How Preventing The First Fall In Dementia Is Vital For Quality Of Life
Are you worried about your loved one with dementia experiencing a fall?
This is a common concern among caregivers, as falls can drastically affect the quality of life for those with dementia and their caregivers.
In this episode with Dr. Pooja A. Patel, we discussed essential strategies to prevent falls and keep your loved ones safe.
Dr. Pooja A. Patel and her proactive care planning services in https://aging-together.com are designed to empower adults and their families to navigate the complexities of aging, healthcare, and long-term care with confidence and clarity.
Understanding the Importance of the First Fall
Preventing the first fall is crucial. Once someone falls, their risk of falling again doubles. This means that taking proactive steps before any incident occurs can significantly improve their safety.
Listen to your gut feeling about your loved one’s safety. If you feel something is off, trust that instinct and seek professional evaluations. Early intervention can make all the difference.
Key Factors Often Overlooked
1. Delirium and Dementia
Many caregivers are familiar with terms like “sundowning” and “hallucinations,” but delirium is often overlooked. Delirium can come and go, and it’s different from the consistent patterns of dementia symptoms.
If your loved one suddenly seems more confused than usual, it might be delirium, often triggered by infections, dehydration, or medications. Recognizing these signs early can prevent falls due to unexpected confusion.
2. Home Environment Adjustments
We often think of the obvious hazards like slippery floors, but what about the throw rugs your loved one has had for years? Their environment needs to adapt as their abilities change.
Removing these rugs, improving lighting, and ensuring clear pathways can reduce fall risks significantly. Even familiar environments can become hazardous as vision, balance, and strength decline.
3. Communication with Healthcare Providers
Effective communication with healthcare providers is essential, especially when your loved one is in a hospital setting.
Different environments can pose unique challenges, and healthcare teams need to be aware of any risks or special needs your loved one has. This can help tailor their care to prevent falls.
Balancing Independence and Safety
It’s natural to want to maintain as much independence for your loved one as possible, but safety should always come first. Finding this balance can be challenging, but approaching it with empathy and understanding can help.
Encourage your loved one to use assistive devices like walkers, even if they resist initially. Frame it in a way that shows you’re prioritizing their independence and safety rather than limiting their freedom.
Easy Wins for Caregivers
Here are some simple yet effective steps you can take today:
<p “”=””>Observe Daily Activities: Notice if your loved one struggles with balance or reaches out to grab onto things for stability.
Review Medications: Some medications can cause dizziness or drowsiness, increasing fall risk. Make sure you’re aware of these side effects.
Simplify the Environment: Remove unnecessary obstacles and make essential items easy to access. This reduces the need for potentially dangerous movements like bending or reaching.
Final Thoughts
Falls are a significant concern, but with proactive measures and an attentive approach, you can minimize the risk for your loved one with dementia.
Remember, early prevention is key, and even small changes can make a big difference.
Stay vigilant, trust your instincts, and don’t hesitate to seek professional guidance to create a safer environment for your loved one.
By focusing on these often-overlooked aspects of fall prevention, you can help ensure a safer and more comfortable life for those you care for.
Read More:
Talking About Caregiver Burnout With Michelle Gordon
Check the other podcasts: https://dignicarebydesign.com/category/podcast/
Email me at: lizette@dignicarebydesign.com
Message me at Instagram: https://www.instagram.com/thinkdifferentdementia/
Listen to the Podcast
Listen to the episode on the player above, click here to download the episode and take it with you or listen anywhere you normally listen to podcasts.
[0:01] Recently, one of my community members’ mom was in the hospital, and she was extremely concerned about her mom falling, and quite rightly so, because a fall can vastly change the quality of life of both the person you are caring for, but as well change the quality of life of you as the caregiver. And in light of that, I invited a friend of mine by the name of Pooja Patel, who is also an occupational therapist with a specialty and subspecialty in fall prevention, specifically in the hospital, but it is also applicable for our caregiving situations at home. And I invite you to listen to our episode today where we talk about why preventing that first fall for any person, but more specifically somebody living with dementia, why preventing that first fall is so, so very vital. So check out today’s episode.
[1:24] Well, welcome back to today’s episode of the podcast. I’m super excited. I have an occupational therapist friend of mine by the name of Pooja Patel, who is here today, and we are going to have a long discussion, a good discussion on falls, because falls are something that’s near and dear to my heart because it can radically overnight change people’s lives. And so I wanted to bring Pooja on today because she has way better experience and talking about fall and fall prevention than me. So I would love Pooja to introduce herself and kind of tell us a little bit about herself before we start to talk about falls. Absolutely. Lizette, thank you so much for having me on your show. I’m excited to be here. So my name is Pooja, like Lizette said.
[2:18] I’m an occupational therapist. I’ve worked in acute care, so that’s inpatient adult hospital, for seven years. I specialized in geriatrics, primarily working with adults and older adults and their families. While I was in the hospital working in acute care, I specialized further in dementia and fall prevention. During my time at the hospital, I was fortunate to sit on the hospital-wide falls committee. And with that, I was also part of a departmental committee working on fall prevention and rehab’s role with that. And through those roles that I held on top of my day-to-day practice.
