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The risk of a fall unfortunately increases as we age, and this is one of the reasons why many people choose to get Age UK Personal Alarms. These devices ensure that help is at hand in the event of a fall. They can also make it easier for people to regain their confidence if they have already suffered one of these accidents.
While people may be more likely to experience falls as they age, these accidents are not inevitable. In this post, falls expert Ashley Martin from the Royal Society for the Prevention of Accidents (RoSPA) gives his advice on elderly fall prevention, and on what makes falls so serious for older people.
Falls are so common in older adults because the risk of falling in the home increases with age. In fact, falls affect over a third of people over 65 years old and 40% of people over 80. The cause of a fall is often multifactorial, involving both environmental hazards and an underlying medical condition.
A substantial number of falls are due to unspecified reasons and occur whilst moving about on one level, which may reflect instability associated with impaired general health. Good strength and balance is important for steadying oneself, so it’s understandable that as our strength and balance reduces naturally with age, we’re less steady on our feet.
As bones become more brittle and skin becomes thinner, the likelihood of a serious injury as a result of a fall increases. With a decline in muscle mass we are also less able to get up from a fall and so even if bones are not broken, the likelihood of lying on the floor for a long period of time leads to the risk of other problems such as hypothermia.
Hip fractures are a particular problem. Less than a third of patients who suffer a hip fracture return to the pre-facture levels of activity.
Falls do not have to be inevitable! We can take action to maintain the strength and balance that will help to prevent falls. We can also take steps to make the home environment safer. Although there will always be some who fall, there is action we can take to prevent them.
Often we hear people say “falls only affect older people” or “I’ll worry about that when I’m older”, which could be a dangerous attitude to hold! Although the consequences of falls are often worse for older people, they can happen at any age. If someone has a series of falls it may be an indicator of other health problems or of a greater likelihood of falls in later life.
What’s more, evidence suggests that the more we do to maintain healthy lifestyles while we are younger, the better prepared our bodies will be to prevent falls in later life.
Falls can be brought on by a mixture of health and environmental factors, so it’s important to address both. In terms of what you can do at home, there are a number of changes you could make to improve your safety.
Firstly, take a fresh look at your home and see if there are any tripping hazards, for example rugs, slippery floors, clutter on stairs and walkways, poor lighting, or highly patterned carpets that are causing a problem with visibility. Then figure out which of these potential hazards could be easily modified to be safer.
Having handrails on both sides of the stairs is a great home adaptation that can make a significant difference. Whilst falls on the stairs are thankfully not as common as in other areas of the home, these falls can cause the most serious injuries. Similarly, grab rails can be fitted in bathrooms and any other places where you notice yourself struggling on occasion.
I would recommend firstly keeping surfaces and particularly paths in good repair, and being cautious of slippery paths or wet leaves in bad weather conditions.
As in the home, it could be worth considering installing grab rails on entrance steps or any other areas of the garden where you notice a mobility or stability issue. There’s really no shame in installing these, and it’s much better to do it at the first sign of instability rather than waiting until it is really needed.
It seems to vary with age. For the 65-75 age range it tends to be where people are more active, for example in the living room or garden. However, for over 75s falls tend to happen more in the bedroom.
Falls on stairs are not the most numerous but, for obvious reasons, can be the most serious.
Loss of strength, balance and gait, decline in vision and hearing, mental health problems and deficiencies in the diet are all contributory risk factors. Although prescription medicines are seldom the cause of falls, they may also be a major risk factor.
In addition to increasing the risk of a fall, these health factors can also increase the risk of injury resulting from a fall. Here are some examples of how certain health problems can cause accidents at home.
|Sympton||Type of Accident|
|Decrease in the blood supply||Fainting, leading to falls, contact burns, loss of confidence|
|Decrease in sensation||Scalds in bath, superficial burns to legs (e.g. standing too close to fire), hypothermia, falls|
|Decrease in the skin or bone condition||Bruising, tearing or breaking of tissues may occur when moving around house if rough edges or protrusions are present in the design|
|Decrease in strength||Loss of balance leading to falls, dropping items, inability to lift or move items|
Make sure you have your eyes tested regularly, as you may not notice a slow deterioration over time. Similarly, ask your GP to check your ears as they play a big part in coordinating balance. GPs and falls clinics may also check a patient’s gait and observe them walking.
