Elderly care India Home Health Care (1)

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INDEX

1. How to Care for Aging Parents
2. How to care for your parents from a distance
3. 10 Tips to Take Care of Aging Parents
4. How to keep Homebound Seniors Active
5. An Elderly Parent transforming from Hospital to
   Home
6. Coping with Care giving for Ailing Elderly Parent
7. Arthritis Causes Symptoms
8. Caring for an Alzheimers Patient
9. Risk of Fall in Elderly
10. Fall Prevention in Elderly

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HOW TO CARE FOR AGING PARENTS
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How to Care For Aging Parents

• As we all get older we need to have serious
  discussion among our close family members
  (spouse, kids, siblings) about taking care of our
  Aging Parents. As they reach 70s and 80s we need
  to check their physical and mental well-being
  and make sure they are leading an
• independent living with excellent quality of
  life.
• If we dont plan properly we all will end up in
  confusion, sadness, helplessness, frustration,
  exhaustion when we have to deal with inevitable
  health related challenges. With solid family
  support, professional support and good
  communication we can renew the sense of love,
  compassion and tenderness in to any family with
  Aging Parent.In order to do that effectively
  adult children should take care of the following
  diligently
• 1. Find out their (Aging Parent) needs Find out
  from your Parent
• what they want whether
• They want to stay at home
• Move close to their kids
• Move to a Senior independent living community
  with common dining hall, cleaning facility,
  medical facility etc.
• Old age home /Nursing home.
• When you notice poor eating habits, poor
  hygiene, neglecting their home, forgetfulness,
  dif?culty driving then you need to counsel them
  to get help
• 2. Find out your Parents assets Find out your
  Parents assets including pension amount, the
  health insurance policies, and free medical
  facilities from the organization where they used
  to work etc.

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• 3. Decide whether you want to be their Caregiver
  It may
• Put emotional toll on you
• You may have to quit the job
• You may lose your bene?ts for your retirement.
• Consider professional help
• Make a Caregiver budget
• Make your own retirement plan
• Understand the costs of keeping your Parent in
  their home
• ( May need home health Nursing care or Medical
  Care Taker care if they have medical problem or
  just an assistant to do their day to day chores)
• 4. Make a joint decision Discuss with your
  Parents, spouse, siblings and Children and make
  a joint decision about the location of the stay.

5. Financial Planning Based on the above make a
budget to take of care of your Parent with the
contribution from your siblings to relieve the
entire ?nancial pressure on you.With careful
planning we can provide conducive atmosphere for
our Parents to Age gracefully.
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HOW TO CARE FOR YOUR PARENTS FROM A DISTANCE
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How To Care For Your Parents From A Distance
Taking care of aging parents from distance is not
only dif?cult but also is a cause of concern for
many working professionals not only living abroad
but Valso in a different city as their parents
in India.
Parents may require care or help during
temporary health situation like surgery or even a
chronic health condition. Other family members
and relatives may step in at this time and help
out for a while but most of the time they may
have to leave before the patient recovers
completely. India Home Healthcare provides
reliable and coordinated care which is tailored
to the patients requirement. The staff, not
only stay in touch with the physician or surgeon,
but also with the family members to update the
progress of the patient. The online patient
portal which gets updated regularly lets the
family members anywhere to log in and follow the
progress of the patient. This can also be used to
take any second opinions if needed. Parents who
have been active, healthy and working towards our
well being all their life either at a job or
taking care of family, show a change in their
health status soon after retirement or once they
think they are getting old. This is sometimes
called empty nesters syndrome where the
parents start showing these symptoms when the
family members (children) move out of the house
and start setting up their own families abroad or
even in a different city in India. The
psychological factors of well being in old age
are overlooked easily even by the family members.
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Depression due to loneliness and decreased
sociability in old age is real and may have
signi?cant effect on the health status. Even when
there is no clear diagnosis of depression, it
will affect the individualshealth more than we
can imagine. According to a study conducted by
Singh and Misra in 2009 on 55 elderly people,
there is direct relationship between loneliness
and old age depression. India Home Health care
provides care givers who provide companionship
to the elderly patients, not only to keep them
active and alert but also help them overcome
activities which are dif?cult for them like
evening walk to the park. These activities are
needed to re- integrate them back in to the
community and maintain the quality of life they
deserve and want. The care givers also help to
maintain a healthy diet plan and monitor even
commonly found and commonly neglected disorders
like hypertension and diabetes which are usually
the risk factors for many diseases in
elderly. India Home Health Care also provides
monthly care plans which include regular doctor
visits, nurse, dietitian and physical therapist
visits every month to prevent and detect any
disorders in the early stages.Aging
surely involves many degenerative processes, but
it need not include diseases. Adjusting to the
changes that accompany old age require ?exibility
and new coping skills. India Home Healthcare
helps not only the parents in the aging process
but also family members who can be reassured that
their parents are in the best hands.
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10 TIPS TO TAKE CARE OF AGING PARENTS
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10 Tips to Take care of the Elderly

