For older adults, a fall can greatly increase the chances of serious decline and death
"Minding Our Elders" columnist Carol Bradley Bursack says a traumatic fall can cause alarming changes that family members may notice.
Dear Carol: My 86-year-old dad fell and broke his arm. After two nights in the hospital, he was sent to rehab, but the confusion that he’s experienced since his hospitalization hasn’t resolved. The family all work full time, so after rehab, in order to keep Dad safe, we’ll need to move him to a facility. There’s a well-respected care home nearby so, considering the situation, I’m not worried about his long-term care.
What does concern me is a friend mentioned that a fall was what signaled the end of her dad’s life. I understand that falls are hard on older bodies, but I didn't know that they led to deaths unless the person hit their head. How common is this? — NM.
Dear NM: I'm truly sorry about your dad’s fall and injury. The physical shock of a fall can be traumatic for an older body, but cognitive changes that can arise from the trauma and subsequent hospitalization are often the most shocking to the family. This type of cognitive change is often referred to as “hospital delirium.”
Some older adults will recover from delirium better than others, but many may not recover to where they were before the trauma. Not fully recovering cognition happens most frequently with those who had borderline dementia prior to the fall. Additionally, the trauma of a broken bone to an older body is much more difficult to overcome than for someone younger.
On a more positive note, your dad may improve once he's in a care environment, which is generally more personal and calming than the hospital or even rehab. Each move is likely to confuse him, though, so I'm not saying that he will go back to how he was before. I’m simply offering hope that some of his symptoms may improve.
My caregiving history includes assisting with many elder falls and injuries. The one that most closely references what your friend is saying about lifespan after a fall would be my neighbor, Joe, who’d fallen and broken his hip. After Joe had spent a week in the hospital, I was able to have him moved to a nursing home within blocks of my house, so I could continue to visit daily. Still, he didn’t adapt well and slipped away six weeks later. My intent is not to worry you excessively because many older people do recover and continue to get along reasonably well for years. However, statistically, many don’t make it much more than a year after a traumatic fall.
The best you can do for your dad is spend time with him and reassure him. I wouldn’t tell him about the potential move to a care facility until he has recovered a little more. Once the time to move him draws near, let him know that the next move will be to a care facility to continue his recovery most effectively. You needn’t mention that the move is probably permanent. Once he’s adjusted, he will likely consider it home anyway.
Carol Bradley Bursack is a veteran caregiver and an established columnist. She is also a blogger, and the author of “Minding Our Elders: Caregivers Share Their Personal Stories.” Bradley Bursack hosts a website supporting caregivers and elders at www.mindingourelders.com. She can be reached through the contact form on her website.