Preventing Falls

Many a fall happen in life, be it in the eyes of others, from power, from grace, or simply a physical bodily fall even as it is not for nothing that Adam had a fall from virtue that tore his image into a multitude of parts making every particle each one of us.

While people desperately struggle to prevent any of these different kinds of falls, in this write-up, we just consider the simple physical or bodily fall that leads to physical harm especially among the elderly.

According to the World Health Organisation (WHO), falls are the second leading cause of unintentional injury deaths worldwide. Each year an estimated 684000 individuals die from falls globally of which over 80% are in low- and middle-income countries. Adults older than 60 years of age suffer the greatest number of fatal falls. 37.3 million falls that are severe enough to require medical attention occur each year.

In 2018-19 falls were identified as the leading cause of injury-related hospitalisations, accounting for 3 out of 4 presentations to the hospital. There were close to 53,000 emergency presentations and 44,000 hospitalisations for people over 65 years.

Around 3% of older Victorians were admitted to hospital as a result of a fall, with an annual increase of 4.4% in fall-related admissions. In that same year, 62% of those aged 65 years and above and admitted to hospital as a result of a fall, were women. Older people are almost 12 times more likely to have a fall than a motor vehicle or pedestrian accident.

Globally, falls are a major public health problem inasmuch as falls are responsible for over 38 million DALYs (disability-adjusted life years) lost each year(2), and result in more years lived with disability than transport injury, drowning, burns and poisoning combined. While nearly 40% of the total DALYs lost due to falls worldwide occurs in children, this may not accurately reflect the impact of fall-related disabilities for older individuals who have fewer life years to lose. In addition, those individuals who fall and suffer a disability, particularly older people, are at a major risk for subsequent long-term care and institutionalization.

It is estimated that at least one-third of people aged 65 years and above fall one or more times a year. Although many of these falls do not result in injury, they can cause: hip and wrist fractures, chest injuries including rib fractures, hip and shoulder dislocations, head injuries and abrasions, bruises and sprains; fear of falling that can result in loss of confidence and restriction of activities. The financial costs from fall-related injuries are substantial. For people aged 65 years or older, the average health system cost per fall injury in the Republic of Finland and Australia are US$ 3611 and US$ 1049 respectively. Evidence from Canada suggests the implementation of effective prevention strategies with a subsequent 20% reduction in the incidence of falls among children under 10 years of age could create a net savings of over US$ 120 million each year.

There are a number of factors that contribute to our risk of falling as we grow older, which include: age-related changes in our body such as poor eyesight, slowed reaction time, cognitive loss and reduced sensation or numbness in lower limbs; weakening of muscles and stiffening of joints; side effects from your medication – especially if one is taking 5 or more medicines; sensory, unsteadiness and balance problems; not doing enough physical activity; poor diet and not drinking enough water; low calcium – increases the risk of having a fracture if you do fall; sore feet or unsafe shoes; trip or slip hazards like rugs or floor mats, uneven or wet surfaces and poor lighting at home or outside. A short-term illness, such as the flu or another infection, or recovering from surgery or a recent hospital stay can also temporarily increase your risk of falling.

Contrary to popular belief, falls are not inevitable and many older people can be prevented from falling. Some risk factors for falls are relatively easy to change and, where falls occur, the severity of injuries can be reduced. The first step is to ensure that if a person is feeling unsteady or has a fall, even one that does not cause an injury, an appointment is made to discuss this with a doctor. Falls can be an indicator of an underlying health problem.

A simple accident like tripping on a rug or slipping on a wet floor can change one’s life. If you fall, you could break a bone, which thousands of older adults experience each year. For older people, a broken bone can also be the start of more serious health problems and can lead to long-term disability. If you or an older adult in your life has fallen, you are not alone. More than one in four people age 65 years or older fall each year. The risk of falling — and fall-related problems — rises with age. However, many falls can be prevented. For example, exercising, managing your medications, having your vision checked, and making your home safer are all steps you can take to prevent a fall.

Many older adults fear falling, even if they haven’t fallen before. This fear may lead them to avoid activities such as walking, shopping, or taking part in social activities. But staying active is important to keeping your body healthy and actually helps to prevent falls. So don’t let a fear of falling keep you from being active! Learn about what causes falls and how to lower your risk of falling so you can feel more comfortable with staying active.

Many things can cause a fall. Your eyesight, hearing, and reflexes might not be as sharp as they were when you were younger. Certain conditions, such as diabetes, heart disease, or problems with your thyroid, nerves, feet, or blood vessels can affect your balance and lead to a fall. Conditions that cause rushed movement to the bathroom, such as incontinence, may also increase the chance of falling.

