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Episode 5: Increasing Falls
Hello there, I’m Jason van Genderen and you’re listening to Episode 5 of The Guilty Carer, this one’s about the frightening reality of increasing falls.
To be honest, I really hesitated about this episode, because re-visiting the trauma of my mum’s many falls still feels very triggering for me as her co-carer, alongside my incredible wife Megan. But… as I promised when I started this series, I committed to sharing the full awkward spectrum of realities that came along with caring for a loved one navigating dementia, so in that light the topic of Increasing Falls is important to cover, because I know a lot of you will have experienced this yourselves.
Of course before we jump in head-long, I do need to remind you that the feelings and expressions covered in this podcast are based on my own personal experience only, and as such does not constitute professional advice. Your circumstance may well be different, and you should always consult your doctor, your geriatrician, paramedics or your local hospital service for detailed clinical assessment and first aid. Okay - now that I’ve ticked that box, let’s jump into Episode 5, Increasing Falls.
(Audio of the aftermath of dealing with one of mum’s small falls)
I well remember how useless I felt when my mum started having more falls. No matter how many rails we installed, how many safety nets we planned for, falls just happened anyway. Initially, the biggest challenge we would have with mum was getting clear information about her fall. And despite us living in the same home, mum would often have a fall and then not tell me until some time later - which I found really frustrating of course because all you want to do is help, right?
And there’s a whole bunch of reasons falls start increasing in frequency. Changes in weight create imbalance, or shift one’s walking gate and ability to self-balance easily. Muscle wastage leads to shuffling rather than stepping. Medications can often impact steadiness too, so your geriatrician needs to regularly review those dosages and efficacy.
Congnitavely, a whole heap of things change in your loved one’s physicality too. Spatial awareness changes, depth perception, delayed reflexes… all these things collude to make falls more inevitable. And it feels fucking horrible to watch someone who used to be physically aware and active reduced to ending up on the floor so many times.
I remember reading someone saying “The more advanced dementia becomes, the closer their feet stay to the ground.” And my experience with mum absolutely mirrored that. The first thing we needed to do was insist mum only wore flat shoes, her beloved wedge-heeled shoes had to go. She also used to wear smooth ballet flats around the house, those had to go to. It took some convincing, but eventually more sensible, lightweight, flat footwear became the norm.
Another thing we did was reduce any floor clutter in her daily pathways around the house. The edge of a rug or hallway runner
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was a prime tripping magnet. Floor ornaments needed to be grouped together and close to walls. Sharp corners on tables, benches and furniture needed to be rounded off or covered in a padded finish.
It all feels horribly clinical to de-code your home like this but honestly, it was something we needed to do to keep mum safe. Our young kids were becoming well versed in mum’s falls as well, and they often went in to check on her, like Arty did in this little audio recording from 2021…
(Audio of Art calling in to check on mum)
We were fortunate to have lots of budding nurses in our home.
Initially, most of mum’s falls resulted in bruises, swelling or skin tears. Megan and I had taken mum to the local medical practice so often that we actually felt confident managing some of these first-aid needs at home. We created a bright red first aid bag stocked with bandages, non-stick dressings, sterile tweezers, wound irrigation pouches, antiseptic gels and instant cold-packs… and we placed it on a hook near our front door so the kids could readily grab it for us if one of us was attending to mum after a fall.
That bag was invaluable. And for those falls at home resulting in bruises and cuts, we generally could manage those there without creating additional distress for mum by taking her to a clinic or hospital. Of course, if we were unsure of anything, we’d always take mum to our local nurse to check, or to the hospital if her injury involved any trauma to her head.
Of course, there were times we were faced with injuries from falls we simply couldn’t manage ourselves.
(Audio of laundry fall aftermath)
That audio was from a horrible fall mum had walking into our laundry area. She mis-judged a small step whilst wearing her slippers and landed hard on the tiled floor, tearing her left temporal artery and creating a very confronting scene with a lot of blood. Throughout she remained very calm thankfully, and kept consciousness despite her blood loss. Ensuring we maintained a calm tone was critical too, particularly given the ambulance was delayed and took almost 40 minutes to arrive.
(Audio of paramedics attending)
Once the paramedics were on-scene, it’s important to leave your emotions aside and focus on what’s most helpful to the situation. I managed to secure a ride-along with mum in the back of the ambulance on this occasion, as the two person crew needed assistance to keep mum alive while we were on-route to the hospital. Mum was also deferring to speaking in dutch, so I remained in the emergency surgery bay at the ED to help translate & re-assure as well.
I learnt a valuable lesson on that day… and that was about being valuable to the emergency dept, instead of being a hinderance. Too often we see families falling to pieces when help arrives and then demanding to remain with their family member. Paramedics, and ED staff - see that as a sign of another person who needs to be managed, at a time when their resources are already stretched. The patient is their priority, not an anxious, well-meaning relative who now ALSO needs their attention.
The more we needed to call paramedics, the more I learnt to be useful - not useless - to their attendance. Think of information that’s helpful when they arrive. Give a short but concise description of how the fall occurred. How long ago it happened. Mention the key physical symptoms, their pain scale, and anything that’s been applied as first aid. Then stand back. Being a help to their first aid means you’re more likely to be invited for a ride-along to hospital with your loved one, although the’s never a certainty either.
At the hospital, I calmly ask to speak with the nursing unit manager and explain any reasons why I could be beneficial remaining bedside with my mum. My mum’s dementia means she’s often distressed in hospital environments and will often try crawl out of hospital beds, creating a falls risk. She will often try remove fluid tubes or monitoring devices as well, so I offer to sit with her and keep her hands and her mind calm. I also can translate her automatic default back to dutch for the nurses and doctors that attend to her. I found when I calmly advocate in this way, I’m more likely allowed to stay with mum - as I free-up already stretched nursing resources.
