Falls
Introduction
The great majority of accidents involving older people are falls. Falls are not an inevitable consequence of getting older. Experts believe that the vast majority of falls could be avoided by some fairly modest changes to our lifestyle and homes.
Despite this, more than 3,500 people in England and Wales die every year as a result of a fall and nearly a third of a million people need hospital treatment, with one in every five falls among women aged 55 and over resulting in fractures.
Although most falls do not result in serious injury, being unable to get up exposes the faller to the risk of hypothermia and pressure sores.
Many older people who suffer from falls never fully recover from either the physical or psychological impact of their injuries. After a fall, an older person has a 50 percent probability of having their mobility seriously impaired and a 10 percent probability of dying within a year.
Exercise
Balance impairment and muscle weakness are the most prevalent risk factors for falls, and therapeutic exercise, addressing strength, flexibility and balance, is the most effective component of falls prevention.
Between the ages of 50 and 70, we lose 30% of our muscle strength. Nevertheless it is possible to improve muscle strength and balance with exercise at any age.
A tailored programme for falls prevention can reduce the risk of falls by up to 54 percent, but not all exercises are effective in preventing falls.
In order to be effective and performed safely, exercise programmes should:
- challenge balance and improve strength, through resistance training and exercise in a standing position
- be tailored to the individual. They should be sufficiently challenging to and progressive for the individual. i.e. pitched at the right level, taking falls history and medical conditions into account
- be sufficiently progressive
- be carried out 2–3 times a week
- be carried out for at least 50 hours over the course of the programme.
Effectiveness is best ensured when the strength and balance training programme is monitored by professionals trained to deliver specialist falls prevention exercise programmes, as they can appropriately assess participants at the outset of the programme, adapt exercises where necessary and ensure progression at the right level, for example by advising on the right intensity and number of repetitions.
The Hidden Dangers of Sitting
Prolonged sitting accelerates the effects of ageing, and increases the degeneration of balance, muscles and joints. It is thought excessive sitting slows the metabolism – which affects our ability to regulate blood sugar and blood pressure, and break down body fat – and may cause weaker muscles and bones.
The link between illness and sitting first emerged in the 1950s, when researchers found double decker bus drivers were twice as likely to have heart attacks as their bus conductor colleagues. The drivers sat for 90 percent of their shifts, the conductors climbed about 600 stairs each working day.
Additionally, avoiding moving round because of fear of falls is a vicious cycle, as this damages balance and strength, and makes a fall more likely. This cycle reduces independence and confidence.
Try to break up periods of sitting with regular movement. If you do need to sit then try to remain as straight as possible, to avoid a stooped posture which can increase the risk of falls.
Tips to reduce sitting time:
- avoid long periods sitting in front of a TV or computer
- stand up and move during TV advert breaks
- stand or walk while on the phone
- use the stairs as much as possible
- take up active hobbies such as gardening and DIY
- join in community-based activities, such as dance classes and walking groups
- take up active play with grandchildren, if you have them
- do most types of housework
- even just standing up and sitting down frequently can help.
Balance
Although balance can be greatly influenced by exercise, other practical steps can also be taken to prevent balance loss. These include:
- avoiding sudden movements, particularly getting out of a bed or chair too quickly. It may help to count to 10 before moving off after sitting for a while
- sitting on the edge of the bed, and doing a few seconds of marching with the legs to get the blood flowing; this will reduce the chance of dizziness on standing up
- avoiding very hot baths or showers, also using a shower seat, as hot water can cause light headedness
- having grab rails and places to sit down in the bathroom and kitchen, which could be an advantage if dizzy spells occur
- talking to a doctor about medication. As we get older, we are more likely to be taking a number of different medications; some of these can make us feel faint, dizzy or sleepy, which can increase our risk of falls.
- using a walking aid if needed. A study on older people who had a fall-related hip fracture found that 64% percent of those who used a walking aid were not using it when they fell
- taking care that we don’t lose our balance when reaching everyday items; consider fitting a cage over the letter box so post doesn’t have to be picked up from the floor, and avoid putting commonly used items in high or low cupboards.
Other Ideas for Reducing Risk
The most serious accidents involving older people usually happen on the stairs or in the kitchen. The bedroom and the living room are the most common locations for accidents in general.
Some ideas for reducing the risk of falls include:
- organising the home so that climbing, stretching and bending are kept to a minimum, and to avoid bumping into things
- keeping tea and coffee near the kettle
- standing straight when walking, avoid shuffling
- staying warm enough, cold muscles do not work as efficiently
- ensuring beds and chairs are at the right height and mattresses and chair cushions are not too soft, to make standing up easier
- making sure to switch on a light before getting out of bed; also talking to your doctor if you have problems with continence, as sometimes incontinence can be improved or even cured. Rushing to the loo, especially at night, can make falls more likely
- getting help to do things you’re unable to do safely on your own.
