Falls and Fracture Recovery at Home

Care by condition

The fall is rarely the whole story. What follows it — the fear, the reduced walking, the weakness that comes from sitting more, and then the second fall — is what actually ends independence. A great many people who move into long-term care do so because of a fall, not because of the condition they were living with beforehand.

Recovery from a fall is therefore two jobs at once: healing the injury, and rebuilding the confidence that the fall took away.

What actually changes at home

• Confidence goes first. People who have fallen walk less, hold furniture, and stop going out — all of which makes another fall more likely, not less.
• Pain limits movement at exactly the point movement is most needed, and undertreated pain is a common and fixable reason recovery stalls.
• Weakness compounds. Muscle is lost quickly at older ages and regained slowly.
• The cause is still there. A fall usually has a reason — blood pressure medication, poor vision, a rug, a night-time bathroom trip, an infection — and unless it is found it will happen again.
• Families become frightened, and fear can lead to over-restricting someone, which speeds the decline it is trying to prevent.

How we help

• Being present for the walking and moving that has become frightening, so a person keeps doing it
• Support with the exercises the physiotherapist has set to rebuild strength and balance
• Personal care during the weeks when washing and dressing are painful or unsafe alone
• Making the actual hazards safe — the loose rug, the dark hallway, the bathroom without a rail, the route to the toilet at night
• Reviewing footwear, which is one of the most overlooked causes of falls in the home
• Pain medication reminders, so pain is controlled ahead of activity rather than after it
• Watching for the things that cause falls: dizziness on standing, confusion that suggests an infection, or new unsteadiness
• Overnight support where the falls are happening at night, which is when many of them do

Who provides the care

Personal support workers provide this care. Where nursing is in the plan — wound care after a skin tear, for example — we place an RN or RPN. Where a fall has not been medically investigated, we will say so, because an unexplained fall in an older adult is a medical question first.

Common questions

My mother has not fallen again but she will not walk. Is that normal?

Very. Fear of falling is a recognized problem in its own right and it does real harm, because less walking means less strength which means more risk. Having someone alongside for the first weeks is usually what breaks the cycle.

Should we just stop her going upstairs?

Not automatically. Restricting someone often accelerates the decline. The better question is what would make the stairs safe — a second rail, better lighting, different shoes, someone present at first — and that is worth asking an occupational therapist.

Can you find out why she fell?

We can observe and report, which is often what leads to the answer — dizziness when standing, confusion suggesting a urinary infection, a new medication. Investigating it is for her doctor, and an unexplained fall should always be looked at medically.

Do you provide overnight support?

Yes. A large share of falls happen on the way to the bathroom at night, and overnight cover is often the most targeted thing a household can do.

Is this publicly funded?

It may be. Ontario Health atHome arranges publicly funded support for people who qualify, and many communities run free falls prevention exercise programmes through public health or community support agencies. Both are worth asking about.

Where we provide this care

We provide this support across communities across Ontario, from the Greater Toronto Area to Thunder Bay. If your town is not listed, call us — we will tell you honestly whether we can staff it properly rather than promising and then failing to turn up.

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