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Seniors home from rehab – now what?

Anxiety is normal after a fall, but there are practical ways to ease the transition

The accident was scary and painful. You fell, breaking one or more major bones. You were hospitalized and then spent weeks in a rehab hospital, healing and painstakingly re-learning the skills you need to go back home. Now your doctors and physical therapists say you’re ready. Congratulations!

So why are you scared?

You’re thrilled to go home, but you worry: What happens next? Are you really ready? What if you have another accident? What if it’s even worse than last time? What if no one finds you when you need help? What if you are now using a walker or wheelchair? Are you really strong enough to return to your life?

Take a deep breath. The first thing to know is that you’re normal. It’s typical to have fears about returning to your life after you’ve been in the safety and security of the rehab hospital, with people always around. A research study by BMC Geriatrics in 2015 reported that 82 percent fear falling after rehabilitation.[i] After all, you were badly hurt, and getting better was hard, painful work.

But there are things that can ease your transition back home – as well as the anxiety that accompanies it. Being practical and proactive about your challenges gets you on the road to solving them.

Have a physical or occupational therapist do a home visit before you return: Your therapists know your strengths and weaknesses, and they understand what to look for in your home. They will start at your front porch and entry: Do you have proper accessibility, especially if you are using a cane, walker or wheelchair? Are stair railings secure? Is the area lighted at night? Inside the home, they will look for obstacles and dangers that you might not think about: throw rugs that could slip, piles of books or magazines that could make you stumble, a bed that is too high, a door that is too narrow. They will also check out your skills – can you reach what you need in the cabinets? Do you need grab bars in the bathroom? Doing this before you come home will allow you to arrange for family or contractors to change and adapt things ahead of time.

If you need a caregiver, check background information and references: It doesn’t matter whether you need someone to come to your home twice weekly for household chores or someone to stay with you for several hours or overnight; if a person will be in your home, you need to check his or her background and references. You can start with an online search, like AARP’s Senior Caregiving Resources page or Care.com, but you still want to be proactive about checking the details of a person’s resume and talking to the references they list. Nobody lists a bad reference, it’s true, but you can get a lot of insight into a person’s work habits and reliability by speaking with others who have hired him or her.

If you are anxious, understand that you might have some PTSD: Post-traumatic stress disorder doesn’t only happen to soldiers or air-crash survivors. It can occur when anything traumatic happens that you didn’t see coming. The National Center for PTSD says symptoms include re-living the event through flashbacks or nightmares, avoiding situations that remind you of what happened, being jittery or hyper-alert for threats, and having your attitude about the world changed in a negative way.  The center suggests seeking help if these symptoms are great enough to cause general distress, disrupt your life, and/or last longer than three months. A study of people over age 65 who were admitted to a hospital after a fall found that about a fourth of the patients developed PTSD, according to the Department of Psychiatry at Weill Cornell Medical College in New York.[ii] The research, which was published in the journal General Hospital Psychiatry[iii], measured 17 symptoms of PTSD. “Anyone who goes through an accident in which they feel their life may be in danger or they could get physically harmed can develop post-traumatic stress symptoms,” said Nimali Jayasinghe, Ph.D., the study’s lead author.

Don’t be too hard on yourself: Because you’re home, you may fall into the trap of thinking that you should be back to 100 percent of your normal self. But this isn’t realistic, and it will only serve to depress you. A more reliable indicator of recovery is whether you continue to make progress. If you are doing better this week than you were last week, see that as a win and keep going.

[i] BioMed Central, BMC Geriatrics, Longitudinal follow-up study on fear of falling during and after rehabilitation in skilled nursing facilities

[ii] Psych Central, Elderly at Risk for PTSD Symptoms After Falls

[iii] Wiley Online Library, Posttraumatic Stress Disorder in Older People After a Fall