From Inactive to Active Too Fast: Go Slow to Avoid a Fall

        Arif Hussain, DO, talks about the risk of falling after a period of isolation and how to stay safe and strong post-COVID.
        After months of isolation and quarantine, post-acute and long-term care facility residents will start to be more mobile as pandemic restrictions begin to ease. Before getting back to walks, dancing, or other activities, it is important to realize that muscle weakness and deconditioning may have occurred due to months of limited mobility. This means an increased risk of falling. Talk to your loved one’s practitioner about how to get back in action safely.
        Do not dismiss the effect of months of limited physical activity. Older adults can lose up to 1% of muscle mass per day if they aren’t getting out of their room or apartment. That’s a big deal because most nursing home residents don’t have much muscle mass reserve to start with. However, it is possible to get stronger, as well as improve gait and balance. Among the things everyone can work on together:
        • An assessment of the need for assistive devices. Especially if there were gait, balance, or mobility issues before the pandemic, it is important to work with the practitioners and therapists to determine if a walker, cane, or other assistive device might provide stability during beginning stages of increased mobility and activity.
        • Good nutrition. It will be important to get the right food to keep bones and muscles strong. Dietitians and other practitioners can help make sure your loved one gets the foods to promote muscle strength and physical health in general. If weight loss or gain is needed, dietitians and the practitioner can help with this as well.
        • A slow start. Start with short walks near railings or other supports. If your loved one notices any signs of discomfort or imbalance, they should sit down and alert a nurse or other team member.
        • An exercise program with both endurance (such as walking) and resistance (lifting light weights) activities. Work with the practitioner and care team on what will work best.
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        Using a cane or a walker may help older individuals return to physical activity safely.
        If your loved one can’t get out, there are activities that can be done at home — whether it’s a single room or apartment. These include leg/arm lifts while in a seated position (with/without light weighted items), getting up out of a chair and sitting down, taking a few steps, and/or light stretching. These should be done with a caregiver’s supervision.
        To further limit the risk of falls, keep your loved one’s surroundings free of clutter and tripping hazards such as loose rugs or uneven flooring. Well-fitting shoes with no loose laces and nonslip soles are also important. Have your loved one’s vision tested regularly, and make sure rooms and hallways have good lighting.
        As tempting as it may be to get back into action quickly, a fall could sideline you or your loved one for months and result in long-term disability or even death. Taking a slow, measured approach to resuming activity after a pandemic will keep your loved one safe — and active — over time

        Questions to Ask the Practitioner:

        • How do you assess my loved one’s risk for falling?
        • Does having a previous fall or injury (such as a broken leg or hip) put my loved one at a greater risk for falling and being injured?
        • What kinds of foods help increase energy and keep muscles and bones strong?
        • What can be done to increasing range of motion?

        What You Can Do:

        • Have your loved one use a walker, cane, or other assistive device as needed.
        • Keep a night-light on in the bathroom in case your loved one gets up in the middle of the night.
        • Tell your practitioner right away if your loved one has any dizziness, weakness, pain, shortness of breath, or other issues.
        • Talk to the practitioner about any specific goals your loved one has for mobility — such as the ability to walk your dog, or wanting to dance at a grandchild’s wedding.
        • Have your loved one participate in physical or other therapy as prescribed/needed.

        For More Information:

        • “In-Home Exercises for Seniors to Stay Active During the Quarantine,” Assisting Hands (blog), April 28, 2020.
        • Joanne Kaldy, “Keeping Residents Active Can Forestall Falls,” Provider, June 2020.
        • Caroline Wellbery, “Muscle Weakness as a Risk Factor for Falls in the Elderly,” Am Fam Physician 2005;71(9):1791.