One minute, everything's fine. The next minute, they're on the floor. Is fall prevention on your radar yet? Or are you waiting until after the first fall happens? If you haven't thought about it yet, you're not alone and this episode is for you. In this episode, I'm talking with Dr. Taylor Rush, who spent years working alongside families navigating dementia and Parkinson's. Taylor's seen firsthand what happens when caregivers aren't prepared for a fall and what changes when they are. We're sharing five tips. Welcome, we're Sue Ryan and Nancy Treister. This podcast brings our years of experience in a variety of family caregiving roles to prepare you to navigate your caregiving journey. We're sharing our personal experiences, not medical advice. And because it's our passion to support you on your journey, we believe no topic is on limits. Let's get started. Taylor, thank you so much for joining us today. You're a clinical health psychologist. You're the director of behavioral sciences and interdisciplinary programs at the Cleveland Clinic Center for Neurological Restoration. You specialize in chronic neurological conditions, particularly Parkinson's, Huntington's, movement disorders, and you focus on integrating behavioral health into specialized neurological care, which includes care partner support. In the work that you're doing, falls are one of the most significant and stressful realities for you to talk about because they are so significant for dementia family caregivers. We're grateful for your expertise to help our listeners today, both to learn ways to prevent falls and how to navigate them when they do happen. Taylor, please share some information for our listeners about you and about what's made falls such a central focus in the work that you do. Sure. Well, thank you so much for having me, Sue. I'm so grateful to be here today. I work at the Cleveland Clinic primarily with neurodegenerative conditions. I not only support our patients, but also their care partners. We have developed a lot of programming surrounding how to support care partners, including an annual care partner symposium where we educate and empower people to learn how to best support their loved ones as well as themselves. This includes a lot of practical education on daily issues they may encounter, and falls tends to come up a lot. We know that with falls, there are a lot of physical risks that are quite scary, but what stands out for me is the emotional impact as well. There's fear and hypervigilance and feelings of I must prevent this at all costs when it truly isn't possible. What I found in my experience over time is that when families are prepared physically, emotionally, logistically, they are able to handle these moments a lot differently. There's less panic. There's less guilt. There's a little bit more empowerment over, okay. We know what to do here. I love being able to offer that kind of support to families. Well, it's so valuable. You've got a front row seat to exactly what happens and how falls affect families physically and emotionally. Before we can prevent falls or before we can even respond to them, it's important for us to understand the kinds of things that put our loved ones at risk. This leads us to our first tip. Know your loved ones' fall risk factors. Taylor, walk us through some of the key factors for us. Absolutely. I think it's an incredibly important place to start because many caregivers don't think about fall risk until after some sort of critical event happens. It's often not really these big dramatic events. It's often very small rushed situations where you blink an eye and it happens. The more we can identify what may contribute to that, the better prepared we can be. Some big categories that I often see are issues with mobility and balance. We know that when people aren't as mobile, they don't have as much strength. That muscle strength deteriorates. That can destabilize them more because their core is weaker, their back is weaker, their legs are weaker. They can't move around with as much steadiness. Those are two biggies to keep an eye on. Visual changes are one that sometimes people don't always think about. I have patients who have less visual acuity. They might get more double vision. They might be diagnosed with something like macular degeneration. They may not see certain things that they could trip over or their depth perception is affected in such a way where they don't realize how steep a step is. Those kinds of issues can certainly increase risk for falls as well. Something that I will often encourage families to discuss with their medical providers is medication because there are certain medications, those that are meant to control blood pressure, some that are meant to help control tremor, that can unfortunately add to feelings of dizziness or lightheadedness. They may try to stand quickly and immediately fall because they don't have enough of a blood pressure push for them to stay upright. Taking your family doctor, whoever prescribes medication for your loved one, is this a medication that might increase their risk for falls? If so, what should I be looking for? That way, that can be a factor on the radar if necessary. When we think about caregiving in the context of dementia, I do think that that adds a layer of complexity. As we know with dementia, it affects something called executive functioning. This is this very important part of our brain that helps us to think ahead, to plan, to problem solve. I kind of call it the look before you leap part of our brain. People may not think