Distinguishing the Signs of Dementia and Depression

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As we get older, it’s expected that our bodies won’t act the same as they used to. We may experience a decrease in stamina, bone and joint problems, increased recovery time from activities, among other things.

However, there are some symptoms typically associated with old age that are actually worth paying more attention to in elderly individuals. Memory loss, decreased appetite, or a decline in activities’ participation could just be side effects of elderly conditions, but significant changes could signal other underlying issues as well. Depending on the symptoms and their severity, certain changes could suggest depression or possibly the onset of dementia as well.

The presentation of dementia and depression can appear similar in elderly residents. ALE discusses the distinguishing features and the differences in these conditions.

Depression Vs. Dementia

Depression in the Elderly

It’s estimated that over 6 million Americans 65 and older experience late-life depression (National Alliance on Mental Illness, or NAMI). The causes are often related to the shift in purpose, abilities, or other events common in later life, such as a decline in physical health as well as loss of family, friends, or a spouse. People are often eager to retire, but sometimes lose a sense of purpose without the structured schedule of working life. This can be especially hard on people who either don’t have children, have children and grandkids who live far, or don’t have hobbies or a regular social life to keep them occupied. In some cases, retirement can be stressful with a reduced income but increased medical care costs. Specific medical conditions that may take away an individual’s independence can also trigger depression as well.

In assisted living, depression is noted as one of the top five ranked health concerns, according to the CDC. In addition to the aforementioned triggers, feelings of despair and loss of independence may be heightened, especially if families and friends fail to make regular visits, or the resident no longer has any social connections. A resident realizing they are no longer capable of living independently in their own home anymore can be crushing to their self-image as well.

Symptoms

Symptoms of depression in the elderly are similar to general symptoms of depression and can include:

  • Persistent feelings of unhappiness, anxiousness, hopelessness, pessimism
  • Feelings of guilt or worthlessness
  • Increased irritability or restlessness
  • Insomnia, early-morning wakefulness, or excessive sleeping
  • Fatigue and decreased energy
  • Unexplained aches, pains, headaches, or digestive problems that do not resolve with treatment
  • Difficulty concentrating, remembering details, or making decisions
  • Appetite loss or overeating
  • Loss of interest in activities that were previous enjoyable

Source: Geriatric Nursing Journal

Medical conditions that tend to induce depression or make depression worse are typically chronic conditions (Parkinson’s, cancer, diabetes, etc.) or acute medical events such as a stroke, heart attack, and even hip fracture. Despite the advances in medical technologies and therapies to aid in an individual’s recovery, there can be complications and setbacks. Even the prospect of dealing with these life-changing events in later life can be overwhelming and core-shaking for an individual.

Certain medications can also cause or exacerbate symptoms of depression, some of which include medications for blood pressure, tranquilizers, beta-blockers, steroids, estrogens, and more. Elderly adults are also more susceptible to the side effects of particular medications. Check out our previous blogs, Effects of Medications on the Senior Body Part I, and also Part II.

Dementia and How it Differs from Depression

The symptoms of depression and dementia sometimes appear similarly, and it’s important to distinguish the two in order to find the right treatment or accommodations for the individual.

Additionally, just because an individual is beginning to show some form of memory loss, it is inappropriate to immediately conclude they have dementia. There are other aspects of cognitive function that enter in a dementia diagnosis.

Common Dementia Symptoms

  • Subtle short-term memory changes
  • Struggling to find the right words
  • Changes in mood / Sundowner’s Syndrome
  • Change in sleep pattern
  • Apathy
  • Difficulty completing normal tasks
  • Confusion
  • Difficulty following story lines or completing stories

Distinguishing the Differences Between Dementia & Depression

Memory: Memory issues are a common problem in old age, dementia, and depression. However, the distinguishing features are the kinds of memory loss or lapses we see in individuals.

Old age – Includes occasional forgetfulness or trouble remembering specific information right away, but can still continue their thought processes, finish sentences, and are able to carry on with their daily schedule and tasks independently.

Depression – Individuals with depression have trouble focusing or concentrating, and can experience some lapses in memory. Coupled with any anxiety or preoccupation in thought, this can distract the mind from properly recalling information.

Dementia – Memory loss starts slowly, but as the condition advances, the loss is consistent and apparent. Individuals with dementia frequently struggle to pull up the right words or phrases in conversation and can have trouble finishing sentences. Learning new tasks can become increasingly difficult as short-term memory deteriorates. They may not remember what they did during the day, what they ate for breakfast, etc. Tasks they’ve done most of their life, such as writing a check or completing basic math problems can become confusing.

Orientation: Generally, elderly individuals with or without medical conditions not affecting cognitive function are aware of the day, year, where they are, and so on. Likewise with elderly residents with depression. Individuals with dementia lose their sense of time and place and may not be able to answer correctly if asked. They may not be able to answer what year it is, in which city they live, etc.

Language: An average elderly individual with normal cognitive function (barring individuals who have had a stroke affecting the language area of the brain) and an elderly individual with depression should be able to properly use their native language, even if it may be at a slower pace. Those with dementia have increased problems with language, either forgetting common words (cat, window, desk), misusing or making up words. Sentences may be incomplete or not appropriate for the context. They may also have difficulty following multiple-step directions, complex or abstract thoughts. Advanced dementia residents may have trouble expressing their needs (e.g., hunger, tiredness, restroom needs).

Those with vascular dementia, the second most prevalent form of dementia after Alzheimer’s, may even resemble someone affected by a stroke because the condition is a result of reduced blood flow to the brain. In fact, vascular dementia can develop after a stroke.

Mood: The average elderly individual presents with their normal affect. Elderly residents with depression have a persistent ‘blue,’ sad, or empty mood all day most days, which doesn’t change much with interactions, activity, or environment.

Individuals with dementia tend to present normally, but can be hypersensitive or reactive at times. Feelings of frustration and agitation can come easily as well.

In the evening and night, some dementia residents experience Sundowner’s Syndrome, an increase in agitation, anxiety, restlessness, fear, crying, or even physical outbursts. Some may experience hallucinations or paranoia, or wander, pace or rock back and forth. There is no solid explanation yet for what specifically causes Sundowner’s but doctors and researchers surmise it might be due to hormone changes, or even fatigue.

Elderly dementia and depression are common in assisted living facilities. This is why it’s important to know your resident and note any change in behavior, disposition, and even physical changes. The elderly body is more sensitive to change and any deviation from the norm can have a cumulative effect on their health and well-being.

Assisted Living Education is committed to providing the best education and resources for the assisted living community. We offer RCFE classes and certification, continuing education and online coursework. Explore our website for other products and services we offer as well, or reach out to us via our contact page for more information!

 

Coping with Elderly Depression During the Holidays

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For most of the population, the holidays are the time of year for family get-togethers, traditions, friends and fun. However, for other people, the holidays can stir up feelings of sadness, resentment, or even initiate a depressive episode. For elderly residents in facilities with little or no family who visit, this can be an especially painful time of year for them.

Assisted Living Education reviews symptoms to look for, and also how to help elderly residents cope with depression during the holidays.