• We are on this earth today because of our
  parents. They taught us the lessons of life, to
  succeed and to get a respectful social image.
  Children need parents help till they get
  settled in their life in all the aspects.
• The same way parents also need support when they
  become aged.
• And it is childrens responsibilities to give
  them a respectful retirement life.
• Here are 10 tips to make our parents happy during
  their evenings of life.
• Avoid loneliness Spend some time with parents,
  talk to them, keep them involved in family
  affairs, get their suggestions and work
  accordingly.
• Dietary Needs Their intake will be less because
  of poor appetite but we have to insist them to
  have balanced diet regularly.
• Medical Needs Take care of their health issues,
  physical and psychological. Talk to them if they
  need any medical assistance, provide them the
  required assistance. Risk of fall will always be
  there because of general weakness and fragile
  bones. We can avoid this by providing extra
  support.
• Regular Exercise Spare some time especially for
  your parents and take them for a morning or
  evening walk, they will be happy to spend time
  with you.
• Finance Parents were independent their whole
  life to take care of their own and the familys
  ?nancial needs but to meet their old age needs,
  they should have some insurance policies which
  make them feel con?dent.
• Never be rude At this age there is a tendency to
  repeat the same thing again and again but we
  should not behave rudely. The children must have
  patience to understand the situation.

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• Listen and solve their problems Children should
  listen to their problems patiently and try to
  solve them.
• Make them feel special By celebrating their
  Birthdays and Wedding anniversary.
• Help them for even small things They need help
  for each and every small thing like getting a
  glass of water, reading newspaper for them. Ask
  them what they need and deliver it.
• Allow grand children to play with them This is
  the best way to keep them happy always. It is
  like letting 6 and 60 year old children play
  together
• .
• These are the few simple methods to keep our
  aging parents happy so they can live with
  dignity and respect.

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HOW TO KEEP HOMEBOUND SENIORS ACTIVE
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How to keep Homebound Seniors Active

• Seniors as they get older may feel comfortable to
  stay at home. Some of them will be independent
  within their familiar surroundings but may feel
  bored at home. Some of them need minimal to
  moderate help to do their day to day activities
  because of their health condition. Some of them
  may need total assistance and may be bed bound
  due to severe disability due to the
  deterioration in their health condition. In all
  the above three situations one may feel lonely,
  boredom and depressed if they dont have a proper
  inspiring companion or caregiver.
• In order to keep the Senior Citizen active we can
  formulate certain recreational activities to
  keep them physically and mentally ?t and keep
  them happy. We can try the following methodology
  whichever works depending upon the individuals
  interest
• 1. Seniors who are independent
• Explore the world via the world wide web-
  Computer games, facebook/twitter/emails/Skype to
  stay connected with friends and families and
  make new friends with similar interests, whatsapp
  with friends and family, listen to the
  lectures/discourses/talks/songs of their
  interests in the computer or laptop with
  speakers attached
• Start a Book Club Read books with big fonts or
  magnifying glass or digital books with large
  fonts and discuss with the club members through a
  Skype call or conference call about the
  characters in the book that they are focusing
  on.
• Puzzle, board games (chess, snake and ladder,
  Chinese checker, scrabble), solitaire, jigsaw
  puzzle, carom board, cards etc.
• Work from home if they are still able to do that
  for couple of hours a day
• Write a letter or call someone and speak to them
  on several topics that are interesting for them.
• Tinker- Able to ?x little things at home and have
  a sense of ful?lment
• Painting, drawing, home indoor gardening,
  listening to the music
• Hire a care giver/companion to give company and
  have a partner to play several indoor games.
• Start a new hobby

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

• Caregiver to help in personal hygiene, walking,
  dining, bathing etc.
• Formulate a recreational activity that gives
  interest to that Senior.
• For e.g. To listen to a good music for one hour
  in the morning, then do exercises for all the
  joints followed by walking inside the house with
  the help of a walker or a cane, then do a little
  writing or drawing or painting for another hour,
  then listen to a book or a magazine read by
  their care giver, then play chess or carom
• for another hour in the evening and go in the
  backyard or outside in
• the wheelchair to get some fresh air and watch
  their favorite program
• in the television
• 3. Seniors who are bed bound and need total
  assistance
• Bed should be closer to the window so that they
  can see outside for birds, people, traf?c,
  workers doing some painting or road repair work
  so that they stay connected to the outside
  world.
• Keep a big clock and a large print daily calendar
  for them to look
• Put soft music/lectures/discourses/talk for them
  to listen
• These are the few tips to maintain a healthy,
  happy quality of life among the home bound
  Senior citizens.

