a button she could push for help if she fell. They decided this was better than destroying what was a wonderful relationship. And because she was a rational, old parent she knew the pendant was a good idea. In fact she pushed that button quite often and let the paramedics know which door was never locked so they could easily come and pick her up! (This also drove her adult children "crazy" but no harm ever came.)

It's probably safe to say that every person over the age of 70 knows of an aging person who has fallen and, unlike a child's fall, has sustained more than just a skinned knee. Since bones thin with aging, they are weaker and can break more easily. And healing is slower in older people. Since fear of falling and breaking a bone is very high up on the list of older people's worries, shouldn't this also concern adult children?

I realize that adding the specific information and at least one creative idea aimed at helping aging parents reduce the risk of falls and fractures will necessitate this post being too long. Thus, Saturday's post will focus on some specifics that I believe are good to know--for both adult children and their aging parents.

*Li, F., Harmer, P., Glasgow, R., Mack, K.A., Sleet, D., Fisher, K. J., Kohn, M.A., Millet, L.M., Mead, J., Xu, J., Lin, M.L., Yang, T., Sutton, B., & Tompkins, Y. (2008). Translation of an effective Tai Chi intervention into a community-based falls prevention program. American Journal of Public Health, 98(7), 1195-1198.


Please note: if you have comments click on the gmail address in the right sidebar. I continue to hear from people who are frustrated because they have spent time writing substantive comments that can't--for some reason--be posted in the comments box.

Things Most Parents Won’t Tell Us… and Why

(Because of responses to Tuesday’s post, this replaces the planned "Food" post.)

The following situations and reactions are truly not exclusive to older people. We’d probably react the same way; but when older people are involved it's different, or does it just seem different? OK. Most parents won’t tell us--

--They’ve fallen. Reason #1 for a remarkable 88-year-old mother: PRIDE. By the time her daughter found out, her mother had fallen many times and bounced back to normal without anyone’s knowing; or if they knew, they’d been sworn to secrecy. This time she broke her 88-year-old hip. It turns out a simple corrective device, placed in her shoes, was all that was needed to solve the balance problem that caused the fall in the first place. But the solution came after enduring hospitalization and rehabilitation for her hip. While she’s still a spunky and amazing 88-year-old, it did “take her down a notch.”

Reason #2: for more older parents than we realize: FEAR--of being forced to give up their home and go to a place where their adult children think falls are less likely—be it moving from a home with stairs to a one-floor apartment or to independent or assisted living, or coming to live with their adult children (granted, much less likely today than it was in previous generations)

--They’ve had a driving incident. Reason: older parents FEAR they'll have to stop driving. This fear is very prevalent. But it but needn’t be if adult children are smart like Kim (Archives: Driving Part 1); rule out medical issues that prevent people’s driving; and know about resources that enable older people to drive well longer (Archives: Driving Part 2). If it's determined that parents are no longer qualified to drive, it will be based on solid evidence. On the other hand, it makes everyone's life easier and happier if safe-driving parents continue to drive (possibly aided by programs like CarFit, http://www.car-fit.org/), as long as it remains legitimate for them to do so.

--Their problems and concerns. Reason #1: THEY STILL FEEL PROTECTIVE TOWARDS THEIR CHILDREN and don’t want to burden them, especially if the adult children are dealing with problems of their own.

Reason #2: They DON'T WANT TO BE TOLD WHAT TO DO, they just want someone to listen and someone who they know cares, to bounce ideas off of.

And to a lesser degree, depending on their children's way of responding---

--What they’re doing. Reason: NO ONE WANTS A LECTURE or being told what to do, be they children, young adults or old adults. One independent-living, 80-something-year old father said: “I told my daughter I was going to the movie with a friend and immediately was told it wasn’t wise because of swine flu. Come on. Children and people with certain conditions and are most at risk and I’m neither.” Another 80-year-old sums up the feelings of many when she confidently says “I still think I can make my own decisions.”

Basically, it seems when parents have reached a certain age and consider themselves independent and able to make good decisions, some may be protective of their adult children and most—if not all—resent unsolicited, even if well-meaning, advice for the reasons above. There is a little poem in my yet-to-be published book that goes something like this:

Our children have knowledge of important things
Things that they think we should know
Forgetting we told them those very same things
When they were young-- years ago.

Something to think about.