Recognizing the Signs

The key to effectively helping your residents through a potentially painful time of year is knowing who they are. Like any other preventative preparation, being familiar with a person’s ‘baseline’ behaviors, disposition, and temperament is crucial in detecting any changes, for better or worse.

These are typical symptoms associated with holiday blues in the elderly:

 

  • Subdued or irritable mood; sadness
  • Fatigue, or trouble sleeping
  • Anxiety
  • Loss of interest in daily activities
  • Change in appetite
  • Lack of attention to personal care, hygiene

 

Though your residents may already exhibit some of these symptoms, knowing their baselines can also help determine the difference between their established behaviors or new ones that seem to surface out of nowhere. For example, do they already have a cranky personality, or have they been extra snappy and sensitive lately? Are they able to independently tend to their personal hygiene and care, or have they really been letting themselves go? Do they have an existing anxiety disorder, or has your resident been particularly on edge or asking repetitive questions about future events or possibilities? Distinguishing these behaviors are important factors in your residents’ care.

Anticipate and Be Proactive

With proper planning and program design, it may be possible to interrupt a resident’s descent into a holiday depressive episode. Well before the holiday season or particular event arrives, try to make an extra effort to engage with those residents who may be at risk for experiencing a depressive episode. One simple way to start is with a conversation.

Converse & Interact Meaningfully With Your Residents

Regular, casual engagements with your residents can build lasting relationships. These relationships can help toward stabilizing emotional highs and lows that may be experienced during certain times of year, like the holidays, where residents can feel isolated and lonely if they have infrequent or even no visits from family or friends.

Having a daily conversation with each and every one of your residents may sound like a daunting task, but really, there are plenty of opportunities to make each interaction a more personal and meaningful one. Conversations don’t have to be a one-time, drawn-out event, but they can be an ongoing dialogue whenever you see your resident either in passing, during medications administration, therapy sessions, mealtimes, or other times you may have scheduled contact with them. Though the priority is to complete certain tasks, intersperse questions or comments to get to know them better and help them feel more at ease and welcome in the environment. A simple wave and a smile or a brief question/answer can carry on to the next positive interaction you can make with them.

Conversations and dialogue can come easy for some residents, but others may need a little prompting or encouragement out of their shell, for a variety of reasons. They may have a shy personality, there could be trust issues, or they may have a disorder or cognitive issue that makes it harder for them to openly interact with people. Or, they may present as an ornery curmudgeon who has difficulties getting along with people. In any case, don’t be too invasive too fast; they may shut down on you. A slow approach tends to work best with more reserved or aloof individuals. Start simply, maybe compliment them on their appearance, or make general conversation, comments, or make small jokes if the timing is right. You may have to uphold most of the conversation in the initial stages. Try to get a sense of what kinds of topics or interests they’re willing to open up to, and go from there. Start inviting them to group activities or outings. These relationships may take longer to develop, but are truly meaningful to both you and them once they feel comfortable with you.

Even for residents who have advanced dementia/Alzheimer’s, or other cognitive or verbal limitations, making an effort to personalize their care can make all the difference as well. Find ways to reach them, or engage in their world with them as long as it is safe and harmless. Sing to them, or talk/sign with them; whatever appropriate method of communication seems to work best. Their responses may be different than others because of those verbal or cognitive capabilities, but pay close attention to their behaviors and body language for positive or negative feedback.

This trust-building can also help during times where residents may be having an especially rough moment/day and exhibit noncompliance or act out in some way. Sometimes having a staff member with whom they feel particularly close to can help calm or even de-escalate a situation that may arise.

Get Everyone Involved in the Festivities

Most facilities will decorate and have events correlating with the major holidays, which is a great start to creating a festive environment. If possible, find out which holidays in particular your residents like to celebrate throughout the year, and make an effort to represent those holidays if they aren’t part of the mainstream/regular celebrations. Even just decorating an area where they frequent (a communal room, or even just their hall or room) can help bring some cheer. If the resident(s) are able, they can help explain the traditions with which they’re familiar and stories they recall from their past.

The winter holidays are also a great time of year to invite folks from the community to interact with residents. Local religious organizations, youth musicians, choirs, a capella or other community groups, and even schools can come sing and/or engage with residents and enrich their holiday experience. Reaching out to youth groups or schools is a great way to enliven everyone’s spirits. Whether it’s an in-person visit, or having children write greeting cards for the residents adds a special cheer to the holidays.

If possible (and weather permitting), plan outings to see or participate in holiday events or plays, tree lightings, or even drive them around to see the lights and decorations around the local neighborhood.

Don’t Forget The Down Time

With all of the activities and bustle of the holiday season, down time or quiet time is just as important, if not more so. Even if elderly residents are enjoying themselves with all of the festivities, it is a change from their daily routine, and may be more physically and emotionally taxing on them as well. As we age, it can take us longer to recover from activities, especially those out of our norm, whether we realize it or not. Planning activities for just part or half the day, and also having “normal” days in between allows for better recovery and less stress on the elderly body.

Assisted Living Education & You

Assisted Living Education is an outstanding provider of products and services for assisted living, as well as RCFE classes and licensing. Our instructors draw from years of experience and up-to-date training to provide an engaging and informative learning experience to our students. We also offer online and continuing education courses. Visit our contact page to reach out to us for any inquiries!

Effects of Medications on the Senior Body: Part II

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In our previous blog, we discussed some of the effects of medications on the senior body, with regard to how drugs are effectively processed throughout the body systems on a cellular level.

Because of age-related changes, elderly people are more susceptible to the effects of drugs. In our last blog, we reviewed how pharmacodynamics and pharmacokinetics are concerns with how the body interacts with and metabolizes a drug. Many drugs tend to stay in the older body for prolonged periods as well. Though some of the side effects discussed in this blog may seem less serious or even inconsequential, because a drug can have a larger or stronger effect on the senior body, these symptoms can actually cause undue stress or even harm to their body.

Assisted Living Education continues the discussion of drug-related side effects in the elderly, finishing up our two-part series on this topic.

Adverse Drug Reaction (ADR)

A serious, negative response to a drug is called an adverse drug reaction or ADR. The World Health Organization (WHO) defines an ADR as “A response to a drug which is noxious or unintended, and which occurs at doses normally used in a man for the prophylaxis, diagnosis, or therapy of disease, or for the modification of physiological function.” This is considered an ‘injury’ from taking medications, and can be from a single dosage or a prolonged exposure to a drug.

Sometimes the term Adverse Drug Event (ADE) is also used, but to clarify, ADE encompasses a broader definition including any injury incurred while the drug was administered, whether or not the drug was identified as the cause of the injury or not. An ADR identifies the drug as the direct cause, and is a type of ADE.

ADRs can be further classified into categories:

Type A: Most ADRs (about 80%+) fall into this category and are expected to some degree due to the drug’s known pharmacological properties. The drug may have a low therapeutic index (TI), meaning that the drug’s efficacy is quite close to the threshold of the drug’s toxicity.  A common example used is warfarin. The drug is specifically designed and prescribed as an anticoagulant; however, some individuals may respond too well and experience excessive bleeding.

Type B: These are less common and unpredictable. The nature of these reactions suggests that they are more individual-specific, such as a hypersensitivity or an allergy.

Some literature lists additional subtypes, but check with your individual assisted living facility for their protocol, if necessary, in classifying ADRs.

