Preventing accidents in the elderly
Hypertension, diabetes, and heart problems makes one vulnerable to accidents, says DR GLADSTONE A D’COSTA
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An extensive review of published literature indicates that whilst most authors use 65 years as a divide for the term “elderly”, others vary the figure from 60 to 55 to even 45 years. It is useful to bear in mind that the term is more an indicator of the degree of impairment in the physical and mental functions of the individual, rather than the number that determines whether the person is “elderly”. It implies a loss of independence associated with impaired vision, hearing, memory, mobility, and cognitive functions. There may be associated age related conditions like hypertension, diabetes, heart problems, and arthritis, contributing to vulnerability to accidents.
The National Institute for Clinical Excellence (NICE) along with the Royal College of Nursing published an extensive and in-depth study of the problem. One in three people over the age of 65 years will experience a fall. Over the age of 85 years, one in two will fall. A child learning to walk falls repeatedly, but gets up again and again, totally unfazed. In the elderly, however, the 3F syndrome sets in-“Fear of Further Falls” which shatters their confidence, resulting in a self-imposed restriction of activities, further aggravating and accelerating the effects of ageing. Only 4% of children falling require medical attention; whereas 21% of patients over the age of 75 require admission, and 50 % of patients with fractures of the proximal femur never rehabilitate completely.
Tsao Foundation Senior Citizens Clinic based in Singapore, highlight further interesting statistics. 778 out of 1,000 of their senior citizens surveyed, had had a fall. Of these, 1/3rd fell in the bathroom, 1/3rd fell on the stairs, and 1/3rd fell whilst walking. Here is where the family can make all the difference in preventing these falls. So let us examine the recommendations of these studies.
Falls in the bathroom: – Water on ceramic tiles or marble is a lethal combination. The person having a bath or shower usually bends down to soap or dry one foot, standing on the other leg on a wet tiled floor and slips. A simple bath mat preferably made of rubber or anti-skid tiles would reduce the danger. A plastic chair or stool would make the bending unnecessary. A hand rail would provide a grip to steady oneself.
In this connection, it is important to distinguish between a towel rail and a hand rail. A towel rail will support a towel. A hand rail is a sturdy fixture designed to support the weight of a person. Contractors often cut corners and pass of one off for the other.
Fall from the stairs: – Considering that stairs account for one third of the falls, it is most unfortunate to see that contractors fail to provide a banister or hand rail on staircases. This is an absolute necessity, if elderly people are to use the staircase safely. Not only should stairs be well lit, but two-way light switches should be mandatory. Imagine you are at the top of a dark staircase, and the light switch is at the bottom; what is one supposed to do? A slight adjustment in the wiring is all that is required, so that the light can be turned on or off, either at the top or the bottom of the stairs. Tiles used for stairs should have anti skid features; and in the in case of a wooden staircase, a metal strip can be fixed to the edge; while taking care that this is fixed firmly. A fluorescent strip at the top and bottom steps, helps easy location.
Falls whilst walking: – It would be stating the obvious to enumerate the hazards of walking on the average street in Goa. The absence of pavements, the loose stones and potholes, and numerous other obstacles, are something no self respecting municipality or PWD would accept or permit. However, there is one area worth mentioning. In community dwellings, the path from the gate to the entrance of the house is often cemented. In the monsoons, this collects moss acquiring the skid properties of ice. A simple remedy is to sprinkle sand or use palm leaves during the monsoons the same way our grandparents did. Tiles resistant to moss would be ideal.
Other Hazards: – Senior citizens have a slower reaction time to smoke, and a smoke alarm is a useful precautionary measure. Often in a multi burner type of stove, the person reaches out to the back burner across a front lit up one. Loose sleeves or a saree catches fire unnoticed and with synthetic materials, there is a disaster within minutes. Stoves should be either the single or twin burner models and loose fitting clothes/ sleeves should be avoided.
Builders frequently club all switches onto one board in the centre of the room to save wiring costs. This results in having to enter a dark room and run an obstacle course to find your way to the switches, stumbling over furniture. One light switch should always be placed near the door at the entrance, so that the room can be lit up as soon as one enters it. A night light is very cost effective, in preventing accidents at night; bearing in mind that the elderly may have conditions like diabetes and prostate problems which induce frequent passing of urine. The provision of a bedside urinal would eliminate the need to walk to the toilet. The furniture should be arranged in such a manner, that it allows a clear access path; at the same time strategically placed, so as to allow an elderly person ready support to lean on, if necessary.
Senior citizens and grandchildren often go together. This means toys, legos and other items are left lying around. These, as well as loose carpets and mats, placed on tiles form “banana skins” around the house, which the elderly can fall over. Toys should be collected in a box and put aside at the end of the day. Mats and rugs must be fixed firmly or removed.
