As a Consumer Directed Personal Assistance Program (CDPAP) aide, you work with chronically ill or physically disabled patients as defined by New York State’s Department of Health. In addition, you will often work with people who are elderly and at an increased risk of falling.

We’re here to help you create a plan to keep your clients safe while your work with them helps keep them in their homes.

Rates of Falls in Elderly Populations

More than one in four Americans age 65 and up fall each year, according to the U.S. Centers for Disease Control and Prevention (CDC), and unfortunately, that number is increasing each year.

According to the National Institute on Aging, six in 10 falls happen at home.

The CDC also notes that one out of five falls results in a severe injury like a fractured hip or a head injury. Those injuries send over three million older people per year to the hospital.

Falls are dangerous, costly, and after one fall, the chances of falling again double.

You can help the older adults you work with, taking precautions to prevent falls. You can also develop a plan for them and you that outlines what to do if they do fall.

Risk factors that can cause elderly people to fall

The first step to preventing and responding to falls is understanding the risk factors and causes of falls. Next, you will want to understand the patient’s history, ability, and concerns about mobility and falling.

The CDC lists several risk factors related to a person’s health and ability that contribute to falls. These include:

●       Advanced age

●       Previous falls

●       Muscle weakness

●       Gait & balance problems

●       Poor vision

●       Postural hypotension

●       Chronic conditions including arthritis, stroke, incontinence, diabetes, Parkinson’s, dementia

●       Fear of falling

Medications and devices are increasing fall risks.

Additionally, medications may play a role and increase fall risk, particularly psychoactive medications. Improper use of assistive devices like canes or walkers is also important to note as a risk factor.

Harvard Medical School’s list of drugs that can increase the risk of falls includes:

●      Anti-anxiety drugs, such as Valium and Ativan

●      Diphenhydramine (Benadryl), an antihistamine. You’ll also find this in over-the-counter sleep aids like Nyquil or combined with pain medications, such as Tylenol PM or Advil PM, since it causes drowsiness.

●      Prescription medications to treat overactive bladders, such as oxybutynin (Ditropan) and tolterodine (Detrol).

●      Tricyclic antidepressants like Elavil, which are usually prescribed to help relieve chronic pain, especially nerve pain.

●      Prescription sleep drugs, including Ambien, Sonata, and Lunesta

●      Narcotics or opioids, such as codeine, hydrocodone (Vicodin), oxycodone (Percodan, Percocet), hydromorphone (Dilaudid), and fentanyl (Duragesic).

Fall risks created by the home environment

There are also many aspects of their homes that pose risks and contribute to falls. Again, you will evaluate some of these yourself and talk with the people you are working with about these.

The CDC has listed these potential risk factors:

●       Lack of stair handrails

●       Poor stair design

●       Lack of bathroom grab bars

●       Dim lighting or glare

●       Obstacles & tripping hazards

●       Slippery or uneven surfaces

How do you evaluate if a patient is a fall risk?

The trust between you and your patient is crucial in determining whether they are at risk of falling. Unfortunately, many elderly people do not discuss falls in their homes, even with their doctors.

The CDC suggests caregivers have direct conversations with older patients that include these questions:

●       Have you fallen in the past year?

●       Do you feel unsteady when standing or walking?

●       Do you worry about falling?

Based on their answers to these questions, you’ll begin to get a sense of the patient’s understanding of their risk for falling. You can also observe their ability to walk, their strength, and their balance for yourself.

If your patient has answered yes to any of the above questions, seems unsteady walking, or has risk factors outlined above from the medical or environmental lists, they may be at an increased risk of a fall.

Their doctors can also help evaluate their strength and stability walking. You can also help by observing their footwear and eyesight and suggest keeping any eyeglass prescription up to date.

What precautions should you take with a patient that is a fall risk?

When you know your patient is at an increased risk of falling, whether from your observation, conversations with you, or their doctor’s advice, you can do things to help lower the risk.

You might move cords and rugs, so they are no longer trip hazards and keep walkways clutter-free. Where possible, you can use more lighting or brighter bulbs as well as install nightlights. If the patient is open to home modifications, installing handrails for both sides of stairways and grab bars in the bathroom are valuable changes.