Manifestations of Adverse Effects

Reviewing a more basic definition, Merck Manual describes adverse drug effects as any that are “unwanted, uncomfortable, or dangerous.”

Some of the more common manifestations of adverse effects are oversedation, constipation, confusion, hallucinations, falls, and bleeding. As we mentioned in our previous blog post, many of these problems are due to overdosage, underdosage, and other drug interactions, since many elderly residents are on multiple medication regimens.

There are certain classes of drugs in particular that are frequently involved with elderly ADR cases. Merck Manual lists antipsychotics, anticoagulants, antiplatelet agents, hypoglycemic drugs, antidepressants, and sedative-hypnotics as common culprits of ADRs.

Additionally, some medications are also highly discouraged for use by elderly residents, due to their side effects or common presentation of symptoms. For example, “first-generation antihistamines” including brompheniramine (found in some Dimetapp and Robitussin Allergy & Cough) are suggested as ones to avoid because of the negative effects they wreak on the elderly body, either immediately or cumulatively. However, 2nd and 3rd generation antihistamines, like the popular Claritin and Aleve, tend to be safer for elderly residents**.

Close monitoring of residents’ physiological mechanisms, disposition, and temperament are especially important during periods when a new medication or change is introduced to the resident.

**Please note that ANY change or deviation from an already-prescribed health care regimen, whether it’s the addition or removal of a prescribed medication, an OTC drug/medication, nutrition supplement, diet-related, or therapy-related change must be authorized through the appropriate channels (the resident’s personal/attending physician/s, dietician, etc.), as well as communicated to anyone involved in the resident’s care. Please refer to your specific facility’s guide for proper protocol on these types of procedures.

Prevention

Adverse effects from medications are a risk factor with any patient, but again, the elderly context is a much more complicated situation. An estimated 90% of elderly ADR cases are thought to be preventable, versus 24% of younger ADR cases. Hospitalization rates are also 4 times higher at 17% over 4% in younger patients.

As we mentioned in Part I of this series, the best way to prevent much of these adverse effects is through careful resident-monitoring and open, effective communication. Any authorized changes must be updated with other health care professionals or family involved in the resident’s immediate care.

Getting to know your residents and their ‘baseline’ dispositions, conditions, and behaviors are crucial for detecting any changes that might suggest an adverse drug reaction or even an acute medical event, which could have a subtle or unassuming presentation to the untrained or unfamiliar eye.

These seemingly simple practices can have a profound effect in terms of resident and individual care, as well as sharpening your own professional skills and approach.

Assisted Living Education

Assisted Living Education is a premier source for education, resources, and certifications in the industry. Our popular services include RCFE Certification, Staff Training, continuing education, and other Assisted Living Education products or online coursework. Explore our website, or reach out to us via our contact page for direct inquiries.

Effects of Medications on the Senior Body: Part I

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Side effects are well-known and even expected with most prescription and over-the-counter medications. However, many don’t realize that these consequences have a more profound effect in the elderly body. As caretakers in the assisted living industry, it is important to know your clientele and note any physical changes, changes in disposition or behavior that may be a result of medications they are taking.

Assisted Living Education covers some common concerns for elderly residents and their medications in a two-part blog series.

Pharmacodynamics & Pharmacokinetics

Elderly residents are particularly susceptible to the effects of pharmacodynamics and pharmacokinetics for several reasons. Pharmacodynamics refers to how the drug interacts with the body and body systems once it’s ingested. This includes the chain of bodily responses, from the effectiveness of the body’s drug receptors, to the body’s own homeostasis, or even the functionality of the body’s organs. Pharmacokinetics refers to the movement of the drug through the body, e.g., how it’s metabolized, absorbed, and ultimately eliminated from the body.

The older the body gets, the more these particular effects become a concern when taking medication. Because the aging body is declining in various aspects, any part of these pharmacokinetic or pharmacodynamic processes could be less effective. Thus, certain medications could become either less effective or potentially riskier, especially when taken with other medications.

Anticholinergic Drugs

Many elderly residents respond with anticholinergic effects. This means that particular drugs block the neurotransmitter acetylcholine from absorbing in the central nervous system (CNS) and peripheral nervous system (PNS). Because of their effects on such critical body systems, there is evidence that links these types of drugs to poorer cognitive function, including executive functions of the brain, loss of memory, and increased risk of dementia, or worsening of dementia symptoms.

Higher Risk of Contraindications

Most elderly residents are on multiple prescriptions due to varying health issues, age-related or otherwise. Because of this, doctors and even caretakers need to be vigilant about ensuring these residents are well-monitored and don’t ingest any other medications or even foods that could combine negatively with one of their existing prescriptions.

Drug-Disease Interactions

As a CNA, nurse, or other assisted living facility staff member, we cannot emphasize enough how important it is to get to know your residents as well as thoroughly noting any observations of behavior/disposition change, physical changes, or anything else that might seem out of the ordinary for a particular resident. These little red flags can be a sign of something more serious, but more importantly, potentially preventable.

This open communication among caretakers, the resident’s attending doctor, plus any other specialists is crucial for several reasons. Keeping everyone in the loop helps better resolve any issues that might occur, and to help distinguish between any new symptoms due to a new health development, or if it might actually be a side effect from one of their current medications.

Merck Manual warns against a prescribing cascade in which a side effect of a drug is incorrectly identified as a sign or symptom of a new disorder, and thus a new drug is prescribed to remedy it. For example, some antipsychotic medications can cause symptoms that present similarly to Parkinson’s Disease, and an uninformed physician may prescribe a medication to reduce effects commonly seen in Parkinson’s patients.

Adverse Drug Effects

Common adverse drug effects seen in elderly residents are oversedation, confusion, hallucinations, dizziness/falls, and bleeding. According to Merck Manual, 17% of elderly individuals are hospitalized due to adverse reactions, as opposed to only 4% of younger individuals. 90% of these hospitalizations are preventable just by opening the lines of communication between residents, their caretakers, and other healthcare providers.

Drug Ineffectiveness

Because elderly individuals have a higher risk of complications, some physicians are more hesitant to prescribe stronger doses of medication. As such, medications may then seem ineffective.

Additionally, if elderly individuals are left to self-administer their medications, adherence and consistency may be poor for a couple of reasons. They may forget a dosage because their memory isn’t as sharp, or they may avoid medications because the cost is too high for their budget or fixed income. Some individuals may not like to take their medications, either because of the side effects, or because they’re just stubborn. It’s possible their behavioral resistance is due to frustration, or even effects of dementia or Alzheimer’s. In these cases, medications may have to be mixed into food to make it more palatable or tolerable to the individual.

In an assisted living facility, this is another reason why communication among staff members is crucial. If a resident is beginning a new medication, communicating their tolerance or intolerance is essential for deciding whether to continue the medication or not. Additionally, facilities can help the individual or individual’s family in making choices when it comes to medication if it is unaffordable. Communicating whether a resident refused their medication is absolutely noteworthy as well.

Assisted Living Education

Assisted Living Education is committed to the highest level of education and services for people in the assisted living community. We offer RCFE Certification, Staff Training, online coursework, including continuing education, and so much more. Our instructors have years of professional, industry experience and teach their courses with engaging, hands-on material and a real-world perspective. Visit our contact page for any inquiries, or give us a call at 1-800-200-0188 for immediate assistance.

