Category: Hospital

The Fear of Falling

Guest blogger Colorado State University and Covell Care Intern, Hailey Jungerman.

Falling can cause major issues for older adults. Injuries can range from an ankle sprain to a traumatic brain injury. These injuries can lead to high direct medical costs and indirect medical costs. Not only that, but it can lead to an increase in fall risk factors.

“Fear of falling often develops after experiencing a fall” (Tomita et al.).The same study shows that even one fall can lead to developing fear. There is a vicious circle that is associated with the fear of falling that can be hard to break without intervention. “Fear of falling is associated with negative physical and psychosocial health outcomes, including depression and
activity restriction” (Lee, Oh and Hong 2018). Once an older adult obtains this fear, the less likely they are willing to participate in activities such as exercise or even leaving their house. This can lead to weakened muscles and depression. Which in turn are more risk factors for older adults.

A team of therapists including occupational and physical therapists can help to overcome the fear of falling. Occupational therapists can assess the home for safety, both occupational and physical therapists can do a fall risk assessment on the client, and both can create a plan to address risk factors. They can suggest home modifications, address risk factors around the house, see how the patient gets around their home, and giving the patient exercises to build strength and work on balance. As the American Occupational Therapy Association’s page says, “Identifying environmental factors that contribute to falls and implementing the occupational therapy strategies to ameliorate these elements can improve safety and reduce health care costs while enhancing the participation of older adults in those communities.”

In order to keep older adults independent, it is important to have them assessed to find their risk factors. Each individual is unique, and so are their needs. Therapists working together can help to improve the quality of life by addressing fall risk in our loved ones.

For more information on Home Safety or Fall Risk Assessments call Covell Care & Rehabilitation at 970.204.4331.

Citations:
Lee, Seonhye, et al. “Comparison of Factors Associated with Fear of Falling between Older Adults with and without a Fall History.” International Journal of Environmental Research
and Public Health, vol. 15, no. 5, May 2018, p. 982., doi:10.3390/ijerph15050982.
Tomita, Yoshihito, et al. “Prevalence of Fear of Falling and Associated Factors among Japanese Community-Dwelling Older Adults.” Medicine, vol. 97, no. 4, Jan. 2018, doi:10.1097/md.0000000000009721.
Toto, Pamela. “Occupational Therapy and Prevention of Falls.” Aota.org, American
Occupational Therapy Association, 2017, www.aota.org/About-Occupational-Therapy/Professionals/PA/Facts/Fall-Prevention.aspx.

Fort Collins Nurse/Author Releases New Book on Cancer Survivorship Care for Everyone

Working as an oncology nurse in the hospital, Alene Nitzky soon realized her skills and knowledge, as well as her co-workers’, were profoundly underutilized to meet the needs of patients undergoing cancer treatment. From the initial shock of a diagnosis, patients progressed to paralyzing fear around their mortality. Not knowing what to do, when, in what order, or who to rely on for help, patients missed key information that would have helped them go through the cancer patient experience with less distress and anxiety.

Afterward, patients were left to their own devices to recover, with little support or guidance, and few skills to help them restore their quality of life. Outside of the healthcare system, instead of taking a distant, clinical, big data approach, Nitzky describes meeting people where they were, in their homes, communities, and support groups, where she could listen to their everyday concerns- the ones they never had time to discuss in short medical appointments. Given time and active listening, they articulated their needs for practical skills in understanding health information, self-advocacy, and self-care that accommodates their lifestyles, and matches their values and preferences around quality of life.

In three, easy to understand, skill-based education programs aimed at closing gaps in information and understanding about cancer and survivors’ needs, the author calls for active prevention and preparation to reduce the trauma of a cancer diagnosis through C.A.R.E.: creativity, authenticity, resourcefulness, and empathy. Navigating the C will walk you through the steps you need to take to get your needs met in a system that so often fails cancer patients in finding the way back to themselves, and the possibility of emerging better than ever.

Everyone can expect to become empowered by reading this book by a passionate advocate for patients and healthcare workers: Patients, caregivers, and survivors will gain self-advocacy and self-care skills to have more control over their follow-up care experiences, and become more active and confident participants in their own healthcare. Ordinary citizens and those who have never had cancer will learn the simple steps they can take to reduce the trauma around an initial cancer diagnosis for themselves, or support their loved ones. Healthcare professionals will examine their own values around providing cancer treatment and survivorship care.

