What to do when an elderly patient falls? A step-by-step guide for caregivers

According to the CDC, over one in four adults aged 65 and older fall each year, with falls being the leading cause of fatal injury among this demographic. Knowing exactly what to do when an elderly patient falls is a critical skill for caregivers and family members alike to ensure a swift and safe response.

Quick Summary

Immediately after an elderly patient falls, assess the situation calmly, asking them to remain still to prevent worsening potential injuries. Call emergency services if severe pain, a head injury, or unconsciousness is present. For minor falls, safely assist them up, and always follow up with a healthcare provider to determine the cause and implement preventative measures.

Key Points

• Stay Calm: Prioritize calmness and clear thinking to effectively assess the situation after a fall.

• Assess for Serious Injury First: Before moving the patient, check for head trauma, neck/back pain, or severe fractures, which necessitate calling emergency services.

• Use the Safe Method for Lifting: If no serious injury is suspected, use a sturdy chair and guide the patient to get up slowly and carefully, never attempting to lift them manually.

• Monitor Closely for 72 Hours: Even after a minor fall, hidden injuries can appear later. Monitor the patient for pain, dizziness, and cognitive changes for at least three days.

• Schedule a Follow-up with a Doctor: A fall is a major warning sign. Always inform a healthcare provider to investigate underlying medical causes and review medications.

• Prioritize Fall Prevention: Make home modifications like improving lighting and adding grab bars, and encourage exercises that improve balance and strength to reduce future risks.

Immediate Steps: How to Respond in the First 60 Seconds

Witnessing a fall can be startling, but your immediate, calm response is crucial for the patient's safety. The first minute is for assessment, not action. Do not rush to move the person, as this could worsen a serious injury, especially to the head, neck, or back.

First, assess the scene to ensure there is no immediate danger to yourself or the patient (e.g., a liquid spill, broken glass, etc.). Then, approach the person and speak calmly to them to help them remain still. This helps prevent panicked, sudden movements.

1. Check for Consciousness: Speak to the person. Are they awake and aware? If they are unconscious, do not move them and immediately call for emergency medical help.
2. Assess for Serious Injury: Ask them if they are in pain and where. Look for visible injuries, such as bleeding, bruising, swelling, or any apparent deformities. Take note of how they landed. Pain in the head, neck, back, or a suspected hip fracture (indicated by a shorter or rotated leg) are red flags.
3. Check Breathing: Make sure their breathing is stable. If they are not breathing, begin CPR if you are trained and call 911.

The Decision: When to Call Emergency Services

Not every fall requires an ambulance, but certain symptoms indicate the need for immediate medical assistance. You should call 911 without hesitation if you observe any of the following:

• The patient is unconscious or unresponsive.
• They have hit their head and exhibit symptoms like confusion, dizziness, headache, blurred vision, or vomiting.
• They are on blood thinners, which increases the risk of internal bleeding.
• They complain of severe pain in the head, neck, back, or hips, and are unable to move.
• There is excessive bleeding from cuts or wounds.
• You suspect a broken bone (indicated by a misshapen limb or severe pain).

If you are uncertain about the severity of the injury, err on the side of caution and call for professional help. EMTs can provide a “lift assist” if the person is uninjured but cannot get up on their own, ensuring they are moved safely.

Safely Helping an Uninjured Person Get Up

If, and only if, the person is conscious, calm, and reports no serious pain or injuries, you can assist them in getting up slowly using a sturdy chair and the following method:

1. Roll onto their side: Help the patient slowly roll onto their side. Encourage them to take their time.
2. Move to hands and knees: Assist them in getting onto their hands and knees. You may place a towel or cushion under their knees for comfort.
3. Crawl to a sturdy chair: Guide them to a sturdy chair, stool, or other stable piece of furniture. A dining room chair is often ideal.
4. Rise to a kneeling position: Place the patient's hands on the seat of the chair and help them get into a kneeling lunge position, with one foot flat on the floor.
5. Push up and pivot: With your support, have them push up using their arms and legs to get into the chair. Their weight should be on the chair, not on you.
6. Rest and monitor: Have them sit and rest for a few minutes before trying to stand again. This helps prevent dizziness.