Balance Disorders in the Elderly

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As we age, we are more likely to encounter health and wellness challenges, but also experience more serious repercussions from these challenges. In particular, dizziness and balance disorders, including vertigo, are a cause for concern. These kinds of disorders are a strong predictor of falls in the elderly, which is the leading cause of death in people 65 years and older.

Assisted Living Education reviews some common balance disorders and treatments, as well as precautions we can take to ensure our elderly residents’ safety.

Balance Disorders

Balance disorders cause people to feel dizzy, faint, or unsteady on their feet.  Some people can even experience sensations of movement, spinning, or floating while sitting or lying down.  In general, balance disorders often stem from medical conditions relating to the heart, nerves, bones and joints, muscles, vision, and the inner ear. However, most problems with balance are related to problems with the inner ear, also called the vestibular system.

The Basic Structure of the Inner Ear
The inner ear contains fluid-filled semicircular canals; inside these canals are tiny, hair-like sensors.  These sensors monitor the rotation of a person’s head.  The inner ear also contains otolith organs; these organs monitor the up/down, left/right, and back/forward movements of the head.  The otolith organs contain calcium crystals that allow for sensitivity to gravity.

Vertigo and Benign Paroxysmal Positional Vertigo

Vertigo is a term that refers specifically to the sensation of spinning, or the sensation that the inside of one’s head is spinning.  It is associated with a variety of conditions, but the most common cause of vertigo is a condition called Benign Paroxysmal Positional Vertigo (BPPV.) BPPV occurs when the calcium crystals in the otolith organs become dislodged from their regular positions and move to another location in the inner ear.  For example, when a person is lying down, the crystals can move into the semicircular canals.  As a result, the semicircular canals might respond differently than they normally would to a change in head position.  This leads to a feeling of vertigo and/or dizziness.  BPPV is usually triggered by specific changes in the position of the head – usually a person will notice a sensation of vertigo after his or her head makes a particular head movement, such as tilting the head up or down, or turning over in bed.

In addition to vertigo, BPPV also causes episodes of mild to severe dizziness, unsteadiness, nausea, vomiting, and nystagmus (abnormal rhythmic movements of the eyes.)  Typically, symptoms are brief in duration, usually lasting a minute or less.  Symptoms can also disappear for a long time and then recur.

Benign Paroxysmal Positional Vertigo in the Elderly

Most of the time, BPPV is not serious and its occurrences are short-lived, but in older people, it can increase the risk of falls.  It also tends to be more common in women than in men.  There are precautions that vertigo sufferers as well as assisted living facilities can take to prevent a fall:

  • Resident can use a cane for support when walking.
  • Facilities can ensure that common areas and resident living environments are well lit at night.
  • The resident should be educated to sit down as soon as possible if vertigo or dizziness arises, or notify nearest staff member.
  • Residents should avoid positions and situations that would likely cause a loss of balance. Facility staff should be able to anticipate a precarious situation in order to prevent an accident.
  • If possible, susceptible residents should discuss symptoms with attending doctors or personal physicians for management or further treatment.

Other Causes of Vertigo

Other causes of vertigo include migraine headaches, head injuries, motion sickness, or more rarely, Meniere’s Disease (vertigo accompanied by fluctuating hearing loss and ringing of the ears,) Acoustic Neuroma (a benign tumor on the auditory vestibular nerve,) Vestibular Neuritis (inflammation of the vestibular nerves,) or Ramsay Hunt Syndrome (a shingles infection affecting the facial nerve near one of the ears.)

Treating BPPV

BPPV can sometimes go away without treatment in a few weeks or months, but it is generally recommended that an individual see a doctor for unexplained vertigo that happens periodically for more than a week, or for episodes that last longer than a minute.  A doctor may recommend one of the following treatments:

  • Canalith repositioning – This procedure involves slowly maneuvering the patient’s head into different positions.  In effect, these maneuvers move the particles inside the inner ear from one area to another.  The doctor moves the patient’s head into a particular position, waits for the patient’s symptoms to cease, then continues to hold the head in that position for about 30 seconds.  This procedure is often effective after the first or second treatment, and patients can learn how to perform the procedure on themselves at home.
  • Surgery – When canalith repositioning is not effective, the doctor may suggest a procedure in which a plug made of bone is surgically placed to block the section of the inner ear that is causing the patient to have vertigo or be dizzy.  When this plug is in place, the semicircular canal is then no longer able to react to movements of the head.  This surgery is 90% effective at resolving symptoms.
  • Medication – Sometimes doctors may prescribe medications for dizziness or vomiting stemming from vertigo that lasts for hours.

As with any concern, symptoms, or disorder, the resident’s attending or personal physician should be consulted before proceeding with any treatment or management program. Nurses, CNAs and other facility staff should note any acute physical or behavioral changes observed and relay them at shift changes. This is especially important since some of our elderly residents have lost the ability to effectively communicate even basic needs, and may have trouble articulating their symptoms.

Assisted Living Education is committed to the highest quality education and services for the assisted living community. Our instructors are industry professionals with years of real-world experience, and teach their courses with engaging and meaningful methods. Assisted Living Education offers courses in RCFE Certification, Staff Training classes, online RN, LVN, and SNF courses, and more! Visit our contact page for any inquiries or give us a call at 1-855-200-0188 for immediate assistance.

Eye Conditions Complicated by Diabetes

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In our previous blog, we discussed various eye conditions that can affect our elderly population. In addition to those conditions, having diabetes only further complicates eye health. Because diabetes in itself is such a prevalent disease, Assisted Living Education has devoted an entire blog to diabetic eye disease and some preventative measures we can take to maintain good eye health for our elderly residents.

Diabetic Eye Disease

Diabetic eye disease refers to a group of four eye conditions caused by diabetes:  diabetic retinopathy, diabetic macular edema (DME), cataract, and glaucoma.  People who have diabetes are at risk for developing diabetic eye disease, which can lead to extreme vision loss or blindness, and the risk increases as they age.  To prevent loss of vision, it is very important for people with diabetes to have a dilated eye exam at least once per year.  According to the National Eye Institute (NEI), somewhere between 40%-45%  of diabetic Americans already have diabetic retinopathy, but only 50% of those people are aware they have it.  In fact, the most common cause of blindness in American adults with diabetes is diabetic retinopathy.  Fortunately, early detection, treatment, and careful management of diabetes can prevent or delay the onset of vision loss caused by diabetic eye disease.

