IL Community News
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always one step ahead
always one step ahead
Between a third and half of people over 65 suffer a fall in any given year.
Whilst many are minor, about a quarter will result in physical injury that requires medical attention, including broken bones.
This area of the site looks at the causes of falls, and how to prevent them.
The causes can be many and complex, the subject of considerable research
in the healthcare community. There are, however, some factors that feature
very regularly:
• A previous fall Somebody who has fallen in the
last year is more likely to fall again. This may be because the same factor
that caused the first fall is still present, or it may be that fear of
falling has reduced their level of activity, making them weaker and more
prone to fall.
• Medications Some widely used drugs, including
anti-depressants and diuretics, can cause dizziness and loss of balance.
The likelihood of falling is increased quite significantly if you take
a combination of four or more drugs.
• Poor balance and impaired gait Balance problems
are common as we get older and less active. Inability to walk in a straight
line or at a steady speed; requiring support in order to walk; inability
to stand on one leg or to sit down in a controlled manner, can all indicate
an increased likelihood of falling.
• Effects of illness Several acute and chronic
conditions increase the likelihood of falling. Parkinson's disease is
associated with a much increased risk, as is stroke, particularly in the
early months of the recovery period. Conditions like Alzheimer's, where
cognitive ability and hazard perception are impaired, also bring increased
risk. Low blood pressure, and low blood sugar levels (hypoglycaemia) associated
with diabetes, can both cause dizziness, leading to falls. Osteoporosis
(brittle bones) does not make you more likely to fall, but it does significantly
increase the possibility of the fall causing a fracture, most likely of
the hip or wrist. Research suggests, however, that arthritis - which one
might imagine contributing to falls - does not have an impact.
• Poor vision Not surprisingly, you are more likely
to trip if you can't see obstacles clearly. Bifocal and varifocal glasses
can also cause problems by distorting the view, if you look through the
wrong part of the lens.
• Environmental hazards Most falls occur in the
home. Familiar culprits are trailing flexes, uneven rugs, poor lighting,
general household clutter left in passageways. Climbing on chairs or stools
to reach items stored in high cupboards. Outside, it is often damaged,
uneven paving or unexpectedly high kerbs that cause problems.
Any fall, even if it doesn't injure you, will shake you up for a while.
It may make you anxious about falling again, so reducing your enthusiasm
for physical activities. Lack of confidence may prevent you from undertaking
everyday outings, such as a trip to the shops.
In the longer term, fear of falling can be as disabling as a fall itself.
For a person who lives alone, or spends long periods without contact,
if they fall and find that they cannot get up again, they may spend many
hours on the floor, in considerable discomfort. Consequences of this can
include hypothermia, pneumonia, pressure sores - and will make recovery
from the fall much slower and less certain.
As mentioned above, about a quarter of falls cause injuries that require
medical attention. Broken bones in particular may result in hospitalisation.
The injuries caused by a fall may prevent a person from looking after
themselves independently. They may be unable to go out alone, or manage
their domestic chores or personal care. Ultimately, they may feel obliged
to move from their own home to an environment where there is more care
available.
For the individual these consequences amount to a great lessening in
quality of life; they may feel anxious, fearful, embarrassed or guilty
about needing support. For friends and relatives, the fall may trigger
a period of having to provide more care and company, irrespective of other
family duties and work commitments. And society as a whole picks up the
not-inconsiderable financial bill: £908 million spent annually by
the NHS on treating the consequences of falls among the over-60s (£600
million of that goes on treating over-75s). Sadly, 40% of those who have
a hip fracture die within six months, and a quarter of all those who need
hospital treatment following a fall die within a year.
There are various steps you can take to save yourself or someone you
care for, from falling.
• Exercise
It is important to keep physically active, to maintain strength and agility.
Any physical exercise that you enjoy is good (if you enjoy it, you are
more likely to do it regularly!)
Walking, swimming, cycling will all build stamina and help keep you supple,
and there are specific types of exercise that you can do to improve
your balance. You can find out more about this, and at the same
time, help researchers at the University of Southampton who are working
on ways to improve balance, by visiting the dedicated website, www.balancetraining.org.uk
(it will open in a new browser window).