ahead of time about how their balance or weakness might play out if they try to move quickly or climb up that step ladder to get something off the top shelf because they're like, well, it's just right there. I just need this. That tunnel vision and lack of judgment in that moment can then lead to an unfortunate situation with a fall. Thinking about how these things can come up so discreetly just in everyday life and just observing your loved one. Do they tend to rush to the bathroom and not grab an assistive device if they've been given one? Do they turn too quickly or impulsively and they may lose their steadiness? Do they stand up and even after they've paused for a moment, they're still a little dizzy afterwards because those micro moments tend to be the ones where fall risk is highest. How can we pay attention to that and observe what may lead to a fall? Because as we are able to keep those kinds of things on the radar, it becomes much easier to manage a situation if and when it should occur. Now that we know what to look for, let's talk about what we can actually do about it. This leads us to tip two, which is reduce risk with fall prevention strategies. Yes. Yes. A precursor to this because I think a lot of times as I'm naming out some of these risk factors, people think they have to address everything all at once. That's a very overwhelming prospect. One thing I want to make sure people realize is you don't have to address everything overnight. Really we're aiming for safer, not perfection. But a few things to consider includes lighting. We know that when lighting is low or dark, that oftentimes that's when people have higher risk of falls. We see them happen in the evening or overnight when they're trying to go to the bathroom. Are we able to install nightlights that are motion censored or floor running lights that allow someone to see a bit better in the evening or overnight? Can there be more lamps around the house that allow for better lighting so that people can see some of the darker corners? That's one area to consider. Grab bars can be your best friend, especially in danger zones like bathrooms. So can there be grab bars installed near toilets in showers or tubs anywhere that is slippery or requires up and down rather quickly? Are there ways that we can stabilize your loved one in some of those more risky rooms? One area that I don't think people often think about very often is the lips of thresholds, so where the flooring meets a doorway. Because if they are even half an inch above the floor, it's just enough for a shoe or a toe to get caught. And so if there's a way to kind of even them to the floor if possible or create a more gradual slope, that can often help to prevent falls. And footwear. Sometimes people are very accustomed to walking around barefoot or in socks in their house and those can be fall risks because when we wear shoes we can stabilize our feet. And so the more we can have comfortable house shoes that are readily available, the better off the person is and it's good for foot health in general too. For some people they have a lot of emotional ties to their area rugs. They really love them. But recognizing what risk does this pose. And a lot of the physical therapists I work with will say the same thing, please get rid of area rugs because the edges curl, it's a different tactile surface that can sometimes get people off balance. So absolutely consider how you may be able to replace your decor in terms of area rugs. And then in terms of physical therapy, I have such incredible regard for the physical therapy teams that I work with because they do such an amazing job at helping people with maintaining or rebuilding strength and mobility and balance. Sometimes I tell people this is a revolving door kind of service. You want to go get what you need and then you leave and live your life and then you go back. And that is something that you do on an iterative basis because the more you can maintain your strength the less likely falls will be an issue. Truly in this situation an ounce of prevention is worth a pound of cure. It definitely is and these tips are so valuable. What I'm taking away from this Taylor is that the sooner in the journey we start implementing these and thinking about them and looking around us, the better it's going to be because they're in place before there's even any chance of a fall happening. One of the things that you mentioned is that the education part of it on falls is also very rarely introduced early enough. This leads us to tip three which is start that conversation early and have a plan. Absolutely. I will tell my patients don't have this conversation the first time when you're in a crisis. I can pretty much guarantee it's not going to go very well. And so you want to have it when you have your wherewithal, your calm, you can think clearly that executive functioning is working. So have these conversations early in your caregiving journey while your loved one is still independent before any falls have happened because otherwise you're going to be Monday morning quarterbacking yourself on what it could have should is that ought to have been done earlier. Because even if a fall is not scary in the moment, they're okay, there's no injuries, it can still be incredibly unsettling and sometimes terrifying. And so having a plan, I think in any situation when we have a plan, we feel better about the situation even if it's a really tough situation. And so a few things to consider as you're planning ahead is you have to ask yourself, I think, some really