INDEX

1. How to Care for Aging Parents

2. How to care for your parents from a distance

3. 10 Tips to Take Care of Aging Parents

4. How to keep Homebound Seniors Active

5. An Elderly Parent transforming from Hospital to Home

6. Coping with Care giving for Ailing Elderly Parent

7. Arthritis Causes & Symptoms

8. Caring for an Alzheimers Patient

9. Risk of Fall in Elderly

10. Fall Prevention in Elderly

11. Fall in Elderly Physiotherapist Perspective

12. The Role of Nurses in the Elderly

Fall Prevention Care Plan

Page 1
HOW TO CARE FOR
AGING PARENTS

Page 2
 How to Care For Aging
Parents
As we all get older we need to have serious discussion among our close
family members (spouse, kids, siblings) about taking care of our Aging
Parents. As they reach 70s and 80s we need to check their physical and
mental well-being and make sure they are leading an
independent living with excellent quality of life.

If we dont plan properly we all will end up in confusion, sadness,

helplessness, frustration, exhaustion when we have to deal with inevitable
health related challenges. With solid family support, professional support
and good communication we can renew the sense of love, compassion and
tenderness in to any family with Aging Parent.In order to do that effectively
adult children should take care of the following diligently:

1. Find out their (Aging Parent)

needs: Find out from your Parent
what they want whether:
They want to stay at home
Move close to their kids
Move to a Senior independent living
community with common dining hall,
cleaning facility, medical facility etc.
Old age home /Nursing home.

When you notice poor eating habits,

poor hygiene, neglecting their home,
forgetfulness, difculty driving then you
need to counsel them to get help

2. Find out your Parents assets :Find out your Parents assets
including pension amount, the health insurance policies, and free medical
facilities from the organization where they used to work etc.

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3. Decide whether you want to be their Caregiver: It may
Put emotional toll on you
You may have to quit the job
You may lose your benets for your retirement.
Consider professional help
Make a Caregiver budget
Make your own retirement plan
Understand the costs of keeping your Parent in their home
( May need home health Nursing care or Medical Care Taker care if they
have medical problem or just an assistant to do their day to day chores)

4. Make a joint decision: Discuss with your Parents, spouse, siblings

and Children and make a joint decision about the location of the stay.

5. Financial Planning: Based on the above make a budget to take of care of

your Parent with the contribution from your siblings to relieve the entire
nancial pressure on you.With careful planning we can provide
conducive atmosphere for our Parents to Age gracefully.

Page 4
HOW TO CARE FOR YOUR
PARENTS FROM A
DISTANCE

Page 5
 How To Care For Your Parents
From A Distance
Taking care of aging parents from distance is not only difcult but also is a
cause of concern for many working professionals not only living abroad but
Valso in a different city as their parents in India.

Parents may require care or help during

temporary health situation like
surgery or even a chronic health
condition. Other family members and
relatives may step in at this time and
help out for a while but most of the time
they may have to leave before the
patient recovers completely. India
Home Healthcare provides reliable and
coordinated care which is tailored to the
patients requirement.

The staff, not only stay in touch with the physician or surgeon, but also with
the family members to update the progress of the patient. The online patient
portal which gets updated regularly lets the family members anywhere to log
in and follow the progress of the patient. This can also be used to take any
second opinions if needed.

Parents who have been active, healthy and working towards our well being
all their life either at a job or taking care of family, show a change in their
health status soon after retirement or once they think they are getting old.
This is sometimes called empty nesters syndrome where the parents start
showing these symptoms when the family members (children) move out of
the house and start setting up their own families abroad or even in a
different city in India. The psychological factors of well being in old age are
overlooked easily even by the family members.

Page 6
Depression due to loneliness and decreased sociability in old age is real
and may have signicant effect on the health status. Even when there is no
clear diagnosis of depression, it will affect the individualshealth more than
we can imagine. According to a study conducted by Singh and Misra in
2009 on 55 elderly people, there is direct relationship between loneliness
and old age depression.

India Home Health care provides care givers

who provide companionship to the elderly
patients, not only to keep them active and alert
but also help them overcome activities which
are difcult for them like evening walk to the
park. These activities are needed to re-
integrate them back in to the community and
maintain the quality of life they deserve and
want. The care givers also help to maintain a
healthy diet plan and monitor even commonly
found and commonly neglected disorders like
hypertension and diabetes which are usually
the risk factors for many diseases in elderly.

