Falls in the Elderly
Falls are a serious problem for older adults, often leading to injury, hospital admissions and in some cases, long-term health conditions.
Indeed, 1 in 3 of adults over 65 living at home will have at least one fall a year*.
Although many falls are preventable, the elderly are particularly at risk due to isolation, illness or immobility.In this short introductory guide, we’ll cover the main reasons for falls and how best to reduce the common factors that can lead to an accident.
What Is a Fall?
A fall causes someone to unintentionally end up on the ground, caused by an event that is not the result of a major intrinsic medical event (such as a stroke).
Falls are a common part of life, but they become more serious in the elderly, who may live alone and be unable to raise the alarm when needed.
Most falls luckily don’t result in serious injury, but prevention is always better than a cure. Taking precautions around the house, seeking help if you feel unsteady and engaging in preventative measures will ensure you remain as safe and independent as possible.
Let’s look at some of the risk factors for falls.
Pre-existing medical conditions
Conditions such as heart disease, dementia and neurological issues like stroke or Parkinson’s Disease can all increase the risk of falls, whether due to physical side effects, confusion or difficulties with problem-solving.
Taking numerous medications can lead to symptoms of dizziness, drowsiness and visual problems. These side effects are often related to prescriptions for the heart, mood regulation, epilepsy and sleep.
Dizziness or lightheadedness
These symptoms may be caused by heart issues and the medication used to treat them. Inner ear problems and dehydration may also contribute to these sensations.
Often as we age, our balance tends to deteriorate. This can be due to muscle weakness, visual deterioration, inner ear problems or general immobility. A previous stroke or neurological issues like Multiple Sclerosis can also affect balance.
Osteoporosis causes bones to weaken over time. In the event of a fall, weak bones are far more susceptible to breaks. Hip fractures are especially common and can lead to hospital admission, surgery and in some cases, long term disability.
Rugs and mats
Rugs and mats are potential hazards around the house, and can easily curl at the corners and slip, causing potential tripping hazards.
Liquid on the floor can cause slips and possibly falls. This can be especially problematic on tiled surfaces, such as the kitchen or bathroom.
Moving around the house
Navigating steps around the house and getting into and out of the bath are activities which may be more difficult for an elderly person. Also, movements such as bending down to pick something off the floor can increase the risk of falls and injury.
Time of day
As we age, we often have to get up to use the toilet in the night. Getting out of bed while tired can easily lead to unsteadiness and accidents. Certain bladder and bowel conditions may necessitate rushing to the toilet throughout the day or night.
Corns, calluses, bunions and in-growing toenails can all lead to pain while walking. While compensating for these the pain, unsteadiness may result. What’s more, ill-fitting footwear, such as slippers, can result in shuffling and tripping.
Vision and hearing problems
As we age, we can suffer from more problems with depth perception and adjusting our sight to low light levels. Conditions such as cataracts and glaucoma further add to the risk of falls. Hearing problems may be indicative of an inner ear issue which can affect our balance.
Drinking alcohol, especially in conjunction with some medications, can cause unsteadiness and potential falls.
Consequences of Falling
The most obvious negative consequence of a fall is an immediate injury. This could present as a head injury or hip fracture, necessitating emergency intervention such as hospital admission.
Falls can cause longer-term health complications and increase the risk of mortality.
Even when there’s no serious injury, falling can result in a significant loss of confidence, impacting our emotional wellbeing and causing us to further reduce our activity levels. This can create a vicious cycle, where we exercise less, become weaker, and therefore more prone to falls in the future.
What to Do After a Fall
Immediately after a fall, it’s important to remain calm. Performing a quick mental body scan for pain can alert you to any injuries.
If you feel fine, don’t suspect any injuries and are confident that you can get back to your feet, you can do so slowly. Firstly, roll onto your side, before pushing yourself up onto your elbow and then hands and knees.
The most effective method for standing up is to find a chair/bed or a stable piece of furniture near your head. If there’s nothing within reach, you might be able to move towards a chair on your hands and knees.
Place your hands on the piece of furniture.
