Ali Habashi: So in your new book, Planning Not To Fall, it touches on 31 stories and 31 tips on how not to fall. Can you give us a sneak peek into some of these stories and some of these tips?

Consuela Marshall: Oh, I would love to. You know, writing this book was just an outpouring of my heart and all of the stories that have been in my head for years

Look, I’ve worked in the same neighborhood for 25 years, so I have seen whole families, like a grandmother and then a mother and then a daughter and an aunt. So I’ve seen patterns and I started taking note of them in the way of how caregiving takes place and in how aging older adults live out their life and what is attributing to all of the falls, and that brought about this book.

So I want to start by saying this book is about tips that I want seniors to see and see in themselves; that “this could be me. I could fall doing that, or I almost fell like that.” That’s what this book is about. It’s presenting tips in a way that a senior who reads the book can really embrace it as something they can internalize and be able to make decisions based on how they want to prevent that from happening in their lives.

So when I wrote the book, I did not want to go down the road of “you have to do this, you need to get grab bars, you need to get the rugs off the floor.” All of those things are true.

But it is in how you present that information to someone that really gets the results and that’s what I had to learn over the years and change my approach when I am providing that type of education. So in the book, I give the tips and I give a story, and an example would be like Ms. Jen. She had a dog named Red, a golden retriever. She loved Red. Red was her life.

She could, she thought that she and Red, they could read each other’s mind, because they were so close. But with that, Red had a lot of tennis balls and they were always on the floor. He couldn’t get enough of tennis balls, and they were everywhere. And one day, Ms. Jen was getting up just to go walk and do something in her house, and she stepped on one of the tennis balls and fell to the floor.

Now you can envision that if you are a dog owner, you can see how that could truly happen, and Ms. Jen fell and she broke her hip. And as smart as Red is, Red cannot pick up the phone and call 911. So Red laid next to Ms. Jen on the floor for hours. And while she was lying there, Red was bringing her all kinds of toys, bringing her the bone, bringing her the stuffed animal, just bringing things to her to try to make her happy.

But he couldn’t get her off the floor and her phone was ringing and she could not get to the phone. So after hours, a neighbor came over or a son came over and saw that she was on the floor. Now that’s a story that you can remember and even relate to versus saying, “get clutter off the floor.”

Don’t you know, or really the tip is. about pet safety, about being aware of how you take care of your pets and how they are integrated into your home. And that’s just one of 31 tips in the book. And I chose 31 because I wanted a tip for every day of the month, and then, by the end of the month you’ll be just full of wisdom on things that you can do to lower the fall risk in your home.

And that’s just one story. I mean, there’s repeated stories like don’t overreach, reaching for things instead of taking that couple of steps to really get to something to unplug it. And for that story I tell about a man who had a chargeable flashlight that you just put it in the wall, and it charges overnight, and you pull it back out of the wall.

And this time he just didn’t move close enough. He just tried to reach in between the recliner and the tall floor lamp. And when he leaned to get it. He lost his balance and fell and had an injury and as a result, his daughter had to come move in with him after he got out of rehab. And the skilled nursing unit, and I think this was even the case in this story, when while he was at the skilled nursing unit, which is often in a nursing home, he saw some of his friends who were actually residents there.

So that was a big eye-opener for him in being proactive and not having injuries that could even possibly lead to you not being able to return to your home. Lots of stories like that.

Ali: I have so many things to say about this too. I do feel too, like I’ve been working at Homethrive long enough where I’ve seen some of these tips, like keep your pets out of the kitchen.

So that’s my first thought with a pet and a fall risk is okay, keep them out of the kitchen. And it makes sense because half the time I’ll turn around and nearly step on the cat because he just decided to come underneath my feet.

But while you were telling that story, I was picturing all of his toys, all of his little balls and things, and they’re just in the living room. They’re at the base of the stairs. They’re right in sort of where the kitchen meets the living room. They’re over by the couch where I would be just walking and not looking at all.

And yeah, it was like a whole different angle to pet safety and fall safety. And I know I’ve registered it. I’ve seen those toys on the floor and gone, “I should push those out of the way before someone steps on one.” But sometimes they’re just there and you don’t really notice. And yeah, I can only imagine also lying down for hours in your living room and the dog is just bringing you more toys.

