Developing A Fall Prevention Plan for the Elderly

“Watch your step! Be careful, don’t fall!” These words are commonly heard around elderly persons and for good reason. As vision, balance, joints and muscle strength weaken with age, the risks of falling increases correspondingly for the elderly. Globally, one in three elderly persons above 65 years old suffer from falls once a year.

Consequences of Falls among the Elderly

Besides being common, falls also have more serious consequences for the elderly and may result in drastic changes to their quality of life.

Physical Consequences

For instance, pains from strains and bruises take longer to heal and brittle bones face greater likelihood of fractures when falls occur. Many fall injuries among the elderly further lead to reduced mobility. Some may end up requiring long-term care admissions or even result in mortality. Of particular concern are hip fractures from falls. According to medical experts:

• 20 per cent of elderly hip fracture patients die within one year after their fall.
• 50 per cent become dependent on a cane or walker.
• 40 per cent will need to be admitted to a nursing home due to an inability to perform daily activities such as eating, bathing, getting dressed and toileting.
• Only 25 per cent of older adults who suffer a hip fracture from a fall actually make a complete recovery.

Psychological and Social Consequences

Apart from physical effects, falls among elderly are often accompanied by unwanted psychological and social effects as well. Many elderly persons develop a fear of falling after suffering a major fall episode. Consequently, their confidence to manage physical situations is dampened and they become more reliant on help from others to get around. In the absence of available help and not wanting to become a burden to others, many elderly persons coop themselves up at home, becoming socially isolated, lonely and depressed.
The social isolation further sustains a vicious fall cycle where:

• An initial fall leads to a fear of falling.
• The fear of falling leads to a reduction in social and physical activities.
• The lack of physical activities leads to increased muscle atrophy affecting muscle strength and balance
• Decreased physical function leads to greater fall risks.

Fall Prevention

What is tragic about falls among the elderly is that often times, many of these falls can be prevented by taking appropriate steps to mitigate the risk of falls. Fall prevention measures can be practiced in the following areas:

Home

According to the Health Promotion Board, 63% of falls among the elderly in Singapore occur at home. Preventing falls from occurring at home should hence be a major concern for the elderly and their caregivers. The following are some simple steps that can be taken:

• Make it a habit to immediately clear away any items that may trip a passerby the moment you spot them in your home. Eg. electrical cords, loose rugs, toys and other small objects on the floor.
• Place your furniture in a way that allows for clear walkways.
• Ensure there is good lighting wherever there are curbs and steps.
• Install rails and grab bars along high fall risk areas such as bathrooms and stairways.
• Use a well-wrung mop when mopping the floor
• Use non-skid mats in frequently wet areas such as the bathroom and wet kitchen
• Provide shower chairs in bathrooms and use portable showerheads that are easily accessible.
• Store items that are frequently used by the elderly on lower shelves that are easily accessible. Use a stable standing stool to reach items that are beyond reach.

Vision

Poor vision is another major cause of falls as it prevents proper visual judgement of objects and distance. The American Optometric Association recommends annual eye-checks for adults above 60 years old. This will allow for early detection and treatment of vision impairing conditions such as glaucoma. Consult your optometrist for better alternatives if the elderly is wearing bifocal glasses as the jump in vision that occurs between the two lenses presents a fall risk.

Footwear and Fall Prevention Devices

A lot of falls occur due to accidental slips in footing or momentary weaknesses in the leg muscles or joints resulting in a loss of balance. These types of falls may be prevented by choosing proper footwear with better grip. Rubber soled footwear worn at home can go a long way in preventing such falls. Avoid socks and slippery bedroom slippers. Also take note that bunions and thicker nails may change the shape of our feet as we age. Poorly fitted footwear can cause abrasions and blisters, causing pain and discomfort and increasing the risk of falls.

As one grows older, walking sticks such as canes or quad sticks should also be used to provide additional support.

Besides footwear and walking sticks, other fall prevention devices such as “bed guards” and support rails can also be installed strategically in places such as the bedroom, toilets and long corridors to provide support and prevent falls.

Exercise

As muscle strength is important for maintaining balance to prevent falls, appropriate amounts of moderate exercise should be encouraged among the elderly. The Singapore Medical Journal notes that exercising for at least 180 minutes per week, with an emphasis on balance, strength and gait training, is effective in falls prevention. Exercise needs to be tailored to the person’s physical capability. The following are some helpful fall prevention exercise videos available on the internet

Fall prevention exercises (accessed Nov 2021)

• Introduction
• Strengthening
• Balancing
• Cool down/conclude

Medical

Some medications such as sedatives, antidepressants and antipsychotic drugs can increase fall risks. Singhealth cautions that taking more than 4 medicines pose a risk of falls for elderly.

For elderly persons who need to take multiple medications, make it a point to discuss with your physician the fall risks involved and explore how these risks may be managed.

Who Needs to Be Concerned

Medical experts warn that in Singapore, one in three elderly above 65 years old and one in two above 80 years old will have at least one fall within a year. Many of these elderlies are silent sufferers, not reporting the fall or seeking medical attention unless they are injured. Even near fall experiences can lead to fall anxiety, resulting in social withdrawal, isolation and depression.

If you are above the age of 65 or live with elderly persons above this age, practicing the fall-prevention measures outlined in this article can help reduce the risk of falls and preserve physical, social and mental well-being.