- reducing or avoiding alcohol. Drinking alcohol can lead to loss of co-ordination and exaggerate the effects of some medicines. This can significantly increase the risk of a fall, particularly in older people. Also alcohol can affect us more as we age, partly because the risk of muscle loss increases, so the body cannot absorb alcohol as easily. Excessive drinking can also contribute to the development of osteoporosis, increasing the risk of fractures.
Home hazard assessments can be requested via a GP. These will likely be carried out by the local occupational therapy team; they can give advice on how to reduce the risk of falls, and may be able to help with equipment such as grab rails.
Slips and Trips
These are a major cause of falls. Risk can be reduced by:
- using a non-slip mat in the bath or shower
- taking care with air fresheners. When sprayed, these can create a slippery ‘film’ on the floor
- avoiding slippy socks or tights on hard floors
- mopping up spillages immediately
- being particularly aware of trailing wires and cables
- removing rugs when possible; otherwise, checking they have non-slip underlay. Frayed carpet can be removed, or someone can be asked to tack it down
- reducing clutter as far as possible, to make sure there is space to move round
- considering a bright collar and a bell for pets, to prevent them being tripped over
- making sure clothes are not trailing and trousers are not too long.
Stairs
The largest proportion of accidents in older people are falls from stairs or steps, and these accidents tend to be the most serious. Tips to increase safety on the stairs include:
- avoiding leaving items on stairs and steps – they can become a tripping hazard
- ensuring stairs are carefully maintained – damaged or worn carpet should be repaired or removed
- trying to avoid repetitive carpet patterns that may produce a false perception for those with reduced eyesight
- ensuring landings, stairs and hallways are well lit with two-way light switches
- making sure banisters are sturdy. The fitting of two easy-grip handrails gives more stability.
Cover up with anything you can find to stay warm, and put something soft such as a cushion or rolled up clothing under your head. Try to keep moving, rolling from side to side to relieve pressure and help stay warm; try to keep drinking.
Outdoors
Getting out and about is good for our physical and mental health. Tips to do this safely include:
- taking our time and not rushing
- repairing uneven surfaces and ensuring outdoor lighting is good
- taking care entering shops, where there may be a lip in the doorway and the inside may be darker; eyes may need time to adjust
- asking the bus driver to wait until we are seated before moving off, and not standing up until the bus has stopped. Staying safe is more important than worrying about inconveniencing others, chances are no-one has noticed anyway
- always using a walking aid if it helps to stay steady, ensuring the rubber ferrules on the bottom of a stick are in good condition. If a stick doesn’t seem enough, a physiotherapist can advise on changing to a different walking aid.
Resources
Saga Get Up and Go – A Guide to Staying Steady https://www.csp.org.uk/system/files/get_up_and_go_0.pdf
NHS website Prevention of Falls https://www.nhs.uk/conditions/falls/prevention/
Gov.uk Falls- applying All Our Health https://www.gov.uk/government/publications/falls-applying-all-our-health/falls-applying-all-our-health
Health and Safety Executive Slippers Cut Falls by 60% https://www.hse.gov.uk/slips/experience/slippers.htm
Epidemiology, Clinical Practice and Health Analysis of Falls that caused Serious Events in Hospitalised Patients https://onlinelibrary.wiley.com/doi/10.1111/ggi.13085
American Academy of Physical Medicine and Rehabilitation Clinical Profile of Falls with Femoral Neck Fractures https://pubmed.ncbi.nlm.nih.gov/24252491/
Australia and New Zealand Journal of Public Health Wearing Slippers, Falls and Injury in Residential Care https://pubmed.ncbi.nlm.nih.gov/15233359/
Age and Ageing An Evaluation of Footwear Worn at the Time of Hip Fracture https://pubmed.ncbi.nlm.nih.gov/12720618/
Lower Extremity Review Slipper Related Injuries of the Lower Extremity Treated at United States Emergency Departments https://lermagazine.com/home/slipper-related-injuries-of-the-lower-extremity-treated-at-united-states-emergency-departments
ROSPA Older People Safety https://www.rospa.com/policy/home-safety/advice/older-people
Royal Osteoporosis Society Avoiding Slips, Trips and Falls https://theros.org.uk/information-and-support/osteoporosis/living-with-osteoporosis/reducing-your-risk-of-broken-bones/avoiding-slips-trips-and-falls/
Public Health England Active at Home https://www.luton.gov.uk/Health_and_social_care/Lists/LutonDocuments/PDF/Leaflets%20on%20Line/PHE-active-at-home-booklet-Luton-Electronic.pdf
Greater Manchester Combined Authority Ageing Hub Keeping Well This Winter https://www.greatermanchester-ca.gov.uk/media/3842/keeping-well-this-winter-final-19-nov-20.pdf
Falls Assistant Spot the Hazard https://www.fallsassistant.org.uk/games/spot-the-hazard