Weight-bearing exercise, such as walking, dancing, kick boxing or weight-lifting
can help to maintain bone density, and is particularly important for menopausal
and post-menopausal women. Strong bones are less likely to fracture if
you do have a fall.
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• Diet
As with all other aspects of health and well-being, eating a good varied
diet, with plenty of fresh fruit and vegetables, will help to keep your
energy levels high and bones and muscles strong.
Calcium and vitamin D are important for bones - we get most of our vitamin
D from exposure to sunlight, so feel free to enjoy some time in the sun,
just don't go out in strong sun without protection.
Eat regularly, to keep blood sugar levels steady. Four or five small
meals are much better for you than one or two big ones with long gaps
in between. You are more likely to fall when you are tired. Starchy foods
like pasta and wholemeal bread will give you sustained energy, which is
much better than the 'quick fix' of a sugary snack when you feel a bit
low.
You can read more about nutrition in our Eating
Well section.
Although moderate intake of alcohol, especially red wine, has been shown
to have health benefits, too much can definitely impair your balance and
judgment, so take it easy!
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• Around the home
Make sure that you make your home as safe as possible.
Arrange electrical appliances so that they are close to the socket, rather
than having a long flex. Make sure that any carpets and rugs are securely
fixed, without curling edges to catch you. Keep an eye particularly on
stair-runners, which can become loose with time, and the carpet at the
top of the stairs, which gets a lot of wear, and can be dangerous if frayed
into holes. Be tidy - don't leave items lying about where they can trip
people up.
To counteract failing vision, make sure that halls and stairs in particular
are brightly lit. You can mark the edges of steps with a high contrast
adhesive strip, to make them more visible.
Resist the temptation to hop up on a chair to lift something down, or
to do jobs like changing lightbulbs or hanging curtains. Store those items
that you use regularly within easy reach, and ideally, wait until there
is somebody available to help you with anything out of the way. If you
have to climb, use sturdy steps properly set up on level ground. If you
don't have family, friends or a helpful neighbour to lend support when
necessary, find out about any local "handy man" schemes: Age
UK organises them around the country, so your local branch is a good
place to enquire.
You can read more about home safety here.
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• Personal care
Vision has already been mentioned as a factor in falls.
Make sure that eyes are tested regularly (free eye tests for the over-60s)
and wear your glasses if you need them. As specs with multiple lenses
can cause problems, consider having two separate pairs for distance vision
and close work. There is financial help available to buy glasses if you
have a limited income.
Feet
are also extremely important. You are less likely to walk with confidence
if your feet are painful. A regular visit to the podiatrist (chiropodist)
to deal with problems like corns, bunions and verrucas is important. If
your soles or heels are painful when you walk, gel cushioning in your
shoes can help. And make sure that the shoes themselves are both comfortable
and secure: floppy slippers and sandals, backless shoes and very high
heels can all contribute to instability.
Take care of general health: many GPs surgeries now
provide "well person" clinics to monitor things like blood pressure,
cholesterol, diabetes and weight. Episodes of dizziness or lightheadedness
may lead to loss of balance. These can be associated with various medical
conditions, as explained above, or may be a side effect of certain drugs,
particularly in combination. It is important never to stop taking your
prescribed medication without consulting your GP. Equally, if you experience
unpleasant symptoms, you should let him or her know, so that your prescriptions
can be re-evaluated.
Ears and hearing are closely involved with balance.
Ear infections can upset your balance, as can a build-up of wax in the
ear canals. So make sure that you get prompt attention for this problem.
Don't
set yourself up for a fall by wearing clothes that trail
or impede your movements. Long skirts and loose trousers can catch your
heel, particularly as you climb stairs, while skirts that are too tight
can make it awkward to move naturally, and cause you to stumble.
If you or the person you care for have osteoporosis, you can help to
protect against hip fractures in a fall, by wearing hip protectors
(left).
These are lightweight shields worn in special underwear or trousers,
which cushion the vulnerable areas and absorb the force of a fall.
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• Alarms and monitors
Somebody who is frail, unwell or confused, is more likely to fall when
they move - for example, trying to get out of bed or a chair unaided.