[3:06] A physical therapy colleague of mine and I actually did a quality improvement project that was later implemented across the system. Now, I work at a very large system where we have close to 15 different hospitals. And so that was a big undertaking, but we’ve really created a interdisciplinary nursing and therapy-driven communication improvement. And so that was kind of the highlight of my time there, really. Oh, for sure. And I know people listening to the podcast really didn’t necessarily understand the implication of a quality improvement program for a large hospital system specifically related to falls because….
[3:55] Falls are the one thing that both put people in the hospital, but when you’re in the hospital, will keep you in the hospital because of a subsequent injury. So reducing falls in a hospital system, specifically a large one, is vitally important. And even further, communicating between different departments is challenging on a day-to-day basis because Because everybody’s got their stuff that they got to get done, you know, just for their jobs. And then trying to make sure that everybody understands how to do it to prevent that one person in the hospital from actually falling is a tremendously big task and a very big job. So kudos to you for doing that. That is awesome.
[4:45] That is a big, that’s a big, should get a big pat on the back for that. We did. It did. Got a big pat on our back. But it’s really hard. I think every family member, when a family member ends up in the hospital, you don’t want your family member to fall in the hospital too, right? That’s not something that you expect going into the hospital. And oftentimes, unfortunately, families get upset when their loved one does fall in the hospital. And it’s really hard to try and explain like, hey, we’re doing everything we possibly can, but there’s so many variables at play here that can cause somebody to fall, right? And so our role really was to come from a place of understanding and solution and try and figure out, okay, what happened during this fall so that we can
Understanding Hospital Fall Risks
[5:35] try and prevent that same situation from happening again in the future, right? And maybe it’ll save some other patients from falling as well in similar situations. So the goal really is here you learn, we analyze what happens, And then we try to implement ways to prevent that from happening again. That is so great. So you were talking about some variables. Yes. Related to falls specifically, and we’ll start in the hospital, but what are some of the biggest variables or things that happen in a hospital that contribute to somebody actually falling?
[6:08] Yeah. I mean, first and foremost, you’re in a completely different environment, right? You don’t know the environment. You don’t know if there’s different safety hazards that might be around the room or in the bathroom. Second is why you’re there, right? Are you there with an infection? Are you there because you fell? Are you there because you’re confused? Did you have surgery? You might be on a whole lot of different medications. Medications can make you dizzy. They can make you confused. They can make you tired, right? If you’ve had infections, you’re probably on antibiotics, right? That can impact your muscles.
[6:46] If you had surgery, you may have had anesthesia. That can be in your system for a long time. And that could cause you to be confused or lethargic. So there’s just those are just some few of the variables, right, that can further increase someone’s risk of passing out, losing their balance, getting dizzy and falling, right, being confused about where they are and panicking and trying to get up. Right. And then actually, lastly, you’re hooked up to a lot of things you’re not normally hooked up to. Right. So you might trip on a trip on a line, a wire, just something that you’re not used to being aware of, because that’s not what you normally have at home. Right.
[7:32] A catheter, an IV, the vital sign monitors, right? If you have a blood pressure cuff attached to you, an oxygen monitor attached to you, a heart rate monitor attached, there’s just so many variables. And then you’re usually in those very one-size-fits-nobody hospital gowns, right? So then you’re tripping on it or you’re really like not really in there all the way and you just don’t know what you’re grabbing and you’re getting tripped up on that too. And so there’s just so So many things that could cause a trip for you to fall. So in those variables, are those variables very different for somebody in a hospital versus at home? For those specifically, I’d say, yeah. I mean, at home, you’re going to have clothes on that you bet you, right? You’re going to be in an environment where you know where everything is. You are likely not going to have as many lines attached to you. Now, some people do have catheters at home or they might wear a heart monitor, but that’s not necessarily something that is new to you if you live with it, unless, of course, you’re going home from the hospital and it’s new for you.
[8:41] But generally, you know where that stuff is, right? On your home medications, you generally know how you feel and you’re hopefully not taking any brand new medications that would have severe side effects, right? Unless, again, you were in the hospital or if you had a change in dose of your medications or something like that. Generally, you don’t tend to wake up confused in your own home unless you are actively battling an infection or if unless you have dementia or delirium that is known, right? So a lot of those specific variables would not be there at home necessarily.
Risk Factors for Falling
[9:20] Now, that doesn’t take away from the fact that risk factors for falling don’t change, right? Right. So if you’re at risk for falling at home, you’re even more at risk for falling in the hospital. That doesn’t necessarily change. So tell people what are some of those risk factors for falling?