Types of diabetic eye disease

  • Diabetic retinopathy affects the blood vessels of the retina, a light-sensitive tissue that lines the back of the eye. It is the most commonly occurring form of diabetic eye disease, and it is initially asymptomatic.  By the time symptoms emerge, the eyes have already sustained a significant amount of damage.  Diabetic retinopathy is caused by consistently high blood glucose levels, which, over time, damage the retina’s blood vessels.  These blood vessels may swell, leak, or bleed; eventually they can become blocked.  This typically distorts vision; the patient may see spots that appear to be floating across their path of vision.  As the condition advances, irregular blood vessels begin to form on the retina’s surface in order to compensate for the other blood vessels that have become unable to transport blood due to swelling and distortion.  If the condition remains untreated, these irregular blood vessels will become more abundant; they begin to grow into the vitreous fluid in the center of the eye and leak or bleed.  Scar tissue is often also present at this advanced stage, posing a risk of retinal detachment, which results in an irreversible loss of vision.
  • Diabetic macular edema (DME) is an accumulation of fluid in the macula that occurs as a result of diabetic retinopathy. The macula is the most sensitive area of the retina, and it is associated with the kind of highly accurate, central vision that allows a person to see straight ahead, recognize faces, read and write, etc.  This accumulation of fluid produces swelling, which results in blurry vision.  Of all patients who already have diabetic retinopathy, half of them will experience DME (NEI,) and it can occur during any stage of diabetic retinopathy.
  • Cataract is a condition of cloudiness in the lens of the eye.  The lens is clear and composed mainly of water and proteins.  Those proteins are positioned in such a way that light can pass through the lens.  Cataract forms when, over time, some of the proteins bunch up together in the lens. This makes it difficult for light to pass through.  Cataract is typically removed with surgery.  For an adult who has diabetes, developing cataract is two to five times more likely than for adults who do not have diabetes.  Cataract also tends to appear at an earlier age for people with diabetes.
  • Glaucoma refers to a group of diseases that cause damage to the optic nerve, which sits at the back of the eye and connects to the brain.  Increased eye pressure causes most types of glaucoma.  When fluid inside the eye builds up but is not able to drain quickly enough, the resulting pressure can damage the optic nerve.  People with glaucoma lose their peripheral vision first; their vision will become more and more centralized over time and eventually be lost. There is no cure for glaucoma, but its progression can be slowed with medication, laser treatment, and surgery.  People who have diabetes have two times the risk of developing glaucoma than people who do not.

What can be done to prevent or delay the onset of diabetic eye disease?

The most effective way to prevent or delay the onset of diabetic eye disease is for people with diabetes to have a comprehensive dilated eye exam at least once a year.  Exams are crucial for early detection, because early stages of diabetic eye disease do not always exhibit symptoms right away.  If diabetic retinopathy has already been diagnosed, patients should have eye exams more frequently, depending on how advanced their diabetic retinopathy is.  People who experience any changes in vision, particularly blurred vision or floating spots, should see a doctor as soon as possible.  In a comprehensive dilated eye exam, the doctor looks for changes in the lens or blood vessels, leaking of the blood vessels, nerve tissue damage, and swelling of the macula.

Also effective in preventing or delaying the onset of diabetic eye disease is keeping blood sugar levels within a normal range as much as possible (according to the Diabetes Control and Complications Trial, NEI.)  Keeping blood pressure and cholesterol under control can also help lessen the risk of diabetic eye disease in people with diabetes.

Working together as a team in an assisted living facility can help ensure that we stay on top of our residents’ health. For those diagnosed with diabetes or other health conditions, frequent visits with the attending doctor or the residents’ physicians or specialists can help catch any new developments in their early stages. Dieticians are also helpful in monitoring the residents’ diets and making the appropriate accommodations are made for their nutritional health. It is important for CNAs, nurses, and other staff to develop good rapport with their residents, and get to know their ‘normal’ or baseline disposition to make any changes in behavior or physical appearance easier to note and subsequently evaluated.

Assisted Living Education is committed to the top care and services for the assisted living community. We are a premier provider in RCFE classes, continuing education, products, licensing, and other services for assisted living. Explore our website for more information, visit our contact page, or give us a call (714) 747-0725 or Toll Free 1-855-200-0188 for immediate assistance.

 

Vision Loss and Eye Degeneration in Elderly Residents

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As we age, it’s natural to experience a deterioration in body systems, to a certain extent. In particular, vision problems are prevalent, especially in the 60+ crowd. As early as age 40, many people tend to notice a change in their vision or eye health. For our elderly residents in assisted living facilities, many of them will have age or disease-related eye issues. Assisted Living Education has compiled a list of common conditions and expectations experienced in elderly eye health.

Age-related Macular Degeneration (AMD)
Age-related Macular Degeneration is actually the most common form of vision loss among people 50 and older. The macula is a small area located near the center of the retina, and is essential for sharp, central vision. It’s unclear exactly what leads to the breakdown of the macula, but it tends to occur over time.

AMD can be broken down into three stages, Early AMD, Intermediate AMD, and Late AMD, and further classified as dry AMD or wet AMD. Most people experience dry AMD. Early dry AMD is noted by the presence of drusen, which are waste deposits that build up in the macula. Typically, individuals are not yet experiencing vision loss. Those with intermediate dry AMD have larger drusen, and may also have pigment changes in the retina. There may be some vision loss present, but otherwise no symptoms. Late AMD individuals experience vision loss because of damage to the macula. Late AMD can be classified into two types, geographic atrophy and neovascular, or ‘wet AMD’.

Geographic Atrophy
Many tend to interchange the terms ‘dry AMD’ and ‘geographic atrophy,’ but they do refer to different stages in AMD. Geographic atrophy is the advanced form of dry AMD, and specifies the deterioration of the deepest retinal cells. This damage affects the photoreceptor cells (rods and cones) of the eye, and thus interferes with how the brain interprets visual information.

Neovascular AMD (also, Wet AMD)
Neovascular AMD occurs when tiny blood vessels develop under the macula. Often times, these blood vessels develop in the wrong place and can leak blood and fluid into the eye, causing scarring and damage to the macula. It is thought that the blood vessels develop in an attempt to clear drusen from the eye. While those with neovascular AMD may only account for 10% of AMD cases, it is the more severe type, and a bigger threat to vision loss.

Because individuals with early and intermediate AMD tend to be asymptomatic, it is important that elderly residents have their eyes examined regularly. While there is no reversing early stage AMD, adopting healthier habits can help slow the process. Exercise, eating plenty of leafy greens, increasing omega-3 fatty acid and antioxidant intake are all suggested.

Intermediate and Late AMD individuals may be able to take certain supplements to slow the advancement of the degeneration. Vitamins C & E, zinc oxide, cupric oxide, beta-carotene or lutein and zeaxanthin are some vitamins & minerals which have been proven effective in delaying the progression of AMD. Of course, the resident’s attending physician should approve any changes to their individual care plan, diet, or medications.

There are more intensive treatments for advanced neovascular AMD, including injections, photodynamic therapy, and laser surgery, all with the intention of slowing the progression and advancement of vision loss.

Dry Eyes
While exact statistics are not clear, dry eye is a common condition seen in elderly residents, despite its ability to develop at any age. Dry eye is a result of either an inadequate amount of tears, or poor tear quality. Tear production tends to decrease with age, and windy or dry climates can aggravate the condition. Poor tear quality happens when one or more of the three components of a tear (oil, water, and mucus) is not sufficient and does not properly nourish the eye.

Dry eye can be a temporary or a chronic condition, with numerous causes, some as simple as a side effect of a medication, allergies, incorrect vitamin dosages, infrequent blinking, or more severe such as disease of the glands in the eyelids, immune system disorders, chronic inflammation of the conjunctiva, or skin disease.

