LOS ANGELES — Restrict daytime sleep, check blood pressure while patients are standing, and don’t overtreat diabetes. And there’s more: No caffeinated coffee, no canes, and definitely no high heels — but ice cream can do wonders. These were some of the fall prevention tips offered by geriatrician Elizabeth A. Landsverk, MD, at the California Association of Long-Term Care Medicine’s annual meeting.
Fall prevention was a major topic at the conference, and for good reason. No other cause is responsible for more injuries in people older than 65 in the United States. No other kind of injury causes more death in this population. A person who falls “may subsequently experience pain, hospitalization, surgical intervention, admission to a nursing home, decreased overall functional ability, poorer quality of life, or a fear of falling,” wrote physicians from the Department of Geriatrics, Palliative Medicine, and Continuing Care at the Los Angeles and West Los Angeles Medical Centers in a 2013 report (Perm J 2013;17:37–39).
Dr. Landsverk, an adjunct clinical professor at the Stanford University School of Medicine and medical director at Silverado Senior Living in Belmont, CA, is founder of a house calls practice called ElderConsult Geriatric Medicine. In her presentation, she provided these tips about preventing falls.
Watch for low blood pressure.
Don’t just measure blood pressure when patients are sitting or lying down. “I spend most of my time checking blood pressure with people standing,” Dr. Landsverk said. “If you treat down to 120 systolic, they might have a blood pressure of 90 while standing and become more likely to fall over.” She suggested not treating blood pressure in the elderly unless their systolic reading is more than 140 mm Hg while standing.
Don’t overtreat high glucose.
Dr. Landsverk recommended maintaining glucose at between 100 and 200 mg/dL in the elderly (not 80–120 mg/dL) to reduce the risk of dangerous low blood sugar. “Think about hypoglycemia,” she said.
Keep patients moving.
Muscle mass declines each day a person is bedbound, Dr. Landsverk said, and the risk of falls rises. “We want to make sure we keep people moving, [so] have someone available to keep people walking,” she said. “Restorative aides are money well-spent. They will cut down workers’ compensation for employees who have to transfer people who can no longer stand or walk.”
Keep patients fed and hydrated.
Elderly people often have reduced senses of hunger and thirst, Dr. Landsverk said, sometimes as a result of medication side effects. She recommended frequent fluids and snacks like ice cream, which she said is especially helpful when patients are anxious.
Restrict sleep during the day.
“If we let people sleep 2 to 4 hours in the afternoon, they’re less likely to sleep at night and more likely to need sleeping pills,” Dr. Landsverk said. She advised nursing homes to keep people moving and awake through activities like tai chi, dancing, and raised gardens.
She also recommended banning caffeine — there’s no need for it, and “they do not need an extra urge to run to the bathroom.” She also recommended avoiding early bedtimes. “There are some places where I see them putting elders to bed at 6 or 7 p.m.,” she said. “If they sleep 6 hours, they’ll be up at 1 a.m. and won’t have staff to keep an eye on them.”
Watch out for canes and high heels.
Canes can used aggressively, and patients can be unstable while using them, Dr. Landsverk said. “Canes can be weapons, so my patients don’t get them.”
As for high heels, she said it’s often difficult to convince female patients to not wear them. “That’s a hard one,” she said. If necessary, “I’ll go back to the family and say they’re at risk of a fall, but we can’t make them not wear heels.”
Consider options for the riskiest patients.
“When someone has poor safety awareness, they’re starting to fall, and they’re impulsive, we can hire a one-for-one for them all the time,” Dr. Landsverk said. “The other thing I do is have them go to a small board-and-care run by a nurse, where ratios of caregivers to residents are higher. Another option is to engineer a soft landing: Talk to the family so they understand this [a fall] is coming.”
Randy Dotinga is a San Diego-based freelance writer.