Risky Business: Falls

This time of year we are all at more risk for falls due to snow and ice on sidewalks and parking lots.  But did you know that people with intellectual disabilities are always at a higher risk for falls, no matter what time of year it is?  Not only is the risk of falling greater for people with intellectual disabilities compared to the general population, but also they are more likely to be injured by the fall. Why are the people we support at a greater risk? 

Decreasing Physical Ability

Sometimes when we are with someone everyday it is hard to recognize that they may not be as strong or as steady on their feet as they used to be.  Look for changes in how they walk.  Do they grab onto rails or walls more frequently to balance themselves?  Do they need extra assistance when getting up from a seated position?  All of these are indicators that a person may be a greater fall risk.  If you see these signs, contact their medical provider about obtaining a physical therapy consult.

Epilepsy

About 25% of the people our HCQU supports have a diagnosis of epilepsy or seizures according to the Health Risk Screening Tool (HRST).  Comparatively, about 2% of the general population will have those same diagnoses.  Having a seizure increases the likelihood that someone will fall.

Impulsiveness

When someone is impulsive they may make sudden movements or have an unsteady walk which can lead to falls.  Be aware that someone with behavioral or psychiatric concerns may be at an increased risk of falls.

Fall Risk Increasing Drugs/Medication (FRID)

A study completed between 2006-2012 showed that people with intellectual disabilities were more likely to be prescribed a medication that has been associated with an increase fall risk. These medications are antidepressants, anxiolytics, hypnotics and sedatives, and antipsychotics.  Any slight changes in walking, feeling dizzy or lightheaded, or change in behavior should be communicated to the prescribing physician.

Incontinence

People who are rushing to the bathroom to prevent incontinence can be at a higher risk for a fall. A frequent toileting schedule can help prevent this problem.

History of Previous Falls

People  with intellectual disabilities who have fallen before or have a history of falls are more likely to fall again for various reasons.  The fall could be related to the above causes or an injury caused by a previous fall.  

Non-use of an Assistive Device

Sometimes people may be prescribed a cane or walker but they choose not to use it, or use it improperly.  If an assistive device has been ordered, try to encourage the person to use the equipment properly.

Special Considerations

If you are supporting a person that is on a blood thinner like Coumadin, Eliquis, Xarelto, Aspirin, or Plavix they will be more likely to bleed if they fall.   The injury might be internal and you will not be able to see it.  Talk with the prescribing medical professional and ask what steps need taken if the person falls.  The medical professional may recommend that the person be taken to the Emergency Room for any fall.

What can I do if a person falls? 

Remain calm, speak slowly, and reassure the person you are going to stay with them.

Various levels of treatment may be needed.  A simple bump or scrap could require a band-aid and maybe an over-the-counter pain medication.  However, if you suspect that the injury is more concerning, you may need to transport the person to the Emergency Room.  For a severe fall, do not move the person and call 911.   If the person is unconscious and not breathing, follow the guidelines by the American Red Cross:  start CPR/AED and call 911. 

If a person has fallen, remember, it is always better to receive treatment and not need it, then need it and not receive it.