Preventing Falls

Falls and fractures in older people are often preventable. Reducing falls and fractures is important for maintaining the health, wellbeing and independence of older people.

A fall is defined as an event which causes a person to, unintentionally, rest on the ground or lower level, and is not a result of a major intrinsic event (such as a stroke) or overwhelming hazard. Having a fall can happen to anyone; it is an unfortunate but normal result of human anatomy. However, as people get older, they are more likely to fall over. Falls can become recurrent and result in injuries including head injuries and hip fractures.

The causes of having a fall are multifactorial – a fall is the result of the interplay of multiple risk factors. These include:

• muscle weakness
• poor balance
• visual impairment
• polypharmacy – and the use of certain medicines
• environmental hazards
• some specific medical conditions, which might make a person more likely to fall

Falls are events resulting from the presence of risk factors. The likelihood and severity of injury resulting from an event is related to a number of possible factors including bone health, risk of falls, frailty and low weight. Strong bones are important for your health. People with low bone mineral density are more likely to experience a fracture following a fall. Osteoporosis is one of the reasons why people have low bone mineral density.

Over 3 million people in the UK have osteoporosis and they are at much greater risk of fragility fractures. Fragility fractures are fractures that result from mechanical forces that would not ordinarily result in fracture, known as low-level (or ‘low energy’) trauma. The World Health Organization (WHO) has quantified this as ‘forces equivalent to a fall from a standing height or less’. Hip fractures alone account for 1.8 million hospital bed days and £1.1 billion in hospital costs every year, excluding the high cost of social care.

Risk factors

Among the many factors which might cause a fall and injury are:

• Footwear: ill-fitting or otherwise unsuitable footwear can interfere with a person’s walking ability. Footwear should always be checked for suitability for what the person is doing on the day.
• Floor surfaces: carpets can have a pile that can cause extra drag on the feet. Some smooth floors present a risk of slipping, particularly if polished or if fitted with rugs or mats.
• Issues of strength and fitness, poor foot care or disorientation of the person can cause instability with increased risk of falling.
• The environment should allow sufficient space, with support such as rails on the wall and other aids to mobility.
• The person’s level of activity may be relevant: if the person is not often mobile during the day, then leg muscles may be weak or dizziness on standing, or walking can occur.
• Dehydration or poor nutrition may affect a person’s balance, with increased risk of falls and injury.

Tips for preventing falls in the home include:

• immediately mopping up spillages
• removing clutter, trailing wires and frayed carpet
• using non-slip mats and rugs
• making sure all rooms, passages and staircases are well lit
• organizing your home so that climbing, stretching and bending are kept to a minimum, and to avoid bumping into things
• getting help to do things you’re unable to do safely on your own
• not walking on slippery floors in socks or tights
• not wearing loose-fitting, trailing clothes that might trip you up
• wearing well-fitting shoes that are in good condition and support the ankle
• taking care of your feet by trimming your toenails regularly and seeing a GP or podiatrist (foot health professional) about any foot problems

Strength and balance training

Doing regular strength exercises and balance exercises can improve your strength and balance and reduce your risk of having a fall.

This can take the form of simple activities such as walking and dancing, or specialist training programmes.

Many community centres and local gyms offer specialist training programmes for older people.

Exercises that can be carried out at home are also available. Ask a GP about training programmes in your area.

It’s important that a strength and balance training programme is tailored to the individual and monitored by an appropriately trained professional.

There’s also evidence that taking part in regular tai chi sessions can reduce the risk of falls. Tai chi is a Chinese martial art that places particular emphasis on movement, balance and co-ordination.

Unlike other martial arts, tai chi does not involve physical contact or rapid physical movements, making it an ideal activity for older people.

Read more about physical activity guidelines for older adults

Sight Test

Look after your eyes and make an appointment to have a sight test if you’re concerned that vision loss (even when wearing glasses) is increasing your risk of having a fall.

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. Avoiding alcohol or reducing the amount you drink can reduce your risk of having a fall. Excessive drinking can also contribute to the development of osteoporosis.