[9:41] I would say, first and foremost, the two that always bring a laugh, but unfortunately are very true, being over 80 years old and being a woman, right? Those two are the biggest risk factors. After that, it’s things like poor bone health, having poor balance, using a mobility device, cognitive changes or issues, sensory issues. So if you have numbness or tingling, or if you have vision or hearing deficits, mostly sleep vision, you know. So those are risk factors that don’t change based on your environment, right? You’re going to, you’re still going to be 80 at a hospital or at home. You’re still going to be a woman. You’re still going to be using an assistive device to walk around if you normally use a walker or a cane, right? Or you should be, correct.
[10:32] If you can’t see at home, you probably still can’t see in the hospital, right? So those kind of things don’t really change from one place to another, and those risk factors are there. So what I hear you saying is if you’re at risk for falling, you’re at risk for falling. It doesn’t really matter where you are. Correct. So just because what I want people to take away is just it’s not because somebody is necessarily in the hospital that they fell. They were at risk for falling at home already. They just hadn’t fallen yet if they fall in a hospital.
Personal Fall Stories
[11:07] Yes, there are some mitigating reasons that could have contributed to that fall in the hospital. But if you fall in a hospital, you were probably at risk for falling at home. You just hadn’t done it yet. In most cases, right? I would say probably in 99% of cases, that’s true, right? Of course, every now and then you’ll have a very, very active fit person who’s independent and younger and doing fine, right? But maybe they had anesthesia and they woke up and they were just like very confused and ended up falling.
[11:40] Or, you know, we’ve had, I’ve heard stories of like, postpartum women after giving birth, they’ll pass out, right? They think they’re fine, they go in the bathroom, and then they pass out because it’s their first time getting up. So like, I’ve heard stories of like younger people, sometimes just because they are overconfident in their abilities, generally, right? Like think we’re invincible. Yeah, we’re invincible. Like we’re fine, right? We can just get right back up and go back to running. But so that happens very rarely, though, I would say. In most cases, it’s generally yes. You were probably already at risk for falling and it just happened to be in the hospital because there were more variables at play. Right. So I want to tell everybody a really funny story about me falling one time. Oh, no.
[12:23] Well, so how many falls do you have to have at 54 before you’re at risk for falling, right? One is too many. I know. I understand. This was stupid. We had just moved and I am petrified of spiders, petrified, hate them. And there’s no good, there’s the only good spider is a dead spider. That’s my philosophy.
[12:45] And we had one of these, I forgot the name of them, but they make a web every night and they’re beautiful, beautiful webs. And the spider is yellow and black and a pretty big spider. And he’d been living out in my backyard for a while. And every day I would look at him and he was gorgeous and stuff. And And we had just moved and we had a whole bunch of boxes that needed to go to the street. And one day I came outside and I picked up the boxes. And as I’m walking through the front yard, new front yard, didn’t know where all the holes and divots in the lawn was. And I started to think, oh, crud, I hadn’t seen the spider. That spider’s on the box. It’s going to walk on me. And so I’m freaking out trying to think where the spider is and I didn’t see the hole. And then I stepped in the hole and landed my bottom on the lawn in front of the house. So yes, it happens. You know, everybody falls, but our job is to try to mitigate falls as much as possible. So how can families figure out or assess the risk of their person at home? And what kind of things do they need to be looking for? I think first and foremost, it’s just observation, right? Are they walking funny? Do they feel like they’re walking differently than they normally walk around?
Observing Changes in Mobility
[14:07] Do you feel like they’re losing their balance a lot? Do you find them reaching for things to grab onto when they’re walking around, right? This is if someone doesn’t normally use a cane or a walker and now you’re identifying that, oh yeah, they try to reach for a counter or a chair to try and hold on or the walls or the door frames when they’re entering rooms.
[14:29] So those are things that I think are easy enough to observe, right? Secondary, I would say getting some oversight over their doctor’s appointments, their medications that they’re taking. Are there changes in medications? Are there medications they’re taking that increase their risk for dizziness or drowsiness, right? Because those can lead to falls even at home. And then cognition. Do you feel like they’re still able to make safe decisions at home? Do they have good problem-solving skills? Do they have good judgment? Do they know not to climb up that stepladder to grab something from the top cabinet, even though they think they can, right?
[15:09] What does that look like? And those are the things that your family member will tell you, right? You call them and they’ll be like, oh, yeah, I reached up and got this out of the cabinet. Oh, how’d you get up there? Oh, I just stepped on the stepladder. And you’re like, mom, stop doing that. You’re not supposed to be doing that, right? And so just having those conversations, I think those are kind of the little things on your day to day that are kind of easy to pick out as far as will they be at risk for falling? So I always tell people the scientific part of their anatomy, their gut already knows if somebody is going if somebody is at risk for falls. I honestly believe people intuitively know when somebody is not safe anymore. We just don’t like to acknowledge that our gutter intuition is necessarily right because the moment I start to.
[16:11] Say to myself out loud, I don’t think this person specifically in terms of people living with dementia, but the moment we start to acknowledge the fact that we don’t feel they’re safe anymore, it means we have to do something about it and we don’t want to do something about it. We don’t want to rock the boat. We don’t want anything to change as long as mom who has dementia is in that little bubble and she’s coping, I’m not going to rock the boat until something happens. But we intuitively know that that person is fixing to have something happen.