Treatment for dry eye commonly involves the use of medicated eye drops, although a small surgical procedure can be performed to block the tear duct if the goal is to conserve tears. If dry eye is due to eyelid or ocular irritation, the doctor may recommend the individual receive ointments, a warm compress, or other eyelid cleaners to relieve inflammation around the eyes.

Cataracts
Cataract occurs due to an accumulation of proteins on the lens. This clouds the lens and prevents light from clearly passing through to the retina, where it is transformed into nerve signals and then sent to the brain.

Most cataracts are due to aging, but there are other types of cataracts:

Secondary Cataract – These can form due to other health problems, or even after surgery from other eye issues like glaucoma.

Traumatic Cataract – Cataracts that develop from a traumatic injury.

Congenital Cataract – Some individuals are born with cataracts, but they may not even affect their vision. However, those with affected vision usually have their lenses removed.

Radiation Cataract – Certain types of radiation exposure can cause cataracts.

Individuals with early stage cataracts can rely on environmental changes to help with vision, such as anti-glare sunglasses, treated eye-glass lenses, brighter lighting, and even magnifying lenses. Those whose daily tasks are affected by cataracts find greater benefit in surgery to remove the cataracts. Cataract surgery removes the cloudy lens and replaces it with a new, artificial one.

Glaucoma
There are several types of glaucoma, all of which cause damage to the eye’s optic nerve and typically result in vision loss or blindness.

One of the most common types of glaucoma is open angle glaucoma. In a normal-functioning eye, there is fluid continuously flowing in and out of a space in the front of the eye (anterior chamber). This helps bring nourishment to nearby tissues. The movement of this fluid occurs at the open angle where the cornea and iris meet. However, when the fluid does not move or drain properly, it causes a build-up and creates pressure, which, if not treated, can damage the optic nerve.

People are typically asymptomatic initially, but as the damage increases, peripheral vision loss begins to fade. If still left untreated, people can experience ‘tunnel vision’ as their sight deteriorates, and eventually, total vision loss.

Other types of glaucoma include low or normal tension glaucoma; angle closure glaucoma; congenital glaucoma; secondary glaucomas, as a result of a primary medical condition; pigmentary glaucoma; and pseudoexfoliation glaucoma. Angle closure glaucomas are a medical emergency; a sudden increase in pressure builds up within the eye because part of the iris is blocking the fluid drainage. In these cases, people do experience severe pain and nausea, blurry vision, and their eye appears red.

There is no cure for glaucoma, however, there are medicinal and surgical treatments, or a combination thereof, that can delay disease progression if the condition is detected early on.

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With these potential eye conditions, or any health concerns in general, it is important for our elderly residents to have regular check-ups and visits with the attending doctors, or their primary care doctor or other specialists. Early detection is key, as well as strict maintenance for any conditions already diagnosed. Establishing good relationships with the residents can also help in detecting any physical or behavioral changes which might indicate an underlying health issue. Each resident’s individualized healthcare plan will outline any current diagnoses or things to keep an eye on.

Assisted Living Education is proud to offer classes, licensing, products, and other services for assisted living. Our instructors are industry professionals with years of experience, and teach their classes in engaging and meaningful methods. For more information, please explore our website, and note that we do offer RCFE Certification, Staff Training classes, RN, LVN, and SNF online courses, and much more! Visit our contact page for any inquiries, or call us at 1-855-200-0188 for immediate assistance.

May is American Stroke Month

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In our last blog, we discussed osteoporosis, as May is National Osteoporosis Prevention & Awareness Month. May is also American Stroke Month!

Because the risk of stroke doubles each decade after age 55 (American Heart Association), prevention and early care are crucial in a positive, long-term prognosis for our elderly residents. Assisted Living Education is here to cover some key information about strokes, including how to recognize if someone is having a stroke, the different types of strokes, and basic prevention measures to implement in an assisted living facility.

Basic Facts

According to the American Stroke Association, someone in the United States experiences a stroke every 40 seconds, and it is the number one cause of long-term disability in this country. The American Heart Association states that every four minutes, a death is caused by a stroke. However, the AHA also states that stroke is one of the more preventable conditions, by as much as one third. Additionally, immediate care is the key to reducing brain damage caused by stroke, as 2 million brain cells die each minute a stroke goes untreated (American Stroke Association).

Recognizing A Stroke: F.A.S.T!

Timely treatment for a stroke is essential in preventing long-term, debilitating brain damage for the resident.

F.A.S.T. is an easy and useful acronym to help identify if someone is                experiencing a stroke.

F: Is one side of the face drooping or is their smile uneven? Ask the person to smile if you are unsure.

A: Are they experiencing numbness or weakness in one arm? Ask the person to lift both arms to see if one drifts down, or if they are otherwise unable to control it.

S: Is their speech slurred or are they having difficulty talking and hard to understand? Ask them to repeat a simple sentence, e.g., “I like chocolate.”

T: Time to call 9-1-1. Even if the symptoms seem to go away, immediately
call 9-1-1 or emergency medical services and note the time that you
first recognized these symptoms.

Other Symptoms

The following symptoms may also be apparent in someone experiencing a stroke, and their sudden onset is a key signal that something is wrong.

  • Numbness or weakness: This can be experienced in the face, arm, or leg, especially on one side of the body.
  • Confusion: The resident may seem suddenly confused, and have difficulty with their speech or understanding speech (dysphasia).
  • Difficulty Walking: Sudden dizziness and trouble with walking, balance or coordination can occur.
  • Impaired Vision: The resident may have difficulty seeing out of one or both eyes.
  • Severe Headache: A sudden headache may come on with no apparent cause or trigger.

Knowing your residents and interacting with them frequently can help you recognize behaviors that are unusual for the individual. Some residents may already have difficulties with speech or cognition, weakness and/or limited mobility due to other conditions,  so it is important to determine and know individual baselines to distinguish symptoms that are out of their norm.

Types of Strokes

There are two main types of strokes, Ischemic and Hemorrhagic, and a less severe event called a Transient Ischemic Attack (TIA). However, each one should be considered seriously for the long-term well-being of the resident.

Ischemic – Clots

The AHA states that 87% of all strokes are ischemic and caused by an obstruction in an artery that supplies blood to the brain. Ischemic strokes are further divided into two categories: thrombotic and embolic.

Thrombotic strokes occur when there’s a clot or obstruction within the brain, also known as cerebral thrombosis or cerebral infarction. These account for about 50% of all strokes. There are two kinds of thrombotic strokes, large-vessel thrombosis and small-vessel thrombosis. Large-vessel thrombosis refers to a blockage in one of the major arteries supplying blood to the brain, such as the carotid or middle cerebral. Small-vessel thrombosis occurs in one or more of the smaller arteries carrying blood to the brain.

Embolic stroke is a clot that occurs in an artery in the body besides the brain. Frequently, they come from the heart and travel through the bloodstream, until they get stuck and can no longer pass, restricting blood flow to the brain.

Hemorrhagic – Blood leaking in/around the brain

A hemorrhagic stroke describes when blood is leaking in or around the brain. The National Stroke Association reports that only about 15% of strokes are hemorrhagic, but they account for 40% of stroke deaths. There are two types of hemorrhagic strokes, intracerebral and subarachnoid.