India Home Health Care also provides monthly care plans which include
regular doctor visits, nurse, dietitian and physical therapist visits every
month to prevent and detect any disorders in the early stages.Aging surely
involves many degenerative processes, but it need not include diseases.
Adjusting to the changes that accompany old age require exibility and new
coping skills. India Home Healthcare helps not only the parents in the aging
process but also family members who can be reassured
that their parents are in the best hands.

Page 7
10 TIPS TO TAKE CARE OF
AGING PARENTS

Page 8
 10 Tips to Take care
of the Elderly
We are on this earth today because of our parents. They taught us the
lessons of life, to succeed and to get a respectful social image. Children
need parents help till they get settled in their life in all the aspects.
The same way parents also need support when they become aged.
And it is childrens responsibilities to give them a respectful retirement life.

Here are 10 tips to make our parents happy during their

evenings of life.

1. Avoid loneliness: Spend some time with parents, talk to them,

keep them involved in family affairs, get their suggestions and work
accordingly.

2. Dietary Needs: Their intake will be less because of poor appetite but we
have to insist them to have balanced diet regularly.

3. Medical Needs: Take care of their health issues, physical and

psychological. Talk to them if they need any medical assistance, provide
them the required assistance. Risk of fall will always be there because
of general weakness and fragile bones. We can avoid this by providing
extra support.

4. Regular Exercise: Spare some time especially for your parents and
take them for a morning or evening walk, they will be happy to spend time
with you.

5. Finance : Parents were independent their whole life to take care of their
own and the familys nancial needs but to meet their old age needs, they
should have some insurance policies which make them feel condent.

6. Never be rude: At this age there is a tendency to repeat the same thing
again and again but we should not behave rudely. The children must have
patience to understand the situation.

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7. Listen and solve their problems: Children should listen to their
problems patiently and try to solve them.

8. Make them feel special: By celebrating their Birthdays and

Wedding anniversary.

9. Help them for even small things: They need help for each and
every small thing like getting a glass of water, reading newspaper for them.
Ask them what they need and deliver it.

10.Allow grand children to play with them: This is the best way to
keep them happy always. It is like letting 6 and 60 year old children play
together
.
These are the few simple methods to keep our aging parents
happy so they can live with dignity and respect.

Page 10
HOW TO KEEP HOMEBOUND
SENIORS ACTIVE

Page 11
 How to keep Homebound
Seniors Active
Seniors as they get older may feel comfortable to stay at home. Some of
them will be independent within their familiar surroundings but may feel bored
at home. Some of them need minimal to moderate help to do their day to day
activities because of their health condition. Some of them may need total
assistance and may be bed bound due to severe disability due to the
deterioration in their health condition. In all the above three situations one
may feel lonely, boredom and depressed if they dont have a proper inspiring
companion or caregiver.
In order to keep the Senior Citizen active we can formulate certain
recreational activities to keep them physically and mentally t and keep them
happy. We can try the following methodology whichever works depending
upon the individuals interest:

1. Seniors who are independent

a. Explore the world via the world wide web- Computer games,
facebook/twitter/emails/Skype to stay connected with friends and families
and make new friends with similar interests, whatsapp with friends and
family, listen to the lectures/discourses/talks/songs of their interests in the
computer or laptop with speakers attached
b. Start a Book Club Read books with big fonts or magnifying glass or digital
books with large fonts and discuss with the club members through a Skype
call or conference call about the characters in the book that they are
focusing on.
c. Puzzle, board games (chess, snake and ladder, Chinese checker,
scrabble), solitaire, jigsaw puzzle, carom board, cards etc.
d. Work from home if they are still able to do that for couple of hours a day
e. Write a letter or call someone and speak to them on several topics that are
interesting for them.
f. Tinker- Able to x little things at home and have a sense of fullment
g. Painting, drawing, home indoor gardening, listening to the music
h. Hire a care giver/companion to give company and have a partner to play
several indoor games.
i. Start a new hobby

Page 12
2. Seniors who need minimal to moderate
help for day to day activities:

a. Caregiver to help in personal hygiene,

walking, dining, bathing etc.
b.Formulate a recreational activity that
gives interest to that Senior.
For e.g. To listen to a good music for one
hour in the morning, then do exercises for
all the joints followed by walking inside the
house with the help of a walker or a cane,
then do a little writing or drawing or
painting for another hour, then listen to a
book or a magazine read by their care
giver, then play chess or carom
for another hour in the evening and go
in the backyard or outside in
the wheelchair to get some fresh air
and watch their favorite program
in the television

3. Seniors who are bed bound and need

total assistance
a. Bed should be closer to the window so that they can see outside for birds,
people, trafc, workers doing some painting or road repair work so that
they stay connected to the outside world.
b. Keep a big clock and a large print daily calendar for them to look
c. Put soft music/lectures/discourses/talk for them to listen
These are the few tips to maintain a healthy, happy quality of life among
the home bound Senior citizens.