Assessing Home Environments
[16:55] Yeah. I would say, I’ll add, the other big, big thing is environment, right? You just scan where they live. Are there a lot of low sitting spaces and surfaces? Are there a lot of cords and tangled wires that you can trip on? Are there a lot of those very pretty, very slippery rugs in every single room, right? Is it mostly flooring or is it mostly carpet? Flooring is easier to slide on if they’re wearing socks around the house, right? So it really, even just looking at the environment for those few things, do they have to reach over a table to reach a remote or a phone or a light switch, right? So these things that seem normal, right? Things that we would often overlook, right? I’m always reaching over stuff I shouldn’t be reaching over to grab something.
[17:49] That gets harder and it gets riskier as someone gets older, right? And, you know, I think to your point, you bring up a very valid point when we’re younger. Now, if you’re just listening to the podcast, Pooja’s significantly younger than me, and I’m 54 in September.
[18:09] So younger than 54 and accommodating for doing things that reaching over stuff to get to the remote, or being able to live in a house with multiple throw rugs, or your lighting in the house is adequate at 54, but when you’re 84, it’s not, right? All of these things change over time. But I believe what happens for a lot of people is mom has been living in that environment for 50 years, and she’s been okay in that environment for 50 years, but her body has changed, her vision has changed, her balance has changed, her strength has changed. And the things that she’s been doing and being able to manage and accommodate for in the environment for that period of time may not still be that way. I look at my mom and dad, they have, this is my biggest, one of my biggest frustrations is they have multiple, multiple, multiple, multiple throw rugs. And I cannot tell you how many times we have had the conversation that you’re going to fall over this stupid throw rug, right? And it did cause my mom a fall a year and a half ago that she didn’t break anything. But from that point on, I 100% know her mobility changed. She is now afraid. And now she will not use the device because she’s only got one arm.
[19:38] So she’s a furniture cruiser, heavy handhold, and petrified of walking any place where there’s not something for her to hold on to. But I cannot convince them to pick up the throw rugs.
[19:51] Because it’s the assistive devices problem, right? It’s not the throat rugs that’s the problem. Correct. Well, no, I don’t even know what the problem was that day, but there wasn’t an assistive device at all. She won’t use them. And so as a therapist, that can be very frustrating because I know that she would be safer with some sort of a device. And I 100% know that both of them would be safer without these multiple, multiple throw rugs in their house. And nursing, home health nursing, PT, OT, you name it, everybody has expressed their professional opinion that it is safer for them to have these things removed. But the reality is it’s their home. And until something happens, I really can’t do anything. Time to get a whole roll of Dysum and just stick it on. You know what? Dyson isn’t even going to work. Legitimately, you want to know what I did when my dad came out of the hospital? I duct taped it down. Fair. That gives you the bevel too, right? Yep. I duct taped over the top of the carpet because they would not let me pick up. I picked up what I could and then I duct taped the rest.
[21:06] Right. Yeah. If you’re not going to let me pick it up, then you’re going to see this eye sore for your safety. For sure. So for people who are, you know, family caregivers who might be concerned for their family, we’re going to, I’m going to ask you a question related to home. So what kind of things can we do or increase at home to help try to keep somebody safe and preventable? And then what kind of things can we do and teach people if their person falls and is in the hospital to prevent a fall in the hospital? Are you feeling stressed as a Christian dementia caregiver? Let me help.
[21:51] I offer a monthly dementia care audit to one listener of this program to provide you with personalized but evidence-based strategies from a biblical perspective. We only have one session available each month. Don’t miss this opportunity to make your dementia caregiving journey easier. Easier schedule your own dementia care audit today so i’ll start with the first part which is at home right the number one place where older adults fall is the bathroom 80 of falls in seniors are in the bathroom and that’s because
Home Safety Recommendations
[22:35] things are slippery especially if you have throw rugs after a shower. If you’ve got an older gentleman who likes to stand for urination, then sometimes that gets on the floor. It’s just a very slippery environment. You’re washing your hands, water gets on the floor. You’re brushing your teeth, washing your face, water gets on the floor. Right? So it’s just a very wet and slippery environment. And on top of that, if it’s a small space, then you’re trying to navigate around a lot of small things within a small space. So that increases your risk of not being able to catch your balance if something happens, right? Because you don’t really have a whole lot of movement to do.
[23:19] Sometimes smaller spaces are nice because you have something to grab onto all the time. But that also makes you less careful because you were like, oh, I can just grab onto something, right? Tubs, bane of our existence, Right. People love tubs. Even if they don’t like baths, they still like having an old school tub in the bathroom. And so stepping over that tub or even just hitting it, you can lose your balance and tumble backwards into the bathtub. Right. I’ve heard that. I’ve seen that.
