THE GUIDE TO PREVENTING FALLS FOR OLDER ADULTS

As a Physiotherapist specialising in seniors' health, I have witnessed firsthand the harsh reality of falls.

Throughout my career, I have often been called upon as a first responder in aged care centres after someone has fallen, to assess for injuries, direct the appropriate response and help as needed.

I have also rehabilitated many patients following a fall-related injury, helping them improve their physical condition so they can return to independent functioning in their daily lives.

Furthermore, I have been heavily involved in falls prevention. This included implementing falls prevention plans and exercise programs in various settings while assessing thousands of patients' mobility, physical condition and falls risk.

Due to my expertise and experience, I have spoken numerous times at many nursing homes and community centres across Australia about how best to prevent falls.

With falls being a huge problem facing everyone over the age of 65, I felt it was important to write this guide about preventing falls and do my bit to further decrease this problem.

Before we get started and dive deep into how to prevent falls however, the first thing you must know is……. falls are NOT a normal or inevitable part of ageing! 

I'll repeat... FALLS ARE NOT A NORMAL OR INEVITABLE PART OF AGEING!

Yes, falls ARE a huge problem facing older adults, but many things can be done to prevent them!

This doesn't mean avoiding everything you enjoy, everything fun, to ensure you don't fall…. NO!

Preventing falls simply means being aware and doing what's required to significantly reduce your risk of falling so you can go on living the life you want to.

Rather than ignoring this problem and putting it to the back of your mind in hopes that it won't happen to you or, in some cases, again, it's time to tackle this issue head-on, for good!

Once done, you can enjoy life as you wish in your golden years, without fear!

Now let’s get started preventing falls.

- Mike

[Note: To get the most out of this guide, make sure you spend the time to read it in its entirety. Once you have done this, you can skip through to any section by heading to the Falls Prevention main page and clicking on the appropriate links.

Also, please share this guide with anyone you feel would benefit from it, and make sure you sign up to the mailing list for a free exercise ebook, regular exercise videos for seniors, and more].

PART 1: THE IMPORTANCE OF FALLS PREVENTION

INTRODUCTION - HOW TO PREVENT FALLS

I like to think of preventing falls the same way we avoid a possible fire in our home or workplace.

We all have some risk of a fire occurring, especially when we cook, use electricity, iron, use the heater or get the fireplace going. 

But what do we do to avoid a fire? We decrease our risk, and we decrease it A LOT!

Fire safety usually looks something like this:

STEP 1: We educate ourselves about the dangers of fire to ensure we remain aware.

STEP 2: We become aware of the risk factors of fire and eliminate them best we can, to prevent any fire from happening.

We prepare ourselves by undertaking proper fire safety. This includes keeping our house up to date with appropriate fire standards, e.g., installing smoke detectors, putting fire extinguishers or fire blankets around the place, familiarising ourselves with fire exits and knowing the emergency phone numbers.

We don't give up here; we take precautions to maintain fire safety to guard ourselves against a fire and put our minds at ease. This may include removing dry leaves from guttering during hot, dry periods, having the fire extinguishers checked as required or changing the battery on smoke alarms.

STEP 3: We still know there is always the chance of being caught in a fire even when we eliminate the risk. We make sure we know what to do if a fire breaks out. For example: get down low and GO, GO, GO! and call emergency!

We cover everything to decrease our risk of a fire happening and what to do to keep ourselves safe if one were to occur. We have done all we can.

We trust our plan. We trust our equipment. We trust ourselves and the fire service. We trust everything will be ok.

We don't sit around in a fireproof suit with a hose, waiting for a fire, all ready to go.

WE GO ON LIVING AND ENJOYING OUR LIVES WITHOUT WORRY!

This guide will take a similar approach to the fire prevention plan above to prevent falls. Carry on to the next section for the falls prevention plan.

THE FALLS PREVENTION PLAN

In PART 1 of this guide, we will go through the consequences of falls to ensure you remain aware and learn everything that could put you at risk of falling.

In PART 2: We will go through what changes to make and how to make these necessary changes to decrease your fall risk as much as possible. You will also work on becoming as healthy and in good physical condition as possible to help you prevent falls. 

As it’s impossible to completely eliminate all risk of falling, there is always the chance that even if you have done everything you possibly could, you still fall. So we want to be prepared for this situation.

In PART 3, we cover how you can be prepared and what to do if you fall to handle the situation safely and effectively.

Once you have completed all parts of this guide, you will have peace of mind and confidence, knowing you have done everything possible to prevent falls, and be prepared.

Furthermore, you will get many added health benefits when you undertake what's set out in this guide. You will improve your physical abilities, you will be stronger, moving better, balancing better, you will be sleeping better, you will have decreased stress, you will feel better and much more!

A FALL CAN HAPPEN TO ANYONE!

There was once a time I was walking through the dining room in a Residential Home, lost in thought about all the jobs I needed to get done before the day was out.

While rushing around the place deep in thought, I had failed to notice one of the cleaners had just mopped the floor.

I was also wearing shoes I shouldn't have been. The grips on the soles of my shoes were worn down. "I'll be right!" I thought to myself a few weeks earlier when I noticed the soles wearing thin. I liked these shoes, so I wasn't ready to replace them just yet.

It was lunchtime, and the room was packed with residents eating their lunch.

As I was walking through the room, suddenly I slipped. The next minute, I was down on the floor, on one knee in front of everyone.