honest questions about your capacity. And on the one hand, I mean this physically. So if you are a 120 pound woman and you have a 250 pound husband, that is going to be a dangerous situation for you and for them if you are the one trying to pick them up after a fall. And so thinking about what does me helping them look like without injuring myself for them. So physical capacity is one side, but then emotional capacity is another. And I always tell my patients, know thyself because some people are really good at staying cool, calm, collected in a moment of crisis. Other people are a bit more reactive, a bit more emotional, they get overwhelmed very quickly and that's not a character flaw, that's just knowing who you are as a person. And what does my reaction tend to be so that I can anticipate and plan for that ahead of time. Another conversation to have ahead of time is at what point do we involve emergency services? What threshold is that something that we will need to consider that? Because again, if you are the 120 pound woman and you have a 250 pound husband, there are a lot of situations where you have to decide at what point is it no longer safe for me to be the one to help them. There might be a situation where you do have an indie lift or some other device that can help you to safely get your loved one off the floor or it may be a situation where other professionals are required. And often if this conversation is not had ahead of time, what I find is that in that moment the caregiver is kind of freaking out and upset and overwhelmed and they're like, I'm going to call 911 and love and it's like, please don't call 911. And they're having an argument in the midst of a challenging circumstance that just makes the circumstance more challenging. And so how do you have a collaborative conversation about this ahead of time? So everyone's on the same page as to what the criteria are for an EMS call. And so that I think if everyone's on the same page going in, it doesn't make the situation stress free, but it can make it easier. And then I know depending on where you live and what resources are available, there are local EMS registry programs so that you can register your loved one ahead of time as my husband has Parkinson's disease, he also has Parkinson's related dementia, therefore, is prone to bouts of confusion or delusional thinking. And so if I call EMS and let them know that I have a situation where they have fallen and maybe they're agitated or upset or they don't recognize that I'm their wife, then they will already have that information ahead of time so that they know how to handle the situation a bit more delicately. And I will second, third, and fourth that with the loved ones I cared for. We had each of them registered with EMS and EMS was so helpful when they had to be called because they already knew nicknames, they already knew the diagnosis, they knew the medications they were on, they knew that kind of the situation. And it kept everything much calmer. We didn't have to have the escalation when they came, they come in differently. So everything was really helpful. So Taylor with us having these conversations ahead of time and knowing our own capacities is so helpful and so valuable. And even with everything you've already talked about, falls are going to at some point in time happen. This leads us to tip four, which is they've fallen. Stay calm and assess. Don't panic in the moment. Correct. And I think, you know, pause, look, assess. Pause and gather yourself. Look and figure out the situation and then assess what needs to happen next. If you stay calm, your calm will become their calm. Because I think a lot of times in that moment the instinct is, what happened? And that doesn't often lead to a fruitful discussion. So start with yourself and assess the situation. Did they hit their head? Are they bleeding? Are they in pain? Can they get up or bear weight? If you are able to assess readily for what needs to happen next, everything will go much more smoothly. Because I think the knee-jerk reaction sometimes is in that moment is, well, why did you go up on that step ladder? Why didn't you just wait for me? And I would have helped you with this. Let's have that conversation later. And in that moment, let's, you know, try to manage your own distress while then addressing their needs. And so that way, you know, you can try to balance the situation. And it's, I think, one of the hardest things the caregiver has to do. And because you love this person and you want them to be okay. And it's really hard to, you know, temper your own emotions in that situation. And I think really knowing when you need to calm 911, and especially if, again, if they are bleeding, if they lost consciousness, if they're significant pain. EMS would rather you call and things end up being okay than you not call and things end up ending not well. So they will come, they can assess, they will decide whether or not an emergency room visit is necessary. They're not going to accuse you of crying wolf. They're going to make sure that you have what you need. I have some patients who are literally on a first name basis with their local EMS squad because of the number of times they've had to call. They've never been scolded for that. It's always been, we're here to help. Let's make sure that you're okay. And so, and then if EMS isn't necessary, and if they're not injured and can safely stay on the floor, it's a, there's no rush to get them off the floor. The floor is not lava. It's okay. And you know, we can slowly help them