Page 13
AN ELDERLY PARENT
TRANSITIONING FROM
HOSPITAL TO HOME

Page 14
 An Elderly Parent Transitioning
From Hospital To Home
Despite the obvious relief of getting your elderly parent discharged from
hospital after an illness or a surgery, it can be quite stressful to transition
them back to life at home. The situation becomes more complicated when
your parents live alone. With the hospitals focusing on reducing the length
of stay, the burden of rehabilitating the patient falls more and more on
the family.

People are getting discharged with greater need for support and care at
home. Even though you might love your parent and might want to take care
of them to the best of your ability, it is becoming difcult for the majority.
With demanding careers and taking care of your own home and children,
it can be a daunting task to care for your loved one when he/she is
recuperating. However, having a clear plan in place for life after discharge
will be immensely benecial to you and your family.

Ideally, a smooth transition should ensure that,

The patient is clinically safe

There are no risks or threat of getting readmitted to the hospital for the
same problem or other complications
The patient is condent of getting back to normal routine
Here are some simple solutions to achieve these goals:

1. Assess your home environment: Before the discharge do a quick home

check and look at it through the eyes of your fragile parent. Make a list of
questions that you need to answer before the discharge, for example: Will
there be a need for a hospital bed or oxygen supply? What consumables
like diapers, gloves, etc. need to be kept in stock?

2. Be part of the discharge planning process: Speak to the physician and the
hospital nursing team about your concerns. Understand how you could
help and the specic tasks your parents would need assistance for. Get a
rough estimate of how long the recuperating period might be.

Page 15
3.Make the necessary changes at home: If your parent needs a hospital bed or
other equipment, you might need to choose a room for them with enough
space. Ensure that there is enough lighting, especially the path from the bed
to the bathroom. Consider the possibility of installing grab bars in the
bathroom. If you plan to involve additional caregivers, plan on a comfortable
space to accommodate them.

4.Get support for the health care tasks:This is the actual bulk of care-giving at
home. It requires your physical presence and assistance in getting your
parent back on his/her feet. Daily tasks like feeding, medication administration,
monitoring for complications or infections need to be performed consistently.
Evaluate if you can perform these tasks and how much time you can devote
to being the primary caregiver. If it is not a responsibility that you can handle,
engage a home health care provider. Before choosing a provider, do a
research on the providers in your locality, understand their credentials,
evaluate the care packages they offer, short list and interview them.

Involve the home health care provider

in the care, even before the discharge
from the hospital. This helps them in
understanding the specic condition of
the patient and therefore to draw the
care plan that he/she needs. Check
the daily tasks that they need to
perform, the signs of complications
that they need to watch for and provide
them with a list of emergency contacts.

Availing support from professional healthcare companies is therefore a valid

option, as it allows the elderly patient to recuperate in their known surroundings,
while reducing the pressure on you and your family. Home healthcare has
shown better results in patient recovery by reducing the recuperation period by
an average of 15%.

Page 16
Dr.AnithaArockiasmay, Head of Clinical Operations at India Home Health
Care, Indias largest home healthcare provider, has experienced the impact
of home healthcare on the patients recuperation and transition to home.
We have served a number of patients, where they were clinically stable
but not fully recovered from the illness. Shortly after discharge to their home
under our care, a signicant improvement was seen. It was surely a
combination of many factors, one being the comfortable and known home
surrounding, and another one being the professional care given by the
family in support with our care provider.

This transition is not just about your parent, it is also about you evolving
from being a child to a care giver. No doubt, it is a challenging and critical
phase in your life. To make it a rewarding and fullling experience,
understand your options and limitations. Ensure that you have a solid plan
in place and execute it efciently.

Page 17
COPING WITH CAREGIVING
FOR AILING PARENT

Page 18
 Coping With Caregiving
for Elderly Parent
In our Indian communities, caring for elderly parents is considered a core
traditional value, that we take pride in. Irrespective of the westernisation
of our societies, majority of Indians choose to care for their parents at
home. With the age expectancy of our population increasing and the
number of children in a family decreasing, the length of time that the
parents are cared for and the intense pressure that results out of it, has
increased quite signicantly.