Intracerebral hemorrhage is the more common of the two, and occurs when a weakened blood vessel ruptures and leaks blood into the brain. As blood collects, it causes an increase in pressure to the surrounding brain tissue. Because of this, brain cells can die and cause the affected area to stop functioning properly.

Subarachnoid hemorrage is when there is bleeding between the brain and the tissue surrounding the brain. This is most commonly caused by a burst aneurysm, but can also happen due to a genetic condition, head injury, bleeding disorders, or blood thinners.

Transient Ischemic Attacks (TIAs)

A Transient Ischemic Attack is when blood flow to the brain is stopped temporarily, and symptoms appear only for a short time, the average around one to five minutes. The temporary obstruction can be a blood clot, or a cholesterol plaque, which can break off and cause arterial blockage.

Sometimes called a ‘mini-stroke,’ TIAs are more appropriately called a ‘warning stroke’ because a more serious one is likely to occur in the near future. Not everyone has a TIA before a stroke, but the AHA indicates that about one-third of those who experience one go on to have a stroke within just a year.

TIAs manifest the same or similar symptoms to a stroke, but they do not cause permanent brain damage or disability. However, it is critical to call emergency services immediately with any signs or symptoms, because at the initial onset, it may be difficult to distinguish between a TIA or a major stroke.

Stroke Prevention in Assisted Living

Though some factors are beyond our control, there are still preventative efforts assisted living facilities can enforce. Of course, each of the following must be approved through the appropriate channels before implementing any changes to a resident’s individual care plan.

Nutrition
Ensuring proper nutrition among residents and healthy eating habits can help fight obesity, reduce bad cholesterol and high blood pressure, all of which can contribute to increased risk of stroke. The in-house dietitian can design appropriate nutrition programs and supplements for residents who present a greater risk of stroke incidence. Common dietary adjustments include limiting sodium intake; supplementing B6, B12 & folic acid; increasing consumption of fruits, vegetables, & high fiber foods; and consuming foods low in saturated fats, trans fats, and cholesterol.  

Medications
Anticoagulants such as warfarin, or antiplatelet medications like Aspirin or Bayer are often prescribed for regular use to prevent blood clots and reduce the risk of stroke.

For residents with high blood pressure, they may require antihypertensives, which can act in a few different ways, depending on the medication. Some work by dilating the blood vessels, others decrease blood volume, while certain types reduce the rate or force of the heart’s contractions.

Exercise
Encouraging exercise and movement in elderly residents can also help in stroke prevention. Exercise can naturally reduce blood pressure and increase the ‘good’ cholesterol (HDL). Mood and sleep patterns also improve with exercise, which can help enhance overall body function. Exercise and movement are also good for blood flow, and keeping the blood vessels and heart strong.

 

At Assisted Living Education, our ultimate goal is to promote the well-being, safety, and happiness of our elderly population. We do this by providing premier education, licensing, products and services for assisted living. Our teachers are long-time industry professionals ready to share their knowledge in a highly engaging, entertaining, yet informative context. Find out how to receive your RCFE Certification, sign up for continuing education courses, or staff training classes. Visit our contact page for our location and how to contact us. We look forward to hearing from you!

 

Osteoporosis Protection in an Assisted Living Facility

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Because May is National Osteoporosis Awareness and Prevention Month, Assisted Living Education is sharing some of our insights and suggestions in helping prevent and protect our elderly residents against dangers related to osteoporosis. In an assisted living facility, it is crucial to take a proactive approach in safeguarding our residents.

The International Osteoporosis Foundation estimates that in the age group over 50, 1 in 2 women and 1 in 4 men are at risk for an osteoporotic fracture. Many people are unaware they have osteoporosis, a decrease in bone density, and are in fact diagnosed after they incur a fracture.

Who is at risk and how can we help?

Post-menopausal women over 65, and men over 70 are at higher risk of developing osteoporosis. Risk factors for osteoporosis can include a genetic predisposition; lifestyle factors including lack of exercise or smoking, which expedites bone loss; and diet deficiencies, including lack of calcium or lack of Vitamin D. While a lifetime of good or bad habits has already impacted an individual, there are some things we can do at our assisted living facilities to encourage some changes and either help maintain good habits or support better ones.

Of course, all activities and changes must be approved by the resident’s attending doctor or physical therapists.

Exercise
It’s common to think that a person’s inability or struggle to walk long distances, carry or lift certain items, or even climb stairs is due to the onset of old age. In fact, it’s actually the lack of sustained exercise in a person’s life that contribute to these difficulties in older age.

Though by the time we receive our elderly residents, we can’t change what the past has written into their bodies, we can still make an effort to maintain their strength and some flexibility. This can help to prevent any future injuries.

Even if residents aren’t fully ambulatory, stretching and incorporating extra movement in their day can have a positive effect on both physical and mental health. Movement can keep the joints warm, and also prevent muscle and bone atrophy.

For residents who are capable, weight-bearing exercises (also called “resistance exercise” or “strength training”) are excellent in building bone density and maintaining healthy bones. Walking, Tai Chi, yoga, dancing, and weightlifting are all great examples, and can even help improve balance and stability as well. Modified versions of these activities are beneficial as well. The International Osteoporosis Foundation states that there is a 47% decrease in the amount of falls by people who practice Tai Chi than those who don’t, and a 25% decrease in the rate of hip fractures.

Diet
The food service department, as well as the in-house registered dietitian should ensure that residents are receiving a diet that supports bone and overall health, as well as remaining within any personal diet restrictions. Additionally, the dietitian can recommend vitamin or other dietary supplements that may benefit the resident as well.

Clear Pathways & Easy Access
Hallways and common areas of the facility should always maintain clear pathways, but it is also important to ensure that a resident’s room or personal space is kept neat and clear as well. Nurses, CNAs, or other caregivers can take a quick glance-over when possible to check on their spaces. Also, make sure walking aids, such as canes or walkers, are within close reach of the bed, even if the resident requires assistance to get in/out of bed or stand/sit down.

Make sure the resident’s most commonly used items are easily accessible (toiletries, books, etc.) to prevent unnecessary bending or stooping which may result in a misstep or injury. Physical or occupational therapists may even suggest having a long-arm reaching tool/grabber handy in case a resident drops something and attempts to pick it up.

Falling or tripping is a major fear and risk for an individual with osteoporosis, and the elderly population in general. For an extensive and thorough list of preventative actions a healthcare facility can implement, our blog Preventing Falls for Elderly Residents discusses in detail how to keep residents safe from falls and injuries.

Medications
Many of the medications used to treat osteoporosis are biphosphonates, which help slow the breakdown process of the bones. Our bones go through a normal breakdown and rebuilding cycle, but as we age, the rebuilding process cannot always keep up with the breakdown. Biphosphonates slow the cells that break bones down (osteoclasts), allowing the building cells (osteoblasts) to work more effectively, and overall help maintain bone density. There are other kinds of medications that also help reduce the risk of fractures, and even one which may even reverse the effects of osteoporosis, but those are reserved for more severe cases. Of course, the resident’s doctor or attending doctor will review each case and decide whether osteoporosis medications are appropriate for the individual.

