These are Responsible for 40% of All Injury Deaths

Q. Recently, we got a call from the emergency room that my husband’s grandmother fell outside of a store and fractured her wrist. It was a rainy night and she slipped on the ramp walking out of the store.

Typically, when you hear about falls, you hear about instances where they occur on a rug that isn’t affixed to the floor in the living room or in the bathtub. You don’t hear a lot about outdoor falls, how often they occur, how they can be prevented, and how to make things safer for loved ones.

We are concerned about grandma, who is currently aging-in-place, and want to protect her as best as we can. Do you have any suggestions for us to better ensure her safety?

A. Falls can happen at any place and at any time, which is why it is so important to take extra precautions to ensure the utmost in fall prevention strategies.

While it is true that falls are most common inside the home, as you have experienced with your husband’s grandmother, it doesn’t mean they can’t happen outside the home, as well. In fact, falls (whether they are inside or outside the home) are the number one reason that seniors end up in the emergency room, accounting for over 50% of injury-related hospital admissions and 40% of all injury-related deaths

Organized efforts to prevent outdoor falls by older adults, sadly, have been somewhat neglected, as most research has focused on falls occurring in the home or hospital environment. However, outdoor falls are frequent with approximately half of falls among adults aged 65+ occurring in outdoor environments. Up to now, little research has been available about the contexts in which outdoor falls occur, how features of the external environment can present as risk factors for outdoor falls, and which outdoor falls are more likely to lead to injury and/or fear of falling.

However, a new study, conducted through New York University and published in the journal Archives of Gerontology and Geriatrics, focused solely on the outdoor fall experiences of older adults living in New York City. The findings are being used to develop and pilot an outdoor fall prevention program.

For the study, the researchers set out to investigate the experiences and fall prevention knowledge of older adults living in the community. Findings were as follows:

• Researchers surveyed 120 adults, ages 55 and older.
• Of those surveyed, 71% (85 people) had fallen outdoors in their adult years.
• Of those who had experienced an outdoor fall, 28 had minor injuries such as scrapes and bruises, 18 had moderate injuries with prolonged pain or soreness, and nine had severe injuries such as fractures, rotator cuff injuries, or injuries requiring stitches or surgery.
• Beyond physical injuries, respondents commonly described having an emotional response to the fall, including fear of falling again or embarrassment.
• A number of people surveyed reported their falls occurring during otherwise healthy activities such as exercising or walking a dog. For many participants, the falls were triggered by environmental factors, such as objects (metal post, branch, stones), surface conditions (slippery or uneven) or stairs, particularly at entranceways. Many participants attributed falls in part to their own practices, such as wearing ill-fitting or inappropriate shoes, not paying attention, or walking too fast.
• In addition, those surveyed frequently described multiple factors that contributed to their fall, such as rushing on an icy surface or being distracted on an uneven surface.

The study highlighted several aspects of the outdoor environment that may represent risk factors for outdoor falls and associated fear of falling. It also revealed a number of unmet education and training needs for outdoor fall prevention among older adults and caregivers.

What You Can Do

While many senior care providers have implemented safety tips and strategies in order to prevent seniors from falling inside the home, there are also additional steps that need to be taken by caregivers for when seniors leave the home, as well.

• Use your best judgement: If the weather looks bad and it isn’t an emergency, urge your loved one not to leave the house.
• Suggest that he or she pay close attention to curbs, ramps and elevation changes, as they are some of the main reasons that seniors tend to trip and fall. Make sure that you are looking out for drops in the pavement, uneven terrain or slippery surfaces (watch for holes, tree roots, and ice).
• Wear shoes that fit: Make sure that seniors are wearing properly-fitting shoes with plenty of traction on the bottom; this can help a great deal. There are also special accessories you can add to the bottom of the soles of your loved one’s shoes to lessen their chances of slipping.
• Walk on grass if sidewalks or roads appear to be slippery or uneven(grassy areas provide more traction and solid footing).
• Wear correct eyewear when walking(reading glasses or bifocals can distort the ability to see potential hazards). Consider wearing sunglasses (glare from the sun can hide areas, which can lead to falls).
• Walk in well-lit areas in the eveningto provide the most visibility for hazards.
• Walk hands-free using a fanny pack or an over-the-shoulder bag instead of a purse or hand-held bag.
• Wear hip pads or protectorswhile walking to ensure the protection of bones and to avoid hip fractures.
• Make sure your loved ones have their mobility aides, such as their canes, wheelchairs, or scooters, whenever they leave the home, even if you don’t think they will be travelling far.
• Accompany your loved one by holding on to his or her arm or hand while walking. This is one of the best ways to make sure an elder has the stability needed.

Health professionals, as well as caregivers, are recommended to consider outdoor environments as well as the home setting when working to prevent falls and increase mobility among older people. Adults could benefit from training on fall prevention strategies, including safety during routine activities such as carrying items on uneven surfaces, going up and down stairs, and opening or closing doors. Education around safe outdoor walking strategies (avoiding distractions, navigating sloped and uneven surfaces, and walking slower) would also be beneficial, and more opportunities for such education are much needed.

What Happens If a Loved One Falls and You Are Not Around?

Sensor-based home monitoring systems can alert a family member or caregiver of an emergency or when something unusual has happened. Some Personal Emergency Response Systems (PERS) also contain GPS technology. If in trouble, the wearer can press a button and be connected with a call center that can dispatch help and notify caregivers. Many PERS devices only work at home, but a few allow the wearer to get help wherever they are — on the golf course, in the car, or around the block. Examples of such technology include the GreatCall 5Star Urgent Response, MobileHelp, or Life Alert.

When Taking Preventative Measures Isn’t Enough

When taking preventative measures isn’t enough, assisted living or nursing home care may be needed for your loved one. Nursing homes in our area can cost as much as $150,000 per year. Life Care Planning and Medicaid Asset Protection is the process of protecting yourself or your loved ones from having to go broke to pay for nursing home care, while also helping ensure that you or your loved ones get the best possible care and maintain the highest possible quality of life, whether at home, in an assisted living facility, or in a nursing home. Please call us to make an appointment for an initial consultation:

Fairfax Elder Law Attorney: 703-691-1888

Fredericksburg Elder Law Attorney: 540-479-1435

Rockville Elder Law Attorney: 301-519-8041

DC Elder Law Attorney: 202-587-2797