Older adults with mild cognitive impairment or certain types of dementia are at higher risk of falling. Age-related loss of muscle mass (known as sarcopenia), problems with balance and gait, and blood pressure that drops too much when you get up from lying down or sitting (called postural hypotension) are all risk factors for falling.

Foot problems that cause pain, and unsafe footwear such as backless shoes or high heels, can also increase your risk of falling. Some medications can increase a person’s risk of falling because they cause side effects such as dizziness or confusion. The more medications you take, the more likely you are to fall. Safety hazards in the home or community environment can also lead to falls.

If you take care of your overall health, you may have a lower chance of falling. Most of the time, falls and accidents don’t just happen for no reason. Here are a few tips to help lessen your risk of falls and broken bones, also known as fractures: Stay physically active. Plan an exercise programme that is right for you. Regular exercise improves muscles and makes you stronger. Exercise also helps keep your joints, tendons, and ligaments flexible.

Mild weight-bearing activities, such as walking or climbing stairs, may slow bone loss from osteoporosis, a disease that makes bones weak and more likely to break. Try balance and strength training exercises. Yoga, Pilates, and tai chi can all improve balance and muscle strength. You can also try lifting weights or using resistance bands to build strength.

Fall-proof your home. For increasing safety in the home to reduce the risk of falling there should be good lighting, especially between the bed and the bathroom or toilet at night and near any internal steps. Light globes could be replaced with CFL energy efficient light globes of 12 watts or higher.

Plug-in night-lights could be used for movement near stairs and the bathroom. Daytime glare through glass doors and windows can be reduced with sheer blinds. Remove clutter and make sure walkways and corridors are kept clear and well lit. Repair or replace carpets with worn areas, holes or long threads. Check that mats and rugs are secure and have no tears or wrinkles.

Put adhesive strips on all mats and rugs, including those in the bathroom. Make sure that chairs and beds are sturdy and easy to get into and out of, and that tables and benches do not have sharp corners and edges. Wipe up spills immediately. Install grab rails in the bathroom (towel rails are not usually strong enough to use as grab rails).

Bathroom tiles can be slippery, especially when wet. Cover these areas with a non-slip material or treatments. Avoid having highly polished floorboards. Install support rails near steps if there is no hand rail. To reduce the risk of falling in an emergency, make sure your house has smoke alarms in working order and a fire blanket or extinguisher that is easy to reach.

Avoid wearing clothing that is too long or touching the floor, as this can cause you to trip over (for example, your dressing gown). Do not wear socks or loose slippers around the home. Ask an occupational therapist about ways to make your home safer.

To increase safety outside the home to reduce your risk of falling: Clear away garden tools. Avoid using ladders, or ask someone for assistance if you need to access something at height (for example reaching to a high shelf in the pantry, or changing a light bulb). Remove leaves, moss, fungi and lichen that make garden paths slippery when wet. Mark the leading edge of outside steps (for example, with white paint) so they are easy to see. Install grab rails next to steps that do not have hand rails. Make sure outside steps are well lit. Keep paths well swept. Repair broken, uneven or cracked paths, patios and other walking surfaces. Report cracked footpaths to your local council. Wear sunglasses and a hat to reduce sun glare.

Take extra caution when walking on wet or icy surfaces. These can be very slippery! Use an ice melt product or sand to clear icy areas by your doors and walkways. Keep your hands free. Use a shoulder bag, fanny pack, or backpack to leave your hands free to hold on to railings. Choose the right footwear. To fully support your feet, wear non-skid, rubber-soled, low-heeled shoes. Don’t walk on stairs or floors in socks or in shoes and slippers with smooth soles. Consider staying inside when the weather is bad. Always tell your doctor if you have fallen since your last check-up, even if you did not feel pain when you fell. A fall can alert your doctor to a new medical problem or issues with your medications or eyesight that can be corrected. Your doctor may suggest physical therapy, a walking aid, or other steps to help prevent future falls.

If, in spite of these precautions, you unfortunately happen to have a fall at home, don’t panic – stay still for a few minutes and try to calm down and then call for help if you can. Decide whether you can get up yourself and if you can get up by yourself, roll over onto your stomach and try to get into a crawling position.

Crawl to a stable piece of furniture, like a lounge chair and try to get up on your knees. Push up, using your strongest leg and arms, still firmly holding onto the furniture and sit down on the furniture.

To maximise your physical wellbeing and reduce your risk of falls 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. Stay healthy!

Bhushan Lal Razdan was formerly of the Indian Revenue Service and retired as Director General of Income Tax (Investigation), Chandigarh. He contributes articles of contemporary relevance in Newspapers and Magazines.