Quality of Care Guidelines

Quality of Care Guidelines

Prevent Fractures in Elderly After a Fall.

Many of the ideas in this section were taken from the American Academy of Orthopedic Surgeons publications entitled, "Don't Let a FALL be Your Last TRIP." Many of these suggestions should be implemented in elderly housing, assisted living facilities, and institutions which house elderly patients.

  • Over the age of 50, get an annual physical and eye examination, particularly an evaluation of cardiac, vascular, and neurological problems.
  • Maintain a diet with adequate dietary calcium (1200 milligrams for people older than 50) and vitamin D (400 international units {IU} for anyone over age 51 and 800 IU's for anyone age 71 and older). Women who are in or past menopause should discuss the use of estrogen or other drugs i.e., tamoxifen, in the prevention of osteoporosis.
  • Participate in an exercise program for agility, strength, balance, and coordination.
  • Keep an up-to-date list of all medications and provide it to all doctors with whom you consult (including herbal products and over the counter medications).
  • Know the side effects and interactions of your medications (including herbal products and over the counter medications).
  • Try to walk only in well-lit areas, as much as possible. Medications should be clearly labeled and stored in a well-lit area according to instructions.
  • Wear properly-fitting shoes with non-skid soles.
  • Light switches should be installed for easy access upon entering or leaving a room, hallway, or staircase. Glow-in-the-dark switches may be helpful.
  • Multiple telephones, a portable telephone, or a service such as lifeline may be necessary for people with a tendency to fall.
  • Avoid excessive alcohol intake.
  • Do not smoke.
  • When getting up in the morning, sit on the edge of the bed and make sure you are not dizzy before getting out of bed.
  • Eat breakfast every morning. Skipping meals can lead to dizziness.
  • Be careful around pets - animals can get in front of people's feet or jump on people.
  • Unsteady persons should use a can or walker. Worn rubber tips should be replaced right away on these devices.
  • Wear glasses if necessary, but remove reading glasses before walking.
  • Wear clothes that fit properly. One can trip on a coat, pair of pants, or bathrobe that is too long.
  • Clutter, such as clothes and newspapers, should not be left on the floor.
  • Cabinet drawers should be closed so one won't stumble over them.
  • Balance training programs, such as Tai Chi exercises, may improve balance.

Bathroom Safety

  • Never grab a towel rack, shampoo holder, or soap tray for support in the shower. These will not always hold a person's weight. If you are prone to falling, use a shower chair and a hand held shower attachment. Unsteady persons or those who cannot lower themselves to the floor of the tub should install a sturdy, plastic seat in the bathtub.
  • Grab bars should be installed on the bathroom walls near the toilet and along the bathtub or shower.
  • Move around the shower only after the soap suds have gone down the drain. Turn slowly and cautiously.
  • Clean up puddles of water immediately.
  • Don't lock the bathroom door so as to allow help to get inside if needed.
  • A slip-resistant rug should be placed adjacent to the bathtub for safe exit and entry.
  • A liquid soap dispenser should be installed on the bathtub/shower wall. It may be difficult to pick up a slippery bar of soap.
  • Nonskid, textured strips should be placed on the bathtub/shower floor.
  • Glass shower enclosures should be replaced with non-shattering material.
  • Stabilize yourself on the toilet by using either a raised seat or a special toilet seat with armrests.

Stair Safety

  • Carry packages that allow you to see the next step.
  • Keep at least one hand on the handrail.
  • Flashlights should be kept nearby in case of a power outage.
  • Handrails should be located on both sides of the stairway. Use on for going up, the other for coming down.
  • Objects should not be left on the stairs.
  • Motion detector lights, which turn on automatically and light stairways should be installed. Dark or deep-pile carpeting should not be used. Solid colors show the edges of steps more clearly.
  • Non-slip treads should be installed on each bare-wood step.
  • Loose area rugs should not be located at the bottom or top of stairs.
  • Loose stairway carpeting or boards should be replaced immediately.

Bedroom Safety

  • Place a lamp and a flashlight near the bed.
  • Night-lights should be installed along the route between the bedroom and the bathroom.
  • Sleep on a bed that is easy to get into and out of.

Living Area Safety

  • Furniture should be arranged so as to create clear pathways between rooms.
  • Low coffee tables, magazine racks, footrests, and plants should be removed from pathways in rooms.
  • Loose area rugs should be secured with double-faced tape or slip-resistant backing. These rugs should be rechecked periodically.
  • Electric, appliance, and telephone cords should be kept out of pathways, but cords should not be placed under rugs.
  • Wobbly chairs, ladders, and tables should be eliminated.
  • Sit in chairs or on sofas that are high enough to make changing from sitting to standing easy.
  • Carpeting should be placed over concrete, ceramic, and marble floors to lessen the severity of injury in the event of a fall.
  • Loose wooden floorboards should be replaced immediately.
  • A sliding closet door may be easier to open without a loss of balance than a hinged door.

Kitchen Safety

  • Throw rugs should be removed.
  • Any liquid, grease, or food spilled on the floor should be cleaned up immediately.
  • Food, dishes, and cooking equipment should be stored at easy-to-reach waist-high level.
  • Step stools with a handrail should be used to reach upper cabinets.
  • Loose flooring should be replaced.
  • Nonskid floor wax should be used.