During the admissions process and subsequent exams, residents will undergo thorough medical evaluations to examine their physical, mental & cognitive abilities, as well as a fall risk assessment to determine if extra precautions are necessary.

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Assisted Living Education is a premier provider in assisted living services, and is dedicated to providing relevant news and updates regarding elderly care. Additionally, we offer RCFE Administrator Certification Training, other assisted living facility staff training, and continuing education courses. We are proud of our teachers, who are industry professionals ready to share their years of experience with highly engaging and informative delivery. For more information, visit our contact page to reach us for any questions.

Preventing Falls for Elderly Residents

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Safety is a number one priority in residential care facilities. With elderly residents, extra precautions must be observed as their physical bodies, health, and frame of mind are more susceptible to injury. Elder falls are of special concern, as a reported one third of the population over 65 will fall each year, and those over 80 increase to over half. These falls can result commonly in hip fractures or other injuries. Additionally, about half of the adults who experienced a hip fracture-related fall are likely to fall again in another 6 months. Elder falls are such a great issue that Congress passed the Elder Fall Prevention Act (H.R. 3513) in 2003 for expanding effective education, services, and research on this topic.

Assisted Living Education provides some common and typical precautions taken in residential care facilities to prevent falls and injury in elderly residents.

Causes of Elder Falls

In order to prevent elderly falls, it’s important to understand why they occur in the first place. There are several risk factors that can increase the chances of a fall.

Weakened muscle tone, gait problems – Elderly who are not as active as their peers may experience a decrease in muscle tone, causing parts of the body to give out more easily.  Difficulty walking because of arthritis, joint, or other issues can also increase the risk of losing balance.

Blood pressure fluctuation – ‘Postural hypotension,’ or a decrease in blood pressure due to rising too quickly from a sitting or lying position can occur more easily in elderly, sometimes with dizziness. Causes for this may be dehydration, side effects from medication, or another underlying disease like diabetes.

Slowed reflexes – As people age, their bodies and reflexes are slower, causing a delay in reaction time. Elderly may not be able to react as quickly to prevent a fall.

Sensory issues – Some people experience a loss of sensation in the extremities. If this occurs in the feet, it is difficult to realize when you are stepping or to detect a change in terrain.

Poor vision – Vision problems can make it difficult to see a clear (or unclear) pathway, or cause a slower adjustment time to changes in light. Poor depth perception can also cause problems around stairs or unfamiliar environments.

Confusion – Moments of disorientation itself or fear/panic from the confusion can cause a misstep. Also, wheelchair or bed-bound residents may forget that they cannot walk and attempt to get up.

Medications – Some medications can cause dizziness or low blood pressure, causing instability.

Preventing Elder Falls & Injuries

The residents in a care facility generally have more compromised health conditions than the ‘outside’ elderly community and can require vigilance to ensure their safety. Knowing your residents, their conditions, and risks can help you and your facility think proactively in taking and enforcing preventative measures.

Commonly seen preventative measures include:

Around the Facility

  • Maintaining clear pathways
  • Avoiding use of carpet or rug to prevent tripping from uneven surfaces. If there is a carpeted surface, commercial-grade is best for the short fibers and extra durability.
  • Using textured adhesives on sloping floors for extra grip
  • Using ramps in place of any steps
  • Installing grab bars in shower spaces and bathrooms
  • Using raised toilet seats or commodes
  • Using a shower seat or bench for bathing
  • Lowering bed heights
  • Installing handrails along the hallways

Make sure the residents’ call buttons are easily accessible, and a timely response also encourages residents to request for assistance.

Individual Concerns & Major Fall Risks

Some residents may use walking aids such as a cane or a walker to help with mobility. Ensuring that these implements are the proper height helps prevent misuse that could lead to a fall. Ill-fitted clothing can also become a problem, especially with the use of walking aids. If there is family involved, asking them to ensure pants or skirts are of proper fit, or even hemming them slightly can be helpful. Reviewing these types of precautions during the admissions process or a debriefing meeting can help the family become more involved and further assist with the care of their family member.

Residents who repeatedly attempt to get up unassisted can be considered a major fall risk. This can happen in stubborn residents or residents with dementia, especially if they have been bed or wheelchair-bound only a short time. They may forget that they are not supposed to get up unassisted, or are determined to reclaim their independence.

The following are extra preventative measures that can be employed for those who present an elevated fall risk.

Bed or personal alarms – Bed alarms detect when there is a major shift in weight or movement, as in a person attempting to sit up and get out of bed. These alarms help alert a staff member to come quickly and check on the resident. Personal alarms work similarly for use in the wheelchair. One type hangs off the back of the wheelchair and clips on to the back of the resident’s clothing. If the resident leans too far forward in an attempt to rise, the device separates and the alarm is engaged. Another type is a pad which fits on their seat, and when a significant shift/decrease in weight is detected, the alarm will sound.

Room placement – Assigning a high risk fall resident to a room near the nurse’s station can help keep eyes on any independent attempts to get up.

Extremely lowered bed heights – Any time a high risk resident is in bed, adjust their bed height to the lowest setting possible so they are closer to the ground in case of any attempts.

Floor mat – For residents persistent in their attempts, a floor mat placed next to the bed during the night, in addition to the lowered bed height, can also offer added protection.

Hip pads were also created in an attempt to prevent injury in case of a fall, but they’ve received mixed reviews. Some studies reveal no significant statistical data in their favor. Additionally, many hip fractures can occur not just from an impact, but because of an abnormal movement or rotation of the hip during a fall.

Other Precautions

For residents who have little or no issues with cognitive or memory functions, they may benefit from extra education from an occupational or physical therapist to review safety and fall precautions. Those recovering from a procedure or injury should already receive instruction on how to accommodate their new (i.e. limited) range of movement. If the resident has limited mobility and uses a walker or wheelchair much of the time, physical and/or occupational therapy generally covers how to safely and properly transfer from bed to standing position/wheelchair and vice versa, as well as commode and shower seat/bench transfers.

Other residents can benefit from such education as well, but may require frequent prompts and assistance due to difficulty in recalling steps and sequences.

Keeping the residents active as much as possible is not only good for their overall health, but can help keep muscle tone and prevent stiffness or muscle atrophy, which can contribute to a fall. Non-ambulatory residents can still exercise to maintain strength in their arms and hands.

The Overall Picture

Considering the overall health of the resident is crucial to their care. One issue can lead to a cascade of problems. For example, a toothache can lead to decreased food and liquids intake, resulting in weakness and risk of dehydration, leading to an increased risk of a fall. What seem like small problems can also escalate quickly in residents with compromised health, so quick identification and resolve are key to maintaining their general health and well-being.

Information from the initial comprehensive health examinations, mental & cognitive evaluations, fall risk assessments, and review of resident’s history all help in designing an individualized care plan. This information can also be useful in evaluating if your residential facility may need additional precautions throughout the premises.

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Assisted Living Education is committed to providing the best in quality education for assisted living services. Our professional instructors have had years of real, hands-on, and practical experience that enrich our already-extensive courses. We offer RCFE classes, licensing, and other products and services for assisted living, plus RN, LVN, and SNF continuing education through our online classes. Explore our website for more information, visit our contact page, or call 1-855-200-0188 for immediate service. We look forward to working with you!