Dizziness, Instability and Falls

By Laurie Fronek, Staff Writer

Common Causes

Fear of Falling

What You Can Do

When to Call a Medical Provider

Many types of physical changes can affect the inner ear, our main center for balance. Problems with the heart, blood vessels, muscles, skeleton, and nerves can disrupt its subtle workings and make us dizzy or unsteady. Other health factors can also disrupt stability, especially in people who are seriously ill or near the end of life—factors like muscle weakness, numbness, and drug interactions.

“Mom, You Have To!”

For caregivers, the greatest challenge can lie in convincing a loved one to accept help for her unsteadiness, says Gail Loughlin, RN, CHPN, clinical liaison at Providence Hospice of Seattle.

“Helping people recognize changes in their mobility is important—as much as they might hate to start using a cane or walker,” Loughlin says. Patients sometimes resist aids like these to preserve their self-image or pride, she explains. They may insist, “I don’t need help. I’m not going to use that cane.”

Your loved one may be more accepting if you avoid making demands, and instead explain how the aids support her goals, especially continued independence, Loughlin suggests. For example, instead of demanding, “Mom, you have to use that walker!” try explaining, “Mom, we know you want to be able to stay in your own home, and we want to help you do that. Using a walker so you don’t fall and break your hip will help make that possible.”

The risk of hip fracture is a constant concern for people prone to falling. “If a person falls and breaks a hip, that means hospitalization, that means surgery, that means pain and extensive rehabilitation,” says Loughlin. She has seen this type of fracture trigger a downward spiral, especially in people who already had a chronic illness. Head injuries caused by falls are another serious concern, she adds.

“There are such dire consequences if somebody has a bad fall,” Loughlin says. “Choosing not to be safe can ultimately take a person’s choices away.”

Common Causes

Here are several common reasons people get dizzy or unsteady.

Inner ear problems can throw off our built-in balance mechanism.
Heart and lung conditions can decrease oxygen to the brain. A common culprit is low blood pressure, which can result from dehydration.
Muscle weakness can make it difficult to move in a controlled, safe way.
Neurological diseases that affect sensation or movement, like Parkinson’s disease, and nerve damage, such as neuropathy from chemotherapy, can make walking difficult.
Decreases in hearing or vision can throw off our sense of space and motion.
Some medicines or drug interactions can interfere with balance. These include sleeping medicines, antihistamines, antidepressants, and diuretics.
If your loved one becomes unsteady, it’s important to identify the underlying cause and get treatment for it. So have her see her medical provider if this symptom develops or worsens.

Fear of Falling

Your loved one may fear falling and getting seriously hurt, especially if he has fallen before. Some people who feel unstable or have already fallen limit their movements to protect them from falling again. No doubt, it’s scary to fall or see someone else fall. But one of the best ways to maintain his strength and independence, as well as safety, is to keep him moving. Encourage him to be active. Also, look for signs that he needs support to move safely. Let him do as much as he can on his own, and be ready to help when he needs you to.

If your loved one has stability problems, ask his medical provider for a referral to a physical therapist (PT) and occupational therapist (OT), suggests Loughlin. A PT can evaluate his mobility and strength and recommend at-home exercises to help maintain both. For example, depending on the patient’s health, he may be able to walk for an hour a day or practice slowly standing up and sitting down in a chair several times. Gentle water exercises or activities like tai chi or yoga can also help with balance and strength.

An OT can look at how a patient performs activities of daily living and advise on methods and assistive devices to make these activities easier. An OT can also teach you strategies for safely helping your loved one move between the bed, chair, and bath, says Loughlin.

What You Can Do

Nearly two-thirds of falls happen at home, according to the American Academy of Orthopedic Surgeons. Simple precautions can help prevent many of these.