The demands of being the care giver can be quite high. It needs a lot of
dedication, time and effort. The critical challenge, for many, is juggling a
busy career, caring for their own kids and home plus the aged parents.
The pressure from all sides can lead to a condition known as the Care
Giver Burnout, which is dened as the physical and emotional strain that
results from taking care of someone. Though it is a rewarding and fullling
experience for many, it can take a toll on the quality of life for the
entire family.

It could result from not sleeping enough, working too much, having too
many tasks to attend to and just not having enough time to care for yourself.
Add to it the nancial implication or the emotional turmoil of watching the
parent suffer from a degenerative condition like Alzheimers or the
unresolved family issues that resurface, these are enough to leave anyone
overwhelmed with the situation.

The demands of being the care giver can be quite high. It needs a lot of
dedication, time and effort. The critical challenge, for many, is juggling a
busy career, caring for their own kids and home plus the aged parents.
The pressure from all sides can lead to a condition known as the Care
Giver Burnout, which is dened as the physical and emotional strain that
results from taking care of someone. Though it is a rewarding and fullling
experience for many, it can take a toll on the quality of life for the
entire family.

Page 19
Care Giver Burnout can manifest as
1. Depression I am not interested in any of this
2. Anxiety I cannot step out of the house, what if my mother needs me?
3. Guilt Am I doing enough?
4. Exhaustion I am just too tired to eat
5. Inability to concentrate I completely forgot my spouses birthday
6. Loss of sleep What if she tries to get out of the bed and falls down?
7. Excessive irritability I just need to be left alone

Physically, it can be present as headache, body ache, weight loss,

weight gain or insomnia. Though our body is capable of handling stress
for a short time frame, it loses the ght after some time and the stress
starts wreaking havoc on our systems.

This is more common in women, as

they are mostly more hands on than
men. While men tend to involve
with the coordination of care,
driving to and from hospitals and
taking care of the nancial matters,
women tend to be the personal care
givers and keep the relationship
going within the family members,
while attending to their own
children and maybe careers.
The warning signs of Care Giver Burnout need to be taken seriously as the
quality of the care you provide to your parent is directly proportional to your
well being. You need to take care of yourself as the stress can only be a
detrimental factor in these situations. Let us now, look at a few tips to
overcome the Care Giver Burnout.
1. Give yourself priority: You should get away from the guilt and need to
understand that you need regular breaks to keep you going. Do things that
you love during those breaks. Set your mind free and come back
refreshed. Simple relaxation techniques like meditation, going for short
walks are great stress busters.

Page 20
2. Seek Help: There are organized providers that provide at home
healthcare. At home healthcare providers, give the same quality of care
that you get in hospitals in the comfort and convenience of your homes.
India Home Health Care Pvt. Ltd.(IHHC) is one such provider which takes
care of the elderly through a wide range of care plans that is developed
and customized to your parent.
Dr.AnithaArockiasamy , Head of Clinical Operations, IHHC points out that
Over 30% of our patients come to us after trying to care for their parents
by themselves.

By the time they approach us, they are exhausted physically and mentally.
They feel like they are ghting a losing battle. However, once they engage
with us, they realise that they have a team that works with them for their
parent and that they have someone with confer with. They understand that
they can delegate the hands on care and get their life back. While starting
a service for an elderly parent, India Home Health Care administers a
questionnaire for the patients family to deduce how much of psychological
support they need, which helps in stemming the Care Giver Burnout.

3. Garner support: Accept help and support from other friends or family.
Discuss the issues you have at hand and the specic tasks that they could
help with. If you are open and honest about the situation, you will be
surprised by the positive responses you will get. Create partnerships with
other siblings. Even if they live far away, speak to them to relieve you for a
few weeks.Try conding in friends, unloading can make you feel a lot better.

4. Accept the reality: Things can go wrong and you cannot control everything.
As is often said, there is no such thing as a perfect care giver.
Do not feel guilty if you fall short of things, at times. Your house need not be
perfectly kept at all times.

5. Take care of your health: Going for regular physical check-ups is even
more important when you are a care giver. Make sure you get enough sleep,
eat well and exercise regularly so that you feel t and ne.

Remember that your parent wants you to be happy and healthy, above
everything. It will hurt them to watch you weaken while taking care of them.
So watch out for those warning signs, learn to lighten the stress and the
risk of burnout.

