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Are Your Loved Ones Falling Through The Cracks?

Elders who have chronic health problems (such as diabetes, osteoarthritis, heart disease, Parkinson’s, dementia, etc.) are more likely to fall then those without any chronic conditions. 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).

Doctors, for the most part, do a good job in treating and managing elders with chronic illness, which helps to lessen the chances of falling.  

There are several other factors, however, that can result in high fall risk for elders with chronic disease. Many of these are often overlooked, but nonetheless are important. They include:
  • Not receiving counseling on diet, medication, and self-care and/or elders are non-compliant with such treatments. Both can lead to a worsening of health conditions.
  • Lack of information on recognizing early warning signs or symptoms of worsening illness. Also, elders may not have the capability (physical and/or mental) to respond to such signs.
  • Doctors may be unaware of an elder’s knowledge deficit about their illness and/or any barriers to adherence with treatments.
  • Elders with chronic illness often see multiple physicians (average of 7 different doctors per year). Many of these doctors may not be aware of each other’s care. This can lead to medication prescribing problems (dangerous drug interactions and side effects), incompatible or contraindicated treatments, or providing differing advice. Also, often no one doctor is responsible for the elder’s care.

As a result, elders with chronic disease often have a worsening of their condition (s), which places them at high risk of falling. 

Additionally, there are two other important factors compounding the problem:
  • Medicare reimbursement for education and counseling, care coordination, advice on fall prevention, and ongoing monitoring of elders with chronic health conditions (the things that can really help to reduce fall risk) is limited.
  • A recent report from UCLA (University of California, Los Angeles) found that many doctors in California don’t routinely screen elders for falls. Of the more than half a million California elders who fall more than once a year, less than half receive any advice on how to prevent falls from their doctor. There’s no reason to doubt that this is happening in other states as well.

As a family caregiver, if one or more the above situations are recognizable and your loved one is either at risk of falling or has fallen, they might be ‘falling through the crakes’. For better or worse, as a result, family caregivers (caring of their loved ones with chronic conditions) may find themselves (by default) facing a host of new responsibilities:
  • 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 bases.
  • 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.

Advice for Caregivers

If you're like most family caregivers, you aren't trained for the ‘chronic care’ responsibilities you face. In fact, these tasks can be unfamiliar or intimidating. At times, you may even feel overwhelmed, stressed or burnt out. Especially if you have to juggle between caring for your loved one and other family responsibilities.

With the right help and support, you can be a good caregiver without having to sacrifice yourself in the process. The following tips can help you get the support you need.
  • Learn as much as you can about your loved one’s chronic condition (s) and about 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 via the phone or email. This will help greatly in coordinating the care between different doctors.
  • Seek out other family caregivers. It helps to know you’re not alone. It’s comforting to give and receive advice and support from others who understand what you’re going through.
  • Get help from geriatric specialists:
    • Geriatric care managers (typically a nurse or social worker) work with families to help with caregiving. They help determine types of services needed, medical management (facilitating communication between doctors, the elder, and family), and keeping everyone informed as to the health needs of the elder. Care managers are ideal for family caregivers providing long distance care (living more than an hour’s travel away). Contact the national organization to find a care manager in your area
    • Geriatricians are physicians (internist, family medicine practitioner) who have special training in the special needs of elders (such as memory loss/dementia, urinary problems, fall prevention, multiple medications, etc.). To find a geriatrician, call your state’s medical society.
  • Know your limits. Are you willing, able and capable of providing the care your loved one needs? Be realistic about how much of your time and yourself you can give. Set clear limits, and communicate those limits to doctors, family members, and other people involved. Dividing up tasks/duties with other family members can help. But as circumstances change, it’s good to be aware of alternative strategies (such as home care services) that might be of help.

Home care services include:

Home safety. Assessment of the elder’s home environment to ensure it is ‘fall-free‘. This includes installing grab bars in the shower, stairway handrails, equipment to make bathing/toileting safe, etc.

Personal Care Services. Helping with daily activities, such as bathing, dressing, housekeeping, shopping, etc. Home health aides are available to assist with personal care, ranging from a few hours a day to live-in care. Health aides might also provide limited assistance with things such as taking blood pressure or offering medication reminders. Having in-home help improves the chances of preventing falls from happening. By encouraging regular exercise, medication prompts, eliminating fall hazards around the home and helping persons navigate high-risk areas (like the bathroom).

Guest post by Dr. Rein, this post originally appeared in E-CareDiary.com

Rein Tideiksaar Ph.D., PA-C is the president of FallPrevent, LLC, Blackwood, NJ, a consulting company that provides educational, legal and marketing services related to fall prevention in the elderly. Dr Tideiksaar is a gerontologist (health care professional who specializes in working with elderly patients) and a geriatric physician's assistant. He has been active in the area of fall prevention for over 30 years, and has directed numerous research projects on falls and has developed fall prevention programs in the community, assisted living, home care, acute care hospital, and nursing facility setting.

Dr Rein has written several online continuing education course on falls: 

Caring for People With Fall Risks
Facts About Falls
Managing Falls In the Nursing Home: Who, Why and What Next?
Managing Falls IN the Nursing Home for Administrators
Preventing Falls
The Fall Prevention Care Process

Click on Dr. Reins Bio to see his complete list of online #CEU courses and learn more.

Posted: 2/25/2015 10:45:12 AM
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