Fall risk is something that those of us caring for elderly loved ones face 24/7. Despite our best efforts, old folks WILL fall sometimes and it's important to know HOW to handle that situation. If you are not able to assist a fallen person to their feet, or feel uncomfortable doing so, call 911 for assistance.

• Remain CALM (even if you don't feel that way inside!). Speak clearly to the patient and look at their face when talking to them. Don't waste your time and energy fussing at them! There will be plenty of time for that later if all goes well! If the patient is obviously injured, call 911 and remain with the patient. Do not move them or get them a pillow or anything! Let them be exactly how they have fallen until the paramedics get there. Speak soothingly to the patient and help them to remain calm. Cover the fallen patient with a sheet or blanket to offset any "shocky" symptoms.

• If the person loses consciousness, ALWAYS call 911 and have them checked out at the ER. Even if they awaken and say they are fine, have them checked! Old folks are brittle and crack easily! Tiny fractures of the skull, spine and neck bones, as well as the pelvis are very common and ya won't know until the docs X-ray to check! Those little cracks and chips can cause a LOT of problems so don't wait and see... have them checked!

• If your loved one is heavy, do NOT attempt to get them up yourself. Call 911. The paramedics are trained for this kind of accident and know more about how to help a fallen person than does the average neighbor or friend. Call the pros to help you! If they believe that the patient needs to be transported to the ER, they will tell you.

• Frequently a person who has fallen will be confused and disoriented - knocked for a loop! Let them remain where they are for 5 minutes or so to allow their mind to clear a little.

• If the patient reports dizziness, begins to slur words or becomes nauseated, call 911.

• Check the patient's pupils and ensure that they are both a normal size. If their pupils are not the same size as one another, or are unusually large or small, call 911 and transport them to the ER.

• Before even attempting to move a fallen person, you must first ascertain if they have any obvious broken bones. After they have "cleared up" from the fall, ask them if they have pain. Touch their limbs and ask if they have any pain where you are touching them. When you have ascertained that they do not have any obvious broken bones, THEN you can get them a pillow or help them into a more comfortable position. If you are the least bit unsure, LEAVE THEM in the position and call 911.

• Assuming that everything seems okay and there are no obvious fractures, allow them to rest while you see how best to help them up. After falling, people are frequently uncoordinated, so even if they protest, you must insist on helping them.

• After putting a pillow under their head and 2 under their lower legs, allowing them to rest for a bit (5-15 minutes), help them into a sitting position. They may become dizzy, so again, allow them, to rest and become accustomed to that position before proceeding. WATCH the position of their limbs! Again, they may be a little loopy and may neglect to move a limb properly and cause themselves more damage. Don't assume that they will position themselves correctly.

• After being in a sitting position for a few minutes (5-10 minutes), if they are feeling okay - not dizzy or nauseated, you can attempt to help them up if they are ambulatory. Squat BEHIND them, and "bear hug" them around the waist. Slow and easy does it. Be SURE their feet are positioned correctly underneath them while rising to your feet with them. If they have fallen beside the bed, have them sit on the edge. If not, get a chair for them to sit in for a few moments. Before allowing them to sit, again, check their foot position to ensure that it's correct before allowing them to sit.*

• If at any point they report pain or dizziness, stop and call 911 for assistance.

• If your loved one has poor ambulation or is non-ambulatory, you will need assistance, unless you have a Hoyer lift available. Get a blanket or a sheet (fold in half lengthwise). Roll the blanket or sheet lengthwise about halfway. If a lift is available, use the sling in place of the folded sheet or blanket. Gently roll the person on their side and place the rolled part of the sheet or blanket as close to them as possible. Gently and slowly roll them onto their back. From the other side, feel under the person for the "roll" and unroll it toward you. This should position them in the center of the blanket or sheet. If they are not reporting any dizziness or pain, you can begin to move them. If they have fallen a short distance from their bed, you can grab the sheet and drag the person closer to the bed before attempting to lift them. If they have fallen a longer distance from their bed, you will have to carry them to their bed in the blanket or sheet. You and your assistant should squat and grab a double handful of sheet or blanket from either end (head and feet). Count and move together to slowly stand and lift the patient. Once standing, carefully move them to their bed. Place them on the bed and allow them to rest for a few moments before trying to remove the sheet or blanket from underneath them. Place a pillow under their head and two under their lower legs to slightly elevate their legs. Allow them to rest and reaccess their condition. Taking blood pressure is a good idea at this point. It's normal for it to be slightly elevated from their norm - it's an exciting experience to fall. If their blood pressure is much lower than normal, call 911.

