Case of the Month
Falls, Independence, and the Family Secret
A 75-year-old woman living in a long-term care facility is falling almost every other day. Staff have also noticed that she is eating less, withdrawing from other residents, using her wheelchair more often, and repeating herself in conversation.
She was 75, living in long-term care, and increasingly unhappy about it.
She had started falling frequently — sometimes every other day. She was eating less, spending more time in her wheelchair, withdrawing from other residents, and repeating the same stories.
Staff were worried. Her family was worried.
She was not.
“I can take care of myself at home.”
That sentence could easily be dismissed as denial.
But it may be saying something much bigger.
She had lost her home, her routines, her privacy, and much of her independence. The life she once recognized as her own had been replaced by schedules, restrictions, unfamiliar food, and people watching over her.
From her perspective, the problem was not simply that she was falling.
The problem was that she no longer felt in control of her life.
Then another part of the story emerged
Her granddaughter had been secretly bringing her the alcohol she used to enjoy at home — small comforts that reminded her of her previous life.
She knew the facility would not approve, so she kept it hidden.
At first glance, the solution may seem obvious:
Stop the alcohol.
But that answer is too simple.
The alcohol could certainly be contributing to her risk of falling and deserves careful assessment. Yet focusing only on the rule being broken risks missing why the rule was being broken in the first place.
Her granddaughter was not trying to harm her.
She was trying to make her happy.
And the patient was not necessarily refusing help because she did not understand the danger. She may have been resisting because every new restriction felt like another part of her independence disappearing.
That distinction matters.
Start with curiosity, not correction
A better conversation might begin with questions such as:
- “What do you miss most about being at home?”
- “What has been hardest about living here?”
- “What do those visits with your granddaughter mean to you?”
These questions can reveal things that a checklist may not.
They also do not replace the medical work.
Frequent falls in an older adult can have many causes, including:
- poor nutrition
- muscle weakness
- medication effects
- balance or sensation problems
- alcohol use
- changes in vision
- cognitive changes
- depression or social withdrawal
- environmental hazards
In her case, several warning signs were already present: reduced appetite, weakness, difficulty walking, increasing reliance on a wheelchair, and changes in memory and attention.
The important point is not to choose between empathy and clinical assessment.
Good care requires both.
Words can either open the conversation — or close it
Language matters.
“Repeating stories” is something you can observe.
“Dementia” is a diagnosis.
“Drinking alcohol” is a behavior.
“Alcoholic” is a label.
“Not following recommendations” describes a situation.
“Difficult” or “noncompliant” can become judgments that stop curiosity.
The faster we turn observations into labels, the easier it becomes to stop asking:
“What else could be going on?”
That question is often where better care begins.
The granddaughter is part of the story too
If the granddaughter is treated as the problem, she may become defensive or hide more information.
If her intentions are acknowledged, she is more likely to become part of the solution.
A clinician might say:
“I can see you're trying to give her something familiar and enjoyable. I'm also concerned that alcohol may be increasing her risk of falling. Can we talk about what she enjoys about it and whether there are safer ways to preserve some of that experience?”
That conversation is very different from:
“You need to stop bringing alcohol.”
Both address safety.
Only one is likely to preserve trust.
Safety does not always have to mean less control
The deeper question in this case is not whether safety matters.
Of course it does.
The real question is:
Does making someone safer always require taking more control away from them?
Sometimes the best care plan is not the one that removes every possible risk.
It is the one that understands what the person is trying to protect — and finds the safest way to preserve as much of it as possible.
That might mean giving the patient more meaningful choices about:
- meals
- daily routines
- social activities
- mobility goals
- visits with family
- familiar pleasures
- how care decisions are discussed
Small choices can matter enormously when many larger choices have already disappeared.
Questions to consider
- What could be contributing to her falls?
- Could poor nutrition, weakness, medications, alcohol, mood, or cognitive changes be playing a role?
- How would you talk about alcohol without shaming her or her granddaughter?
- How would you evaluate memory concerns without making her feel that decisions are being taken away from her?
- Which parts of her daily life could she still control?
- Could the care plan offer more choice rather than simply more restrictions?
The takeaway
When someone appears resistant, the first question should not always be:
“How do we get them to comply?”
Sometimes a better question is:
“What are they afraid of losing?”
In this case, reducing falls matters. So do nutrition, cognition, alcohol use, mobility, and safety.
But so do dignity, familiarity, pleasure, identity, and control.
Good care has to make room for both.