It’s 3pm on a Sunday. James is sitting on the couch, watching the Panthers trudge through another wasted season under Matt Rhule, when the phone rings. It’s mom. She’s incredulous. “Dad’s fallen, and he can’t get up!” James gets up, sprints to his car like he is the 2019 version of Christian McCaffrey and drives across town to his parent’s house.
James’ dad, Charles, is laying on the floor in obvious pain. He can’t get up because his right hip is in so much pain that he can’t stand. EMS is called to help Charles get up. After multiple attempts to get him up, they bring in a stretcher. EMS thinks he has broken his hip, so he is taken to the ER. James stands on the porch and watches the ambulance drive off – red lights glowing in the distance. His eyes start to puddle. His mom is inconsolable – sobbing on his shoulder.
Following the ambulance on the way to go ER, James starts thinking back on things.
He had been thinking Charles has been “slipping” a little bit over the past year. His memory seems a little less sharp than usual. He and Esther, his wife of 53 years, were eating Sunday lunch after church a few weeks ago, and she became concerned when Charles couldn’t figure out how much tip to leave on the table. She called James that night after Charles went to bed – concerned. James had a busy day at work the next morning, so he told her everything was going to be ok, and he went to bed.
Charles fell about two years ago and again about six months ago. He did not seem injured, so James shrugged it off. Charles, a proud 78-year-old veteran, did not tell his doctor about the falls. Heck, it’s hard to get Charles to even go to the doctor when he’s sick. At that point, it occurred to James…I wonder if dad’s doctor even knows he has fallen twice in the past two years?
The ER doctor comes into the room. He pulls up the X-ray at the bedside. Charles has a subcapital fracture of the right hip. Stunned, Esther and Charles can only think of one question for the doctor – “will he be able to come home right after surgery?” The ER doctor sits down and holds gently holds Esther’s hand. He explains that this is a big surgery and Charles will need to go to rehab for about six weeks to work with physical therapy and occupational therapy before going back home.
Esther lets out a bone chilling wail.
Addressing falls in the elderly – before they happen – is essential
James calls Charles’ doctor the next day. He speaks to Dr. Smith’s nurse who lets James know that his dad had never discussed with the doctor that he had fallen before. Well, James asked…did Dr. Smith ever ask my dad if he has fallen or if he felt safe when he was walking? The nurse sat on the other end of the phone – quiet. It doesn’t look like it, she finally responds.
The statistics on falls in the elderly are staggering:
- One in four Americans aged 65+ falls each year
- Every 11 seconds, an older adult is treated in the emergency room for a fall
- Every 19 minutes, an older adult dies from a fall
- Falls are the leading cause of fatal injury and the most common cause of nonfatal trauma-related hospital admissions among older adults
- Falls in the elderly caused over 34,000 deaths in 2019
What is your plan?
Charles is admitted to the hospital and undergoes an uneventful surgical repair of his right hip. On post-operative day three, he is transferred to a local skilled nursing facility. James meets with the case manager and the medical team and realizes that he has a lot of work to do before his dad comes home in a few weeks.
How is he going to get it all done?
His sister, Bonnie, lives in Oregon. James has a demanding job, a family, and can’t afford to take time off work. Charles’ insurance will pay for most of the rehab, but he is still going to owe thousands of dollars to the facility and to the hospital.
James doesn’t know where to start.
Tips to prevent falls:
The best plan for having elderly patients who are at high-risk of falling is to do everything possible to prevent falls. Since falls are not entirely preventable, having a strategy in place in case of falling is crucial.
- Keep floors clutter free
- Install hold bars in the bathroom
- Move bedrooms downstairs and consider downsizing when elderly
- Be open and honest with your doctor if you’re feeling unsteady on your feet or have fallen. Programs are available through many agencies to assist the elderly in preventing falls. Stride Right is a great program Bream Medical utilizes with partner, Centerwell Home Health
- Ensure adequate intake of vitamin D
- Remove loose objects from the floor
- Avoid clutter on the floor
- Keep a night on in the house at night
- Keep up-to-date on vision exams. A common reason for falls is inability to see well
- Ensure you review you medication list with your doctor to avoid polypharmacy
Talk to your parents:
No one likes to admit their parents are getting older. Parents don’t like to admit it either. But having a plan for an emergency is critical to ensuring things go as smoothly as possible.
Ideally, these conversations would happen in the primary care setting and be carefully planned out in consultation with your primary care physician. However, given that most appointments in corporate medicine are rushed, these conversations frequently do not happen.
- Set up a meeting with your parents to discuss what their desires would be if they were to end up with a life-threatening illness or a state of health in which they cannot function normally and need significant assistance
- Understand your insurance – know what your insurance covers, does not cover, and what your maximum out-of-pocket costs are. Know if there is a limitation on the number of rehab days provided and if your insurance covers home health services – and for how long those services are covered
- Understand your parent’s financial situation. Do your parents have enough savings to cover out-of-pocket costs in case of emergency?
- Help your parents assess their home for safety based on the fall tips above
- Ensure your parents have a living will and appropriate end-of-life desires are communicated in writing (ideally with a MOST form)
- Talk with your siblings and extended family about what your plan would be in case of an emergency in your family
At Bream Medical, we understand that these conversations are difficult – but are critically important. Our annual physical examinations are at least 45 minutes to ensure that we address all our patient’s concerns. Family members are always welcome to be a part of these discussions.
If you are concerned about a family member who has fallen, is at risk of falling, or may be on too much medication, schedule an appointment with Bream Medical today!
How did Charles do?
Charles had an uneventful stay at the skilled nursing facility for rehabilitation. He worked really hard with therapy and was discharged home a week early. James was able to make the adjustments needed to minimize the risk of falls at his parent’s home and took FMLA from work for a month to complete the needed tasks. Esther is thrilled to have her husband back home.
Bream Medical is an all-inclusive, non-corporate practice that provides urgent care, primary care, and direct primary care services in Salisbury, Stokesdale, and Edenton, NC, and provides telemedicine consultation anywhere in North Carolina. We provide excellent healthcare by prioritizing patients care – not profits. To learn more about Bream Medical, visit https://breammedical.com or call 704.216.1263.
*Fall statistics taken from ncoa.org and CDC.gov