Our top three ways to help prevent falls

Putting slippers on

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.



Making older people feel useless


Life can only be understood backwards, but it must be lived forwards.

Soren Kierkegaard

“There’s not much more I can contribute to life” she said, stooping over her walking stick, looking at the ground. “I can’t see, I can’t hear and I can’t even walk properly. What use am I now?” She spoke in a clear, steady voice to her carer, looking to him for some kind of response. “You can teach us what it is to age” he replied “because we all will do. You can teach us the importance of patience because we’re all less so these days. You can teach us what it is to have faith in people; tell us what it felt like to trust people coming to your front door, not feeling the need to lock it behind you. You can teach us what it means to respect, because there’s not much of it around at the moment. You can tell us your stories, share with us your wisdom and teach us to live. Tell us all the things that your eyes have seen. If people can’t see your use, then they’re not looking hard enough.”

How sad that we can let our older population believe that they are useless. How sad that we allow them to be excluded from our society. How strange that we ask for a long and healthy life and then fear old age. Their lives, their stories, their experiences can only enrich our own. Maybe if we viewed getting older in a different way, with help from the media and advertising, older people wouldn’t feel as old, wouldn’t feel as useless.

Carers: where would we be without them?

Canary_0657.colourWe all have a partner, relative or friend who we would give everything for should they fall ill or just need us around that little bit more. And it is probably in our human nature to care for another, in every way that we can, to relieve their sadness or pain. But this care giving can, over time, take its toll on that care giver and lead to them sacrificing their own physical and emotional health as well as struggling financially to deliver the care that they want to give and that they feel their loved one deserves.

Rarely have unpaid carers received the praise and recognition they are due. Carers UK suggest that billions of pounds are saved by the government each year due to the ongoing input of carers in our communities. These carers, who are supporting an older, disabled or seriously ill relative or friend make every effort to keep them in their own home, comfortable, safe and loved. The costs to them can be great; in terms of physical pain and emotional and financial strain. Their efforts and contribution to society are not recognised widely enough and are often not recompensed in any way.

The Care Act 2015 could bring a change to this, with every carer due to be offered a Carer’s Assessment, irrespective of the time or level of support they give, focussing instead on the impact that caring has on that person’s wellbeing and what they are prevented from otherwise doing. More companies are looking into ways that they can accommodate the additional caring responsibilities of their employees, recognising that we all have more than one role in our lives.

Our social system simply could not cope without these carers and no one could replace the amount and quality of care that they give. In addition to increased financial support being invested into supporting them, much more should be done to allow them a life outside of their caring roles. In the same way that technology can help people with illnesses and disabilities, technology can also help carers; to relieve some of their strain and to allow them added freedom to access friends, activities and jobs that they would like but have struggled to do so far. No piece of technology can replace human contact and skill, but it can certainly work alongside, add to and complement that which is already there.

We would very much support increased recognition of carers, ensuring appropriate levels of support are given to every aspect of their life and hope that the Care Act 2015 will be the first stepping stone towards achieving this.

A smile can go a long way


Today I met Margaret, a 91 year old lady being assessed for her long term accommodation needs. She is suffering with high anxiety, low confidence and loneliness. She doesn’t have a family and longs for company. She commented on how nice my smile was when I met her and it made me realise how important the little things in life are, particularly to those like Margaret, who are struggling.

Smiles alone cannot heal physical or mental pain, or miraculously cure the latest epidemic of loneliness, but they can certainly offer brief relief. They can make someone feel momentarily less alone and help make them feel a little more connected and present in this world.

Lavender Shortbread could make your loved ones smile , why not try it today?

LAVENDER IS ONE OF THE MOST NOSTALGIC FRAGRANCES, bringing scenes of childhood vividly to the mind: high summer days that last for ever, lavender bushes shimmering against the blue sky, the bees blundering in and out among the flowers, stirring up the intense, sweet sensation. Lavender FieldBut lavender is much more than just pretty & calming. It is one of the most powerful remedies in the plant world. http://www.care2.com/greenliving/7-ways-to-use-lavender-for-home-remedies.html Avid listeners of The Archers will have heard Camilla, Duchess of Cornwall raving about the lavender shortbread that were baked for her by Ian, the chef at Grey Gables. By using simple lavender sugar, that can be bought at major supermarkets  you can make beautiful heart shaped lavender shortbreads and bring a bit of nostalgia and sweetness to someone you care about. http://www.bbc.co.uk/food/recipes/lavender_shortbread_43952. https://i1.wp.com/ichef.bbci.co.uk/food/ic/food_16x9_448/recipes/lavender_shortbread_43952_16x9.jpg If you cant find lavender sugar you can even make it, see top tips.

