The prevalence and risk of falls in older people has been highlighted in the news lately, with the costs resulting from these falls making the headlines. There are some simple ways to reduce the likelihood of falls and to prevent further falls taking place.
When someone has a fall, they are usually asked a set of specific questions to identify the possible causes of that fall and markers to indicate the risk of future falls. They will also be observed walking, or standing up from a chair to assess their strength, balance, coordination and control. Following one or more falls, some patients can be referred to a Falls Clinic where they will receive a comprehensive set of tests and be seen by a range of health professionals including a doctor, nurse, occupational therapist and physiotherapist. General health checks will be carried out and follow up appointments arranged to monitor the patient’s progress.
As a general guide, there are certain common causes which could increase the risk of falls and preventative action can be taken to avoid possible premature incidents of falling.
Our top three simple ways to reduce the chance of falls
1. Nutrition, hydration and staying active – Diet plays a big part in our overall health and it is important that older people are eating and drinking enough of the right kinds of food throughout the day. Poor diet can lead to lower energy levels and poorer condition of bones. Ask your GP surgery for help with balancing your diet and making sure you get enough important nutrients to support and strengthen your body. Increasing your intake of Calcium – tinned fish (with bones), nuts and broccoli; Vitamin D – oily fish, egg yolk, liver & sunlight; and Iron – red meat, seafood, wholegrain cereals, green leafy vegetables, eggs, seeds & nuts – can all help in preventing fracture or breakage from falls.Dehydration can lead to loss of energy and dizziness, particularly in hot weather. Make sure you have easy access to a regular supply of fluid, preferably water. If you are unsteady on your feet, keep a jug of fresh water by your seat and drink from it regularly throughout the day. Keeping active, even in tasks around the home, can help keep our muscles and joints working and strong. Inactivity can lead to a decrease in muscle tone and an increase in stiffness of joints, leading to reduced flexibility and mobility.
2. Environmental – Slippery floors and unsuitable footwear are some of the major factors contributing to over a third of all falls annually (RoSPA, 2014). Loose wires, worn rugs, uneven flooring and items left lying around can all pose risks for possible falls. It’s important to eliminate as much clutter as possible from your home and to reduce hazards which could cause you to trip. We’ve found this website which can help identify and reduce hazards in your home which could cause you to fall: http://www.health.wa.gov.au/stayonyourfeet/steps/hazards.cfm
3. Visit your GP – to review your medication and ask about being referred to a local exercise scheme to improve coordination, balance and flexibility
The cause of a fall is often multifactorial, so you might want to consider these other factors;
- Fall history – Those who have already fallen are up to three times more likely to fall again within a year (Kapas, 2014). Make sure you visit your GP surgery to alert them about your fall and ask them for further advice on reducing the risks of future falls.
- Gait – How we walk and control our walk and our posture/transfers can play a big part in the likelihood of increased falls. Our reflexes, muscle strength, coordination and flexibility usually decline with age. These can further be affected by a specific illness or disease affecting our skeletal system for example, or as a result of prolonged inactivity (Kapas, 2014). If you notice a change or decline in your walk it would be advisable to visit your GP following which the adoption of a new exercise regime designed to strengthen muscles and increase flexibility may be recommended. Contact Age UK to get a list of the nearest centres to you which provide these exercise classes. They have a lot of information on their website about falls prevention and exercises to help reduce the risks of falling.
- Sensory – Sight, hearing and touch can all impact on how well we mobilise. Conditions such as glaucoma, cataract and macular degeneration can cause problems with the quality of our sight and therefore contribute to risks associated with falls. Conditions affecting our ears or balance and conditions such as diabetes which may reduce our sensory receptors, can all increase these risks. Make a note of anything you note which is affecting your mobility or coordination. Mention this to your GP or other health professional that you see.
- Medication and medical history – Older people will often have a range of different medication treating different conditions which can often increase the risk of falls, which is why it is so important to visit GPs in order to review the risk factors associated with this. The medications most commonly associated with falls in older people come under the following categories;
- Antihypertensives – ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, hydralazine, methyldopa
- Beta-blockers – propranolol, timolol
- Antidepressants – sertraline, trazodone, dosulepin, amitriptyline
- Diuretics – such as bendroflumethiazide, furosemide, co-amilofruse
- Benzodiazepines – (treating anxiety) diazepam, temazepam, chlordiazepoxide
- Antipsychotics – chlorpromazine, flupentixol, haloperidol, olanzapine, quetiapine, risperidone
- Other sedatives/hypnotics – sleeping aids such as zopiclone, nitrazepam, sedating antihistamines (e.g. diphenhydramine, promethazine)
- Opioids – (pain relief) morphine, buprenorphine, diamorphone, fentanyl, methadone, oxycodone, tramadol, codeine
- NSAIDs – anti inflammatory – diclofenac, ibruprofen
- There are also higher risks of falls associated with some medication treating cardiovascular conditions and those taking antiepileptic medications (Kalpas, 2014) and those experiencing urinary incontinence and urgency (FRAZE, 2011). Again, make a note of any unusual symptoms that you notice and mention this to your GP so that she can make suitable changes to your prescription or complete further tests. Always check the side effects of the medication that you’re taking and don’t be afraid to ask your GP questions about medications that are prescribed. If it’s difficult to get to see your GP, you can pop into a local pharmacy and ask the pharmacist there as they can give you a lot of helpful information about different medications.
- Mobility – Is a walking aid being used and is it being used appropriately i.e. at all times when required? Is it the suitable type, size and condition for the person using it? Is a walking aid required? If you feel you may benefit from a walking aid or a new walking aid, you can visit your nearest independent living shop to receive advice on what would be most appropriate for you.
- Condition of feet – As well as being aware of the condition of the footwear being worn, close attention should be paid to the condition of the actual feet and regular chiropody appointments should be arranged to maintain foot health. Free foot health is offered on the NHS, so ask your GP about a referral. Also, it is really important to take care of your feet so check out this website for tips on how to do so: http://www.nobilis.co.uk/general-health/71-happy-feet-the-importance-of-foot-care-in-the-elderly
- Cognitive and mental health – Delirium, acute confusional state or paranoia can all contribute to an increased risk of falls but can be monitored through GPs. Conditions which can confuse the way we think or view things can also increase our risk of falling, as they cloud judgement and can muddle our minds.
- Alcohol/drug usage – As with all drugs entering the body, their impact can affect the whole body, leading to side effects which will increase the risk of falls.
- Any mind altering substance has the potential to affect our bodily functions and perceptions, so increased use of recreational drugs and alcohol can increase our risk of falls.