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Tripping Over Issue of Independence

Author: Helen Dennis, Specialist on Aging

Question: My 83-year old mother took a serious fall in the street that landed her in the emergency ward, intensive care, the regular hospital and finally in rehabilitation.    She is a fiercely independent fabulous lady who walks two miles a day, takes classes at a university, drives and goes to movies, the ballet, museums and more.  I recently told her that she is doing too much.  I think she fell because she was fatigued, even though I cautioned her that she needed to slow down.  At what point do you take over for an older parent?  I feel somewhat responsible for her fall.           

Answer: There is a fine line between knowing when to “take over” for older parents and having them make decisions for themselves.  There is no textbook that tells you when that time is right – if ever.

We know that falls can be traumatic and serious, particularly in the later years.  Jon Pynoos, co-director of the Fall Prevention Center of Excellence at USC’s Andrus Gerontology Center, notes that almost everyone has a family member who experienced a fall, many of which are serious.  He further comments that we all are just one fall away from an emergency room, surgery or a nursing home.

Studies indicate that 30 percent to 50 percent of falls are preventable.  They can be avoided by managing medications, maintaining physical activity such as strength and balancing exercises, and modifying the home and community.

However, if 30 percent to 50 percent of falls can be prevented, that means 50 percent to 70 percent cannot.   It sounds as though your mother is in very good shape, both physically and mentally.  It’s quite possible that her fall was a freak accident, perhaps one that could not be prevented.

That is not to downplay the seriousness of falls.  According to the Fall Prevention Center, about 125,000 people over age 60 fall each year in Los Angeles.  The impact is not only physical and emotional.  Falls cost too.  In 2004, about 11,000 people 60 and older who fell were hospitalized at a mean cost of $46,234 per person.

Even though risk factors for falling increase with age, it is not an inevitable part of aging. Here are some interesting national statistics among those 70 years and older:

  • 3 in 10 fall each year.
  • 2 in 10 need home health care after being in the hospital.
  • 1 in 10 suffers a serious injury, such as a broken bone or head injury. Falls cause 90 percent of broken hips; only half of those will get around as they did prior to the fall.
  • In the U.S., 16 percent of emergency room visits and almost 7 percent of all hospitalization are for fall-related injuries.

A challenge is to communicate effectively to an older adult who is at risk for falling.  B. Sue Black, associate professor of extension at West Virginia University, outlined some useful tips.

  • Use the “I” message to promote honest communication.  Here’s a good example:  “Mom, because of your recent serious fall, I’m concerned about you safely living alone in that big house.”   Here is an example to avoid:  “You must move Mom; it isn’t safe for you to live alone in that big house.”
  • Avoid making irrevocable decisions.  Keep the options open.  Consider saying something like, “This seems like the best option at the moment.  Let’s see how it works for the next four weeks.  At that time we both will reassess the situation.”
  • Avoid too much protection – even though it comes from love. To protect and even over-protect is natural.  However, protection typically is the last thing that older adults want.
  • Don’t force your values on your parents.  What you might think is best or even detrimental for your older parents is not always true.
  • Get rid of the “shoulds” or guilt.  They are not good guides for decision-making and can reduce an objective analysis of options.
  • Consider the feelings, desires and needs of everyone.

For more information, go to

Feeling responsible for an accident is a difficult belief to shake.  Perhaps the best you can do is to evaluate the next steps to minimize risks of falling: Encourage your mother to maintain strength-building and balance exercises, assess and modify the home environment as needed and review medications.  And use some of those communication tips.

Thank you for your good question and best wishes for your mother’s full recovery, safety, independence and happiness.

Copyright 2010 Helen Dennis. All rights reserved.

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