Page 21
 Arthritis
Causes & Symptoms
Arthritis is a nagging problem when managed diligently can be controlled
effectively. The person who is affected can lead a normal qualitative life
when he understands his/her problem better. There are many types of
arthritis namely Osteoarthritis, Rheumatoid arthritis, psoriatic arthritis,
gout etc. Among these, osteoarthritis and rheumatoid arthritis are more
common. Osteoarthritis is due to degenerative changes in the joints due to
wear and tear resulting in joint inammation, pain, swelling, restriction of
joint mobility thereby affecting the basic function like sitting, standing and
walking, Knees are the most common joints that are affected. Then, comes
the hips, small joints in the hands, and ankles. With proper medical
consultation and physiotherapy these individuals can lead a pain free
normal life.

Rheumatoid arthritis is a condition with

severe joint inammation with remissions
ad relapses. The cause is unknown. It can
start with any joint. Usually this is
symmetrical. Both the knees will be affected
and then both the ankles, both the hands,
both the elbows, both the shoulders and
then the spine will also be affected. If not
treated properly the joints can result in
crippling deformities.

These patients should consult a Rheumatologist periodically to control the

joint inammation with proper medications along with a comprehensive
physiotherapy care.

Page 23
 ARTHRITIS
CAUSES AND SYMPTOMS

Page 22
Physiotherapy plays a vital role in the management of arthritis. If there is a
joint swelling it is better to apply a soft gel type ice pack wrapped over a
thin cloth for 10 to 15 minutes. Any acute pain and swelling in the joint will
respond better to cold pack. This is followed by gentle isometric exercises.
For example if there is a pain and swelling in the knee, knee pressing
exercises can be done by keeping a turkey towel role under the knee. As
the pain and swelling comes down the exercises can be progressed. In the
case of sub-acute and chronic joint pain, heat therapy is ideal. Electric hot
pack or hot water bag can be applied at home after nishing the simple
exercises. Exercises should be done methodically. When exercises are
done methodically the muscles in and around the arthritic joints will get
strengthened and improve the blood circulation thereby do the repair
process resulting in pain reduction. The strong muscles will stabilize the
joints and improve the endurance too.

Page 24
 CARING FOR AN
ALZHEIMER'S PATIENT

Page 25
 Caring For An
Alzheimers Patient
Alzheimers disease is an illness of the brain. It is caused by a large number
of brain cells dying which leads to loss of memory and the ability to think
clearly. This often leads to the entire family getting affected and not just the
patient. Since Alzheimers patient becomes forgetful and disoriented which
gets worse as the disease progresses, it is often a close family member that
steps in as the primary care-giver. Caring for an Alzheimers patient is hard
because the family member also needs to deal with the personality changes
that happen due to the disease and the dependency increases as the
condition progresses.

The following points can help the primary caregiver to understand their loved
one better and to care for them more efciently:

1. Maintaining a stable daily routine in a familiar environment can bring

down the patients stress levels to a great extent

2. Keeping them amidst family members and reminding them about the
past will be essential to keep them engaged with the present

3. Keeping the surrounding area free of fall risk will be critical to

prevent falls and further complication

4. Nutritious food at regular time is essential for maintaining good health.

5. Caring for yourself is a necessity as it brings you relief. You could do

this by taking assistance from friends, other family members, opting for
partial/full home care assistance, getting exercise and eating well.

Page 26
RISK OF FALL IN
ELDERLY

Page 27
 Risk Of Fall In
Elderly
An old woman aged 70 years fell on her face during early morning hours
causing severe bruise and swelling in her cheek. When you assess this
particular lady you gather so many pre-existing fall risk factors for her.
A patient with rheumatoid arthritis for 25 years, taking psychiatric medications
for many years, diabetic, post R breast removal cancer prevention medicines,
thyroid medicine with inactivity resulted in muscle weakness, poor balance
and giddy/dizzy/syncope spell due to multiple medicines. This is a perfect
example of a few risk factors for falls in elderly.

Out of 1.27 billion people in India, 60 and over population contribute 7.7%.
Falls are the major problem and in medical terminology it is known as
Geriatric Giants.

What are the reasons for the fall in elderly?

There are two main reasons. They are intrinsic factors and extrinsic factors.