• Again, check the patient's pupils and ensure that they are both a normal size. If their pupils are not the same size as one another, if the pupils are unusually large or small, call 911 and transport them to the ER.

• Assuming the patient is doing okay, at this point you can check for any skin breaks, scrapes, tears, etc. If the person has a scrape on their knees or elbows, etc., cleanse it with saline solution and a gauze pad, apply ointment and a telfa pad with tape (porous paper or plastic tape is best - seriously sticky tape is VERY hard to remove from thin, fragile old skin without tearing the skin, so use the paper or mesh-style plastic stuff. Use as little tape as necessary to keep the telfa pad in place. If the person has a skin tear or more serious cut that is bleeding, roll a gauze 4x4 and press it directly onto the wound. Either hold it onto the wound, applying direct pressure or secure with one strip of tape to make a pressure bandage. When the bleeding has slowed or stopped, you may remove the pressure bandage and clean up the area with saline. If the wound is still bleeding freely or oozing a lot, roll a telfa pad & apply antibiotic ointment to it. Press this directly onto the wound and tape down so that it applies pressure to the wound. You may apply a piece of 4x4 gauze or another telfa pad over this if needed. If the wound is not bleeding or oozing a lot, you may apply antibiotic ointment to a telfa pad and apply it to the wound. Secure with as little tape as needed to hold the bandage in place. You can expect bruising around a wound like this, so applying an ice pack will help relieve any pain and minimize the bleeding under the skin.

• Assuming everything has gone well, allow the person to rest for at least 2 hours if they seem okay - insist on this even if they protest. If they fall asleep, awaken them at 20 minute intervals for the next few hours. If the person cannot be aroused or is very difficult to arouse, call 911 and transport them to the ER. Check pupils and blood pressure each hour to ensure they are normal for the patient.

• Be SURE to call the patient's doctor whenever they have fallen. Even though people DO fall for innocuous reasons falling is also a symptom of other problems and should ALWAYS be reported as soon as possible to the physician so that they can decide whether the patient needs to go to the ER, come in for a visit or be allowed to remain at home.

• WATCH the patient carefully for the first 48 hours after a fall. If the patient develops any significant pain, other than a little bruising and local soreness, or any other changes in pupils, blood pressure, cognition (more confused than normal; slurring words, etc.), call their doctor for advice or take them to the ER to be checked out.

If you feel uncomfortable with doing ANY of this, PLEASE call 911 and allow the paramedics and ER to assist.

---

* When my mom fell getting out of bed unassisted early one morning, I neglected to check her foot position before I allowed her to sit. One of her feet was not pointing straight ahead, and when she sat, it cracked her femur near her hip (we heard it!). Learn from my error!!

This message has been edited. Last edited by: Moms_Buddy,

I copy this here bcause you all need to hear this .Thank you Moms_Buddy again.

"Falls can happen with someone right there. I have had Mom fall with me right by her. All anyone can do is be as vigilent as possible. She should be wearing a gait belt at all times so that the caregivers have something to grab if she starts to go down. If they are not aware of how to use gait belts properly, Home Health can send out a rehab person to demonstrate.

What you are describing sounds very similar to the ambulation behavior mom exhibited when her balance started going downhill - a vascular effect of smoking.

Has she had the pneumonia vaccine? It won't help with all types of pneumonia, but for viral types it's good.

ANY FALL SHOULD BE TAKEN SERIOUSLY whether the person has bruising, bleeding, bumps or not. Fractures of vertebrae are very common and should be followed up by a PCP or orthopedist ASAP. They are often very painful and can further make the patient more off-balance and prone to falling again.

Falls in elderly people, while mostly preventable, are inevitable, especially in people who have vascular problems. Consult with the PCP about PT and balance therapy. Best case scenario is for him to slap her in the hospital for a few days, then into a rehab for a couple of weeks to heal and to get her OFF the cigarettes. If she is not currently on O2, now would be a good time to check her O2 levels 'cause they CAN'T be good..."

Sorry any of us face falls, but it is a part of the deal.

Sis, if she's falling in the hall with a walker, I don't think a cane will help! Even the 4 footed canes are not as stable as walkers and of course, any walking aide is only useful if people will use them properly... This becomes a problem with MANY of our loved ones!

Rosie's Granddaughter, do you think it would be ok if your Granny used a cane (especially one of those with 4 feet that can stand on its own) just inside her apartment? If she absolutely refuses to use the walker in her apartment maybe she would agree with a cane.

I know I'm not familiar with your Granny's situation and my grandmother isn't at that stage yet, so I sincerely apologize if I'm over-simplifying a complicated situation.

So sorry to hear about the falls.

We do understand.