[23:47] Happen. Toilets, trying to get up and down from the toilets, or if you’re reaching for toilet tissue paper that’s too far, or if you’re trying to reach over to the sink to turn it on while you’re sitting on the toilet, right? There’s just so many reasons that you might want to reach outside of your base of support, which is the balance of your body, right? If you want to reach out of that, there’s so many ways to fall either forward or sideways. And then especially in those small spaces. Now, let’s say you’re sitting on the toilet and you’re reaching over to the tub to turn the shower on because you want it to get warmed up before you step in, or you reach over to turn the sink on because you want the water running. And then you lose your balance and you fall sideways. And there’s this small, tiny little gap between the toilet and the vanity or between the toilet and the tub. And now you’re stuck in this really small space. It’s really easy to get hurt, right? It’s really easy to stay stuck. And then you’re down longer because you can’t figure out how to get up because you’re stuck there in a weird spot, right? So it just becomes a really risky situation.
[24:56] Things to do about this, right? Any home safety assessment or occupational therapist, physical therapist, nurse, anyone who enters your home is going to give you the standard recommendations for a safer bathroom. A shower chair for a walk-in shower or a bathtub transfer for the tubs. Grab bars that are constructed and not clamped, not sealed, not heavy-duty ones on the suctioned. You want the ones that are drilled in for good measure. Get rid of those throw rugs, right? That’s a big one. Grab bars around the toilet so you have something to hold on to that’s sturdy and not just a vanity or just the tub or the shower rod, the towel rod. I get that all the time, right? The teller rods are not sturdy to carry over 100 pounds of weight for you to pull up on. So those would be the biggest thing. And lighting. Lighting’s another big one. Often people like to have their bathrooms dim or just, you know, especially for those who enjoy a good bath, they like having dim lighting, right, in the bathrooms. Well, that’s a safety risk, especially for an older adult who might not be able to see very well. Maybe they can’t see if something dropped off the counter and is now in their way, now they’re going to chirp on it. Right. Um.
[26:10] So those are some of the things. If they really want that, then install a dimmer, right? So at least at night, it can be bright enough for them to see. And if they’re taking a bath, they can dim it if they want to, right? So those would be like the go-to home safety recommendations for the bathrooms that most people will get recommended for. Now, outside of the bathroom, the second most common, it’s usually a toss-up between a living room or the bedroom. It depends on where they spend the most of their time, right? Right. But that’s often because of cords. Right. There’s telephone cords. I don’t think I see as many landlines anymore. So hopefully there’s not as many corded phones in people’s living rooms and bedrooms as much anymore. But there’s still like lamp wires or cell phone charging cables or just any sort of cables. There’s still often so many wires just hanging out everywhere. So getting Getting, being able to clip those or get them out of the way so that they’re not hanging, right? Light switches, can they be remote controlled or phone controlled so that you don’t have to reach too far if the switch isn’t far enough for them, right?
Communicating with Hospital Staff
[27:18] Especially at night, if they want to get out of bed in their bedrooms, right? If they want to get out of bed to the bathroom, they have to, do they have to walk in the dark to turn the light on or are they able to turn a light on before getting out of bed, right? So they don’t fall out of bed. We get a lot of slips out of bed because they can’t see where they’re going or they’re tangled up in the sheets. So lighting is a big thing, but cords and just the general environment for safety is another. Now, moving into the hospital, if you have a family member who has fallen at home or has been told that there are a risk at falls for home, if you know that they have vision needs or hearing needs or cognitive needs, it’s important to communicate that to the hospital staff, right? Because what you have decided works at home is not going to translate very well to the hospital. But you want to try to, right? You want to try and translate as much as you can. So if they need glasses to see, you want to make sure they have their glasses. If they need hearing aids, you want to make sure they’re charged and they have them. If you know that they benefit from having signs at home, around the home, right, as reminders or something. That’s important for us to know because we can do that in the hospital, right? We can put up a sign that says, please call, right? Or a sign that says your bathroom’s on the left, right? Or you’re in the hospital. Just so they don’t, if they’re confused, they have something that they already know works.
[28:46] It’s important to know if there are medications that make them confused or dizzy, because then And in the hospital, the nurse knows that, OK, once the person has this medication, we need to keep a higher, we need to keep a better look on this person, especially if they’re going to try and get up.
[29:06] In the hospital, it’s really just a lot of that communication. A lot of family members want to really try and just help their family member up when they want to get up. But because of all these different things that might be going on, even a family member could be assisting their family member in the hospital to the bathroom, and then there’s a fall, right? Because they weren’t expecting all these extra variables that we talked about earlier. And so it’s really important to communicate that to the hospital staff because the hospital staff can then try their best to work all together to minimize the risk of that person falling. So are there effective interventions that you’ve used in the hospital that people can use at home? Yes. Yeah. I would say that. I mean, environmental modifications, again, is the biggest one, right? Making sure there’s a clear path from the bed to the bathroom. We do that in the hospital. We recommend it for home.