1. Intrinsic factors:

1 .Balance and Gait (ambulation):

Legs and spinal muscle weakness due to stroke, parkinsons, arthritis,
neuropathy, neuro-muscular disorder, vestibular disorder etc.
2. Medications (Polypharmacy):
Taking more than 4 medicines and sedatives increases risk of fall.
3. a. Vision: Visual impairment like glaucoma, macular degeneration,
retinopathy, bifocals etc.
b. Visual motor reaction time is extended
4. Cognition: Dementia, confusion etc.
5. Cardio-vascular causes:
Orthostatic hypotension, carotid sinuses syndrome neuro-cardiogenic
syndrome, cardiac arrhythmias, valvular disease etc.
6. Urinary Incontinence

Page 28
2. Extrinsic factors:
1. Poor lighting
2. Stairs with inadequate handrails.
3. Rugs and oor surfaces with low friction.
4. Loose clothing
5. Poorly tting footwear
6. Lack of equipment (assistive devices) like walking sticks,
walking frames, Zimmer frames, etc to assist them in ambulation

Consequences of fall:
1. Black eyes and soft tissue injuries suggest that the faller was not conscious
as they fall.
2. Fracture & Dislocation: 5% of falls end up having a fracture out of which 1%
will be fracture neck of femur.
3. Disuse atrophy and muscle wasting during recovery period.
4. Long term bedridden patients develop pneumonia, pressure sores,
dehydration and hypothermia.
5. Psychological: Fear of falling falls under the Psychological category.

Interventions:
Multi-disciplinary approach to assessment and treatment results in best
outcome. Provisions of safety devises such as grab handles, high friction/non
-slippery oors, selection of proper footwear , high power lighting to name a
few, hip protector, regular exercises, monitoring medications and addressing
the environmental issues are the key.

Page 29
FALL PREVENTION IN THE
ELDERLY

Page 30
 Fall Prevention In The Elderly
Falls are one of the most common fears of the elderly. Although any one
could fall, the chance of falling gets higher and the after-effects of the falls
become more serious with age. Falling causes injury, loss of mobility and
even death. However, it is not something that should give you sleepless nights
as these can be prevented, once you evaluate your personal risks for fall and
learn about ways to overcome those.

Falls are common in the elderly age group because of normal changes
related to aging such as poor balance, impaired vision, reduced mobility or
side effects of medication. As we age, our reaction time to avoid hazardous
situations declines as the nerves that conduct impulses from the brain to the
muscles weaken with age.

By incorporating a few changes in your lifestyle, you can bring down the
chances of falling quite drastically.

Here are some tips to get started upon:

1. Exercise regularly: It is important to keep moving as regular exercise

keeps your muscles stronger and nerves more alert. Yoga and other forms
of exercise like Tai-chi are often recommended for seniors as they focus on
muscle strength and balance.

2. Check your vision: Poor eyesight puts you at a high risk for falls. Plan to
visit your Ophthalmologist for a vision check at least once a year. With age,
the chance of developing glaucoma or cataract becomes quite high. This is
more signicant if you have diabetes or hypertension.

3. Review your medication with your physician: The changes in the

different systems as people age, affect how the body is able to absorb,
use and eliminate the excessive medication. The same medicines which
you took earlier may have different effects with age. Some of them may
cause excessive sleepiness or muscle weakness which again puts you at
a risk for falling. So make it a point to discuss the medication you take,
including the non-prescription ones, with your physician and understand
their side-effects.

Page 31
4. Use Mobility Aids: If you have problems with balance and coordination,
your doctor will prescribe mobility aids like canes or walkers. These devices
help you keep moving safely.

5. Make your home safer: Assess your homes for potential hazards and
address them. Simple things like the way your furniture is arranged,
avoiding use of rugs or mats on the oor, de cluttering the oor, making
sure the path from the bedroom to bathroom is well lighted have a great
effect on your safety within the house.

6. Enrol in a regular health assessment

program:
There are a few healthcare providers who
provide at home health assessment including
checking your immediate environment
for potential hazards and work with you to
make your health better and home safer.
This helps in promoting independent living

Who is India Home Health Care and how can we help?

India Home Health Care Pvt. Ltd. is a leading at home health care provider
based in Chennai and Bangalore. We offer quarterly visits by doctors and
monthly or bimonthly visits by Registered Nurses to assess the health status
of the elderly. We have developed a detailed health assessment tailored to
the Indian population. Our Registered Nurses are trained professionals with
experience in hospital setups and are therefore well equipped to handle any
situation at the patients home.

Each visit is structured to identify any changes in the health status, in addition
to reviewing the medication intake and check the environment of the patients
home to assess the safety from a health perspective.

