Elderly aunt has starting falling at home - how to deal

[Purplecatshopaholic]

My lovely 90 year old aunt, who is totally compos mentis, is getting physically very frail and has started falling at home (lives alone, miles from us). She has an alarm which triggers carers to come which seems to be working well as far as it goes. My brother wants us to go on a rota to phone her every night to check she’s ok. I think this is a bit daft - she could fall 2 minutes after a call for one thing, and has the alarm for another.. I just wondered what others have done? I think maybe an electric wheelchair for in her flat so she isn’t walking? Anything else you have tried when they start falling over and can’t get themselves up?

She needs an assessment by an occupational therapist who can assess for things like walking aids, grab rails, and perching stools. The equipment needs to be tight for her. Not one thing will fit all. An assessment can be arranged via the gp, council (social services), or privately.

Yes she needs a Falls Referral so they can assess why (perhaps she needs BP meds reducing, her vision has deteriorated, she is having new arrhythmias, has an infection, developed neuropathy etc....) and to mitigate the risk using aids, rearranging furniture etc....
Electric wheelchair would be a bad idea as her mobility would only reduce further.

Does she already use a walking frame or stick inside the house ? If not perhaps get one. If you do decide on a daily phone call rota then I'd check what time suits her and make sure you all call at the same time.

Many times I call my mother she complains that I'm trying to kill her by making her rush to answer the phone ! (She loses track of time so calling at the same time of day wouldn't make much difference in my case)

As pp’s have said, in most areas a referral to the falls team will enable physio and OT assessments ,some areas have falls clinics with medical oversight otherwise there’s a need for the GP to exclude medical events/ medication related falls. You can reduce risk of falls but can’t eliminate them unless you overtly compromise someone’s lifestyle. Have you chatted through with your aunt what she wants to happen in the future? Is she wanting to stay where she is currently living? Many people will accept the risks involved if they want to stay living independently so it’s just mitigating those risks in the most appropriate way. As soon as you stop someone walking they will start to lose their muscle strength/ mobility.

P.s. I presume she has a key safe? Do any of her neighbours have the code? Some people have informal systems with their neighbours where eg. If the curtains aren’t open by a certain time, the neighbour will then know there could be a problem . Not so much of an issue if she has daily carers visiting am and pm.

Does she have space and ability to operate an electric wheelchair? How would she get in and out of it?
Get her assessed by OT at home call her gp practice orxwrote in with your concerns and ask for elderly assessment and referrals
Arrange care visits ss funded or private eg age uk
look into care homes or sheltered accommodation for future
Get lpa sorted

Not a wheelchair. And especially not an electric one. The less she walks the less she'll be able to walk. She needs to use her muscles as much as possible.

Daily phone calls are less use for falls than the existing button (and what if she falls in a hurry to answer the phone?)

As others have said, OT assessment of both her and the house to see if she needs a stick, frame, grab handles etc.

Ask the GP about referral to a falls clinic.

And exercise classes. Can she (or you, as a present) afford a regular class or some physio sessions? For physio, look for one who specialises in older people, and personally I'd recommend one who uses a combination of physio and pilates. That worked absolute wonders for my dad.

Most wheelchairs are too big to use around the house.

Your house needs to be completely set up for them.

She might find a walking frame helpful - or not depending on why she is falling.

Sometimes people fall even If they are medically optimised (see above re: falls assessment) and all the protective stuff is in - kit, alarm etc.

Sometimes you need to be pragmatic and accept it.. my grandfather fell a lot at end of life even in his nursing home but he could walk and wanted to walk and it was better for him to do so (albeit with a falls risk) than be wheeled about and lose yet more muscle mass.

Risk-beneift analysis meant that as a family (he was incapax) we accepted that one of his falls might end up with a broken hip, hospital admission and probably palliation / or very high risk surgery.

If you are reading this and have elderly relatives who haven't yet got to the falling stage lots of local authorities do falls prevention type exercise classes - if you can get them there it's good socialisation and beneficial. I've sold it to the current oldie on the basis that it is something she can do to help herself maintain independent living for longer. She goes weekly and likes the outing (and her vending machine hot chocolate afterwards.. it's a real shame the leisure centre doesn't have a cafe as it would enhance the socialisation element).

A physio will also be able teach methods to help her get herself up after a fall.

