My friend is a health care worker who assists an elderly woman with dementia. She has already fallen twice and fractured her pelvis. There have been no falls the last 6 months due to careful supervision. The patient should use a walker, with the worker following her to assist as necessary. My question is where should we position ourselves when walking with a frail elderly person? If we walk behind them, isn't this useless if the person falls forward? My husband fell in this way when I was walking behind him. He was using a walker and tripped when the walker encountered a step. I was useless to prevent the fall since he fell away from me.
What if the client doesn't use a walker? Should you walk next to them? Should you hold their arm?
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The best thing to do is to get a qualified and experienced Physical Therapist first to show you how to support the person, then to watch you doing it and correct your technique.
You need to get up close and personal. You stand hip to hip with the person, and you place your arm behind their back, around their lower waist, and hold on to their opposite hip so that you are holding the person actually up against you. This prevents any stumble developing enough momentum to become a fall before you can get a firm hold. The person then holds on to your arm, and off you both go, as with a three-legged race.
If the person is using a walker, you may prefer to use a gait belt. This, again, fits around the person's lower waist/upper hips rather than waist as such, and has handles which you can hold firmly as you stand behind the person.
It is of no use trying to catch a person who has already started to fall. You're most unlikely to have the physical strength or speed to be able to do it, and you may injure the person in the attempt. That's why your hold needs to be firm enough to prevent their weight overtipping their centre of gravity in the first place.
There is also a lot to be said for a wheelchair, of course :)
In regards to your husband's fall, since his fall was due to the walker hitting a step, try to watch where your husband is placing his walker and attempt to anticipate any problems. DO NOT GRAB for the walker as it falls forward because the weight of your husband and the leaning walker can cause you to lose your balance and to fall also. (I had a CNA who grabbed the walker from behind as the resident was falling forward and she fell forward also landing on top of the resident and their walker.)
Always use a gait belt with someone who is unsteady on their feet (even when the person is using a walker-- That way you have something to hold to so that you can help steady the person if they are having trouble with the walker.) If a gait belt is unavailable, then you can hold on the waistband of their pants or slacks while they walk.
Contact your local Physical Therapist and ask to be shown how to use a gait belt on your Loved One.
Google "How to use a gait belt" and you will find several YouTube videos on how to use a gait belt.
Copy and Paste the URLs listed below to your web browser for some videos and PDFs on "How to use a gait belt".
https://www.youtube.com/watch?v=SaGHn0JOpkQ
"Using a Gait Belt Safely and Effectively On Any Size Person" shows how to correctly put a gait belt on a person.
https://www.youtube.com/watch?annotation_id=annotation_947055&feature=iv&src_vid=OBVqxwggZ3U&v=_irfJdCL2Dw
"Transfer from Bed to Wheelchair CNA Skill NEW" shows how to transfer a person from a bed to chair. (I brace one or both of my knees against the patient's knees to prevent their knees from buckling during the transfer.)
http://www.med.umich.edu/1libr/FallsPreventionCommittee/UsingAGaitBelt.pdf
"Using a Gait Belt from University of Michigan" pamphlet
https://www.caregiver-aid.com/ambulation-gait-belt/
http://www.elder-home-care-help.com/gait-belt.html
Hope that this information is helpful.
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Once the gate belt is on you walk to the side and a bit behind the person with your hand on the gait belt at all times.
If the person begins to fall you can get behind them and position yourself so you can guide them down safely Do NOT try to prevent the fall or you both may go down. Once they are safely down then you can try getting them up but if you can not do it safely call emergency service and request a "lift assist" there will be no transport to the hospital so in most areas there will be no charge for the lift assist. You may have to sign a paper stating that there was no request for transport to the hospital.
The gait belt should be positioned between the waist and chest
It should not be loose enough that it will slide around and you need to get your 4 fingers under it and be comfortable. It should not be so tight that it is uncomfortable for you to keep your fingers in place and the person you are guiding should be comfortable.
There are different kinds I would get one that is wide and sturdy. I had two, one wider and heavier duty and a thinner more light weight one. The heavier, wider one was more comfortable and easier to get one and buckle.
When buying one the person selling should be able to show you the correct way to put it on. I wrote my Husbands name on the belt on the inside so I could quickly tell at a glance what was the inside and if it was upside down or not. Made getting it on faster and easier.
Ask your family doctor for "home health help". The therapist is is an excellent resourse and will give you practical information and how to use a gait belt if that's an option.
Or contact the local hospital to see if the have people to advise you.
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