Friday, November 2, 2012

The Humpty Dumpty Syndrome

A friend of mine had a serious fall over the weekend.  She was lucky.  Her injuries, although serious, were not life altering. Although my friend was young, falls are frightening at any age; for aging adults they can be a death sentence.

According to an article posted by the Communicable Disease Center in Atlanta, Georgia, “among older adults (those 65 or older), falls are the leading cause of injury death. They are also the most common cause of nonfatal injuries and hospital admissions for trauma.” In my assisted living communities, falls are tracked like meteorologists track hurricanes.  Every time a resident hits the ground, the cause and effect of the fall is reported, and the resident, injured or not, is assessed and evaluated for at least three days following the accident. 

 A resident who falls frequently is considered “at risk,” and must be assessed by a physical therapist or a primary doctor. When appropriate, a professional will recommend a change of lifestyle such as the use of a walking assistance device.    Falls are so critical that they are discussed every morning at the daily stand up meeting, and every department director is notified when a resident falls with or without an indication of injury.

Not long after entering the field of assisted living, I worked diligently to recruit a new resident, Irene. We became fast friends during that time, and I was devastated when she fell a few days after moving in.  She had gotten up early in the morning and pattered barefoot into the bathroom.  When her bare feet hit the cold tile, it surprised her enough to throw her off balance, and she toppled hitting the edge of the commode on her way to the floor. 

The nurse on duty responded to the ringing call button to find her in extreme pain, unable to move the left side of her body.  The nurse was positive Irene had broken her hip.  I arrived at work just as the emergency medical team was wheeling her to the waiting ambulance.  I stopped them a moment to squeeze her hand, wish her well, and assured her we would wait impatiently for her return.  I was totally unaware the ordeal she faced once she was admitted to the hospital.

Irene’s surgery and hip replacement was only a very small part of her recovery.  In order to walk again, she had to embark on a long journey of arduous recuperation. Once she finally left the hospital she was a patient at a nearby rehabilitation center for close to eight weeks.  Each day she endured strenuous physical therapy that sapped her strength and hurt her tired body.  The family kept us informed, but their reports during her long siege were discouraging.  Irene was depressed, confused, and suffered serious memory loss. She hated the pain she experienced as the therapists forced her to continue her exercises. She often refused to participate, choosing to sit in her room and withdraw from socialization.  Her progress was slow, and for a while we feared she would not be strong enough to return to our community.  If Irene did not come to the plate and comply with her therapy, she would spend the rest of her life in a nursing home.

Someone from our staff called or visited weekly.  We sent cards and gifts hoping we could encourage her to continue fighting.  Finally, after several weeks she seemed to gain enthusiasm and reached the level of competency that would allow her to return as an assisted living resident.  She would never again be able to live as an independent resident, but would remain in her apartment receiving the necessary assistance.

I excitedly anticipated Irene’s return, but I was dismayed when I greeted her at the door.  I was not prepared for the change both physically and mentally that had taken place.  Irene had lost weight, her face was strained and her eyes were dull.  She looked at me as if we had never met, when in fact we had spent days and weeks together preparing for her to move into her new apartment.  I was shocked to see my friend so lethargic, and I was appalled that a once totally alert, fun, intelligent lady had been reduced to such a sad, unhappy woman.  Her memory loss was significant, and her confusion obvious.

I learned later that Irene’s cognitive ability was compromised by the anesthesia given during her surgery.  Many patients, as they age, are effected by the sedation and are rendered mentally less functional than before surgery.  These altering effects may or may not dissipate over time.  For Irene, the later was true. 

Since then I cringed every time my team reported a fall.  Often what appeared to be a simple loss of balance could not only be life altering, but life threatening.  Some falls cannot be prevented; hips have been known to break before the fall.  Others can be deterred with a little common sense and proactive thinking.   Eating well, vigorous exercise, and maintaining a safe and uncluttered living environment are key elements.  

Proactive fall awareness is important.  It is impossible to prevent every occurrence.  My friend’s recent fall could not have been predicted or avoided.  A bar to assist her in the bathroom was improperly installed and gave way.  Nonetheless, the infamous “f” word should stay foremost in our mind.  As we maneuver ourselves through a somewhat unsafe and difficult world full of obstacles, we want to stand tall and keep our feet on the ground.