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AN ELDERLY PARENT TRANSITIONING FROM HOSPITAL
TO HOME
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An Elderly Parent Transitioning From Hospital To
Home

• Despite the obvious relief of getting your
  elderly parent discharged from hospital after an
  illness or a surgery, it can be quite stressful
  to transition them back to life at home. The
  situation becomes more complicated when your
  parents live alone. With the hospitals focusing
  on reducing the length of stay, the burden of
  rehabilitating the patient falls more and more on
• the family.
• People are getting discharged with greater need
  for support and care at home. Even though you
  might love your parent and might want to take
  care of them to the best of your ability, it is
  becoming dif?cult for the majority.
• With demanding careers and taking care of your
  own home and children, it can be a daunting task
  to care for your loved one when he/she is
  recuperating. However, having a clear plan in
  place for life after discharge will be immensely
  bene?cial to you and your family.
• Ideally, a smooth transition should ensure that,
• The patient is clinically safe
• There are no risks or threat of getting
  readmitted to the hospital for the same problem
  or other complications
• The patient is con?dent of getting back to normal
  routine Here are some simple solutions to
  achieve these goals
• Assess your home environment Before the
  discharge do a quick home check and look at it
  through the eyes of your fragile parent. Make a
  list of questions that you need to answer before
  the discharge, for example Will there be a need
  for a hospital bed or oxygen supply? What
  consumables like diapers, gloves, etc. need to
  be kept in stock?
• Be part of the discharge planning process Speak
  to the physician and the hospital nursing team
  about your concerns. Understand how you could
  help and the speci?c tasks your parents would
  need assistance for. Get a rough estimate of how
  long the recuperating period might be.

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• Make the necessary changes at home If your
  parent needs a hospital bed or other equipment,
  you might need to choose a room for them with
  enough space. Ensure that there is enough
  lighting, especially the path from the bed to
  the bathroom. Consider the possibility of
  installing grab bars in the bathroom. If you
  plan to involve additional caregivers, plan on a
  comfortable space to accommodate them.
• Get support for the health care tasksThis is the
  actual bulk of care-giving at home. It requires
  your physical presence and assistance in getting
  your
• parent back on his/her feet. Daily tasks like
  feeding, medication administration, monitoring
  for complications or infections need to be
  performed consistently.
• Evaluate if you can perform these tasks and how
  much time you can devote to being the primary
  caregiver. If it is not a responsibility that you
  can handle, engage a home health care provider.
  Before choosing a provider, do a research on the
  providers in your locality, understand their
  credentials, evaluate the care packages they
  offer, short list and interview them.
• Involve the home health care provider in the
  care, even before the discharge from the
  hospital. This helps them in understanding the
  speci?c condition of the patient and therefore
  to draw the care plan that he/she needs. Check
  the daily tasks that they need to perform, the
  signs of complications that they need to watch
  for and provide them with a list of emergency
  contacts.
• Availing support from professional healthcare
  companies is therefore a valid option, as it
  allows the elderly patient to recuperate in their
  known surroundings, while reducing the pressure
  on you and your family. Home healthcare has
  shown better results in patient recovery by
  reducing the recuperation period by an average
  of 15.