Page 32
FALLS IN ELDERLY -
PHYSIOTHERAPISTS
PERSPECTIVE

Page 33
 Falls In Elderly- Physiotherapist
Perspective
An 85 year old lady fell down while draping her 7 year old Grand Daughter
with a blanket and didnt have pain or discomfort in her body immediately.
After couple of days she was having pain in her back for which she went for
an orthopaedics consult followed by MRI which revealed multiple crush
fracture in the lumbar and dorsal spine. She had complete rest with back
brace for few weeks followed by comprehensive physiotherapy. Overall it
took six months for her to recover from the day of fall and affected her quality
of life especially to lead an active and independent life.

About one third of people over the age of 65 and almost half of people over
the age of 80 will fall at least once a year. Doctors, Nurses, para- medical
persons, family member ,and friend etc can identify fall risk person in their life
and refer them to Physiotherapist for further management.

Physiotherapists can help reduce a persons risk of falling by:

Assessing a persons risk of falling.

Helping his home as safe as possible.
Educating that person about the medical risk factors linked to fall
Designing individualized exercises and balance training.
Working with other health care professionals and community services
to create programs for people who want to reduce their risk of falling.

Physiotherapist can do a thorough evaluation which includes:

A review of ones medical history

A review of ones medication
A simple vision test
A home safety assessment
A simple screen of ones thinking abilities.
A check of ones hear rate.
BP measurements while changing position from sit to stand.
Feet and footwear assessment.

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 Assessment of any nervous system disorders such as stroke,
Parkinson, etc
Measure ones leg strength using simple tests such as timing how long it
takes you to rise from a chair.
Determine how quickly and steadily one can walk.
Assess ones balance for instance , by having one stand on one leg or
rise from a chair and walk
Use special test to measure the balance

Based on the evaluation results, Physiotherapist will design an exercise and

training program to improve ones balance and strength. A recent systematic
review of many published studies found that exercise based programs in the
home or in group settings are effective in preventing falls. These programs are
especially effective when balance exercises are performed in a standing
position without using much arm support.

1. Balance Exercises
Balance training has been shown to be an
important and effective part of falls
prevention. Ones Physiotherapist will
design exercises that challenge his ability to
keep his balance including such
exercises as single leg standing

2. Walking and Moving

When people walk very slowly or unsteadily, they are at risk for falling.
His Physiotherapist can improve his walking ability by making him
do such activities as:
Dance steps
Walking in circles
Figure 8, exercise to strengthen the core abdominal muscles that
help stabize ones body
Obstacle course

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3. Doing more than one thing at the same time safely
Older adults who have difculty walking and talking at the same time are at
high risk of falling. To help increase their safety during activities ones
Physiotherapist can design a,dual task, training program. This kind of
training will challenge one to maintain a walking speed while he do another
task such as counting backwards, engaging conversation or carrying a
bag of groceries.
4. Strength Training
Strengthening exercises are a key element of fall prevention when they are
done in conjunction with balance training. Ones Physiotherapist will design
strengthening exercises that focus on his leg and the muscles used in
maintaining posture.

5. Aerobic Training
Walking is one of the safest way of aerobic training. Physiotherapist will
formulate walking program according to the patients capacity.

6. Education& Fear Management

Physiotherapist will talk to the patient how best to manage his own risk of
falling and to build his self esteem to overcome the fear of falling.

7. Community Program
Physiotherapist can participate with local groups in organizing different fall
prevention activities at the community level like in the malls,
senior citizen centres, clubs etc.

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THE ROLE OF NURSES IN THE
ELDERLY FALL PREVENTION
CARE PLAN

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 The Role Of Nurses In The
Elderly Fall Prevention Care
A Nurse has got a major role in preventing falls in Elderly population. From
the time of admission to the hospital to the time of discharge she can
categorize the patients in to low risk, moderate risk and high risk. From that
category she can formulate a care plan to prevent fall in the hospital, at home
and in the community.Falls can be due to multiple reasons.

Patients who take benzodiazepines, antipsychotic, diuretics, anti-depressants,

narcoleptics, opioids, insulin, oral hypoglycaemic, anti -coagulants, cardiac
and hypertensive will lead to disorientation, giddiness and fatigue.

Patients who have dementia, hip fracture, Parkinsonism, stroke, osteoporosis,

arthritis and depression should not be left alone. Patients who have urinary
and faecal incontinence need bladder and bowel habit retraining, diaper care
to prevent rash/pressure sore.In addition patients who have visual impairment,
functional disability and prior history of fall should have appropriate
intervention to prevent further falls.

