The Complex Family Dynamics of Fall Prevention

September 22 Is National Falls Prevention Awareness Day.

Senior man walking up the stairs

"Dad, wait! Let me help you!" Ever since Dad fell last month, Joanna has been worried sick about whether he's safe. The doctor said that with Dad's osteoporosis, another fall could lead to a hip fracture or serious head injury. "I'm fine, quit hovering," says Dad. But Joanna notices that he's spending more time on the couch instead of doing the exercises his doctor recommended. "I feel like a helicopter daughter!" Joanna exclaimed to her co-worker as she made the third call of the day to be sure Dad was OK.

This worried daughter's experience no doubt is familiar to millions of Americans who are caring for older or disabled loved ones. "Falls are one of the most common health problems experienced by older adults and are a common cause of losing functional independence," said Dr. Mary Tinetti of Yale School of Medicine. "Given their frequency and consequences, falls are as serious a health problem for older persons as heart attacks and strokes."

Addressing the risk of falls can be a real challenge for families! If an elder parent has a health condition such as diabetes or heart disease, families know the drill: Make sure Mom gets to her healthcare appointments, takes her medications and follows her doctor's advice. But fall prevention is more complicated. While their loved one is dealing with balance problems, adult children often deal with "balance problems" of their own—balancing the concern that their loved one might fall again, versus the knowledge that their loved one needs to keep active to avoid a decline in health. Seniors and families frequently tussle over independence issues—and worrying about falls definitely amplifies the concern!

If this describes you, what can you do? The first step is to do your homework. Learn more about your loved one's particular fall risks—such as arthritis, dementia, osteoporosis, vision or hearing loss, muscle weakness, or taking multiple medications. Remember that a history of falls is considered a red flag, as well.

Next, think about your loved one's living situation. If your loved one's care needs are great, a supported living environment, such as a nursing facility or assisted living, often is the safest choice. But most seniors prefer to stay in the comfort and familiar surroundings of their own homes. Or, they move in with family members. Can they be safe there?

Evaluate the suitability of the home.

Some homes just don't lend themselves to safe living for seniors with disabilities. Barriers like steep stairs outdoors and no bathroom on the ground floor would mean prohibitively expensive remodels for many families. But for many other homes, modifications and repairs to make the home a better fit are feasible. An occupational therapist or aging life care professional (geriatric care manager) can make recommendations for safety improvements that can lower the fall risk.

Yet even with handrails and improved lighting added, you might worry about your loved one's safety while you're not around to supervise. Many families hire professional in-home care to ensure their senior loved ones' well-being, and when it comes to fall protection, there are plenty of advantages:

Caregiver with senior client going for a walk.

Medication safety. Prescription drugs can reduce the risk of falls by helping seniors manage their health conditions. And yet, some of those same medications actually raise the risk of falls if they cause dizziness, drowsiness and confusion. For example, says Dr. Tinetti, certain common blood pressure medications decrease the risk of debilitating strokes and heart attacks—but they also increase the risk of falling by up to 40 percent! An in-home caregiver can take your loved one to the pharmacy, provide medication reminders, and report side effects right away.

Help with bathing, dressing and grooming. Falls experts tell us that when it comes to home safety, the bathroom often is the "danger zone." Staying clean and well-groomed is so important for a person's health and self-esteem, but the effects of arthritis, a stroke or Alzheimer's make it hard to bathe and use the toilet. Bathroom modifications plus the help of a caregiver make the bathroom safer. Getting dressed likewise can throw a senior off balance as they pull a sweater over their head or step into trousers. Adaptive clothing is available, but when Mom wants to wear that favorite blouse with lots of buttons or the dress with a back zipper, the caregiver can lend a hand.

Keeping seniors on the move. Inactivity leads to decreased balance, loss of muscle mass, and weaker bones—all big risk factors for fall injury. If your loved one has fallen, the doctor will most likely prescribe an exercise program, perhaps including walking, tai chi, a fall-prevention exercise class, or videos at home. But exercise might be out of your loved one's comfort zone if fear of falling has converted them into a couch potato. A professional caregiver can provide transportation to exercise classes, or supervision and encouragement as your loved one exercises at home.

Memory care. Problems with thinking, perception and vision put seniors with Alzheimer's disease at a higher risk of falls. A serious injury such as a hip fracture complicates their condition and hastens the progression of the disease. Yet seniors with dementia benefit tremendously from being physically and mentally active. Boredom and inactivity are often the root of wandering, aggression, sleep disturbances and other challenging behaviors. Select a trained in-home caregiver who can provide supervision and appropriate activities.

It's the little things. Experts say dirty, scratched eyeglasses are a fall risk. The caregiver can take care of that. And what about footwear? Slippers cause slips, and flip-flops can cause flips and flops! Loose, poorly fitted shoes are a big fall risk. But slip-ons are easier to put on, so seniors tend to choose them. The caregiver can help your loved one put on a lace-up shoe for better support and stability.

Preserving dignity. Complicated family dynamics sometimes enter in when we try to protect an older loved one. It's a time of role reversal—and some families report that their elder loved one seems to "act out" and take even more risks in response to the hovering! It's often easier for seniors to accept personal care and household assistance from a professional, which saves face and normalizes the parent-child relationship. Choose an agency that trains their caregivers well. Those caregivers will treat your loved one like the adult they are.

A trained, professional caregiver can be there when you can't, to be sure your loved one is safe. If you hire through an agency that provides training, you might even learn some fall protection tricks you hadn't thought of! Seniors, family and professional in-home caregivers working together make a great fall protection team. Home care provides the peace of mind that encourages seniors to be active, and lets worried families sleep at night.


Cover of the Fall Prevention guide

Give yourself a fall prevention checkup!

Older adults and their families should learn more about the risk of falls—and then use that knowledge to lower the risk. With all the things to remember, fall protection might seem like a daunting goal! To help you take steps to lower the risk, download a free, easy-to-use Fall Prevention Guide, created by Right at Home with Dr. Rein Tideiksaar, a leading expert on fall prevention for the elderly.

For information on topics related to home care and healthcare, visit our Home Care and Healthcare Advocacy group on LinkedIn.


Right at Home, Inc. is a national organization dedicated to improving the quality of life for those we serve. We fulfill that mission through a dedicated network of locally owned providers of in home care services.