Preventing a Fall

Encourage your loved one to get up slowly from sitting and lying down to prevent the dizziness that comes from changes in blood pressure.
Offer help when she is changing position, getting up, or walking. Ask the medical provider or OT about using a gait belt. This specially designed belt goes over a patient’s clothes. The caregiver grips the belt securely to help move or steady the patient. It’s meant to reduce the risk of patients falling and caregivers getting injured.
Have your loved one wear nonskid socks, slippers, or shoes. “Stocking feet on a slippery floor—that’s bad news!” warns Loughlin. Backless slippers can be a hazard, because the feet can slip out. Shoes should fit snugly, support the arch and ankle, and have low heels and nonskid soles.
If your loved one is unsteady, ask her medical provider about using a cane, walker, or wheelchair. An overhead pull can help someone who is weak raise herself up in bed by giving her something to grab hold of.
To help someone walk, offer your arm. For greater steadiness, stand alongside the person, reach with your closest arm around her back for support, and use your other hand to support her forearm that’s next to you.

Around the House

“Make sure there’s good lighting, especially for people with vision problems, so they don’t trip over things they didn’t see,” says Loughlin. Nightlights may help in the evening.
Put things for your loved one in easy-to-reach places.
Keep floors dry. Put nonslip rubber mats where the floor may be wet. Don’t wax floors, and get rid of throw rugs.
Keep walkways clear of obstacles, like furniture, electrical cords, and toys.
Elevate chair seats--by placing pillows or folded blankets on them, for example--so your loved one doesn’t have to get into and out of a low seat.
Put handrails along stairways, in the bathroom, and along the route from bed to bathroom. Using bed rails can prevent falls from bed. These come with hospital beds, and you can attach some to a regular bed. Keep in mind that some people may become confused and hurt themselves trying to climb over the rails.

After a Fall

If the person starts to fall, try to guide her to the floor, protecting her head if you can. This is safer than trying to stop the fall, which may hurt you both—especially if you have to lunge to get to her.
Take a moment to calm yourself and your loved one. A fall is frightening for both of you, and she will probably be shaken up. Also, we often try to get up right away after falling, but it’s usually safer to take a minute to catch your breath and then decide the safest way to proceed.
Before she gets up, ask if she is OK and whether she has any pain. Look and feel for bleeding, bruises, broken bones, and other injuries.
If you think she might be hurt, don’t move her; call for emergency help. The next section explains signs that mean you need to call a medical provider.
If everything seems OK, allow some time for her to rest, and then help her up to a chair or bed.

Helping Someone Up

If the person is strong enough, let him pull himself up using you for support. This is generally safer for both of you than your trying to pull on him. Stand in front of him with your feet about shoulder-width apart. Hold one bent arm in front of you so he can grasp it and pull.
If your arm is too high for him to reach, or you don’t feel steady enough to support him alone, place a chair in front of him with the seat facing him so he can pull himself up onto it. Spread your legs about shoulder-width apart and hold the chair with both hands to keep it steady. If you use a wheelchair for this purpose, make sure the brake is set.
If you cannot help him up on your own, stay calm and make him comfortable. For example, he might like a pillow or a blanket. If you are at a healthcare facility or a residential center with staff, get a staff person to help you. If you are at home, call someone who can come over and help you, such as a neighbor or friend. If no one else is available, call 911 or your area’s emergency number for assistance—even if it’s not an emergency.

Expert Advice

“It’s important for families to know that if somebody has fallen and can’t get up, and the caregiver can’t get him up, it’s OK to call 911. Say ‘This is not an emergency, but we need help getting him back in bed.’ They can send someone to help. It doesn’t mean the person has to go to the hospital. They can just help put him back in bed.”—Gail Loughlin RN, CHPN, hospice nurse

When to Call a Medical Provider

After a fall, if any of the following are true, don’t move your loved one and do call for emergency help.

You suspect a fracture or other serious injury.
Your loved one has severe pain.
There’s blood or fluid draining from the mouth, nose, or ears.
Your loved one has a convulsion, or seizure.
Your loved one loses consciousness, even briefly.

If your loved develops any of these problems after falling, call a medical provider.

Dizziness
Blurred vision
Headaches
Nausea
Numbness in arms or legs
Changes in behavior
Unusual agitation
Changes in gait
Loss of balance
Seizure
Increased sleepiness

Any time your loved one develops new or sudden bouts of dizziness or unsteadiness, let his medical provider know. This could be a sign of an underlying problem, such as an ear infection or a stroke, or it could be a reason to adjust medications.