The Crucial Post-Fall Follow-Up

Even if the fall seems minor, the risk of hidden injuries or underlying causes is high. Close monitoring is essential for the next 24 to 72 hours.

Symptom	Significance	Action Required
Confusion/Memory Loss	Possible head injury or concussion	Monitor closely, contact doctor, go to ER if worsening.
Persistent Headaches	Sign of head trauma	Seek immediate medical attention.
Increased Pain/Swelling	Possible fracture or internal injury	Contact doctor, seek medical evaluation.
Unusual Bruising	Can indicate internal bleeding	Contact doctor, especially if on blood thinners.
Difficulty Walking/Balance	Could be hidden injury or balance issue	Schedule a doctor's follow-up appointment.

Notify the patient's physician, as a fall is often a sign of a larger issue. The doctor will likely perform a thorough evaluation, which may include reviewing medications, assessing blood pressure, and checking for underlying health conditions.

Fall Prevention: Addressing the Root Causes

A fall is a warning sign. To prevent future incidents, it's vital to address the reasons behind it. A healthcare provider can help identify causes, such as medication side effects, vision problems, inner ear issues, or neurological conditions.

Caregivers can also make crucial home safety modifications:

• Clear Clutter: Keep pathways clear of clutter, electrical cords, and loose items.
• Secure Rugs: Remove small throw rugs or secure them with non-slip backing.
• Improve Lighting: Install brighter bulbs and nightlights in hallways, bathrooms, and bedrooms.
• Install Grab Bars: Place grab bars near toilets, showers, and stairways for support.
• Modify Bathrooms: Use a non-slip mat in the shower or tub and consider a shower chair or a handheld shower nozzle.
• Assess Footwear: Ensure the patient wears supportive, low-heeled shoes with good traction.

For more detailed strategies on home safety, the National Council on Aging provides excellent resources. Click here to learn about fall prevention home safety. Encourage regular exercise, like Tai Chi or gentle strength training, to improve balance and mobility.

Conclusion: Your Role in Safety

Knowing what to do when an elderly patient falls is a critical skill for any caregiver. By staying calm, assessing the situation carefully, and knowing when to call for professional help, you can dramatically improve the outcome. The next step is always preventative—working with the patient and their healthcare providers to understand the root cause of the fall and make necessary adjustments to their environment and care plan to minimize future risks.

Frequently Asked Questions

What should I do if an elderly person falls and hits their head?

If an elderly person hits their head during a fall, you should call 911 immediately, even if they seem fine initially. Head injuries can cause delayed symptoms like confusion or internal bleeding, which are especially dangerous for older adults.

What is the safest way to help an elderly person stand up after a fall?

The safest way is to use a sturdy chair as support. Guide the person to roll onto their side, move onto their hands and knees, and then use the chair to push themselves up. It's crucial that they do most of the lifting to avoid injury to both of you.

Should I always call for medical help after an elderly fall?

It is highly recommended to seek a medical evaluation, even after what seems like a minor fall. A healthcare provider can check for hidden injuries like hairline fractures or internal bleeding and help identify underlying causes to prevent future falls.

What are common home hazards that cause falls?

Common hazards include clutter in walkways, loose throw rugs, poor lighting, especially at night, and a lack of grab bars in bathrooms or on stairs. Making simple home modifications can significantly reduce fall risk.

How long should I monitor a patient after a fall?

After a fall, it is recommended to monitor the patient for at least 72 hours. Pay close attention to any changes in their pain, balance, or mental state, and report any concerns to their doctor.

Can medications increase the risk of falls?

Yes, many medications can cause side effects like dizziness, drowsiness, or low blood pressure, all of which increase fall risk. It is important to have a doctor or pharmacist review all medications annually.

What if I am not strong enough to help them up?

If you are not strong enough to assist the person safely, do not risk injuring yourself or them. Call for a "lift assist" from your local emergency services (non-emergency number if no serious injury) or 911 if needed. They are trained to move people safely.

What happens in a post-fall assessment by a doctor?

A doctor will typically check vital signs, review medications, perform blood tests, and assess gait and balance. They may also order imaging tests like X-rays to check for hidden injuries.