Think about it. If you allowed a family member to sit in the ED bay, would you want to manage someone who constantly asked for updates or demanded attention or would you bend the rules for the rational family member being helpful and calm? I think you know the answer to that one right?
Being an effective advocate for your loved one means being an extension of them. And I found that approach worked for most allied health visits as well, allowing me to accompany mum into radiology and pathology consultations too.
At home, we took additional steps to help keep mum safer as well. She wore a falls detection pendant around her neck, which would alert a back-to-base service if it detected a sudden fall. If you subscribe to one of these monitoring services, be prepared for a few false alarms too, but all-in-all they’re a vital tool for knowing when a fall has occurred.
(Audio of pendant [false] alarm)
Luckily that wasn’t a serious fall, but it could have been. Mum was very disoriented and confused about the person speaking to her from the speaker unit on the wall, asking if she needed help. But it demonstrates the value of a falls-detection pendant or wrist band.
By this time mum had also been using a Rollator Walker. If you are considering a Rollator, make sure your loved one gets one fitted for their height and walking position, otherwise they can actually be a hindrance rather than a help. Now on that - I don’t know of a single frail elder who willingly embraced a Rollator either, and my mum absolutely didn’t want to use one either. So we selected a Rollator with a seat in the middle, which lifted to store a handbag, for example. Rather than forcing mum to walk with it right away, we got
her used to using it when we were outdoors as a mobile seat, then a place she could store her handbag and free her arms, and then by the time the ‘newness’ of the Rollator was gone she more willingly accepted it as a permanent walking device… although she never got the hang of applying the squeeze hand-brakes so we did still hang onto her to help control her speed and direction.
In the house, we also installed some monitoring cameras so that we could be alerted if mum had a fall inside, or play back the vision to find out how mum had fallen as she often had great difficulties recalling what had happened.
One of the hardest things we had to do, was remove the key to mum’s outside door. With a small set of stairs to navigate outside, it was no longer safe for mum to walk down those steps alone after she experienced several stumbles doing just that. Instead, we replaced the key with an internal doorbell that she could press whenever she wanted to go outside, and one of us would come and walk with her.
The guilt of effectively locking my mum within her granny flat was over-whelming. It changed so much about our dynamic. That move alone meant one of us always needed to be home at all times. The doorbell that replaced the key became a chime of anxiousness inside our home. Sometimes mum would press it every few minutes, asking where her key was.
In time mum adjusted to the locked front door, and although it eliminated falls outside on the driveway it also meant she spent more time inside, so more falls happened here. As I mentioned earlier, falls are going to happen anyway, no matter whether you’re inside or outside.
We maintained at-home physiotherapy visits for mum throughout, to both evaluate her mobility and assist it. Learning new routines is difficult when we’re set in our ways, so Megan guided mum through daily mobility exercises.
With mum’s advancing dementia and frailty the falls went from being monthly to weekly to almost daily. It sounds terrifying explaining it like that but in our experience, that’s the pathway we faced. For Megan and I, falls became a constant conversation point every day. It was the single biggest threat to my mum’s ability to remain living with us. Fortunately she hadn’t broken any bones yet in her falls, but we both knew her next fall could well smash her hip and place her out of our care permanently. It terrified me, because we had changed our whole life to include her here in our home… and I couldn’t picture what her life would be like if that choice was taken away from us.
Aside from the first-aid bag I mentioned earlier, I also had a permanently packed overnight bag ready to go. It had a change of clothes for mum, for me, some deodorant and long-life snacks and a charged battery pack to power a phone or laptop. I’d also pack some curiosity items to look at, as every hospital admission took hours and I needed things to distract mum from the bed she would find herself confined to.
With more frequent calls for paramedics and hospitalisations I created a single page, laminated information sheet about mum - which would accompany her in the ambulance rides right through to hospital admissions. I wanted to have a page that - at a glance - could humanise mum as well as convey critical information about her.
A condensed medical history was at the bottom, along with any known allergies & current medications she took and dosage. At the top of the page, a photo of what mum looked like happy and healthy, so they could see what ‘well’ looks like for mum. It also contained a section with prompts or actions to help create conversation or make her calm, as well as known things that would upset or startle her. And rather than listing information generically, I made them one-line sentences written in the first person. For example:
“I have advanced Alzheimer’s Disease and Vascular Dementia.”
“I am hard of hearing, I have an acoustic neuroma in my left ear.”
“I will try and remove a cannula and medical electrodes.”
“I am spooked by loud sounds and echoes.”
You get the idea. By personifying these details as “I statements”, I turned the information page into an advocacy tool that could speak on mum’s behalf when she or I couldn’t.
That single page was something paramedics and ED staff appreciated SO much, because it spoke to the woman lying in front of them rather than a medicare number & history in a faceless database. And I strongly encourage you to consider creating a one page visual story about your loved one too. Keep multiple copies on the fridge so they’re easy to find and share.
I hope sharing my experience of navigating increasing falls has been helpful for you, and that you can take some of those tips and adapt them for your circumstance as well. Don’t forget we have a private Facebook group called ‘The Guilty Carer’, you can continue our conversation about this episode there and I’ll also post a copy of my one-page information page about mum there, so you can use that as a base to create your own if you wish to.
I’ll be releasing a new episode monthly from here, and I will look forward to your company next time for Episode 6. Until then, be kind to yourself and bye for now.
The Guilty Carer is a podcast series produced by 11eleven, hosted by me Jason van Genderen and mixed by Dean Mackie at Voicegarden. Copyright 2025, all rights reserved.