There are various alerting products available that will let you know when
the person you care for is trying to move, so that you can be on hand
to assist them.
Bed and chair monitors work by sensing changes in pressure
as the occupant moves, and triggering an alert. You can also have features
such as automatically turning on a light when a person gets out of bed
in the night.
If
you are worried about a confused friend or relative falling on
the stairs or wandering out of the house and into danger, again
you can set up motion or proximity sensors that will alert you if they
move into areas of risk. The sensors can be combined with a discreet wristband
tag, worn like a watch (right). As well as advising you of the situation,
some systems include a spoken message - recorded in your own voice - to
reassure or prompt the person to go back to a safer area.
As well as these passive alerts, you are probably familiar with the active
alarm systems which can be used to summon help in the event of
a fall. These usually include a telephone with emergency push button and
a pendant alarm, which should be worn all the time, so that it is accessible
if needed. The signal is transmitted to a call centre, which then calls
emergency services and/or a designated friend or relative, to provide
assistance.
This type of personal alarm can bring great psychological benefits, as
well. Fear of falling can be as incapacitating as a fall itself: knowing
that you can summon help in an emergency can make the difference between
living independently, or moving into a care environment.
For family carers, the range of monitors and alarms available can help
alleviate worries about leaving the cared-for unattended, whether for
short or longer periods.
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• Low Beds and Mats
For people who are liable to fall or climb out of bed and hurt themselves, an ultra-low bed is ideal.
The options now available include straightforward low level beds, designed to accommodate a mobile hoist
(an important consideration in the selection of any care bed), as well as ultra-low electrically powered
profiling beds, which offer all the advantages of being able to adjust the position of the pillow, backrest
and leg rest sections, in order to make the occupant as comfortable as possible, as well as the ability for
the carer to work at a height which is safe and convenient for them, before returning the bed to a much
lower level.
For extra security, safety rails may be used and / or a thick supportive mat be placed next to the bed,
to cushion any fall. Care must be taken in this case, to ensure that the patient cannot become entrapped
between the bed and the mat.
You can read more about care beds here.
Even a minor fall is bound to leave you feeling shocked and shaken, so
give yourself a little time to recover, and try to remain calm.
If you feel unable to move, try to summon help, by activating a pendant
alarm if you have one, or by calling out or banging on a wall. If you
can, crawl or pull yourself towards the telephone and call 999.
If you have fallen on a hard surface, like a kitchen or bathroom floor,
try to move yourself to a warmer, carpeted one. if you are in a draughty
area, like a hallway, try moving to a warmer one.
If it is possible, reach for something that could help to keep you warm,
like a duvet or blanket, or some items of clothing.
Remember that lying completely still can cause more problems, so while
you wait for help to arrive, try to shift your position, or rock yourself
gently. This will keep you a bit warmer and more alert, and prevent stiffness
and pressure damage. If you have an injury, though, you should keep the
injured area still.
Don't try to get up if you think you are injured - you could cause more
damage.
If you are uninjured, and feel that you can get up once you've had time
to recover a bit, take it in stages. Turn onto your hands and knees and
crawl towards a chair - one without castors. Use the seat of the chair
as a rest for your hands as you push yourself upright, with first one
foot, then the other, flat on the floor. Sit on the chair and rest for
a while before standing up.
After any fall, it is a good idea to see your doctor, who can check for
possible causes and help you avoid future falls.
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• If someone you care for falls
Don't panic - check that they are breathing and conscious. If not, call
for emergency help immediately.
Reassure them, if they are conscious, and cover them with a blanket to
keep them warm until help arrives.
Do not attempt to move them if they are injured.
If they are uninjured you may be able to encourage them through the procedure
described above to get back up safely using a chair, but if they are unable
to do so, be careful not to risk injuring yourself in helping them.
You can attend workshops and learn how to assist a fallen person safely,
and there are products, such as an
emergency lifting cushion, that can
assist. If you are caring for someone who is prone to falling, it would
be prudent to be prepared.
Otherwise, it is better to summon help from professionals. Ambulance
crews are accustomed to assisting, and in some areas of the country there
are dedicated fall assistance teams who attend fall-related emergency
calls, allowing the ambulances to deal with more life-threatening cases.