to get up based on education that hopefully you have previously received from some of your care providers and physical therapists that help you to safely get from floor to knees to up. And that is, that's so important. It's, it's, there's no rush to get them up. They can just rest for a little bit. So, Taylor, what you're talking about with these tips are that are so practical helps us to stay calm and to be clear headed. And I know from personal experience how the fall can shake you to your core when caring for my grandmother, she fell. And I was able to get her up safely. We got her in a chair. We addressed everything was fine. Fortunately, she wasn't injured. But the immediately, immediately after verifying all of that, I just went into just crushing self-judgment. I had let her fall. It was all my fault. I should have done something else. I should have, should have, should have. And yeah, it didn't matter that 30 seconds before we'd been having a conversation, she was fine. She was just walking into the kitchen, all of those kinds of things. I just went right to blame, which prevented this. What you're talking about is calm and being level headed. And I don't know if anybody else has ever felt that way, but I certainly did. So tip five is really valuable for this in which is, you know, yeah, when they fall, how do you manage the emotional aftermath from the fall? And I think to your point, the emotional impact can often last much longer than the fall itself. And you get into that woulda, coulda, shoulda zone and, you know, thinking about all the things that you think you should have done. And I will always tell my caregivers, you know, you are doing the best you possibly can in a situation that no one is ever fully prepared for. And so you kind of have to give yourself a little bit of grace because just because you feel responsible doesn't mean that you were responsible. And so and think about how you might say that to someone else because my guess is you wouldn't hold someone else up to that same bar that you hold yourself up. And so, you know, sometimes we have to be the friend that, that we would be to others. And so, but the hypervigilance, the fear, sometimes the hovering afterwards to make sure that they're OK and like, you know, following them around wanting to make sure that you could prevent any fall that may occur. Those are all incredibly common. And the guilt especially, I think, is there even though, again, it's not, there's nothing you did wrong. There is no blame to be had. It is just something that happens. And so recognize that, you know, there are times when, you know, you need to give yourself grace and there are times when you need to debrief for yourself and recognize the emotional impact that this has had, because oftentimes it's just, oh, I'm on to the next. And you never really have time to think about how you feel about it. And sometimes that does mean that you may need a little additional support. And perhaps that means talking to a psychologist or possibly seeking out a caregiver support group, because you're definitely not alone. No one is alone in this experience, and it helps to know that you're not alone. So know when support may be a helpful adjunct in this journey. Well, thank you so much for that. And Taylor, the expertise, the compassion, the practical wisdom that you've been sharing and brought to this topic about falls today for us is so incredibly valuable. Thank you very much. Before we wrap up, please tell our listeners how they can find more information about you and about your work. Sure. So I work for the Cleveland Clinic Center for Neurological Restoration, and we are a center of excellence for both Parkinson's disease as well as Huntington's disease. And so we do have a dedicated website through the Cleveland Clinic. I also partner with the Parkinson's Foundation and do a lot of work with them on mindfulness practices. And they have so many caregiver resources that I think, while some are specific to Parkinson's, a lot are, I think, helpful for a broad array of individuals, including those who are caregiving for someone with dementia. And in addition, I believe that we will have a summary checklist after today of some of these ideas so that you don't have to be hurriedly writing everything down and we can have everything in one place for you as part of the show today. Yes, we will have everything in the show notes. And to your point, we have a checklist that we'll include on the show notes and add to the website. Let's summarize. Taylor, thank you for teaching us how to navigate this very, very important and stressful reality of dementia caregiving. Falls are going to happen from understanding about our loved one's risk to what happens during the falls and afterward. This conversation is so valuable for our caregivers. We shared five tips. Tip one, know your loved one's fall risk factors. Tip two, reduce risk with practical prevention strategies. Tip three, start the conversation early and have a plan. Tip four, stay calm, assess. Don't panic in the moment. Tip five, manage the emotional aftermath of a fall. If you have tips about this topic, please post them on our Facebook page or our Instagram page. The links are in the podcast description. Every podcast also has a matching blog on our website where we've effectively taken the detailed notes for you. Just look for the blog with the same number as this podcast. If you like this podcast, please subscribe to it, follow it and share it with others. We really appreciate it. We're all on this journey together.