If you are on four or more medications, make sure you have a medicine use review with your doctor or pharmacist and check regularly whether you still need to be on the medicines you have been prescribed. People on multiple medications are far more likely to fall.
Loss of confidence is a significant outcome for many who have a fall. This in turn leads them to a more sedentary lifestyle and increases the risk of loneliness and isolation.
We recommend people talk to friends and family, their GP or a support service [see bottom of page] about any concerns after a fall to ensure the right measures are being put in place to reduce the risk of it happening again.
Exercise such as walking might be good for general health but there is no evidence that it helps with strength and balance.
Strength and balance exercises are important and there’s lots that you can do easily at home. The NHS has some simple balance improving exercises listed on their website with easy to follow images and instructions. Some of these include side steps, walking toe to heel and standing on one leg (with hands against a wall).
Try to practice these at least twice a week, or whenever you get a chance. You could challenge yourself to one exercise each time you are waiting for the kettle to boil!
Similarly, any exercises which improve strength and balance will be useful. Many people find that yoga and Pilates are good for gently building strength and balance, without too much exertion or risk of injury.
It’s important to always check with your GP if you’re unsure about an activity, and mention any health conditions you may have to the class instructor.
The first thing is don’t panic. Stay calm and take a moment to listen to your body to see if you are hurt. If you feel you can get up, slowly help yourself up using nearby furniture to stabilise yourself. We recommend familiarising yourself with our video (see above) demonstrating how to get up safely after a fall.
You may wish to have a mobile phone or alarm on hand in case you need to call for assistance, allowing you to remain still until help arrives.
Protecting the head is important and injuries quite often happen when people put their arms out to try and break the fall. However, this is not something that we have covered in detail because it is very difficult to think about how you are falling when it can happen so quickly.
They should notify their GP as it might be a symptom of something else, or the start of a problem with falls.
It varies, but there are usually falls services for people with a history of falling and there may be some rehabilitation available from an occupational therapist or physiotherapist. If people who have had falls are not referred to these services, they should contact their GP to find out more.
This is dependent on many factors: the nature of the injury, whether there is permanent disability and the level of the patient’s ability to look after themselves. It is impossible to generalise, but in general terms it’s people who have a recurrent risk of falling (usually with multiple health issues) that need more care. A fall in itself is not an indicator of someone needing full-time care.
There are many useful resources online, including information on ways to prevent falls in elderly people and how to regain confidence after a fall. Here are a few that we recommend.
RoSPA – has lots of useful information on how to stay safe at home and on preventing falls at home. The organisation has been running its Stand Up, Stay Up campaign for over two years, educating businesses and individuals across the country on how to prevent falls in older people.
Age UK Personal Alarm service – If you are worried about the risk of falls at home, you may find a personal alarm invaluable for the peace of mind it can bring. If you’re unsure, feel free to arrange a no obligation demonstration with a representative who can answer any questions you may have.
Age UK – offers advice on preventing falls and a guide to spotting hazards in your home. Age UK also has a guide called Staying Steady that looks at falls and how to reduce your risk of having one. In addition, you can access an advice line that can be called for any further guidance, and attend exercise classes at local Age UK centres.
NHS – The NHS lists some useful and simple exercises that, if practiced regularly, can improve balance and subsequently reduce the risk of falls.
Move it or Lose it – Similarly, Move it or Lose it recommends some exercises which focus on improving strength and balance. It also runs exercise classes across the country which are developed specifically to improve agility, flexibility, balance and strength in older adults.
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