Further Simple tips to prevent falls

1. Make an appointment with your health care provider

Start by making an appointment with your health care provider. To assess your risk and discuss fall prevention strategies, your health care provider may want to talk about the following:

• Your medications. Make a list of your prescription and non-prescription medications and supplements or bring them with you to the appointment. Your health care provider can review your medications for side effects and interactions that may increase your risk of falling. To help with fall prevention, your health care provider may consider weaning you off medications that make you tired or affect your thinking, such as sedatives, antihistamines and some types of antidepressants.
• Any previous falls. Write down the details, including when, where and how you fell. Be prepared to discuss instances when you almost fell but were caught by someone or managed to grab hold of something just in time. Details such as these may help your health care provider identify specific fall prevention strategies.
• Your health conditions. Certain eye and ear disorders may increase your risk of falls. Be prepared to discuss your health conditions and how comfortable you are when you walk — for example, do you feel any dizziness, joint pain, shortness of breath, or numbness in your feet and legs when you walk? Your health care provider may evaluate your muscle strength, balance and walking style (gait) as well.

2. Keep moving

Physical activity can go a long way toward fall prevention. With your health care provider’s OK, consider activities such as walking, water workouts or tai chi — a gentle exercise that involves slow and graceful dance-like movements. These activities reduce the risk of falls by improving strength, balance, coordination and flexibility.

If you avoid physical activity because you’re afraid it will make a fall more likely, tell your health care provider. Your provider may recommend carefully monitored exercise programs or refer you to a physical therapist. The physical therapist can create a custom exercise program aimed at improving your balance, flexibility and muscle strength.

3. Wear sensible shoes

Consider changing your footwear as part of your fall prevention plan. High heels, floppy slippers and shoes with slick soles can make you slip, stumble and fall. So can walking in your stocking feet. Instead, wear properly fitting, sturdy, flat shoes with non-skid soles. Sensible shoes may also reduce joint pain.

   4. Remove Home Hazards 

Take a look around your home for potential fall hazards. To make your home safer:

• Remove boxes, newspapers, electrical cords and phone cords from walkways.
• Move coffee tables, magazine racks and plant stand from high-traffic areas.
• Secure loose rugs with double-faced tape, tacks or a slip-resistant backing — or remove loose rugs from your home.
• Repair loose, wooden floorboards and carpeting right away.
• Store clothing, dishes, food and other necessities within easy reach.
• Immediately clean spilled liquids, grease or food.
• Use nonslip mats in your bathtub or shower. Use a bath seat, which allows you to sit while showering.

5. Light up your living space

Keep your home brightly lit to avoid tripping on objects that are hard to see. Also:

• Place night lights in your bedroom, bathroom and hallways.
• Place a lamp within reach of your bed in case you need to get up in the middle of the night.
• Make clear paths to light switches that aren’t near room entrances. Consider trading traditional switches for glow-in-the-dark or illuminated switches.
• Turn on the lights before going up or down stairs.
• Store flashlights in easy-to-find places in case of power outages.

6. Use assistive devices

Your health care provider might recommend using a cane or walker to keep you steady. Other assistive devices can help, too. For example:

• Handrails for both sides of stairways
• Nonslip treads for bare-wood steps
• A raised toilet seat or one with armrests
• Grab bars for the shower or tub
• A sturdy plastic seat for the shower or tub — plus a hand-held shower nozzle for bathing while sitting down

If necessary, ask your health care provider for a referral to an occupational therapist. An occupational therapist can help you brainstorm other fall prevention strategies. Some solutions are easily installed and relatively inexpensive. Others may require professional help or a larger investment. If you’re concerned about the cost, remember that an investment in fall prevention is an investment in your independence.

Adapted from

Gov.uk-Falls: Falls: applying All Our Health – GOV.UK (www.gov.uk)

CQC-Preventing Falls in Care Settings: Preventing falls in care settings – | QCS Blog

Hospice of the North Coast-Fall Prevention: Simple Tips to Prevent Falls

  Prevention: Simple Tips to Prevent Falls – Hospice of the North Coast (hospicenorthcoast.org)

How to Prevent Falls in Littleton Co– How to Prevent Falls in Littleton CO – Dody Chiropractic