My girlfriend and I were talking yesterday that the calm days can be just as stressful because you know that most likely it is just another calm before the storm.

Granny now refuses to use her walker in her apartment...said she needs to learn to walk again without it (at 88) even though her dr and I have both asked her to use it. I know another fall will be soon. She fell two weeks ago out in the hallway WITH the walker!

One day at a time.

what an eye opener for me!
mom has fallen 2 times this month- she says that she sits on side of bed and then she accidently falls asleep.
the first time she layed there for 40? or so minutes before i heard her calling me.
she is on cumidin and it was a miricle she didnt bleed to death.
when i found her the blood has already clotted!
she wouldnt let me call ambulance or take her to e.r.
also the second time.
.same senario..but no bad cut.
i worry about internal bleeding in her brain. she was horribly bruised and cut on head the first time.
am trying to get bed railing for her but also worry she will try and climb over..
i finally got her to 'allow' me to put a baby monitor in her room so i can get to her fast if she calls me
but i deep down dont think she will use it much, cause she doesnt want to bother me... scream!!!
i find myself almost expect a crisis at any given moment
so my ulcer is eating me up and headaches are coming more in frenquency.
you have noooo idea how thankful i am for this forum!
well.. you probably do at that.

Mom's neighbor lady had an anxiety attack a week ago, and I was showing up at Mom's as the EMTs were loading her up. She asked to speak to me and they allowed this. She had called hospice before calling 911, and they had someone there to stay with her husband before the EMTs even got there. They (hospice ) contacted her daughter, and I called another neighbor, who had taken care of their little dogs, before. The darlings got their walk with someone they knew, the bird feeders got filled, hubby was cared for by a trained volunteer, daughter brought mom home, another volunteer spent the night and did the cooking and feeding, and now there is some one in and out daily to help her.
All this support from all directions, has relieved her to the point that she tells me she has been able to cut back on her on antidepression meds for now. She knows she is not in this all alone, and there really are people who will come at a call that can deal gently and firmly with the hub, and the pups will not go lacking, no matter what.
These folks came from somewhere up north, semi-retired here, and dove right to our moderate sized town's various activeties, contributing a great deal to community welfare, and being very good neighbors. It seems that now, she actually feels embraced and at home.
Just stop sometimes, and "Say hello in there". As we all know, It can mean so much.

As neighbors, I honestly beleive we have given her all the advice and help that is within reason, but there will be more, when ever. She is such a lovely, blind sided person. Always , she thought he would take care of her, and now she must be his caregiver. He is in the late eighties and she is in her late seventies. No children in common, but she has a daughter close by( 30 miles) who is coming by now and handling shopping. I met her once, at the time her main concern seemed to be the free roaming cats in the area, one I share, but for me it is way down on the list of what this neighbor needs to attend. I think things are undercontrol now, as well as they can be. Bless her heart , trying to do for him. He was a terrific friend to my Dad. It is just safety for all involved that concerns me.
I will never ignore their needs. I just can't take chances with Mom's team, bless 'em for doing what they have done for a neighbor of Mom's, It is certainly not in the job description to run next door, and chip in.
Once again, Mom ( and I) is blessed to have found such wonderful folks to be with her.

BC in that kind of situation I would most definitely help out. The fear that this precious woman could be doing more harm than good in a situation like this horrifies me to no end! She needs to understand this and if she cant then you need to intervene on their behalf. When these lovely well meaning people reach a point in life that they no longer make wise decisions they dont always reach for help...bad things happen and guilt invades a beautiful well meaning soul like you wouldnt believe...
Does this couple have adult children? If so contact them and tell them your concerns. Try their doctor, anyone who will listen to your well meaning concerns about their situation...I would if I was put in the position like you have been placed...I dont want you feeling any guilt if something happens either because thats a very real possibility here BC, you've got enough on your plate already without having to worry about a next door neighbor

Since the last time I posted here, the neighbor has "gone to the floor", 3xs. His wife had continued to call to my Mom's and hoped for help from my Mom's caregivers. It was awful to have to have a talk with them and with her about liability issues, if he got hurt, if they got hurt, and their absence from Mom. Fortunately no worse case scenarios came to pass. I felt like something scraped off of a shoe while we had this talk, I included resource info for our area, in this talk. She has since availed herself of these resources, mainly hospice, and she understands what that means. She discussed the problem with his Dr. and that was his recommendation. Not mine.
I hate to be selfish at a time like this, but I can't handle having one of Mom's team get hurt helping a neighbor, or their absence from Mom. Any one else deal with this? What do you do as a neighbor, when these things come up? This probably should be a new topic.