Consuela: Well these are true stories. These are not things fabricated.

These are true stories and even as a therapist in getting referrals, the last two referrals were due to falls. I mean, they’re always due to something that could have been prevented. When you’re talking about falls, there’s a small percentage of falls that they couldn’t have been avoided because you didn’t know you were going to pass out.

You had no warning or a history of dizziness, or you just stood up and this is something new and you hit the floor. It happened. But those are rare. Ninety-nine percent of falls that occur are things that could have been prevented.

Ali: You said something else too, which I think is something that most of us don’t think about, which is the fact that when an aging person does fall, I think we all think of the broken hip.

We all think of the injury, and then the recovery. But I feel like we don’t often think about the ripple effects it has for the whole family.

Consuela: Oh, absolutely.

Ali: Like not just in the initial scariness or the initial treatment, but in moving back in and learning that now they can’t live alone.

Or now we actually all have to change our lives and uproot our lives and move into the same place and we have to downsize, or we have to figure out a senior living community that can help. And it’s just, so much more vast.

Consuela: Yes. That ripple effect is staggering in how a fall impacts the entire family unit, because you have people who are really maybe already struggling financially and just barely staying above the water, just doing life. Now mom falls and then suddenly they’re using vacation days to sit at the hospital and they are taking off work and then they are having to possibly leave their jobs or having to find help that they can afford that can come into the house to assist with that person’s care.

And in those devastating cases when it is already known that that person is not going to be able to come back to their house because of major injuries, then it is even a bigger problem with looking at what is the next place for them. And that’s the driving thing for me is getting seniors to see and make these choices for themselves because it doesn’t just affect them.

It does have that ripple effect throughout the whole family because the whole family unit is disrupted and I’m glad you made that point because it is definitely a valid point there.

Ali: So you not only worked with caregivers, but you were one yourself several times over. So what are some of the lessons that you took away from that personal experience?

Consuela: Having been a therapist for years and then becoming the caregiver to my mom was a big light switch for me. That wasn’t my first stint at being a caregiver. I did assist with my daughter who has some physical challenges, but that was just integrated into my life. It was just who I was.

She grew up with me. I mean, it was just became us. It was just a rhythm of our family. And then my mom, different story. So the lesson I learned from that is it’s just not a physical thing. I was for so many years, going in there and teaching daughters and sons that this is how you do the correct transfer and put her in a wheelchair, the bathroom, and all of these things that were textbook.

And I was teaching them, and I was telling them and saying, you’re doing this the wrong way. And you know, just really trying to help them. And I didn’t understand the power of the emotional component that’s in that equation that I didn’t have because I was just a therapist who showed up at the door and I didn’t have that emotional pull on me.

I could just come in there and give you the textbook and leave, but with my mom I realized why caregivers were doing things that just didn’t make sense. It was that emotional pull because I became that same person.

She wanted to do things a certain way and I’m trying to just honor that decision, even though I know it was antiquated, it was more work on me, and as a therapist I knew that, but that part of the brain doesn’t even function when there’s this emotional thing going on. Like she gives you the side eye because you’re not moving fast enough and why didn’t you do it the way she wanted to do it?

And then you find yourself conforming into you’re doing things that they want you to do. That make your life more difficult. I didn’t know that before becoming my mom’s caregiver. I would say to a daughter or son who was in a caregiving role “this bed needs to move. There is no room for the wheelchair or the walker to get on the side of the bed so that you all can get close enough so that when she gets on the bed, she’s in the right spot because this big dresser is here. All of these things are here.”

So they were like, for instance, they would park the wheelchair or the walker at the end of the bed. There’s no room for the wheelchair to get closer, and they would be pulling and tugging and getting her there and barely getting her on the edge of the mattress to see it. And I’m like, why don’t y’all just move this dresser or just push the bed over, then mom will give this look.

“Now my dresser always been there. I need that dresser there.” They’d go around the moon. “I bought this from Sears in 1955 and I’ve always had it there, you know?” I would listen and say, “but it needs to move. It’s hurting your daughter to get you that far up the side of the bed.”