Finally, those on the fringes of clinical care- the decision-makers and administrators- will gain insight into what really happens to the end-users of cancer services and how their lives are impacted by their experiences in healthcare. Nitzky appeals for the importance of reducing the trauma of a cancer diagnosis, the intrinsic value of community programs, and smaller, individual approaches to cancer survivorship care, where big healthcare and big business miss the mark.

Navigating the C: A Nurse Charts the Course for Cancer Survivorship Care. By Alene Nitzky, Ph.D., RN, OCN. Blue Bayou Press, 2018. 216 pages. $19.95 paperback, $9.99 Kindle. Available on Amazon.

Navigating the C is available on Amazon:   https://a.co/ciTYFWi

Local Signing event at Elevation 5003 on January 28:   https://www.eventbrite.com/e/navigating-the-c-book-signing-meet-the-author-tickets-42151424044

February 12 at Raintree Athletic Club, and February 22 at Hope Lives! For more details, visit https://cancerharbors.com/events 

It CAN Happen to You

Healthcare companies spew out statistics all the time. How many people fall. How many people have a broken hip. How many people hit their head. But, the numbers are usually so huge we can’t even wrap our minds around them. We often sit outside of those groups and say, “Wow that’s a lot of people. But, it’s not me.” And off we go about our day.

I have met 100’s, possibly 1000’s, of people that have fallen and ended up in the hospital or in a rehab setting. I have met ZERO people that told me they knew they would fall one day. Every single one of them is shocked over it. Countless people have told me, “I have been so independent. This just isn’t me.” Other people tell me, “I don’t belong here [in the hospital or rehab].”

Most of us don’t see ourselves as a patient with a broken hip. Or a man with a fractured humerus that’s headed into surgery. We see ourselves as active, engaged, careful, safe, aware. Let me tell you. It CAN happen to you.

Falls are the #1 reason people over 65 go to the ER in Northern Colorado. The hospitals are working very hard to reduce this with community outreach and trying to refer people to services like ours after they have a fall.

What can you do to reduce your fall risk? Here are two recommendations that will almost certainly reduce your fall risk.

  1. Work with a personal trainer.

This does not mean the same thing as “work out”. Working with a personal trainer ensures you are working on the right things for you. Everyone is different. We have had different injuries over the years, we have different body types, some folks have strong legs, other people have a stronger upper body. So often people tell me they “walk every day.” That’s great! Keep it up. But, work with a personal trainer TOO! Walking everyday helps you get better at walking. It does not mean your balance is where it needs to be, it doesn’t mean you can correct yourself quickly if you start to fall. Even if you work with a trainer twice a month, you will start to see an improvement as they will give you exercises to do at home. Or, they can work with you 2-3 times a week and you will be in better shape than you can imagine. We have clients that are older than 100 years old that work with a trainer. Guess what? They are not falling!

  1. Get a home safety assessment.

Home safety assessments are completed by occupational therapists. They will come to the client’s home and look at things you can’t even guess they will assess! OT’s are the experts that are highly trained in looking and assessing how people interact with their environment and daily routines. This may include lighting in the home, how people get in and out of the tub or shower, use of stairs, taking out the garbage, get up and down, how they sit at the table, and more. You can find several checklists online. This will never be as all-inclusive or person specific as an OT home assessment in your actual environment. Most falls happen in the home. There may be fall hazards right in front of you that you can’t recognize and are easy to eliminate.

If you don’t want to be part of the huge population of people that fall, please take the opportunity to be proactive in lessening your, or your loved ones, risk. It makes a different. The research supports personal training and home safety assessments as avenues to reduce fall risk. A fall could be in your future if you don’t take the steps to prevent it!

Why Hire a Private Care Manager

Of all the services Covell Care provides, Geriatric Care Management creates the most questions. Families don’t understand what a private care manager does. People have met care managers in other settings like hospitals and home care agencies and think all care managers do the same thing. Think again.

Geriatric Care Managers (also may be referred to as an Aging Life Care Professional) wear a multitude of hats when working with Covell Care clients. They may sit down with families and review concerns, plans for the future and give expert advice and guidance while breaking it down into tangible steps. Care managers may be tethered to a family throughout their loved one’s life through aging, dementia, disease progression, hospital stays and even hospice. The relationships between families and care managers are deeply personal on both sides. There is very little red tape in hiring a care manager because insurance rules and regulations do not limit all that a care manager can do. It can be incredibly powerful to remember that because insurance doesn’t pay for a service you can still receive it.