I agree that a wheelchair would be a bad idea for the many reasons given above. My mother is in a care home and they do their absolute best to allow residents to be as mobile as possible while they still can. Once you lose mobility, it causes additional problems and can be the beginning of the end.

An OT assessment is the way to go. But the outcome will depend on your aunt actually using whatever mobility aids she is offered. My mother had a stick and refused to use it.

And I agree with you OP there is no benefit to a daily phone call.

Useful food for thought - thanks everyone. My sibling is on the way up there just now - we are organising carers which she has agreed to.

We were in the same position until 2 weeks ago, now my dad (also 90) has had 2 falls and spent 2 weeks in hospital. His blood pressure drops when he stands and he’s liable to collapse. Having lived through the broken hip story with Aunt , we think it’s time for a care home. He simply cannot live safely at home.

All excellent advice above.

FWIW, many people go through a phase of being a regular faller, and many of them actually don’t injure themselves in a significant way. Being on the floor waiting for help is not pleasant but they may prefer that to massive changes in their living arrangements (for those with capacity to make that decision). I’m not saying that this is ideal or risk free but it may be the least worst option for them for a while.

Also, advise her that if she does fall and isn't injured, she must try to move around on the floor/change position. Anytime over an hour on the floor is considered a 'long lie' and puts the kidneys at risk of damage but keeping moving will reduce the risk and means she can avoid hospital.

As others have said, an OT home assessment is needed.

There are falls detectors that can be linked to pendant alarms to alert when someone has fallen. Obviously that doesn't prevent a fall but it does prevent being on the floor for a long time.

That’s fascinating - I had no idea (& used to work in gen med -many long liers!) - I wonder why this isn’t more widely publicised - do you have a link or ref?

It is a good idea to call her once per night - even better to have her push the button on her epirb at 6 pm to tell you she's fine..( from experience with a 92 year old relative living happily at home.) Examine the epirb and know how it works and how it can map Aunt.
Sometimes a person falls without access to their ebirb and if you have a routine of hearing from them every day then it won't be more than one day that she is left fallen on the ground.
Ideally your Aunt should wear her epirb and be able to call for help - it first alerting an ambulance, then a neighbour, then you. Her closest neighbour should have an emergency key, your Aunt's phone number and your phone number in case they are worried.

Evidence clearly shows a relationship between recurrent falls and morbidity and mortality in older people.

If, anecdotally, you know a lot of people that fall/fell a lot and were broadly unaffected, evidence suggests that's anomalous. Not doubting you may do, but I think it's important not to understate that falls in older people should wherever possible be prevented due to the significant risk they pose.

There is also evidence of the relationship between speed of response to a fall and poorer outcomes. For example in one study, of those who experience a 'long lie', half went on to die within the following six months, even without a direct injury from the fall. So where falls do occur, every effort should be made to put in place measures which would mean they would be responded to swiftly.

OP, you've had some great advice above. If your aunt is capacitated, she absolutely must be taking the decisions about appropriate measures, changes to her home environment etc. It's therefore crucial she has the information about the risk falls pose to make informed choices. It's also a good opportunity to open up a discussion about her wishes for when she may not have capacity and making an advanced care plan.

I was going to say the same thing as BeaTwix. When you get to your 90s and falls start to become frequent it's not just a question of calls to carers or checking in, or referral to the falls clinic. It's no longer a matter of tripping or grab rails it's overall frailty.

Falls are dangerous and inevitably lead to fuller time care - whether at home or in a care home. My DF had a fully adapted home but was being found on the bathroom floor with a bashed head where he'd been for hours before his regular carer arrived. It was extremely difficult to get him up and there were frequent visits to A&E as he collided with the TV or door frame on his way down.

He was 90 when it began and we had to accept that he needed full time care. He now lives in a care home.

I've put cameras in my dad's house and check in on him a few times a day that way. Nothing in bathroom or bedrooms.means I can see he's up and had breakfast etc. He gets exhausted talking too much and I try to make sure he is in a safe place before I phone him so he doesn't fall rushing for the phone. He has developed epilepsy so it's been great to check on him as I'm 2.5 hours away and brother 6 hours.

Did this for in-laws too and saved mil life as she had fallen outside and her husband hadn't noticed she wasn't there. They didn't communicate much in their 90s. My Husband checked the camera and couldn't find his mum in the house then looked on the ring doorbell and she was on the ground outside. Secluded property noone walking by. It was November and dark and very cold. Shed have been very unwell if we hadn't noticed. Dad was fully on board with this.