Solar heaters and geysers can get water up to scalding temperatures. If a thermostat has been fitted, this should be turned down. If a mixer tap has been provided, teach the person to turn the cold water tap on first. If a bucket is used, the water must be tested with the back of the hand first. Taps are easier to manipulate if they have the lever rather that the knob design. The same applies to door handles; knobs being more difficult to operate.
Finally, the medicine cabinet. The elderly are often on multiple medications which are to be taken in a specified frequency and at set timings. Given the visual and memory impairment, dosage errors are common. It is, therefore, suggested that the medication be carefully supervised or wrapped in individual packets, labelled or colour coded.
Looking after the elderly is a very difficult and challenging task, which can test the patience of the most loving family. The suggestions made above are based on sound research, and none of them are particularly difficult or expensive to install.
To quote the NICE report, “Family members should systematically assess the home environment and make necessary changes. Don’t wait for accidents to happen before you start doing something.” We owe our presence here to them; let us show our gratitude in these simple, yet effective measures.
The author is a member, National Executive Committee, Voluntary health Association of India
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Atala SIT-ting Pretty
By Anthony Simoes
Chief Minister Digambar Kamat was speaking to ‘Herald’s’ Editor Weekend Sujay Gupta: “I hope the Home Minister is on top of the situation and will ensure that the state does not get a bad image.” Famous last words?
So I visited the Police PRO Atmaram Deshpande to get the latest on the drug scene. I tripped on his carpet. “Never mind that,” he said. “Earlier we had been instructed to sweep everything under the carpet. Now, thanks to Digu-bab, we are setting up an SIT (Special Investigating Team) to look into this police-politician-drug mafia nexus.
“With this SIT, we are taking a hole-istic approach. Once we have everything, we can dig a big enough hole in which to bury all the drugs, the evidence, as well as that ‘so-and-so’ Sujay Gupta. I wish he would stick to writing about the joints where he eats on weekends.”
“Never mind him,” I said soothingly. “I’ve come here to give publicity to your SIT and how it will solve Goa’s brush with drugs, so it can have its tryst with destiny.” “Sir,” said Atmaram earnestly, “if you will only SIT down I will explain all about our SIT.” And so, over tea and vadas, he outlined the plan.
“First of all, Ravi Naik will be asked to SIT at home, since he is the Home Minister. We will gift his son a rocking horse, so he can SIT on it and play at being a cowboy fighting the baddies in the badlands.
“Second, we will form a group to mend fences with the media, the NGOs, the Church, the Leader of the Opposition, Sabina Martins, and others we have angered over the years. You know all those who don’t like to express an opinion or take sides? We will ask these honourable gentlemen and ladies to SIT on those fences.
“We will also be buying some Arab stallions. These are for the likes of Bassi and Bansal, who refuse to get off their high horses. Bansal had agreed to convert his office annex into a five-star stable for his Arab acquisition. At one time, he had his great drug lord friend Dudu housed there in style, complete with not only all modcons, but also his mistress. So when Bassi and Bansal SIT, they will feel as if they are in the saddle, even while the cops are actually up the creek without a paddle.
Other groups can simply SIT on the sidelines. Still others will SIT on important files. But the smartest ones will SIT on earlier investigations in which dirty tricks were played, like bogus panchanamas, white ants that eat drugs in police custody, and then transport them to the flea market, etc…”
At this point, Atmaram noticed that both my tea cup and vada bowl were empty. But he was not going to let me off the hook. He looked at me sternly and said: “I know how cynical you MIDDLE writers can get, so I will take you back to basics. We will start with the fundas.” He walked to his bookshelf.
“This is it,” I thought. “Now he’s going to throw the book at me; maybe the entire bookshelf.”
Mercifully, he returned with just the ‘Concise Oxford Dictionary’. “Listen to the dictionary meaning of SIT,” he said: “Take or be in a position in which the body is supported more or less upright by buttocks resting on the ground or on a raised seat.”
“Now,” said Atmaram, “we spend years sitting on our backsides, and the brain slowly eases itself down into less respectable parts of our anatomy. So, we are always mentally under pressure – we sit on our brains. It gets squashed smaller and smaller, as our backsides get bigger and bigger. So how do you expect positive results?” he asked indignantly. I said nothing.
“It’s alright for you guys who write MIDDLES,” he continued, “your top and bottom are not under pressure, so your MIDDLES can be free. And it does not take any intestinal fortitude. All it takes is a brave Editor who is willing to stick his neck out, while you take all the credit.”
Well, some people have really got it made…!
