Mountaintop Consulting Services

Fun Times and Big Dreams

Holiday cheer and family memories. Who doesn’t dream of an ideal get-together with joy, delicious food, and loads of fun? Why not add to the cheer by inviting our oldest relatives?

We know they don’t move like they used to, but we bribed our youngest and strongest to help. It will be fine!

We pull up to the older adult’s home, elated to see them in their best sweater, smiling eagerly in anticipation. Doubt creeps in as we get to the car and discover that not everyone plops easily into a sedan. We readjust, manipulate, angle, and pray. Success! A brief fight with the seatbelt, and we are on our way. 

Holiday Cheer to Disaster

Our helpers greet us upon arrival. The strongest one realizes that people don’t come with handles and compensates by pulling harder. The second helplessly ping pongs back and forth between the driver’s seat and the outside of the passenger door, all hands and no opportunities. Family gathers on the porch, hollering “helpful” advice. The older adult wants to do it, but they can’t. Likely embarrassed, they pick a coping skill – playing it off, laughing, crying, or becoming angry.

In the hubbub, Houdini the dog makes a break for it. The porch helpers excitedly appoint a recovery crew before his entire tail disappears in the neighbor’s shrubs. In that split second, the elderly person, freshly freed from the horrid metal shell of shame, stands disoriented in the dark. Flustered, not used to the terrain, and not sure whether to get the dog or find respite inside, they shift their weight.

They let out a shriek as their foot catches the only crack in the driveway. Eyes begin the journey back to the squeal, in time to see the end result of a sickening thud. The family forgets Fido and gasps in unified horror.

An Ounce of Prevention

Most fall-prevention programs focus on the hospital setting or the older adult’s residence. They often involve extensive assessments, environmental modifications (e.g., grab bars, transfer poles), and assistive mobility equipment (e.g., walkers). The idea is a controlled, predictable, and safe environment that optimizes the older adult’s ability. What do we do with the added dimensions of excitement, distraction, unfamiliar environment, and no supportive equipment?

Risk factors

Risk factors include (but are not limited to):

• Muscle loss – especially involving fast-twitch muscle fibers, primarily impacting the thighs and resulting in difficulty transitioning from sitting to standing
• Medical conditions – paralysis from stroke, gait disturbances from Parkinson’s Disease, etc.
• Medications – may drop blood pressure, impact heart rate, or cause sedation
• Cognitive status – may become lost, be oblivious to the environment, or overestimate abilities
• Sensory loss – Particularly in those with poor vision

Observing

Observation ideally begins before the visit. First, we recognize the older adult’s ability. If they take longer than 12 seconds to stand up and walk ten feet, they are at risk for falls. The longer they take, the worse the risk. Do they sway or appear dizzy? How do they do with their assistive device? Can they control it, or does it take off on them? Do they have a healthy arm swing, or keep their arms down and shuffle? Do they have a board-like Parkinsonian posture, resulting in leaning forward and accelerating too quickly when walking, or falling backward when being assisted up from a sitting position?  Do they get confused about where they are going? What do they eat, and how often do they exercise? Negative answers indicate a need for additional support in the host’s home.  

Interventions

For the party, the standard interventions apply. We use all available portable assistive devices that will fit into the space they are going. These include the encouragement to:

• Wear glasses and hearing aids
• Wear properly fitting, closed-toe shoes
• Use assistive devices (e.g., canes, walkers, wheelchairs), use the best device they have that allows them to sit and rest if they become fatigued

Interventions for the host’s home involve:

• Continue to observe the older adult and environment, being proactive about trip hazards
• Be available for needs, such as hands-on walking assistance, carrying items, and toileting
• Bathroom – don’t leave unattended, especially if there is nothing to hold onto; may need help and special supplies
• Have adequate lighting, even if that means using a flashlight
• Pick up throw rugs and small area rugs
• Remove clutter
• Avoid slippery floors and surfaces, including snow and ice
• Provide a place to sit, preferably with arms
• Consider a gait belt, which is inexpensive and requires minimal training; provides a supportive place to hang onto when assisting with ambulation
• Get into the car bottom first, then swing legs in
• Get out of the car feet first, then use the door frame as a support to rise to standing

For family and friends involved in an older adult’s long-term care, effective fall prevention involves lifestyle modifications. Older adults’ muscles lose the ability to respond to hormone signaling (such as testosterone). Alternatively, eating approximately 1.4-2.0 grams (per kilogram of body weight) daily of high-quality protein, with 30-50 mg of that at breakfast and 30-50 mg at dinner, provides a signal that muscles respond to. Capitalizing on this signal with resistance training builds muscle.

Resistance training starts with the older adult’s current function and increases in intensity as able. As muscle builds, bone density improves. Greater physical fitness and the flexibility that comes from functional movements reduce the risk of falls and injuries. On top of these interventions, encourage:

• Cessation of alcohol and smoking
• Maintaining a healthy weight – underweight and overweight both suffer from sarcopenia
• Vitamin D supplementation if levels are low

Open and honest dialogue with the older adult, caregivers, and other family members helps weigh the risks and benefits of outings. At some point, the older adult may need family to celebrate in their residence.

As always, medical conditions are complex, older adults may not disclose all conditions, and medications may require monitoring as health status changes. Always involve the primary care provider when starting any diet changes or exercise programs.  

Here is to a safe, joyful, fall-free holiday season!