I didn’t know that. Now I understand why the daughter would not make changes because her mom didn’t want the changes to happen. And I began to see more clearly how that emotional thing, that relationship that existed before of who’s the boss and who’s not the boss, how that plays into the caregiving role.

So that was the biggest light bulb moment for me when I became my mom’s caregiver. I wanted to say, everybody that I walked out the house saying, when are they going to get it? I am so sorry because I really understand what you were going through.

Ali: It’s that eternal struggle too, because at some point your parents who raised you from diapers suddenly need your help and you’re trying your best and you’re a different person because you’re an adult now. And I’m sure they can only see you as baby Consuela. She doesn’t know what’s going on. You’re my daughter.

Consuela: You’re not my therapist. You’re my daughter.

Ali: You’re my baby. Actually, now as a therapist, when you go into people’s homes, do you come at it from that angle

Consuela: A whole different approach and I’m having those conversations separately.

That person who’s being cared for. That aging older adult, and I’m really showing them the side that they don’t often see. Also I’m appreciating what they’re saying because that dresser being there means something to them because it is part of them, is part of that permanent memory.

And I have to appeal to that. But at the same time, I have to say that if your daughter is to continue in this role and you don’t want her injured and you don’t want her to injure you, this is something you really need to think about.

Ali: For the caregivers in our audience who might be worried about their loved ones falling down in the future, like maybe they’re just getting to that point now, can we get into a few expert recommendations from you on that subject?

Consuela: Yes. The first thing I want to say is if you’re worried about it, do something. You don’t have control about what they will allow you to do, but don’t be passive and you’re at work and you’re tense every time the phone rings and wondering did they fall?

Don’t live like that. If you have that inner thing in you saying “Mom’s going to fall,” you already just see the writing on the wall, do something about it. And what does that mean? You don’t always need a therapist. Certain things are just common sense.

Start having common sense conversations with your loved one about falls in what you can identify and try and appeal to them.

And if you don’t know what to do, get help. And that means talking to your doctor about it. Seeing if you can get a therapy evaluation to, number one, identify whatever things are going on in their body, if it’s balanced, if it’s weakness, if it is coordination, and getting that occupational therapist in there to really look at the environment.

What are the environmental risks that need to be addressed and things that need to be modified and get a get away from this HGTV you’ve got to knock down walls, put in all of these expensive showers. I don’t know how these young kids have these budgets. Anyway, to do all of those things is not needed. Not in a lot of cases, but I won’t say in all cases.

There are a lot of stairs and sunken tubs and some hazards, yes, they may need some major overhaul or moving to another location, but there are a lot of little things that can be done that can significantly lower the risk. Changes in the home environment and education to them by a therapist and changes in their behaviors that can reduce the fall risk.

So don’t ignore it. Get doctor’s orders for therapy. And don’t go to an outpatient center. You need a therapist that’s going to come to you, that’s going to be in the home looking at everything. So it can be approached in two ways: home health. And then there are private practice therapists who operate as mobile outpatient clinics that can come into your home.

But it would definitely be worth it to have a home assessment done by an occupational therapist to identify those fall risks and arm you with information that you can do to start modifying the home.

Ali: Is there any piece of equipment or a behavioral change that you kind of swear by for most people, or is it truly unique to everybody’s situation?

Consuela: It’s truly unique based on what’s going on with that person’s body and mind. All of that. It says it’ll be an individual assessment, but there are some common sense things. The throw rugs, getting rid of clutter, making sure you have adequate lighting in your house.

Grab bars never hurt anyone, putting up grab bars and not just in the bathroom. They are handy in a lot of areas of the home. I’ll give you an example–in the closet. Because a lot of people get dressed in the closet and they’re stepping into pants, they’re bending over trying to find their shoes, and they’re prone to fall in the closet. So even putting a grab bar in the closet for somebody to hold onto while they’re dressing in the closet is an excellent example of an easy remedy that can lower a fall risk.

Ali: And when you say throw rugs, do you mean removing them all together?

Consuela: No. I always tell people in the areas that you’re frequently in. Because you go in there saying, “get all the throw rugs out of your house.” There’s a lot of emotional ties to everything that people have. I always approach it really minimally.

