Living Alone and the “Long Lie” Everyone needs a plan, not just the elderly.

“The Long Lie” is being stuck lying on the floor for longer than 1–2 hours. It happens to people who live alone, or who who spend most of the day alone.

What is your plan for when you find yourself lying on the floor, alone? Do you have one?

Walking the dog in the field at sunrise

Scenerio #1

He laid at the bottom of the stairs for two days before his daughter found him. She lived in the same town, just blocks away. She thought she checked on him often enough. He was independent and resented her concern, calling it “ageism.” So she had backed off to a few days per week. His last memory was hanging his cane at the top of the stairs. I admitted him to home health services with broken bones for physical therapy and for prevention of reoccurrence or complications after his hospitalization.

Scenario #2

She laid in her back yard in the snow for 8 to 12 hours until the next morning when people came out of their heated homes to leave for work. She lived in small town where the homes were close together, but she had a high, wooden privacy fence around her yard. She had taken her trash out after dark for the next day’s pick-up and had slipped on a patch of ice. She had been in so much pain that she had been unable to crawl back to her house or get up the porch steps. The night was cold and everyone was inside closed doors and windows with too much noise to hear her. Her voice was hoarse from screaming for help all night so it took a while for someone to hear the next morning. On the hospital med/surg unit, I dressed the sloughing eschar wounds that had formed from frostbite in large, black spots all over her body. Some were hard, some soft. They would take weeks to months to heal.

Scenario #3

When he didn’t show up for the a genealogy group, a friend called a neighbor, and the police were called for a wellness check. Nobody had seen him for days. He was involved in the community, and was very social, and it wasn’t like him to just not show without telling somebody. He was found lying in his own diarrheal feces on the floor. The estimated time of death was two days prior. He was a member of my church.

These stories have been modified for privacy reasons and due to not knowing some details. They represent a small fraction of my direct personal experiences as a nurse. They aren’t just anecdotes. Statistics say that brushing shoulders with the Long Lie is a common experience for health care workers.

Falls are the leading cause of injury-related deaths in people 65 and older, and are the leading cause of non-fatal injuries for all ages of adults in the U.S. According to the first CDC link, one in four adults over age 65 will be injured by a fall.

But falls are not just an old people problem. And lying on the floor or the ground for hours, days, or weeks is not just caused by falls. I have cared for people young and elderly who laid on the floor for a long time due to the inability to stand, or due to losing consciousness for countless reasons.

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Reasons you may find yourself on the floor regardless of age:

• losing too many fluids or not taking in enough fluids causing dehydration to the point of losing consciousness. This can be instigated by a virus or bacterial infection such as the Hanta virus that killed Gene Hackman’s wife, Becky. While Hanta virus is rare, becoming dehydrated from illness is common. Losing too many fluids can also be caused by extreme sweating, any condition that results in diarrhea, and vomiting too much
• cardiac events such as a slow heart rate (bradycardia), a fast heart rate (tachycardia), a heart attack, or an irregular heart rate. Bulimia can cause a cardiac event by creating too much potassium loss from purging. Potassium, calcium, sodium, and magnesium must stay within a certain range for the heart to function correctly. Medications may build up in the system or be wrongly dosed causing a heart rate that is too slow or too fast or a blood pressure too low or too high to support brain function. Over-the-counter medications can also react with each other or with prescription medications causing heart beat and blood pressure irregularities.
• pulmonary (lung) events such as a chronic obstructive pulmonary disease (COPD) or congestive heart failure (CHF) exacerbations, an asthma attack, or a long and severe coughing jag from any cause. These conditions can make breathing so difficult that standing is no longer possible. Lack of enough oxygen to the brain is the primary result. Another result is the build-up of carbon dioxide when it cannot be expelled from the body efficiently through breathing/exhaling, making the blood acidic enough to reduce brain function.
• seizures. Seizures are unexpected in people who have never had one before. They can be caused by fevers, medication withdrawal, illicit drug use, or an unknown reaction to something as simple as flickering lights
• a vasovagal response. The vasovagal response is losing consciousness due to a brief and quick severely lowered heart rate and blood pressure. This can be physical only and happen during a bowel movement. It can also be a psychological response which turns physical. The psychological response happens when seeing blood, pus, or a needle. A vasovagal response can also happen when having labs drawn or when walking into a dark room from bright outdoors. Sensors in key areas of arteries are overstimulated and tell the brain to drop the heart rate and blood pressure. People usually wake up and recover from the vasovagal response quickly without any issues, but unfortunately if it happens when you are alone, you could be injured. The drop in heart rate and/or blood pressure can also sometimes snowball into a seizure, a cardiac event, or cerebral event such as a stroke.
• low or high blood sugar
• extreme fear or extreme surprise causing the coronary arteries to contract and cut off circulation to the heart and/or brain
• stroke
• standing up too quickly

After finding one’s self on the floor, one might not be able to get back up if there was an injury or if the cause is not immediately correctable. In the case of dehydration or disease associated delirium there may be extreme weakness. In the case of a seizure there may be a postdromal stage with confusion. With a stroke there may be loss of use of one or more extremities. With a fracture there may be extreme pain and immobility.

What is your plan for when you find yourself on the floor? Do you have one?

Everyone who lives alone needs a plan.

EVERYONE

The best course of action is to

1. Have someone check in on you daily at the minimum by phone. This person, or these people need to be responsible enough to take a second action if they do not get ahold of you within a pre-arranged time frame. If more than one person agrees to check on you, and there should ideally be more than one, a calendar of who is checking when should be in place. One should never assume the other is checking if they don’t know for certain.
2. Give a neighbor or a friend a copy of your door key and make a plan that they will come look in on you in person if your check-in person cannot reach you. Every check-in person needs to have this person’s phone number.

These two steps will keep you from laying in your back yard with a broken hip or wrist in the snow for more than 24 hours. These steps will keep you from laying at the bottom of the stairs with a head injury for more than 24 hours. They will keep you from being found dead two days, or two weeks after you died.

There is a third step.

3. Keep a way to contact someone reachable from the floor in each level of your home. This could be an intercom, an AI voice device, an extra phone, a medical alert system such as Life Alert, or a call button that alerts on a family member or friend’s phone.

This third step will cut the time down from 24 hours to a few hours. The elderly are not the only people who need to avoid the Long Lie. 20-somethings in a new apartment need to avoid it also.

Grandparents living alone and grandchildren in their first apartment sometimes form a buddy system checking on each other daily. Childless independent adults form bonds with nieces and nephews, or with friends who form a mutual check-in plan. Elderly neighbors or local social groups form daily phone trees and build a check-in plan into the tree. We can be creative, just so long as everyone is checked on at least once daily.

Make a daily check-in plan, and stay vertical!