[30:03] Communication is huge, right? So interdisciplinary communication in the hospital between nursing and doctors and the therapy team to make sure that everyone’s on the same page as far as how does the person move? Do we need to be hands-on? Do they need any sort of assistive device to move around? And that translates to home if the person’s getting up on their own or if they have hired caregivers or home health support, or if it’s family members, right? If their granddaughter’s home from school and wants to go hang out with grandma for the day, what does she need to know, right? About when grandma gets up, how to help her, or anything that would be necessary for any caregiver to know at home, right? Communication is a big one. And then something we do very frequently in the hospital that I don’t often see recommended for home, but I would like to see it implemented at home more, is delirium assessments, right? Delirium risk assessments.
Delirium and Fall Risk
[31:02] So delirium is when someone becomes confused for a short period of time because of some reason. And generally, once that reason is resolved, the confusion goes away. way. But during that time frame, right, of that confusion, a person’s at increased risk for falling because they’re confused about what’s going on. Maybe they forget that they normally use a cane or a walker. Maybe they forget that they’re in a different room or what time of day it is or anything, right? It could be anything. And so in the hospital, you try to be really diligent about screening for delirium, especially if they’ve had surgery or if they’re on a new medication or if they’ve been stuck in the room for more than 10 hours so that they know what time of day it is, where they are, or what’s going on.
[31:48] And then based on how they do on that, and if they have any other risk factors, right, if they’re over 80, if they’re female, if they’re a woman, if they’re known to have cognitive decline, right, if they have vision and hearing challenges, we want to make sure that we have enough assessment and intervention in place around that to minimize the risk of delirium. And I’d like to see that transfer to home because, unfortunately, it does happen at home, especially for those with cognitive changes or diagnosed dementia. We hear it as their sundowning, right? But even within sundowning, sometimes there’s delirium, right? And so sundowning is more consistent. There’s like a pattern to it, right? But delirium can show up in either time frames, right? And so it’s important to be able to then differentiate, is this person delirious or is it the dementia or are they suntowning, right? But even pain meds, right? Pain meds can make someone delirium. Pain meds can make someone delirious, right? I’ve seen that with so many patients over the years, right? They end up coming with pain or post-surgery and they’re on these very high -dose pain medications, and then they’re feeling loopy, and then they’re confused, and then it’s just kind of a downward battle from there, right? And then you take them off the pain meds, and they’re good as new. They’re fine, right? Nothing happens.
[33:15] And that can happen at home too, right? If they get into a rhythm of just getting pain medications at home, and then sometimes those pain medications are a higher dose, or if they’re mixed with something that they don’t normally take or drink, right? That can cause confusion. It can cause delirium, right? And so we want to address that factor too of being able to assess for any risks that could lead to delirium at home too. And I just don’t think there’s enough education or awareness around it for family caregivers. I think oftentimes we really leave it to the professionals to do that and intervene as necessary. But professionals aren’t always around at home, right? So how can family assess for that if that’s a concern? So it’s really interesting that you bring up delirium because before you and I started recording this podcast today, I did a whole series of five quick tips episodes that I’ve I’ve been recording and the last one was, would have, will have come out on the Friday before this one airs today’s episode. I talked about hallucinations and delusions and I brought up delirium in that episode. And I said, oh, I need to do a whole episode on delirium. So it’s twice now. I’m like, okay, I think the next episode after this one’s going to be on delirium because Because you’re right.
[34:44] Delirium is different and it comes and goes and we don’t necessarily recognize it for what it is.
[34:50] Right. And especially in the hospital, you have been so many times when we’ll talk with nursing and they say, oh, they’re confused. They have dementia. And we go in and we’re like, no, I think they’re just delirious. Right. And sometimes to the untrained eye, it’s very easy to be like, oh, yeah, they’re older. They have dementia. But we have so many people now who are in their 80s, 90s, 100s, sharp as the tack. And it’s really important to identify if it’s truly a chronic cognitive change,
Cognitive Assessments for Safety
[35:26] or if it’s an acute cognitive change that is likely delirium. And I think that’s a really important piece to differentiate. Oh, I agree. And I find it really interesting. Interesting i don’t know if you’ve i know we’ve kind of sidetracked a little bit here but delirium is very interesting it’s an interesting topic but have you heard anywhere when i did several of my certifications in in dementia and dementia caregiving have you ever heard that.
[35:58] People who hallucinate bugs typically have delirium. Have you ever heard that? No. So in one of my certification classes, apparently, and I should actually go research and see if I can find it independent of this class that I took, but I was taught that when people are hallucinating bugs, frequently they are having a delirious episode as opposed to people who are hallucinating other things like children or people, other people.
[36:30] And I have found experientially in acute care, when people have been hallucinating bugs, it was delirium. It was not an acute, it was not a hallucination per se. It was a delirium. It was a hallucination consistent with delirium by hallucinating bugs. And ever since I found that it out. I’ve paid attention to when people tell me that they’re hallucinating and you can almost see there is like, it seems to be fairly consistent that when somebody’s hallucinating bugs, it’s more likely a delirium, a hallucination from a delirium and not from dementia.
