Losing balance and falling down is one the most common accidents that happens to elders. About one-third of people over age 65 fall each year. Although most people are not injured when they fall, the more falls an individual has, the greater the chance of injury, such as a broken hip bone. While anyone can fall, there are certain health conditions that place elders at high risk of falling. For instance, elders who have walking difficulties and/or impaired balance are at greater risk. Another important condition, one that is rarely talked about, is urinary incontinence (or loss of bladder control). Elders with urinary incontinence (UI) are three times more likely to fall than elders without urinary problems. And, roughly 30 to 50 percent of elders suffer from UI.
UI, best described as an unintentional leakage of urine, can contribute to fall risk in several ways:
- Loss of urine can lead to slipping on wet floor surfaces.
- UI accompanied by an overwhelming urge to get to the bathroom can lead to falling when hurrying.
- UI can lead to episodes of dizziness or fainting shortly after urination; usually associated with enlarged prostates in men.
- Acute or sudden illness, such as a urinary tract infection, can cause UI, confusion, drowsiness, low blood pressure and balance loss.
- Medications used to treat UI, such as anticholinergics or alpha blockers, can cause low blood pressure and fall risk, especially when getting up from a seated or lying position.
- Nocturia (waking at night to urinate) can result in poor sleep and feeling groggy, which can decrease balance and increase fall risk.
For many of my patients, I recommend the following strategies for reducing risk:
- UI is not always a usual part of the aging process. Bladder control problems can occur for many reasons (e.g., urinary tract infections, enlarged prostate gland, weak or overactive bladder muscles, certain medicines, etc.). Therefore, it’s important to get a medical evaluation if you are incontinent.
- Under a doctor’s care, incontinence can be treated and often cured. Treatments include strategies such as bladder control training (attempting to alter how the bladder stores and empties urine), strengthening pelvic muscles used for urination, using undergarments designed to control urine leakage, lifestyle changes (diet modifications and avoiding caffeine and alcohol) and medications to control urine flow.
- Early diagnosis and appropriate treatment of UI can reduce the risk of falling and injury as well. Factors associated with UI and falling may be related; for instance, impaired walking/balance, need for assistive devices, reduced dexterity, poor toilet transfers, etc. Modification of these factors can potentially decrease both falls and UI.
To help prevent falls, it helps to make the home into a safe environment by:
- Installing hand rails and using a walker to get around.
- Providing grab bars next to the toilet and/or a raised toilet seat to help with safe toilet transfers.
- Providing a bedside commode to avoid rushing to the bathroom, especially at night.
- Keep the pathway to the toilet obstacle free and leave a nightlight on in the bedroom/bathroom at night.
- Install non-slip rug in bathroom to avoid slipping on wet floors
- Respond to toileting requests promptly, especially if elder requires assistance to get to the toilet.
- Ensure that elder is wearing suitable clothes/undergarments that can be easily removed or undone by self or caregiver.
- Help the elder avoid foods and beverages that irritate the bladder (e.g., caffeine, alcohol, chocolate, very spicy foods, etc.).
Rein Tideiksaar Ph.D., PA-C, (or Dr Rein as he is commonly referred to), is the president of FallPrevent, LLC, Blackwood, NJ, a consulting company that provides educational, legal and marketing services related to fall prevention in the elderly. Dr Tideiksaar is a gerontologist (health care professional who specializes in working with elderly patients) and a geriatric physician’s assistant. He has been active in the area of fall prevention for over 30 years, and has directed numerous research projects on falls and has developed fall prevention programs in the community, assisted living, home care, acute care hospital, and nursing facility setting. To learn more, check out the Doctor’s professional profile on LinkedIn: http://www.linkedin.com/pub/dr-rein/6/759/592. If you have any questions about preventing falls, please feel free to email Dr. Tideiksaar at firstname.lastname@example.org