Let’s adopt People friendly communities

Thanks to Connecting Mackay for image

Thanks to Connecting Mackay for image

It seems that every day there is another tweet or news notification about a town, city or community becoming ‘dementia friendly’. Alzheimer’s Society has set out their five year strategy which includes the movement towards dementia friendly living; encouraging communities to take greater steps towards empowering people with dementia; enabling them to feel more confident and more included in society. A powerful step in recognising that it’s not necessarily the condition or diagnosis that creates a barrier, but society itself that does this. And this social model, this school of thought, should surely apply across society and for all those with different needs and diagnoses. It’s wonderful that Alzheimer’s Society are raising awareness of the need to improve inclusion of a particular group within our community and with such apparent fervent uptake from people within these communities. But this should be the starting point to becoming a more inclusive society generally. “If only we could put ourselves in the shoes of others to see how we would react” wrote John Howard Griffin (2009, cited in Krznaric, 2014, p.76) “then we might become aware of the injustice of discrimination and the tragic inhumanity of every kind of prejudice”.

In the UK alone there are an estimated 1.2 million people who use wheelchairs (taken from 2000 NHS purchasing supply, so likely to be much higher); 1.86 million people with sight loss (2012); 9 million people who are hard of hearing (RNID, English Federation of Disability Sport, 2015) and 985,000 people with a learning disability (Key facts about disability, 2010). Further to this 1 in 4 British adults experience at least one diagnosable mental health problem in any one year (Mental Health Foundation, 2015) Our society – on a large scale and on an individual basis – needs to become more aware, more understanding, more accommodating and much more inclusive. In the UK at least, we have wealth to make this a reality and not just in financial terms. We have the skill set and training of leading technologists, architects, health professionals, teachers and professors. We have a wealth of charities and advocates for specific illnesses, diseases and disabilities and, most importantly, we have a wealth of people who are living with those illnesses, diseases and disabilities who we need to listen to and include in moving towards the creation of not just Dementia Friendly Communities, but People Friendly Communities.

English Federation of Disability Sport (2015) Facts and Statistics Available at (http://www.efds.co.uk/resources/facts_and_statistics) [Accessed 08/01/2015].

Griffin, JH (2009) (cited in Krznaric, 2014) Black Like Me. London: Souvenir Press, 2009

Krznaric, R (2014) Empathy: Why it Matters and How to Get It. New York: Penguin Random House Company, 2014

A new way of living?

Cohousing communities

Loneliness and community living

The astonishingly high rates of loneliness in this country, particularly amongst our older age population have been prevalent in the media of late. Shocking statistics note that lacking social connections is as great a cause of early death as smoking 15 cigarettes a day (Monbiot, 2014); twice as deadly as obesity and can increase the chance of premature death by 14% in the most extreme of cases (Age UK, 2014). At the same time it is believed that loneliness amongst younger people – those 18-34 years old – is thought to be an even greater problem, as services don’t exist to cater to this age group in the same way they do for children or, although being increasingly threatened with closure, for older people. Last year the office for National Statistics found Britain to be the loneliness capital of Europe (Gil, 2014). Humans are social beings which is evidenced by the presence of their large neocortex, a part of the brain involved in higher social cognition, which makes us ‘hard-wired’ for interacting with others (Vrticka, 2013). So, when the doors are closed on our streets; the 6” fences erected around our homes; people absorbed in the world of mobile phones and other technology and the individual and individualism taking over from the sense of community and interdependency, the risk of losing what it means to be social, increases, with a loss of community and loneliness in its wake.

It’s true that although there has been a slight resurgence in community life, with the street party craze, the increasing popularity of allotment ownership (there are year+ waiting lists in London) and farmer’s markets, the focus in our society is almost entirely on the individual. In addition to this, people are; working longer hours, often with less pay; struggling to afford to buy houses, often forcing them out of their preferred location and splitting families; and struggling to manage extended work hours and rising childcare costs. Maybe it’s partly because nobody has the time or energy to think of anyone else as they’re all too busy trying to keep on top of their own lives, that there has been a decline in neighbourliness, community living and general friendliness. It’s not that we don’t care about people, with Britain leading the way amongst other developed nations in giving to worthwhile causes, but it doesn’t currently feel like ‘we’re all in this together’, even though most of us are sharing the burden in some capacity.

‘The old and young must unite to solve the problems facing Brittan’ Stephen Burke has confidently stated (2014), despite some of the media efforts to damage these relationships within communities and between generations. The latest focus has honed in on older people taking up much needed multiple bedroom properties when first time buyers are struggling to purchase their first homes. However a new wave of living is gaining popularity within Europe which is addressing these fractions and rebuilding that sense of true community living. Multigenerational housing, Intergenerational living, community living and cohousing projects are all possible tonics to these problems.