[37:13] That’s interesting. I wonder, I’d be curious if you find that study. Yeah, I would be curious too. If it’s correlational or if they actually did delirium screening on every individual who was verbalizing hallucinations and then identified that they were delirious. I have no idea. Like I said, I never went back and researched it because it was a certification class. You know how it is. You get a lot of this information and then sometimes it’s hard to track back where does it come from. Yeah. And since you mentioned hallucinations and delusions, I think it’s important to identify that those also increase someone’s risk for falling, right? So if someone’s hallucinating, that obviously audio, auditory hallucinations are…
[38:05] Devastating. And if someone’s hearing somebody to go get up and go do something, and this person is generally bedridden or needs help getting up, and they’re hearing these voices telling them to get up and do something, they’re going to try and get up and do something because in that moment, they don’t remember that they need help, right? Visual hallucinations are also difficult because Because they might see something and they want to go grab it or they want to go get rid of it, right? Often you’ll see someone kind of, I mean, when you said bugs, right? People are trying to swat things away because they think they’re there. And if they’re not, they’re swatting at the air. But in doing so, they might lose their balance and then fall, right? And so it’s important to understand that too. that can also cause falls. For sure. So what would you tell caregivers about managing the balance between independence and safety? This is a hard one. I know.
[39:13] I’ve dealt with this a lot in the hospital as well as with my caregiver coaching now. But it’s hard, right? You want them to maintain their independence, but you want them to do it safely. Sometimes it’s kind of what you did with the duct tape, right? If you’re not going to get rid of them, it’s your house, you want them there, that’s fine.
[39:35] We’re going to put something down so that we can make this safer for you, right? Meeting them kind of where they’re at is often the easier part, or not the easier part, I should say, is often the recommended situation. Other than that, it’s often either Either you’re going to butt heads a lot because you’re asking them to do things safely so that they can keep doing it and they won’t listen. I often recommend if you find that what you’re suggesting is not being received well, then try to find an alternative and figure out how you can meet in the middle and really come from a place of, I want to make sure that you are safe, right? It’s not about you’re going to lose your balance. You’re going to fall. all. You’re going to end up in the hospital. You put it on yourself, right? I want to make sure that you’re safe because I care about you, because I love you. I don’t want you to get hurt, right? And so then it doesn’t feel like you’re attacking them or trying to take away something that is important to them. And instead, you’re coming from a place of love and care, and hopefully they can see that. I’ve heard people.
[40:48] I’ve heard families say that that generally works, usually reframing it so that it’s coming from a place of loving care and not from a place of attacking or trying to change how they do things. Because oftentimes, you know, older adults already deal with a lot of loss of purpose and individuality. And then when you have family telling them that they can’t do something or they should do something differently, it really isolates them even more.
[41:14] So that’s usually my biggest recommendation, I know obviously if it really becomes hazardous or at super high risk, they’ve already fallen up multiple times and they’re just one fall away from breaking something or really getting injured, then at that time, it really comes down to making some really difficult decisions, right? Does this person need 24-hour care? Does this person need to move into more of a supportive living environment? And what does that look like? Right.
[41:39] So in what you just spoke of, is that more for people who you can still reason with, as opposed to somebody living with dementia who has lost the ability to reason? Because I’ll use one of my current clients right now as an example. Her mom has moderate dementia, mild to moderate dementia, and should be using a walker, has home health right now. PT is working with her on using a rollator, but she walks away from it and she doesn’t remember at all to use the walker. And we’ve been working on strategies. What I told her was, if your mom values that information, if she wants to learn how to use the rollator, she might still be able to learn, but she has to want to do it. And if she doesn’t, she’s not going to learn how to use the rollator. And so then it really does become an external reminder all the time to use it for safety, but you cannot always do that. Even in a facility, the person could walk away from the rollator. So I guess my takeaway for people who are helping somebody living with dementia is that you can do as much as you can do, but they may They always, because of their cognitive loss, they are always going to be at risk for falling.
[43:05] It doesn’t, we can put them in bubble wrap. We can do all of the things to change it as much as we can, but we just have to accept at some point or another, it is likely going to happen. At some point, like you said, to answer your question, yes, the whole I statements and reframing it to the place of love and care is very much with someone you can reason with, right? It’s someone who is giving pushback because they’re feeling like they’re losing their independence, because they’re feeling like they’re being told what to do, right? And they have the ability to understand where you’re coming from. Now, it’s very likely that because all their cognitive skills are intact, they very much still can say, I understand where you’re coming from, but I’m still not going to do it, right? Oh, I’ve had that too. That’s different. That’s different. I mean, and that at that point, you just can’t do anything about it, right? You can’t tell them, you don’t want to tell them what to do. And quite frankly, even if you do, they’re not going to listen. They’re still not going to do it. And then it’s maintaining the relationship a little more because eventually over time, they may need that help.