As anyone that is involved in the aging process with a loved one knows, the experience can be overwhelming, stressful and possibly the hardest thing a person will experience. There are so many moving parts in the aging process. You may have to tend to a loved one’s medical needs, physical changes and hardships, medication regimes, memory loss, personality changes, pain, recovery from surgery, safety concerns, incontinence, quality of life, adding ramps, grab bars, shower seats to the house, arranging appointments and maybe unexpected trips to the ER. The list can feel endless. On top of all of the moving parts, our current healthcare system is far from simple and navigating the system is harder than ever. A Geriatric Care Manager can co-pilot this process with a family offering emotional support, expert guidance, simplifying the most complex of situations and advocate for a family and their loved one throughout it all.

During a recent personal experience, I was reminded not only of the benefits of working with a care manager but really how imperative it actually can be.

About a month ago my husband and I flew home from vacation in Europe. Upon our return, my husband began to experience severe pain in his lower rib area. Within 24 hours of being home we were in the ER where a radiologist discovered my husband’s lungs contained multiple blood clots–also known as pulmonary embolisms. His pain stemmed from the damage the clots were causing inside the lungs and after multiple medications designed to curb the pain, one finally worked and he could rest. My husband was admitted to the hospital for 4 days. During that time, it was also discovered that he had two blood clots in his right leg. Because of the pain medication, my husband’s thinking was not clear and he relied on me to talk with the docs. As he improved, he continued to wear oxygen during the day and night to support his lungs.

I participated in monitoring the saturation of the oxygen by using the hospital’s pulse oximeter–a machine that simply measures how much oxygen is in your blood (the goal in Colorado should be always over 90%) and how many beats per minute the heart is beating. Throughout the 4 days, my husband could maintain good saturations without the oxygen when he was up and walking around. When he would rest, his lungs would then breathe more shallow and his oxygen saturations would drop below 90%.

Once we were given discharge orders from the hospital we headed home–without oxygen and without an order to receive it. I used my home oxygen monitor and discovered he was continuing to drop as low as 68% once we were home–this is not an acceptable oxygen level for anyone.

What followed next was incredibly stressful. We called his on-call doctor to report the findings. Because the hospital record did not indicate oxygen levels had dropped the doctor would not write orders for home oxygen. The records at the hospital were incorrect and no matter what I explained, the doctor wouldn’t budge. So, I called the hospitalist and received the same information. I called the nurse that took care of my husband in the hospital and she was certainly frustrated that oxygen had not been ordered but her hands were tied. I called the on-call doctor again. I took my husband to the ER and explained he would not drop below 90% unless he fell asleep–and he obviously wouldn’t be sleeping in the ER bed. No oxygen was ordered. I called the oxygen company. Nothing could be done without the doctor’s order. I was frustrated to tears. Because the health care providers were not helping (this all happened over a weekend) I knew we had a doctor’s appointment on Monday so we propped him up on pillows to help elevate the chest and lungs creating a better chance for him to breathe better at night and I woke him up every 1-2 hours. By the time Monday had come, I was as tired as he was.

What would have happened if I didn’t have a health care background? My husband would have continued to sleep every night dropping into those low numbers which can lead to passing out and not being able to wake up, long-term impairments and longer healing time for the lungs and potential other harmful–possibly fatal– issues. Luckily, we knew how to work towards getting a resolution and jumped through hoop after hoop.

These are the types of things a care manager can step in and help with. If I would have had a care manager in place would we have even made it out of the hospital without the order for O2?  More than likely, a care manager would have ensured all the I’s were dotted and T’s crossed and the oxygen would have been ordered without all the headaches (we did receive the home oxygen unit on Monday!). A care manager could have stayed at the hospital with him waiting for the doctor when I had to go to work for a few hours to see clients of my own. I ended up missing the doctor’s visit and my husband had forgotten to ask several of the questions about the medications. Once I returned, the doctor was on to the next patients and didn’t return to repeat the information. That extra, knowledgeable, patient advocate would have really helped! The second night my husband was in the hospital the nurses wanted us to do education about his injectable medication at 10pm. Because of the jet lag, the previous late night and early mornings I was so tired I don’t remember driving home that night. A care manager could have potentially arrived at that 10pm time to participate in the education on my behalf. The list goes on and on. And this is only for a 4 day hospital stay. Can you imagine all the things that can go haywire with longer stays?

I share this experience with you to help frame where the Geriatric Care Manager could potentially fit into your life. Not only in the hospital for more acute issues but in the day-to-day. Hiring a care manager will make things easier and even make things better overall because details won’t get missed or forgotten. The pressure can ease up from you being the one-and-only person to keep it all together. Less stress. Less tears. More sleep. More time. More clarity.

To find out more about what a care manager can do for you and your family call our main line at 970-204-4331.