Post-fall assessments—are these important? If you want to prevent dangerous falls in the elderly, be proactive in getting medical assessments after a fall.
Why? A fall may indicate a new and dangerous medical condition that requires care. For instance, conditions such as dehydration or a severe urinary tract infection might lead an elder to become debilitated and fall.
Elderly persons who have fallen are at a greater risk of falling again. While it is prudent for any older person to be proactive in identifying and minimising fall risk factors, it is critical to do so promptly after a fall.
Unless caregivers are proactive in asking questions, busy physicians may not be thorough. While the majority of physicians have the best of intentions, research has shown that elderly patients often do not get prescribed treatment. By being proactive in a respectful manner, you may ensure that crucial details are not neglected (such as medications that worsen balance).
Here are post-fall evaluations that you may request that physicians do. This will allow you to ensure that your loved one has had post-fall assessments and prevent the likelihood of future major falls.
1. Post-fall assessments for the presence of an underlying new disease
If a senior has been exhibiting widespread weakness, delirium, or other symptoms of illness, this is almost typically the course of action taken by a physician. Make a point of mentioning any symptoms you've seen, and inform the doctor about how rapidly the changes occurred.
Almost any new health condition that weakens an older person might cause a fall. Common examples include…
- Urinary tract infection
- Dehydration
- Anemia (low red blood cell count), which may be caused by gastrointestinal bleeding or other factors, is characterised by a low red blood cell count
- Pneumonia
- Heart issues including atrial fibrillation
- Strokes, including mini-strokes that do not result in unilateral weakness
2. Blood pressure and pulse readings when seated and standing
These post-fall assessments are particularly crucial if you have been concerned about falls or near-falls connected with dizziness or fainting.
If your elderly relative takes blood pressure medication, you should clarify with his or her doctor that standing does not cause a reduction in blood pressure.
The most beneficial test was measuring blood pressure while sitting and standing. However, physicians only performed the procedure one-third of the time.
3. Blood testing
After a fall, it is generally advisable to examine a senior's bloodwork. If an older person's blood count isn't right or if things like blood sodium get too high or low, they might fall more often.
In general, a complete blood cell count (CBC) and an evaluation of electrolytes and kidney function are excellent starting points.
The doctor should explain any abnormalities in the blood work, whether they might be linked to falls, and how the doctor plans to treat them.
Bring the glucometer or blood sugar log if your loved one has diabetes and uses insulin or other drugs to reduce blood sugar. Episodes of low blood sugar (hypoglycemia) are a significant risk factor for falls, but a laboratory blood test often doesn’t detect times of low blood sugar.
4. Medications evaluation
Many older people are taking medications that make them more likely to fall. Frequently, these drugs may be lowered or removed. Be careful to inquire about the following drugs with your doctor:
Sedatives, tranquillizers, and sleep aids
For example, zolpidem (Ambien) is often used to induce sleep, whereas lorazepam (Ativan) is frequently used to treat anxiety. Antipsychotic drugs, such as risperidone or quetiapine, may potentially enhance drowsiness and fall risk when used to treat agitated dementia symptoms.
Diabetes and hypertension medicines
As stated before, it is very uncommon for older persons to be "over-treated" for these disorders, meaning that they are taking a dosage of medicine that causes their blood pressure (or blood sugar) to be lower than what is optimal for health.
"Anticholinergic" pharmaceuticals
These drugs are often prescribed to older persons, many of whom are unaware that they impair balance and cognition. They include antihistamines, drugs for an overactive bladder, vertigo, and nausea, as well as some kinds of antidepressants that may be used for nerve pain. See this page for further information on detecting and avoiding anticholinergics.
The Centers for Disease Control recommends that older adults concerned about falls request a medication review.
5. Gait and balance
A gait evaluation necessitate, at a minimum, that the physician observes the senior's gait with close attention. Additionally, there are a few straightforward methods for checking the balance.
Simple things to try if your gait and balance seem to be off-balance are as follows:
- Address any pain or discomfort if it seems to be the source of the issue. Many elderly individuals have foot, joint, or back discomfort.
- Consider referring the patient to physical therapy for a gait and balance evaluation. Often, a physical therapist may propose adequate strengthening exercises and, if necessary, help fit an older person for an assistance device (such as a walker).
6. Vitamin D concentration
Studies show that treating older persons with low vitamin D levels (e.g., less than 20ng/mL) may help prevent falls. Low amounts of vitamin D may also lead to brittle bones.
If your elderly loved one spends a great deal of time inside and does not take a daily vitamin D supplement, he or she is likely to have a low vitamin D level. In most individuals, taking a daily supplement of 800-1000 IU will ultimately keep vitamin D levels normal, but if you are particularly worried about falls or vitamin D, speak with your doctor about having your level evaluated. When vitamin D levels are very low, physicians may sometimes treat with greater vitamin D dosages for a few months.
7. Evaluation for underlying cardiovascular or neurological disorders
These chronic problems vary from the "acute" ailments we often search for immediately after a fall.
In a minority of instances, an older person may fall due to a persistent heart or blood pressure condition. Paroxysmal fast atrial fibrillation is an example of this since it causes the heart to race at times.
In addition, elderly individuals can acquire a new chronic neurological disorder, such as Parkinson's disease.
If you are concerned about these possibilities, ask your doctor, if it's possible that a heart issue caused this fall.
It is especially beneficial for you to inquire about these issues if you continue to have falls or near-falls, especially if you have previously reduced the dangerous drugs and overtreatment of high blood pressure.
8. Referrals for vision, podiatry, and home safety
Your loved one may need a vision exam, podiatric treatment, or a home safety assessment. If you've brought an elderly person in after a fall, it's a good idea to ask the doctor if these services could be of assistance.
I highly encourage home safety assessments, if they are available in your region. If the older person has not had a vision exam lately, it is also a good idea to do one.
Conclusion
Post-fall assessments are very important! If you wish to help avoid future falls, it's also crucial to ensure that the physicians have ruled out all potential contributing factors.
Even if you're very certain that your loved one merely tripped and fell, a thorough investigation might reveal factors that increased the likelihood of such incidents. Consider purchasing a fall detection watch to help prevent falls in the elderly.
The CPR Guardian Personal Alarm Watch is an easy-to-use standalone mobile phone watch with an integrated SIM card. It’s a personal alarm that contacts family. They can view the location and well-being of the wearer remotely by using the Guardian mobile APP for Android and iOS. Carers can call the fall detection watch just like a mobile phone. Please do not hesitate to contact us if you need help.
