Fall Prevention and Its Relationship to Safe Toileting

NAFC's intern Megan Spradlin, headed to nursing school for her BSN this coming winter, did some research recently on fall prevention and its close connection to safe toileting.With Falls Prevention Month upon us, it is a good time to revisit this topic.Megan is going to be well primed for MUSC's accelerated BSN program_

Nationally, September has been designated as Falls Prevention Month. The first day of fall occurs on September 22nd, also a day when passionate people across the country will stand together to observe the 5th annual National Falls Prevention Awareness Day. Forty-six states will participate in Falls Prevention Awareness Day this year, joining over 70 national organizations, professional associations, and federal agencies that comprise the Falls Free © Initiative to raise awareness through educational presentations, risk-screening activities, and other outreach strategies. They are standing together to bring attention to common-sense, effective strategies to help older adults reduce the risk of falling. The National Council on Aging (NCOA), a longstanding collaborative partner of the National Association For Continence, promotes proven programs for seniors to stop falls before they even start.

Every 15 seconds, an older adult is seen in an Emergency Department somewhere in our nation for a fall-related injury. Unintentional injury is the fifth leading cause of death in those aged 65 and older, and two-thirds of all injuries are related to falls. One third of people over the age of 65 fall each year, and 50 percent of those are 80 and older. Five percent of older people who fall require hospitalization. Many people may suffer a fear of falling that can lead to their loss of independence. Currently, the U.S. Centers for Disease Control (CDC) has budgeted only $2 million per year to prevent falls among older adults. Yet, this is a serious problem that costs more than $28 billion in direct medical costs from fatal and nonfatal injuries each year. For people age 72 and older, the average health care cost of a fall injury totaled $19,440 in 2010.

Risk factors for falls include: muscle weakness, history of falls, gait and balance problems, need to use a walker or cane, visual impairment, arthritis, difficulties doing activities of daily living (bathing, dressing, transferring, and toileting), depression, cognitive impairment or memory problems, and age greater than 80.Urinary incontinence is frequently reported as a risk factor for falling. Elderly men with moderate or severe lower urinary tract symptoms are at a significantly greater risk for falls, and the risk dramatically increases as symptoms worsen. These symptoms include urinary urgency, urinary frequency, and the need to strain to initiate urination. Another risk factor includes taking over four medications. This specifically includes diuretics often prescribed to treat hypertension (i.e. hydrochlorothiazide, or HCTZ), as such medications may cause a sudden drop in blood pressure when standing up from a reclining position. Also, drugs with an anticholinergic effect are commonly used to treat symptoms related to urinary frequency and incontinence. The side effects of the anticholinergic can, in some cases, contribute to falls (blurred vision, drowsiness and sedation, confusion, disorientation, dizziness, weakness, hallucinations, and delirium). Furthermore, taking more than one medication with an anticholinergic effect increases the risk and severity of falling. All older persons should be advised of these adverse effects so that risk prevention and management may be assessed.   There are many effective measures and precautions you can take to reduce your risk of falls:

  • When getting out of bed, sit on the edge of the bed for a few minutes before standing
  • Keep the path to the bathroom clear of clutter
  • Wear slippers with non-skid soles
  • Remove environmental hazards like loose rugs
  • If using a walker or a cane, keep it bedside
  • Increase safety and fit of wheelchairs
  • Take time to turn on lights and keep a working flashlight at bedside
  • Frail and elderly with multiple risk factors may benefit from a bedside commode
  • Ask your doctor or pharmacists about substituting medications to reduce side effects and risks of drug interaction
  • Increase lower body strength and improve balance through regular physical activity, especially stretching exercises
  • Have your vision checked annually and wear eyeglasses when accessing the toilet