Jo please be careful! We cant have our gal gettin hurt like that! How awful I remember when my Hunny fell in the shower many moons ago unfortunately there were glass doors involved! Knee took quite a beating, 3 homes later the first thing that comes out during a remodel is glass doors! I dont care what anyone says its a fear of mine not to mention a well placed one! Take the doors out if ya got em shower curtains work just fine grab bars are a must and if you have ceramic anywhere in those showers that protrude and can possibly break off during a fall when trying to grab please take them out and replace with another wall tile! I wont tell you what I have seen, suffice it to say it was just THAT BAD!!
Jo I hope you feel better soon! (((hugs)))

grab bars are the best thing I have ever installed.Worked for the others and now for me.

Wow, Jo! I hope you are on the road to recovery! That old saw about how accidents happen most often at home...ummmm... more proof positive. And of the accidents that happen in the home, guess where they most frequently occur? (I think Jo already knows the answer to this one...) YEP! The bathroom!

I think about falling EVERY time I bathe or shower, not just when I have a leedle "whoops" that could have been bad but I caught myself... I hope EVERYONE reading this will do the same - never bathe or shower with your brain in idle! Even when I was a young woman, I realized that sometimes I became a little disoriented when my eyes were closed (standing in the shower); a trifle dizzy during a hot shower when I had a cold (full sinuses and congested ears); slightly inattentive when I was rushing and thinking about other things; Discombobulated and weak when bathing during a bad cold or flu... All it takes is to have one's mind outta gear for a few moments and suddenly one is looking at the shower stall from a different direction!
PAY ATTENTION! If you cannot pay attention for whatever reason, take a sponge bath.

USE those hand grips in the shower and in the tub - they are there for a reason! If you have none, get some safety bars TODAY and install them!

I am a spilled water nazi! I don't care if it's only a few drops - that's plenty enough for me to go flyin' if I hit those droplets under a full head of steam!

Jo, I hope you were able to remember WHY you fell and have taken steps to assure it doesn't happen again - at least not the same way! Be careful out there!

my worst fear is falling and injuring myself.I feel one year on the ice and broke my wrist and had to continue with my duties.I know once you have a serious injury at my age you never are the same as you were.
MY MOTHER FELL WHEN HER SHOES GRABBED THE FLLOR , SHE WENT DOWN AND BROKE HER HIP.Her life changed completely.

My father had polio when he was 14. He was told he would never walk again, but he did. Heck, he worked 42 years in a factory, climbing ladders, moving heavy objects. His left leg was paralyzed, but he could swing it from the hip, and that was how he walked. He fell frequently, and said he never got hurt because he relaxed when he went down.
Once he got AD things changed. As the disease progressed he would move his walker forward, but forget to move his feet. I can't tell you how many times I bent over, scooted underneath him, and held him up until my roommate could help me get him fully upright again. He had stages where he was very agitated, and would let go of the walker and try to run. Of course he hit the floor immediately, but somehow always avoided serious injury. I called the EMTs at least once per week.

I however, am not able to fall without getting seriously hurt. In 2003 I stumbled on the edge of the sidewalk, shattering my left ankle, and breaking my right leg. Last week I slipped in the shower and ended up with a dislocated shoulder and a mild concussion. I'm beginning to think I am rapidly progressing from caregiver to needing a caregiver.

Thanks for the idea, MariaBee - I started a discussion for Fall Prevention!
http://eldercare.infopop.cc/eve/forums?a=tpc&s=49560359...1083034&r=5071083034

I hope EVERYONE will contribute to it and to this thread... It's AMAZING how many different ways there are for doo-doo to occur! Telling YOUR story or close call may save another person from a similar or more severe mishap!!

Keep 'em comin'!

Another experience with falls.... a neighbor....So often, I feel I should have known something yesterday.... I got lucky, my Mom's neighbor was flat out lucky. She is in her late 70's, her husband is in his late 80's. She's about 5ft even, tiny, he's about 6'4". (I'm 5'7") He broke his hip about 6 months ago and has been suffering from some sort of senility for over a year. She has resisted all help, thinking (as she has told me) that he would not accept anyone but her to tend him.
He had a "sit down", in the shower, and she called me. Mom could spare me at that time so I went over. She had done most of the right things, a pillow, covered with a quilt, he was warm and comfortable. She had assured herself that there was no injury, and I think she was afraid that if she called official help, they would take him away from her. Fortunately he was on a bath mat. He was cooperative with me, and between us, protecting his feet as we did it, we were able to tug him to the bed side,using the bathmat as a slide. Then he was able to turn, get an arm up on the bed, his feet under him and an arm around my shoulder. Then we were able to rise safely so he could get in the bed. THIS WAS NUTS I should not have been a party to this. We were lucky. He was not hurt, we didn't get hurt. AGAIN I THANK THE POWER IN CHARGE, no one was hurt in this process. In a heart beat, it could have all gone very, very, wrong.
Respectfully Yours, Bobcat