Lift one knee and position the foot of your stronger leg flat on the floor. Pushing down through your foot and hands, lift yourself into a half standing position.
Gently re-assess while holding onto the furniture to ensure there is no significant pain/injury. If you used a chair to help you stand up, slowly step round (while holding onto the chair/bed), before sitting down.
Call for help if needed. This might be a loved one, or the emergency services if you’re experiencing pain or dizziness.
If you’re unable to get up using the method above, try calling for help or banging on the wall. If there’s a blanket nearby, cover yourself to keep warm. Use a personal alarm or alternatively a mobile phone to summon help if they’re available.
We’ve analysed the factors that may influence falls. However, where possible, it’s best to address these issues before they lead to an emergency situation.
Let’s look at some precautions you can take to guard against falls:
One of the biggest causes of falls is immobility. We aren’t always as active in our older years and spend more time sitting down. However, this becomes a vicious cycle. The more afraid we are to walk, the weaker and more prone to falls we are. Getting up and exercising regularly is vital.
Use appropriate walking aids
As we encounter balance issues, it’s important to utilise equipment to keep us mobile. Despite the stigma of using a walking stick or frame, safety should be our first priority. Furthermore, if we focus on the additional preventative measures listed here, these walking aids might only be required temporarily until we gain more strength.
As we age, we invariably may be placed on medication to control unstable health conditions. Some of these prescriptions may result in dizziness and unsteadiness.
Optimise your nutrition
Ensure you’re eating a balanced diet and hydrating enough during the day. Such measures will reduce the incidence of associated medical conditions which may lead to falls.
Balance issues are often be caused by weak muscles, which you can focus on training through a series of specific exercises. Your doctor may refer you to a physiotherapist for the prescription a customised exercise programme. Such strengthening can improve your bone health and guard against osteoporosis.
Another series of exercises can focus on your balance, where you practice placing yourself in increasing unstable positions in a controlled environment, which will improve your muscle coordination and reaction time.
Visit the podiatrist/chiropodist
If you have foot or nail problems, this can impact your walking and increase the risk of falling. A podiatrist/chiropodist can assess any foot problems and recommend any measures such as insoles to improve your biomechanics.
Wear appropriate footwear
Using well-fitted footwear with adequate grip will ensure you have good foot clearance and don’t slip or trip.
Get a vision check
Visual problems may be one of the primary causes of falls. Ensuring that you have a regular vision test to monitor any medical conditions and change your glasses prescription will help you identify potential falls hazards and operate in low light conditions more safely.
Have a hearing test
Hearing issues becomes more prevalent with age, while inner ear problems can cause unsteadiness. Visit the GP for a checkup.
Equipment can help you stay safe at home and can be accessed through your GP and referral to an occupational therapist. Grab rails can be installed near steps or in the bathroom, to help you navigate certain areas of the house. Chair raises can assist with sitting to standing, while grabbers can make it easier to pick up dropped objects. Walking aids may provide extra confidence when mobilising around the house or outside.
Where to Seek Help
There can be a certain stigma attached to seeking help for fear of falling, with some sufferers concerned that they’ll lose their independence. However, it’s vital to reach out. Falls can be an early sign of other medical conditions, such as dehydration and infection, which must be addressed.
The first step is to talk to your GP, who can refer you to the appropriate professionals. That might be to a specialist falls assessment programme at your local hospital or a social worker, community physiotherapist or occupational therapist to assess your living environment and current functional status.
What Can You Expect?
You should expect your healthcare practitioner to conduct a walking a balance test to uncover any issues which may predispose you to falls.
If you’ve had previous falls or are deemed at risk, you might be offered a falls risk assessment, taking into account any previous accidents, your current health status and any issues at home.
A home hazard assessment, for example, can identify how your living environment may be improved, including any equipment needs.
Falls are a common risk in older age.
If you have concerns regarding your safety, reach out to your loved ones. Even if family and friends live nearby and call regularly, develop a plan in case of emergency.
Speak to your GP and get the intervention required to keep you safe in your home and community.
* Visit the NHS website for more information.