Preventing Avoidable Falls And Hospitalizations

Falling and winding up in the hospital is a problem for elders, many of whom have complex health conditions.

The most common conditions leading to falls and hospitalization include:

• Urinary tract infections
• Adverse medication reactions
• Poor disease management

In many cases, these conditions are preventable by family caregivers. A family's involvement in identifying and acting on potential warning signs, and keeping loved ones healthy and safe is an important role.

Urinary Tract Infections

Urinary tract infections (UTIs) happen when bacteria in the bladder grows in the urine. Elders experience a weakening of the muscles of the bladder. This leads to more urine being retained in the bladder and poor bladder emptying, which leads to more bacteria in the urine and UTIs.

Typical signs and symptoms of a UTI:

• Urine appears cloudy
• Strong or foul-smelling urine
• Frequent or urgent need to urinate (which can result in shaky balance and falling, especially at night).
• Pain or burning with urination

Elders with UTIs often don't exhibit the hallmark sign of fever because their immune system is unable to mount a response to infection because of aging. In fact, elders may not exhibit any of the common symptoms (or don't express them to their caregivers).

Conditions that make elders more susceptible to UTIs:

• Diabetes
• Enlarged prostate
• Immobility (for example, those who must lie in bed for extended periods of time)

Simple ways to reduce the risk of UTIs:

• Drink plenty of fluids (2 to 4 quarts each day).
• Avoid caffeine and alcohol (both irritate the bladder).
• Keep the genital area clean.
• Wear cotton-cloth underwear, and change them least once a day.
• And most importantly, if you think that a person might have a UTI, see your doctor right away for an evaluation!

Adverse Medication Reactions

Falls and hospitalizations due to adverse medication reactions are also common among elders. If an individual does not follow the prescribed dosage, it could put their health at risk by causing mental and physical deficiencies. The main hazard is falling.

Drugs often misused:

• Anxiety and depression medications
• Pain relievers
• Sedatives for sleep disorders
• Antihypertensives

Common side effects from medications:

• Sedation/lethargy
• Confusion
• Trouble seeing
• Incoordination/poor balance
• Dizziness
• Weakness

Mismanagement of drugs:

• Double dosing (taking too much because individuals forget they already took the medication).
• Self-medicating. Often a person cannot afford their medication, so they take another person's medicine because it's less expensive and easier than going to the doctor.
• Taking an extra dose to "feel better." This happens with medications used to treat depression, anxiety or chronic pain. It can easily cause an overdose.

Signs indicating a problem:

• Memory difficulties, after taking medication
• Becoming unsteady when walking or lose balance easily
• Frequent falls
• Change of sleeping practices
• Becoming irritable, sad, or depressed

If loved ones show any one of these signs, it's time to have a discussion with the elder's doctor about a potential medication problem.

Equally hazardous to one's safety is medication non-adherence (not taking medications as prescribed by a doctor). The outcome for elders who do not follow their doctor's medication orders is not good. In some cases, a disease continues to progress and becomes worse. In other situations, the ability to function normally or maintain balance is impaired. In both instances, medication non-adherence can lead to a fall.

Drug non-adherence happens every day and includes behaviors such as:

• Skipping a daily dose of a prescribed drug.
• Failing to pick up a refill of an existing medicine or a new prescription at the pharmacy.
• Deciding for whatever reason to stop taking a drug or taking more medication than directed.

Strategies aimed at helping elders take their medications as prescribed:

• Develop a Routine. Take medicines at the same time(s) each day. It helps to link taking medications with something else one does around the same time(s) each day, such as brushing one's teeth.
• Follow Directions. Take only the recommended dosage at one time and finish the entire prescription if instructed. Ask the doctor or pharmacist whether certain foods or drinks should be avoided while taking the medicine.
• Don't Self-Treat. Medicines affect people differently. Let the doctor know if the medicine doesn't seem to be working or if it is causing problems. Don't stop taking the medicine on your own. Don't change dosages or stop taking a medication without first consulting the doctor.
  Key steps to ensuring successful medication adherence include:
• At least twice a year, ask the doctor to review all medications and check the appropriate dosage of each medication, and stop any unnecessary ones.
• Let the doctor know if the medicine doesn't seem to be working or if it is causing problems.

Disease Management

Elders who have chronic health problems (such as diabetes, osteoarthritis, heart disease, Parkinson's, dementia, etc.) are at risk of falling. One of the main reasons for this is that many ‘chronic diseases' negatively affect ones strength, balance, thinking processes, etc. As well, multiple medications used to treat chronic conditions are associated with dangerous side effects (such as dizziness, balance loss, confusion, drops in blood pressure, etc.).

Family caregivers take on the responsibilities of providing good care. These include:

• Becoming more knowledgeable about their loved one's conditions (its symptoms and treatments); including how to avoid falls.
• Monitoring their loved one's health condition (s) (both physical and mental) on a daily basis.
• Managing medications (making sure that all drugs are taken as prescribed and up-to-date).
• Coordinating doctor visits and communicating between doctors (often among several physician specialists).
• Caring for the safety needs of their loved ones.

• Learn as much as you can about your loved one's chronic condition (s) and how to provide good care.
• The more you know, the less anxiety you'll feel about your new role and the more effective you'll be.
• Make time to get to know all your loved one's doctors and arrange to be kept up-to-date on all medical issues.

Rein Tideiksaar Ph.D., PA-C is the president of FallPrevent, LLC, Blackwood, N.J., a consulting company that provides educational, legal and marketing services related to fall prevention in the elderly. Dr. Tideiksaar is a gerontologist (healthcare professional who specializes in working with elderly patients) and a geriatric physician's assistant.