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Dr.AnithaArockiasmay, Head of Clinical Operations
at India Home Health Care, Indias largest home
healthcare provider, has experienced the impact
of home healthcare on the patients recuperation
and transition to home. We have served a number
of patients, where they were clinically
stable but not fully recovered from the illness.
Shortly after discharge to their home under our
care, a signi?cant improvement was seen. It was
surely a combination of many factors, one being
the comfortable and known home surrounding, and
another one being the professional care given by
the family in support with our care
provider. This transition is not just about
your parent, it is also about you evolving from
being a child to a care giver. No doubt, it is a
challenging and critical phase in your life. To
make it a rewarding and ful?lling experience,
understand your options and limitations. Ensure
that you have a solid plan in place and execute
it ef?ciently.
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COPING WITH CAREGIVING FOR AILING PARENT
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Coping With Caregiving for Elderly Parent
In our Indian communities, caring for elderly
parents is considered a core traditional value,
that we take pride in. Irrespective of the
westernisation of our societies, majority of
Indians choose to care for their parents at
home. With the age expectancy of our population
increasing and the number of children in a
family decreasing, the length of time that the
parents are cared for and the intense pressure
that results out of it, has increased quite
signi?cantly.
The demands of being the care giver can be quite
high. It needs a lot of dedication, time and
effort. The critical challenge, for many, is
juggling a busy career, caring for their own
kids and home plus the aged parents. The
pressure from all sides can lead to a condition
known as the Care Giver Burnout, which is de?ned
as the physical and emotional strain that
results from taking care of someone. Though it is
a rewarding and ful?lling experience for many,
it can take a toll on the quality of life for
the entire family. It could result from not
sleeping enough, working too much, having too
many tasks to attend to and just not having
enough time to care for yourself. Add to it the
?nancial implication or the emotional turmoil of
watching the parent suffer from a degenerative
condition like Alzheimers or the unresolved
family issues that resurface, these are enough to
leave anyone overwhelmed with the
situation. The demands of being the care giver
can be quite high. It needs a lot of dedication,
time and effort. The critical challenge, for
many, is juggling a busy career, caring for
their own kids and home plus the aged parents.
The pressure from all sides can lead to a
condition known as the Care Giver Burnout, which
is de?ned as the physical and emotional strain
that results from taking care of someone. Though
it is a rewarding and ful?lling experience for
many, it can take a toll on the quality of life
for the entire family.
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• Care Giver Burnout can manifest as
• Depression I am not interested in any of this
• Anxiety I cannot step out of the house, what
  if my mother needs me?
• Guilt Am I doing enough?
• Exhaustion I am just too tired to eat
• Inability to concentrate I completely forgot
  my spouses birthday
• Loss of sleep What if she tries to get out of
  the bed and falls down?
• Excessive irritability I just need to be left
  alone
• Physically, it can be present as headache, body
  ache, weight loss, weight gain or insomnia.
  Though our body is capable of handling stress
  for a short time frame, it loses the ?ght after
  some time and the stress starts wreaking havoc
  on our systems.
• This is more common in women, as they are mostly
  more hands on than men. While men tend to
  involve with the coordination of care, driving
  to and from hospitals and taking care of the
  ?nancial matters, women tend to be the personal
  care givers and keep the relationship going
  within the family members, while attending to
  their own children and maybe careers.
• The warning signs of Care Giver Burnout need to
  be taken seriously as the quality of the care
  you provide to your parent is directly
  proportional to your well being. You need to
  take care of yourself as the stress can only be a
  detrimental factor in these situations. Let us
  now, look at a few tips to overcome the Care
  Giver Burnout.
• 1. Give yourself priority You should get away
  from the guilt and need to understand that you
  need regular breaks to keep you going. Do things
  that you love during those breaks. Set your mind
  free and come back refreshed. Simple relaxation
  techniques like meditation, going for short
  walks are great stress busters.

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• Seek Help There are organized providers that
  provide at home healthcare. At home healthcare
  providers, give the same quality of care that
  you get in hospitals in the comfort and
  convenience of your homes. India Home Health
  Care Pvt. Ltd.(IHHC) is one such provider which
  takes care of the elderly through a wide range
  of care plans that is developed and customized
  to your parent.
• Dr.AnithaArockiasamy , Head of Clinical
  Operations, IHHC points out that Over 30 of
  our patients come to us after trying to care for
  their parents by themselves.
• By the time they approach us, they are exhausted
  physically and mentally. They feel like they are
  ?ghting a losing battle. However, once they
  engage with us, they realise that they have a
  team that works with them for their parent and
  that they have someone with confer with. They
  understand that they can delegate the hands on
  care and get their life back. While starting a
  service for an elderly parent, India Home Health
  Care administers a questionnaire for the
  patients family to deduce how much of
  psychological support they need, which helps in
  stemming the Care Giver Burnout.
• Garner support Accept help and support from
  other friends or family. Discuss the issues you
  have at hand and the speci?c tasks that they
  could help with. If you are open and honest
  about the situation, you will be surprised by
  the positive responses you will get. Create
  partnerships with other siblings. Even if they
  live far away, speak to them to relieve you for a
  few weeks.Try con?ding in friends, unloading can
  make you feel a lot better.
• Accept the reality Things can go wrong and you
  cannot control everything. As is often said,
  there is no such thing as a perfect care giver.
• Do not feel guilty if you fall short of things,
  at times. Your house need not be perfectly kept
  at all times.
• Take care of your health Going for regular
  physical check-ups is even more important when
  you are a care giver. Make sure you get enough
  sleep, eat well and exercise regularly so that
  you feel ?t and ?ne.
• Remember that your parent wants you to be happy
  and healthy, above everything. It will hurt them
  to watch you weaken while taking care of them.
  So watch out for those warning signs, learn to
  lighten the stress and the risk of burnout.