A scheme in the Netherlands enables students to live rent free in a retirement home in exchange for 30 hours of their time to be given to some of the older residents in the home. In Germany, the introduction of Mehrgenerationenhaus (the multigenerational house) in 2003, sees older people, young children and adults coming together in centres which cater for all. The older attendees volunteer to read stories to the children and offer child minding services to the exhausted parents. Teenagers offer to teach the older attendees technology skills whilst all benefit from company. And closer to home, The Threshold Cohousing community in Dorset which consists of 14 dwellings half of which are affordable rent and shared ownership. They are based around a community market garden and common house and living is based on community and green principles.

Perhaps the major difficulties with these types of schemes is each individual being able to adopt and adapt to a true community spirit away from the independent lifestyles that they are more familiar with. Of course this way of living will not suit all and although architects and town planners would be wise to consider options such as this for future housing developments, choice should still be offered to all. However, the focus on more community style living can be framed as the rebuilding of family-like links which can contribute greatly to fighting isolation, loneliness and vulnerability whist also respecting the private life of each individual.

Age UK (2014) Local Age UKs awarded £21m in funding from the Big Lottery Fund to combat loneliness Available from http://www.ageuk.org.uk/latest-news/big-lottery-fund-backs-local-age-uks-beat-loneliness/ [22nd December 2014]

Burke, Stephen (2014) Old and young people must unite to solve the problems facing Britain. Available from: http://www.theguardian.com/society/2014/jul/21/old-young-people-unite-solve-problems [22nd December 2014]

Gill, Natalie (2014) Loneliness: a silent plague that is hurting young people most. Available from: http://www.theguardian.com/lifeandstyle/2014/jul/20/loneliness-britains-silent-plague-hurts-young-people-most [23rd December 2014]

Monbiot, G (2014) The age of loneliness is killing us Available from: http://www.theguardian.com/commentisfree/2014/oct/14/age-of-loneliness-killing-us [23rd December 2014]

Vrticka, Pascal (2013) Evolution of the Social Brain’ in humans. What are the benefits and costs of belonging to a social species? Available from: http://www.huffingtonpost.com/pascal-vrticka/human-social-development_b_3921942.html [23rd December 2014]

How does your river flow?


One older lady once said to me, on finding herself in a psychiatric ward following the “breakdown” she’d experienced; “I can just about deal with stiff joints and bad backs, but when people start questioning my mind and I start believing I’m losing that too, then I feel lost and very scared”. Losing control of our bodies, in whichever form this may take, can be scary, embarrassing and hugely anxiety provoking, but when the choice of what to do about that is then also taken away from us, these emotions multiply and dent our self-belief and confidence even further.

Is that the main fear of old age – of losing control of our bodies with an instinct of self-preservation? Of having to give up an element of our independence to be ‘looked after’? Of losing our youth and everything that, in direct contrast to ageing, it represents?

Attending a recent lecture given by a celebrity of the occupational therapy world, Michael Iwama spoke about the relationship between rivers and life; the beginnings at the mouth of our river; the meandering flow of the course of life; the richness of our riverbed and the depth and strength of our banks – shaping, holding and supporting our life’s flow, and the deposits of sediment or rocks which, just like problems in life will create blockages and impede flow. This metaphor demonstrates so clearly the journey we all take in life and the problems or blockages that we come up against. However it also illustrates quite powerfully our ability to keep going, despite the blockages that we might come up against, or the rocks in the river that impede the flow. There will always be a hole to get through, irrespective of how small this space might be. The river must keep flowing.

He further uses driftwood as a metaphor for assets and liabilities in our life which represent the talents and skills that we have or the dislikes and characteristics we possess. This driftwood could, on meeting sediment deposits in the river, either block it up further or else collide with the deposits and knock them out of the way, thus freeing up the blockage. We all have strengths as well as needs and, when meeting a blockage in our river or a problem in our life, it is worth considering how to use our driftwood to help dislodge the problem. We all have a narrative and the older we are, the longer the narrative, the longer the river, the greater the courage and strength to keep flowing.

If we have an older relative or friend who has reached a blockage in their river, whether that be through physical ill-health, cognitive ill-health, mental ill-health or emotional ill-health, take some time with them to discover their narrative and their stock of driftwood; their likes, skills, talents and motivations. Unless you have Power of Attorney and permission to make decisions for that person, include them in your discussions and give them the information they need to take part in any decision making. Having open and honest discussions may provide you all with a solution for freeing up the flow of life, for making life more comfortable and smooth. There will always be a hole to get through, but everyone needs to be involved to find it and plan the best course of action to get through it, without getting lost, confused and scared in the process.

Who cares?

The subject of remaining in your own home can often be a point of tension within families – balancing that much wanted need and desire of older people to remain independent whilst not worrying family members to distraction.

We believe that communication is key and, in particular, listening to each other’s perspective to get to a solution that is right for everyone.

We are not saying that the discussion will be easy – but it might just make things easier to deal with – something we have tried to illustrate in the infographic below (click on the link for a higher quality version).

Who cares? Infographic

Who cares? Infographic