Non-slip mats in the bathtub are also helpful. Double-sided tape can keep decorative throw rugs from slipping, though it is often more effective to remove them entirely.

You can also help your patient rearrange cabinets and other storage, so the items they use regularly are easily accessible, preferably without the need for a step stool.

It will also be necessary for your patient to get all of their regular health checkups. Their doctors will be able to monitor for changes and refer them for physical or occupational therapy or change their regimen.

What can you do to help patients lower their fall risk?

It is vitally important that your patient keep moving and engaging in activities to preserve their mobility. Exercise, even simple exercises like getting up from a chair and sitting down with control, can increase thigh and stabilizing muscle strength.

The CDC also stresses the importance of taking Vitamin D to improve bone, muscle, and nerve health. You can help make sure the elderly people you work with take their vitamins, along with all their prescribed medicines, every day.

Proper diet also plays a significant role, providing necessary nutrients and protein to maintain muscle health while managing weight.

Creating a plan in case of a fall

If your patient falls, it will be helpful to have already a plan for how to respond. For example, you can create a project with the person you’re caring for.

A fall that becomes an emergency will be stressful to the patient and you. You can make sure you both have the information you need by keeping a list of emergency contacts on your phone and in a high-traffic area, like on the refrigerator or by the front door.

You may also consider keeping a list of the patient’s medications, prescription, and over-the-counter, as well as any vitamins or supplements in the same spot. Paramedics and emergency doctors will need this information.

What should you do after a patient falls?

Knowing what to do if someone falls in their home is critical. Your reaction and assistance can help keep them calm and mitigate their pain or further injury.

AARP outlines some valuable information on how to evaluate how you should respond. As you might imagine, many people’s first impulse when someone falls is to help them get up. However, if the person is seriously injured, it may be better to have emergency services help move and transport them, so it’s crucial to assess their injuries first.

Assessing injuries after a fall

You will need to call 911 if they are not breathing, have lost consciousness, or are bleeding, and applying pressure to stop the bleeding isn’t working.

You should also check them for any bone fractures. As AARP outlines, if they have pain from pressure on an arm or leg, that’s a sign of a fracture and requires a call to 911.

While paramedics are on their way, you can help your patient by being calm and reassuring. Consider covering them in a blanket for comfort and to keep warm, as physical trauma from a fall could also cause some shock.

Getting up if injuries are minor

If your patient doesn’t appear to have serious injuries, you can help them slowly and carefully get up. Encourage them to use the support of sturdy furniture to make their way to a standing position. You should also be careful not to injure yourself in helping them up and be sure they can support themselves as they stand up.

The person who fell should take some time to rest after a fall. In addition to any physical injury, they have likely experienced some psychological shock. Taking some time to process the scare and rest securely will help lessen the shock.

At this point, you can also address any bruises or scrapes.

Identify the cause of the fall

Once your patient is safely upright and rested, it is essential to identify the source of the fall. The chances of falling again are significant and mitigating risks at this point is crucial.

If the home environment contributed to the fall, discuss whether the patient is open to making changes to their home as outlined above, like installing railings, lighting, or removing tripping hazards.

If the fall was likely related to their health or medications, encourage them to speak with an appropriate doctor or physical therapist to see what changes they can make or exercises they can add.

Helping your patient with a fear of falling

Addressing the specific risk factors contributing to your patient’s fall may also help them face their fear of future falls. Fear of falling often leads elderly people to avoid doing things that seem risky or possibly contribute to future falls.

However, you must help them move confidently about their life. Avoiding activity could lead to increased muscle weakness, which is a risk factor for falls.

Your role as a CDPAP aide in preventing falls in elderly people

In short, you can have a significant impact on your patient’s risk of falling. Your careful, regular attention to both their health and environment can help identify risk factors and options for mitigating them.

There are many simple things you can do for your client on your own or with the assistance of their doctors to keep them strong and healthy.

If an elderly person does experience a fall, it is important to stay calm and help assess what care they need. If they have been seriously injured, you will have a plan in place for getting emergency medical workers to your patient and providing them with all the information they need.

Because the risk of falls increases after a fall and as patients age, it is essential to be proactive in addressing any risk factors as early as possible. Falls are common and increasing in elderly patients, but they are preventable. You can be part of that solution.

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