In the bathroom, those rugs I don’t care if they have the rubber backing on them or not. They are fall hazards in the kitchen. They are fall hazards. Remove them out of the way, out of areas where you’re frequently walking. Now, if you have a guest bathroom, but you are never in that bathroom, don’t worry about it. I mean, let it be pretty in there.

Keep the rugs there. But wherever you are, those rugs need to go. And if you don’t want them to go, tape them down. And as far as like area rugs, these big room size rugs now, those definitely put sticky back tape under those.

Ali: Okay, so I will say we have a lot of members at Homethrive who are a caregiver to someone with dementia or Alzheimer’s. What’s the connection between fall safety and dementia?

Consuela: There is a correlation there because what you have when your loved one is living with a dementia diagnosis is that you have decreased reasoning skills, decreased rational thinking, decreased problem solving, all of that right there. And the decreased perception, even depth perception or even cognitive perception of what you’re seeing.

All of those are just recipes for a fall. So falls are very common in those who are living with their dementia. And along with that many people don’t realize that with that dementia diagnosis, yes there are those cognitive changes, but simultaneously there are physical changes that are happening at the same time.

Because that disease may initially present as just cognitive because that’s how you are aware of something’s going on. You see that. But coupled with that is that physical change that happens as that disease progresses throughout the brain and it begins to tap into those motor centers in the brain

Then you start to see the gait changing. The posture changing. They’d maybe be more leaning forward, head down, just not having fluid movements, and beginning to just have more weakness because they’re not up and about as much. Whereas in the beginning, they’re all over the place because they’re looking for something, they’re ready to go, they need to go to work, and they have all this hypermobility.

But over time those skills start to decline. And so with the progression of the disease and you’re seeing a lot more of the motor components, then you have a two edged sword because now you’ve got the cognitive things going on, and you’ve got these physical changes, a bigger recipe for falls.

So those who are living with dementia are at high risk of falls, and it’s something that caregivers really need to pay attention to.

When we’re talking to caregivers of those living with a dementia, just realize therapy is available.

But it is really not for the person living with dementia. It is really for the caregiver, for teaching them and training them how to adapt, how they are providing the care, how they’re assisting with ADLs and what they need to do to prevent injury to themselves and to the one that’s living with the dementia.

So I want to really make that point.

Ali: I think that’s an amazing point that we don’t often hear. One last question, which is just can you tell us a little bit about what you’ve learned about the difference between how our environment affects the risk for falls and how our behavior affects the risk for falls?

Consuela: In the book, I make a point of putting in this research, and it says home visits by occupational therapists can prevent falls among older adults who are at increased risk of falling. However, the effect may not be caused by home modifications alone. Home visits by OTs may also lead to changes in behaviors that enable older people to live more safely in both the home and the external environment.

And what that says, and what I have weaved throughout my book is that it is not all about equipment, it is about behaviors. Making the choice not to get on a step stool. Making the choice not to stand in a chair, that’s a behavior. Making the choice to flip on a light switch. Although you’re saying, oh, I’ve been in this room a hundred times, I don’t need the light.

That’s a behavior and it’s a behavior that can catch you off guard and lead you down a trail that is going to cause you to have a fall. It is not just about equipment, it’s not just about buying things, putting things in place. It’s about changing your approach as you age. Your body changes, your responses, your actions change.

It’s not a bad thing. It’s happening to all of us all the time. And the fact that that chair was there and you sat in that chair a hundred times, but now your body and your joints are all different. Maybe that recliner is not meant for you anymore. It’s just changing your mindset and changing your behavior.

About how you approach your life, how you slow your pace, not multitasking. All of those are behaviors that can decrease falls tremendously. You can put in all the safety devices you want, but that doorbell ring and you take off a hundred miles an hour. you’re going to fall and you’re going to increase your likelihood of falling.

But so that’s a big thing that I really talk about in my lectures, in my workshops is that yes, I’m going to give you some tips and I’m going to show you some equipment, but I really want you to look at your behaviors. What are some things that you need to change in how and why you behave the way you do that’s going to have a bigger impact?