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Arthritis Causes Symptoms
Arthritis is a nagging problem when managed
diligently can be controlled effectively. The
person who is affected can lead a normal
qualitative life when he understands his/her
problem better. There are many types of
arthritis namely Osteoarthritis, Rheumatoid
arthritis, psoriatic arthritis, gout etc. Among
these, osteoarthritis and rheumatoid arthritis
are more common. Osteoarthritis is due to
degenerative changes in the joints due to wear
and tear resulting in joint in?ammation, pain,
swelling, restriction of joint mobility thereby
affecting the basic function like sitting,
standing and walking, Knees are the most common
joints that are affected. Then, comes the hips,
small joints in the hands, and ankles. With
proper medical consultation and physiotherapy
these individuals can lead a pain free normal
life.
Rheumatoid arthritis is a condition with severe
joint in?ammation with remissions ad relapses.
The cause is unknown. It can start with any
joint. Usually this is symmetrical. Both the
knees will be affected and then both the ankles,
both the hands, both the elbows, both the
shoulders and then the spine will also be
affected. If not treated properly the joints can
result in crippling deformities. These patients
should consult a Rheumatologist periodically to
control the joint in?ammation with proper
medications along with a comprehensive
physiotherapy care.
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ARTHRITIS CAUSES AND SYMPTOMS
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Physiotherapy plays a vital role in the
management of arthritis. If there is a joint
swelling it is better to apply a soft gel type
ice pack wrapped over a thin cloth for 10 to 15
minutes. Any acute pain and swelling in the joint
will respond better to cold pack. This is
followed by gentle isometric exercises. For
example if there is a pain and swelling in the
knee, knee pressing exercises can be done by
keeping a turkey towel role under the knee. As
the pain and swelling comes down the exercises
can be progressed. In the case of sub-acute and
chronic joint pain, heat therapy is ideal.
Electric hot pack or hot water bag can be
applied at home after ?nishing the simple
exercises. Exercises should be done methodically.
When exercises are done methodically the muscles
in and around the arthritic joints will get
strengthened and improve the blood circulation
thereby do the repair process resulting in pain
reduction. The strong muscles will stabilize the
joints and improve the endurance too.
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CARING FOR AN ALZHEIMER'S PATIENT
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Caring For An Alzheimers Patient

• Alzheimers disease is an illness of the brain.
  It is caused by a large number of brain cells
  dying which leads to loss of memory and the
  ability to think clearly. This often leads to
  the entire family getting affected and not just
  the patient. Since Alzheimers patient becomes
  forgetful and disoriented which gets worse as
  the disease progresses, it is often a close
  family member that steps in as the primary
  care-giver. Caring for an Alzheimers patient is
  hard because the family member also needs to
  deal with the personality changes that happen
  due to the disease and the dependency increases
  as the condition progresses.
• The following points can help the primary
  caregiver to understand their loved one better
  and to care for them more ef?ciently
• Maintaining a stable daily routine in a familiar
  environment can bring down the patients stress
  levels to a great extent
• Keeping them amidst family members and reminding
  them about the past will be essential to keep
  them engaged with the present
• Keeping the surrounding area free of fall risk
  will be critical to prevent falls and further
  complication
• Nutritious food at regular time is essential for
  maintaining good health.
• Caring for yourself is a necessity as it brings
  you relief. You could do this by taking
  assistance from friends, other family members,
  opting for partial/full home care assistance,
  getting exercise and eating well.

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RISK OF FALL IN ELDERLY
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Risk Of Fall In Elderly

• An old woman aged 70 years fell on her face
  during early morning hours causing severe bruise
  and swelling in her cheek. When you assess this
  particular lady you gather so many pre-existing
  fall risk factors for her.
• Apatient with rheumatoid arthritis for 25 years,
  taking psychiatric medications for many years,
  diabetic, post R breast removal cancer prevention
  medicines, thyroid medicine with inactivity
  resulted in muscle weakness, poor balance and
  giddy/dizzy/syncope spell due to multiple
  medicines. This is a perfect example of a few
  risk factors for falls in elderly.
• Out of 1.27 billion people in India, 60 and over
  population contribute 7.7. Falls are the major
  problem and in medical terminology it is known as
  Geriatric Giants.
• What are the reasons for the fall in elderly?
• There are two main reasons. They are intrinsic
  factors and extrinsic factors.
• 1. Intrinsic factors
• 1 .Balance and Gait (ambulation)
• Legs and spinal muscle weakness due to stroke,
  parkinsons, arthritis, neuropathy,
  neuro-muscular disorder, vestibular disorder etc.
• Medications (Polypharmacy)
• Taking more than 4 medicines and sedatives
  increases risk of fall.
• a. Vision Visual impairment like glaucoma,
  macular degeneration, retinopathy, bifocals etc.
• b. Visual motor reaction time is extended
• Cognition Dementia, confusion etc.
• Cardio-vascular causes
• Orthostatic hypotension, carotid sinuses syndrome
  neuro-cardiogenic syndrome, cardiac arrhythmias,
  valvular disease etc.