I've had a few falls in the past I've had to deal with, and it's truely mind boogling how they happen and what people do about them. About 25 years ago, Mom was pulling weeds, 68 at the time. She and Dad were still very independent. Any way she slipped and fell on the patio, she was achy but Dad thought she was just briused and helped her up a flight of stairs to the bedroom. It must have been 5 hours later when they recognized that her distress was beyond normal bruising and called me to help take her to the emergency room. Well, I arrived and was glad to find they'ld called one of my brothers also. He helped me put my foot down about getting her down the stairs and into the car for transport, and convinced my Dad that EMTs were going to have to figure this out. The dear priss wanted me to help her get her girdle on, if she was going out in public, ( the ER is very public, right) and I had to convince her that they would cut it off and ruin it if she wore it. She had a broken hip and subsequently had a hip replacement. The EMTs had a devil of a time getting her out of there. So glad I turned the job over to them, but Mom and Dad both were embarressed by "the fuss".
After Dad passed, but before we got to 24/7 companionship for her, she fell in the kitchen having breakfast. She had the cordless phone with her but didn't call for help. She actually finished her breakfast by taking it off the table, and putting it in the chair. She had a phone conversation with one of my brothers and did not complain of her circumstance.
She thought if she could just get to the den, she'ld be able to get up, but she left the phone behind as she scooted herself probably about 25 feet. Then she had exhausted herself, couldn't get up and had no phone. Fortunately all 3 of us were calling in at different times of day and she only spent about 8 hours (way to long) on the floor. She got checked out OK, but the bruise on her ankle was missed and developed into a ulcer.
The surgeon recommended to us diagnosed her with veinous insufficiency and her feet started to swell. Then the podiatrist burned the tip of her toe with a drimmel(?), and said don't be concerned, it cauterizes itself, no problem. That ended up infected. Hosptalization for intraveinous antibiotics and toenail removal. Later, a liver problem that turned out to be "probably a reaction to some drug or other".
We came to within hours of losing her, because the Liver biopsy couldn't be done, because she needed fresh blood platelets administered, because she would bleed to death if they poked a hole in her liver, because the eye doctor had put her on high dose vitamens with mega E for maculer degeneration.
She truely was within hours of death before they decided Prednisone was the answer. After 2 weeks of rehab and learning to use a walker and getting an exercise regimen, she came home.
The exercises did more for her circulation than any drug, the ulcer healed, and here 2 1/2 years later, she's fiesty, her feet aren't swelling, and she takes very few pills.
Oh my, I am sorry for going on a rant, there.
Back to the topic of falling. I get there for my shift(someone is there 24/7 now) she says,"I hope that girl didn't hurt her back". I'm saying, "How would she hurt her back,Mom". She says "helping me up". I say "helping you up how Mom". She says, "Off the floor when I tried to pick up the mail". "Why didn't she tell me you fell Mom". "I told her not to bother you since everything was Ok".
I'ld always told them Mom was the boss, so this was my doing. I asked her why she told on herself if she told "the girl" not to tell, and she said " 'Cause it's OK now".
Team meeting. When is Mom the boss, when is she not? What has to be reported and why.
A few arm bruises were the only repurcusions of that incident.
I will be printing off this list of do's and don'ts, and going over it with each team member and posting it in a prominent place.
Thanks so much and respectfully yours, Bobcat

Shall we also talk about preventing falls, or should that be another thread?

I'm so thankful for our hospital bed (although mom hates it) because with the rails up at night, she can't forget that she is unable to walk without assistance and get up to go to the bathroom. This is how she had her first major fall.

Another thing I practice religiously is walking with mom wherever she goes. This is a real PITA sometimes , but between me, the walker, and the gait belt we haven't had a fall in a very long time.

Then, when I re-seat her to watch TV or to eat, etc., I MOVE the walker way out of the way. That way she can't just grab it up and take off on her own to destinations unknown. When she's ready to move, she has to call me to retrieve it for her and then we are able to do it together again.

Another item worthy of mentioning: ALL FALLS in elderly people should be taken SERIOUSLY! With few exceptions, people fall for a reason and not only can directly injure themselves from the impact of the fall, but also can loosen bits of plaque in their arteries and veins, causing a cerebral accident (TIA or stroke) or even a heart attack.

Falls should ALWAYS be reported to the physician, regardeless of outcome.