[44:09] So a couple of last questions. What role does cognitive evaluations or assessment play in fall prevention and how can we use them in both the hospital and at home? So a little similar to assessing for delirium risk, but cognitive challenges also can increase one’s risk for falling tremendously. So in the hospital, we try to do a basic screening to understand if they have good safety awareness, good facial spatial awareness, good judgment, right? Can they make decent decisions based on what the environment presents? And then problem solving. If something’s not going the right way, can they problem solve their way through it, right? Because those are all skills, cognitive skills, that are required to help analyze a safe situation that may prevent a fall. If they are having trouble with those areas, including memory, so especially in the hospital, we’re often telling patients, call before you get up. Make sure you call the nurse if you want to get up. Don’t get up by yourself. Please call if you need help. And if they have short-term memory deficits, they’re not going to remember that. They’re not doing it on purpose. They’re not willingly getting out of bed when you’ve asked them not to, right? They just simply forget. And they’re going based on their basic needs. They need to use the restroom. They’re going to get out of bed and go.
[45:33] So it’s important to understand that so then you can put specific interventions in place. In a hospital that looks like alarms, bed alarms, chair alarms, so that they’re motion sensors, so that when they start getting up, it alerts the nurse or anyone on the floor that, hey, this person is getting up. They shouldn’t be getting up by themselves. Can somebody go help them? It’s like putting reminders or visual and verbal, visual and written instructions of where is the button? What does it look like? When should you be pressing it? it so that if they are, and it should be in a spot that they can look at directly, that they’re going to frequently look at, right? So that they see that, right? Hey, I need to call. I want to get up. I need to call.
[46:17] So it’s things like that. And then for, again, safety, judgment, problem solving, all of that basically encourages us to communicate the fact that this person needs help when they get up. They shouldn’t be left alone if they’re going to be up and at it either in the room or the bathroom or wherever it is. Now, similar applies to home. If they have short-term memory deficits, things like they might forget that they left something on the floor, and then they trip over it. Or similarly, like you were saying earlier, if they’re supposed to use an assistive device, maybe they forget that they need to do that. They’re not willingly putting it to the side, right? They forget. that. And so how can you make sure that they still try to use it as much as possible? Maybe, again, more signs around the home, right? If they get to the door of the bathroom and you have a sign on there that says, do you have your walker with you? And then they remember, oh no, I forgot it. And then maybe they can get it, right? But it’s a lot of environmental cueing. It’s a lot of directional cueing where things are. They might forget where something is placed at home, and then they’re reaching over things, bending over, looking into cabinets, reaching up and looking into cabinets to find something. And it’s important to know, like, hey, mom really likes to have this. Let’s make sure it’s somewhere easily accessible and in a place where she’ll remember to look. All right.
[47:41] So, yeah, I think, yes, absolutely. I think assessing cognition is it’s extremely important to then be able to facilitate safe environments in both the.
[47:52] Well, this has been very, very helpful. Thank you so very much.
Key Takeaways for Caregivers
[47:56] Is there anything else you’d like to share with people as we conclude, as we end? What are some key takeaways that might be easy wins for people who are helping somebody at home to help prevent them from falling? One of the big things I like to highlight is that that first fall is what you really want to try to prevent. Once someone has fallen, it doubles their risk of falling again. So you really want to try and avoid that very first fall. Second, what you said about your gut. If you feel in your gut that your parent or your family member is not quite where they were and they might be at risk for falling, they probably are. Get those professional evaluations in, figure out what the recommendations are and try to do something about it before the fall happens. And then three, communication. Communicate every time with doctors, with other professionals, and then if they end up in the hospital, absolutely make sure that you’re communicating any sort of fall risks that you are aware of with the nurse, with the therapists, with the doctors, whoever you get your hands on. Oh, this was so valuable. Thank you so very much. So how can people get a hold of you? if they want to connect with you?
[49:16] I am at my email is my best place to reach me. It’s Pooja, P-O-O-J-A at aging-together.com.
[49:26] I love that. Well, Pooja, thank you so very, very much. Fall and fall prevention is very near and dear to my heart, specifically after that first fall. Like, totally, I 100% can see it. I did not know the statistic that it doubles your risk for falling. I know other statistics related to falls, but not that that first fall doubles your risk of falling. All I know for experientially with my mom is it radically changed her life, that first fall. You know, it made her afraid and she doesn’t move the way she did, which, of course, puts her at bigger risk for falls and all of that stuff. Thankfully, so far, she has not fallen again. And I will be giving you gray hair if I tell you what she does at home.
[50:17] You know, right now, what I want people to take away from this is that we want to prevent that first fall, but we also have to recognize that sometimes despite everything that we’ve done, we cannot prevent that fall. But we do everything we can to prevent that fall, but also just acknowledge that we want the person to continue to live too. Absolutely. Thanks so much, Lizette, for letting me share my story. Oh, you’re very welcome. This was fun. Thank you very much for being here. Absolutely.