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• 2. Extrinsic factors
• Poor lighting
• Stairs with inadequate handrails.
• Rugs and ?oor surfaces with low friction.
• Loose clothing
• Poorly ?tting footwear
• Lack of equipment (assistive devices) like
  walking sticks, walking frames, Zimmer frames,
  etc to assist them in ambulation
• Consequences of fall
• Black eyes and soft tissue injuries suggest that
  the faller was not conscious as they fall.
• Fracture Dislocation 5 of falls end up having
  a fracture out of which 1 will be fracture neck
  of femur.
• Disuse atrophy and muscle wasting during recovery
  period.
• Long term bedridden patients develop pneumonia,
  pressure sores, dehydration and hypothermia.
• Psychological Fear of falling falls under the
  Psychological category.
• Interventions
• Multi-disciplinary approach to assessment and
  treatment results in best outcome. Provisions of
  safety devises such as grab handles, high
  friction/non

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FALL PREVENTION IN THE ELDERLY
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Fall Prevention In The Elderly

• Falls are one of the most common fears of the
  elderly. Although any one could fall, the chance
  of falling gets higher and the after-effects of
  the falls become more serious with age. Falling
  causes injury, loss of mobility and
• even death. However, it is not something that
  should give you sleepless nights as these can be
  prevented, once you evaluate your personal risks
  for fall and learn about ways to overcome those.
• Falls are common in the elderly age group because
  of normal changes related to aging such as poor
  balance, impaired vision, reduced mobility or
  side effects of medication. As we age, our
  reaction time to avoid hazardous situations
  declines as the nerves that conduct impulses from
  the brain to the muscles weaken with age.
• By incorporating a few changes in your lifestyle,
  you can bring down the chances of falling quite
  drastically.
• Here are some tips to get started upon
• Exercise regularly It is important to keep
  moving as regular exercise keeps your muscles
  stronger and nerves more alert. Yoga and other
  forms of exercise like Tai-chi are often
  recommended for seniors as they focus on muscle
  strength and balance.
• Check your vision Poor eyesight puts you at a
  high risk for falls. Plan to visit your
  Ophthalmologist for a vision check at least once
  a year. With age, the chance of developing
  glaucoma or cataract becomes quite high. This is
  more signi?cant if you have diabetes or
  hypertension.
• Review your medication with your physician The
  changes in the different systems as people age,
  affect how the body is able to absorb, use and
  eliminate the excessive medication. The same
  medicines which you took earlier may have
  different effects with age. Some of them may
  cause excessive sleepiness or muscle weakness
  which again puts you at a risk for falling. So
  make it a point to discuss the medication you
  take, including the non-prescription ones, with
  your physician and understand their side-effects.

33

1. Use Mobility Aids If you have problems with
   balance and coordination, your doctor will
   prescribe mobility aids like canes or walkers.
   These devices help you keep moving safely.
2. Make your home safer Assess your homes for
   potential hazards and address them. Simple
   things like the way your furniture is arranged,
   avoiding use of rugs or mats on the ?oor, de
   cluttering the ?oor, making sure the path from
   the bedroom to bathroom is well lighted have a
   great effect on your safety within the house.

6. Enrol in a regular health assessment
program There are a few healthcare providers who
provide at home health assessment including
checking your immediate environment for potential
hazards and work with you to make your health
better and home safer. This helps in promoting
independent living
Who is India Home Health Care and how can we
help? India Home Health Care Pvt. Ltd. is a
leading at home health care provider based in
Chennai and Bangalore. We offer quarterly visits
by doctors and monthly or bimonthly visits by
Registered Nurses to assess the health status of
the elderly. We have developed a detailed health
assessment tailored to the Indian population.
Our Registered Nurses are trained professionals
with experience in hospital setups and are
therefore well equipped to handle any situation
at the patients home. Each visit is structured
to identify any changes in the health status, in
addition to reviewing the medication intake and
check the environment of the patients home to
assess the safety from a health perspective.
34
FALLS IN ELDERLY - PHYSIOTHERAPISTS PERSPECTIVE
35
Falls In Elderly- Physiotherapist Perspective