Nurse can initiate fall prevention care plan for the above mentioned
patients as follows:

1. Toileting needs: To ask the patients every one to two hours whether he/she
needs to use the bathroom, answer call light promptly, remind the patient to
ask for assistance and reorient to call night if necessary, eliminate side rails
and asses need for bedside commodes and individual toileting schedule
and/or bowel and bladder training.

2. Sync opal Episodes: To evaluate postural hypotension and/or cardiac

arrhythmia and consult with physician, review medications with pharmacy
consultant and physician, consider uid volume decit then evaluate intake
and output, teach the patients to change the position slowly, especially from
lying to sitting to standing, maximize the patients time out of bed as much
as clinically possible to increase tolerance, keep the bed in the low position,
assist with all transfers, consider use of TED hose and perform a
nutrition consultation.

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3. Environmental hazards: Eliminate potential hazards such as uneven
surfaces, debris or water on the oor, keep the light and water within the
reach, keep eyeglasses within reach and ensure adequate lighting .

4. Weakness/Unsteady gait: Evaluate for possible therapeutic interventions,

remind patients to request assistance, keep call light within reach, confer
with rehabilitative services and the interdisciplinary team and assist the
patient to obtain and wear appropriate, non-skid shoes.

5. Sensory/perception decits: Frequently reorient the patient to the

environment, keep furniture and other objects in the same position,
evaluate presence and adequacy of glasses and hearing aids, assess the
environment to maximize safety, consult with vision/hearing specialist as
needed, refer to occupational therapy and consider a conference with
rehabilitative services.

6. Knowledge decit: Ensure assistive equipment is used appropriately,

be sure the patient is comfortable with adaptive and assistive devices,
ensure the resident is able to use the call light. If the light is difcult to press,
consider a foam pad call light or other adaptive call lights and ensure
frequent visitors are aware of the use of assistive devices.

Once the care plan is formulated among the three categories (low risk,
moderate risk and high risk) then appropriate staffs are delegated to perform
the task. In all the categories the nurse should maintain the safe unit
environment which includes removal of excess equipment/supplies/furniture
from rooms and hallways, coil and secure excess electrical and telephone
wire/cords, clean all spills in patient room or in the hallway immediately and
place a signage to indicate wet oor danger.

For low risk individuals apart from maintaining above mentioned

safe unit environment the following safety interventions should be taken:

i) Orient the patient to surroundings, including bathroom location,

use of call light.
ii) Keep bed in lowest position during use unless impractical
(when doing a procedure on a patient)
iii) Keep the top two side rails up.
iv) Secure locks on beds, stretcher and wheelchair.

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v) Keep oors clutter/obstacle free (especially the path between bed and
bathroom/commode)
vi) Place call light and frequently needed objects within patient reach.
vii) Answer call light promptly
viii) Encourage patient/family to call for assistance as needed.
ix) Assure adequate lightening especially at night.
x) Use proper tting non-skid footwear.

For moderate risk individuals apart from maintaining safe environment

as mentioned earlier and follow low risk intervention plus
institute agging system.

Institute Flagging system:

a. Apply fall risk arm band

b. Falling star (yellow) outside the patients door
c. Falls risk sticker on the medical record and monitor and assist patient in
following daily schedules:

Supervise/assist bedside sitting, personal hygiene and toileting

as appropriate.
Reorient confused patient as necessary.
Establish elimination schedule and use of bedside commode if appropriate.

Evaluate the need for:

Physical therapy consult if patient has history of falls and or mobility
impairment.
Occupational consult

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For high risk individuals apart from maintaining safe environment
as mentioned previously follow low and moderate fall risk interventions
plus institute agging system:

1. Apply fall risk arm band.

2. Falling star (red) outside the patients door.
3. Falls risk sticker on the medical record.

Remain with patients while Toileting

Observe 6o minutes unless patient is on activated bed or chair alarm.
When necessary transport throughout hospital with assistance of staff
or trained care givers. Consider bedside procedure.

Evaluate need for following measure going from less restrictive

to more restrictive:
Moving patient to room with best visual access to nursing station.
Activated bed/chair alarm
24 hour supervision
Physical restraint only with authorized prescribed order

Once the patient is ready to go home the nurse should make a home safety
assessment by following above mentioned guidelines and then transfer the
patient to a safe home with proper caregiver if necessary. At community
level the nurses can address the senior citizen group on fall prevention
and safe mobility.

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