The New York Times published How to Prevent Falls by Jane E. Brody January 8, 2018. The article served as a PSA about preventing falls and protecting against serious injury if you do find yourself in a sudden descent from an upright position. The article talked about the uptick of fall injuries during the winter months when surfaces become slippery with ice because of falling temperatures associated with winter. They also talked about slipping in the bath and tripping over clutter.
The article also reviewed the right way to fall. When falling forward, try to twist as you go down to land on your side then roll over to your back. If you are falling backward, tuck your chin to your chest to avoid hitting your head and keep your arms in front of you, to lessen the backward impact. These lessons can help but what if you didn’t know that event was happening?
Coming Back to Consciousness
Dad’s fall was due to Orthostatic Hypotension which resulted in subdural hematoma. In other words, his blood pressure dropped and he fell. When he hit head on the pavement, the impact triggered bleeding in the brain aka, a stroke.
Orthostatic Hypotension itself causes dizziness, confusion and in extreme cases, passing out. This could explain why Dad had no recollection of the fall. He says he doesn’t remember even walking out of the restaurant minutes before.
The subsequent trauma can lead to brain damage and even death. Dad was very lucky that Mom was with him and ensured that he received immediate care. I have a cousin whose in-law had a similar accident earlier in the year. He fell on a busy street. However no one was with him. Minutes passed before people noticed that he was not conscious. Unfortunately his brain was irreparably damaged.
In total, Dad stayed in the hospital for 34 days. He didn’t fully wake up until December 25. He did not begin to remember people until 3 weeks in.
Dad entered the hospital on December 7. About a week into the stay, one of the attendants informed Mom that Dad was supposed to be released from the hospital on December 19 into a skilled nursing facility, and that she needed to find one. Mom started researching options for facilities near her home and work. The literature for each facility looked great but what skilled nursing could provide did not seem to be enough. The information about the services varied. Mom had images of Dad laying unresponsive in a home. She supposed she would visit him before and after work. With just the weekend to research and the target discharge date a few days away, Mom asked for something more. The attending case worker that day said, “well this is normal for medicare patients.”
Mom was incensed. Yes, Dad was 80 but she carried him on her insurance. Did the case worker even look at the file?
Dad’s main doctor, noting Mom’s distress during one of his visits, consulted with her. He would consider Dad for Acute Inpatient Rehab in the hospital if Mom had visual proof that Dad did not have a pre-existing neurological condition like Parkinsons before the fall.
Luckily, mom had a video on her phone of dad dancing to calypso music at a cousin’s birthday in Trinidad just 3 weeks before the accident. The very next day, the doctor signed off on Acute Inpatient Rehab. He said he only sent people onto this program who were expected to make a full recovery.
By the end of the week, Dad was on the Acute Rehab floor. Here he would relearn everything – to sit up, to feed himself – everything to become independent again. But first, he would have to wake up.
The therapist came daily to work with him, to try feed him, get him to move. After 2 full days of therapy, Mom snapped. Her patience gone, she railed at the form on the bed. “You were accepted into this program. You need to work to get better. You need to eat and gain strength or I’m going to leave you in a nursing home!”
The very next day, on December 25, Dad became responsive thus starting the gym regimen. It was Christmas Day so Mom played Parang – folk music from Trinidad. On the 27th he started to recognize people. On January 9, the day of his release date, Dad’s doctor made a video of him dancing. Ok it was more like swaying his hips and shuffling feet. Dad was an inspiration for other patients entering the rehab wing.
Conclusion and Learning
After 18 days in Acute rehab, Dad was released to go home to follow up with a regimen of occupational, speech and physical therapy. More details to come on that in future posts.
Orthostatic Hypotension is not limited to older people. It can affect people at any age. It can cause dizziness, lightheadedness, feeling faint or even passing out. If you routinely feel these symptoms when rising from a seated or lying position, you may choose to consult your doctor or try ways to combat low blood pressure.
- Eat smaller meals more frequently to combat the dipping in pressure that happen after larger meals.
- Stay hydrated. This is increasingly important as people age. As we age, the body loses the ability to tell that it is thirty. This was one of Dad’s issues. A few months before the fall, his primary care doctor had told him that he needed to drink more water.
- Stand up slowly from a seated or lying position. Instead of just getting up and going, if you feel lightheaded make sure that you stabilize yourself before you move into open space.
- Before you get up, pump or flex the calves to get blood circulating upwards. Flexing your feet helps fight gravity and circulate your blood back up the heart and head.
In addition to learning more about the perils of low blood pressure, I also learned about nursing and rehab facilities this winter.
I was most familiar with the Skilled Nursing Facility. Growing up as a piano student, I would routinely go to nursing homes to play for residents. There were patients of varying abilities, assisted by a nursing staff.
What is acute inpatient rehab? The goal of acute inpatient rehab is to help people regain the basic skills required for independence and self-sufficiency before they’re discharged from the hospital and re-enter community living.
There wasn’t one specific place to learn about rehab versus skilled nursing. The best comparison I found was on the Main Line Health website for Bryn Mawr Rehab. The linked site is marketing for their rehab but the service is similar to the care that Dad received. However, I really liked the comparison chart.
I am not a doctor and I offer no medical advice. These are just my own experiences within this serious situation. If you find yourself experiencing these symptoms, please be aware and take precautions for your future.