• An 85 year old lady fell down while draping her 7
  year old Grand Daughter with a blanket and
  didnt have pain or discomfort in her body
  immediately. After couple of days she was having
  pain in her back for which she went for an
  orthopaedics consult followed by MRI which
  revealed multiple crush fracture in the lumbar
  and dorsal spine. She had complete rest with back
  brace for few weeks followed by comprehensive
  physiotherapy. Overall it took six months for
  her to recover from the day of fall and affected
  her quality of life especially to lead an active
  and independent life.
• About one third of people over the age of 65 and
  almost half of people over the age of 80 will
  fall at least once a year. Doctors, Nurses, para-
  medical persons, family member ,and friend etc
  can identify fall risk person in their life and
  refer them to Physiotherapist for further
  management.
• Physiotherapists can help reduce a persons risk
  of falling by
• Assessing a persons risk of falling.
• Helping his home as safe as possible.
• Educating that person about the medical risk
  factors linked to fall
• Designing individualized exercises and balance
  training.
• Working with other health care professionals and
  community services to create programs for people
  who want to reduce their risk of falling.
• Physiotherapist can do a thorough evaluation
  which includes
• Areview of ones medical history
• Areview of ones medication
• Asimple vision test
• Ahome safety assessment
• Asimple screen of ones thinking abilities.

36

• Assessment of any nervous system disorders such
  as stroke, Parkinson, etc
• Measure ones leg strength using simple tests
  such as timing how long it takes you to rise
  from a chair.
• Determine how quickly and steadily one can walk.
• Assess ones balance for instance , by having
  one stand on one leg or rise from a chair and
  walk
• Use special test to measure the balance
• Based on the evaluation results, Physiotherapist
  will design an exercise and training program to
  improve ones balance and strength. Arecent
  systematic review of many published studies
  found that exercise based programs in the home
  or in group settings are effective in preventing
  falls. These programs are especially effective
  when balance exercises are performed in a
  standing position without using much arm
  support.
• Balance Exercises
• Balance training has been shown to be an
  important and effective part of falls
  prevention. Ones Physiotherapist will design
  exercises that challenge his ability to keep his
  balance including such
• exercises as single leg standing
• Walking and Moving
• When people walk very slowly or unsteadily, they
  are at risk for falling.
• His Physiotherapist can improve his walking
  ability by making him do such activities as
• Dance steps
• Walking in circles

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• Doing more than one thing at the same time safely
• Older adults who have dif?culty walking and
  talking at the same time are at high risk of
  falling. To help increase their safety during
  activities ones Physiotherapist can design
  a,dual task, training program. This kind of
  training will challenge one to maintain a walking
  speed while he do another task such as counting
  backwards, engaging conversation or carrying a
  bag of groceries.
• Strength Training
• Strengthening exercises are a key element of fall
  prevention when they are done in conjunction
  with balance training. Ones Physiotherapist will
  design strengthening exercises that focus on his
  leg and the muscles used in maintaining posture.
• Aerobic Training
• Walking is one of the safest way of aerobic
  training. Physiotherapist will formulate walking
  program according to the patients capacity.
• Education Fear Management
• Physiotherapist will talk to the patient how best
  to manage his own risk of falling and to build
  his self esteem to overcome the fear of falling.
• Community Program
• Physiotherapist can participate with local groups
  in organizing different fall prevention
  activities at the community level like in the
  malls,
• senior citizen centres, clubs etc.

38
THE ROLE OF NURSES IN THE ELDERLY FALL
PREVENTION CARE PLAN
39
The Role Of Nurses In The Elderly Fall
Prevention Care

• ANurse has got a major role in preventing falls
  in Elderly population. From the time of
  admission to the hospital to the time of
  discharge she can categorize the patients in to
  low risk, moderate risk and high risk. From that
  category she can formulate a care plan to prevent
  fall in the hospital, at home and in the
  community.Falls can be due to multiple reasons.
• Patients who take benzodiazepines, antipsychotic,
  diuretics, anti-depressants, narcoleptics,
  opioids, insulin, oral hypoglycaemic, anti
  -coagulants, cardiac and hypertensive will lead
  to disorientation, giddiness and fatigue.
• Patients who have dementia, hip fracture,
  Parkinsonism, stroke, osteoporosis, arthritis
  and depression should not be left alone. Patients
  who have urinary and faecal incontinence need
  bladder and bowel habit retraining, diaper care
  to prevent rash/pressure sore.In addition
  patients who have visual impairment, functional
  disability and prior history of fall should have
  appropriate intervention to prevent further
  falls.
• Nurse can initiate fall prevention care plan for
  the above mentioned patients as follows
• Toileting needs To ask the patients every one to
  two hours whether he/she needs to use the
  bathroom, answer call light promptly, remind the
  patient to ask for assistance and reorient to
  call night if necessary, eliminate side rails
  and asses need for bedside commodes and
  individual toileting schedule and/or bowel and
  bladder training.
• Sync opal Episodes To evaluate postural
  hypotension and/or cardiac arrhythmia and
  consult with physician, review medications with
  pharmacy consultant and physician, consider ?uid
  volume de?cit then evaluate intake and output,
  teach the patients to change the position slowly,
  especially from lying to sitting to standing,
  maximize the patients time out of bed as much
  as clinically possible to increase tolerance,
  keep the bed in the low position, assist with
  all transfers, consider use of TED hose and
  perform a
• nutrition consultation.

40

• Environmental hazards Eliminate potential
  hazards such as uneven surfaces, debris or water
  on the ?oor, keep the light and water within the
  reach, keep eyeglasses within reach and ensure
  adequate lighting .
• Weakness/Unsteady gait Evaluate for possible
  therapeutic interventions, remind patients to
  request assistance, keep call light within reach,
  confer with rehabilitative services and the
  interdisciplinary team and assist the patient to
  obtain and wear appropriate, non-skid shoes.
• Sensory/perception de?cits Frequently reorient
  the patient to the environment, keep furniture
  and other objects in the same position, evaluate
  presence and adequacy of glasses and hearing
  aids, assess the environment to maximize safety,
  consult with vision/hearing specialist as
  needed, refer to occupational therapy and
  consider a conference with rehabilitative
  services.
• Knowledge de?cit Ensure assistive equipment is
  used appropriately, be sure the patient is
  comfortable with adaptive and assistive devices,
• ensure the resident is able to use the call
  light. If the light is dif?cult to press,
  consider a foam pad call light or other adaptive
  call lights and ensure frequent visitors are
  aware of the use of assistive devices.
• Once the care plan is formulated among the three
  categories (low risk, moderate risk and high
  risk) then appropriate staffs are delegated to
  perform the task. In all the categories the
  nurse should maintain the safe unit environment
  which includes removal of excess
  equipment/supplies/furniture from rooms and
  hallways, coil and secure excess electrical and
  telephone wire/cords, clean all spills in
  patient room or in the hallway immediately and
  place a signage to indicate wet ?oor danger.
• For low risk individuals apart from maintaining
  above mentioned
• safe unit environment the following safety
  interventions should be taken
• Orient the patient to surroundings, including
  bathroom location, use of call light.
• Keep bed in lowest position during use unless
  impractical (when doing a procedure on a
  patient)
• Keep the top two side rails up.
• Secure locks on beds, stretcher and wheelchair.

41

• Keep ?oors clutter/obstacle free (especially the
  path between bed and bathroom/commode)
• Place call light and frequently needed objects
  within patient reach.
• Answer call light promptly
• Encourage patient/family to call for assistance
  as needed.
• Assure adequate lightening especially at night.
• Use proper ?tting non-skid footwear.
• For moderate risk individuals apart from
  maintaining safe environment as mentioned
  earlier and follow low risk intervention plus
• institute ?agging system.
• Institute Flagging system
• Apply fall risk arm band
• Falling star (yellow) outside the patients door
• Falls risk sticker on the medical record and
  monitor and assist patient in following daily
  schedules
• Supervise/assist bedside sitting, personal
  hygiene and toileting as appropriate.
• Reorient confused patient as necessary.
• Establish elimination schedule and use of bedside
  commode if appropriate.

42

• For high risk individuals apart from maintaining
  safe environment
• as mentioned previously follow low and moderate
  fall risk interventions plus institute ?agging
  system
• Apply fall risk arm band.
• Falling star (red) outside the patients door.
• Falls risk sticker on the medical record.
• Remain with patients while Toileting
• Observe 6o minutes unless patient is on activated
  bed or chair alarm.
• When necessary transport throughout hospital with
  assistance of staff or trained care givers.
  Consider bedside procedure.
• Evaluate need for following measure going from
  less restrictive to more restrictive
• Moving patient to room with best visual access to
  nursing station.
• Activated bed/chair alarm
• 24 hour supervision
• Physical restraint only with authorized
  prescribed order
• Once the patient is ready to go home the nurse
  should make a home safety assessment by
  following above mentioned guidelines and then
  transfer the patient to a safe home with proper
  caregiver if necessary. At community level the
  nurses can address the senior citizen group on
  fall prevention

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