I remember hearing one of the ladies shriek in fear, worried I'd been hurt and seeing other ladies jump when they saw it. 

There was silence. Everyone was looking at me.

"Aren't you the guy that's meant to stop us from falling?" a man named Merv chimed in laughing, while I'm still down on one knee.

"I'm just stretching, Merv," I replied, jokingly, with a smirk on my face while faking a stretch. 

Merv was right; I had fallen. The Physiotherapist, an expert on falls prevention, much younger than everyone else in the room, had fallen for all to see.

AND, this fall could have easily been prevented!

AND..... I knew my shoes were putting me at risk. It was not like these shoes were stopping me from replacing them or the slippery floor made me rush over it.

I just never thought it would happen to me.

A few of the ladies asked me if I was ok. I was fine, luckily. Not a scratch. 

I got back up and got on with what I was doing. 

Whoa, close call! That could have been much worse.

Luckily, I was young with good physical capabilities. If not, this could well have been a different story.

Most of us assume that an incident won't occur to us. We usually think, "that just happens to other people". 

But, A FALL CAN HAPPEN TO ANYONE!

This story is to highlight the importance of falls prevention. Take falls prevention seriously, because you could fall too!

THE FACTS ABOUT FALLS

Roughly 30-50% of people over the age of 65 are at risk of falling; this risk increases to the higher end (50%) as we continue to age [1].

Once over 65 and having already fallen, this risk increases again [1].

Our falls risk increases for many reasons as we get older (covered below). Combine this with bones becoming weaker, our muscle mass decreasing and usually less fat covering our bones, the chances of a falls-related injury are increased and injuries sustained are usually more severe.

The most common injuries are fractures, with hip fractures being the most serious and occurring more commonly in women [2].

Furthermore, our recovery time following an injury increases as we get older, taking longer to get us back to where we once were.

Now, don't be too alarmed. The primary physical injuries - broken bones, cuts and knocks to the head occur in only a small percentage of falls. Most falls result in only minor cuts and bruises, if that.

But they can also be frightening and an unwanted fall cycle can be triggered, affecting life in other ways [See Diagram below].

From the above diagram, a fear of falling can develop after a fall.

Due to this fear of falling, physical activity is usually undertaken less (or in some cases avoided), leading to decreased physical abilities. Consequently, the risk of falling is further increased.

The cycle continues, and it becomes increasingly difficult to undertake the activities required for daily living.

As you can see, falls have both physical and mental effects. They can cause injury and disrupt quality of life in a big way.

You may have also read or heard the very scary statistics or some horror stories about falls and associated fractures, which can compound this fear of falling. I won't go into these statistics. A simple search will find them.

Yes, these statistics can be frightening, and we must do all that is possible to ensure we prevent falls, which is 100% possible. However, there is no need to get caught up in these statistics surrounding falls. 

In my career as a Physiotherapist, I have helped rehabilitate hundreds, after a fall, and it is very rare someone does not make a full recovery. Those that don't are usually much older and/or frail and tend to have limited cognitive abilities.

Worrying about the dangers of falls is impractical for preventing them. 

Any fears causing you to avoid movement or certain activities are holding you back from living life and making progress in preventing falls. These fears usually require more than just an understanding to overcome. However, they are possible to be overcome and you can make big progress.

Overcoming the fear of falls is complex, I have written an article covering it a little, and how to overcome it here: OVERCOMING THE FEAR OF FALLING

You can get to the bottom of why you are falling and improve these areas of your life causing your falls. These improvements will help prevent any more falls.

You want to be doing everything to ensure you're not avoiding any movement or activities in your life, but of course, taking precautions if/and where necessary.

It starts by changing your focus from avoiding falls to doing what's required each day, getting yourself in the best physical and mental shape to prevent falls and eliminating or minimising the factors putting you at risk (discussed next section).

This Falls Prevention article aims to help you to continue living your life the way YOU want to and doing what's required to prevent falls. This is the key to a good falls prevention plan and the key to overcoming falls.

From this point onward, we will stop focusing on the scary what-ifs of a fall. Instead, we will focus on the things within your power that CAN be changed to prevent falls, which we will cover in this article, and we will start putting these into action.

To do this, let’s now take a look at what could put you at risk of falling.

To prevent falls, it's important to be aware of the different factors that could be putting you at risk of falling [1, 2, 3, 4].

Once identified, every risk should be eliminated or minimised, one by one. We will discuss all the risk factors in greater depth in the upcoming sections.

Factors that could be putting you at risk of falling are:

Physical Changes

• Decreased physical abilities (e.g., decreased vision, decreased balance, strength, proprioception and gait issues)

• Chronic health conditions (e.g., vertigo, arthritis, dementia, diabetes, incontinence, stroke)

Behaviours

• Risk-taking behaviours out of one’s capabilities

• Lack of awareness of one’s own risk of falls - cognitive decline

• Fear of falling leading to avoidance behaviours

Habits

• Lack of activity/exercise

• Poor sleep patterns

• Inadequate nutrition

• Alcohol abuse

• General lifelong habits which now pose a risk

The Environment Around You

• Hazards around the home (indoors and outside)

• Other indoor and outdoor risk factors

  • These hazards above include trip and slip hazards, uneven surfaces, poor lighting or glare and no handrails on stairs or grabrails in bathroom

Medications

• Certain types of medication (and quantity of medication) pose a fall risk

Clothing/Equipment

• Loose-fitting, long or baggy clothing

• Footwear -  worn, incorrectly fitted or not appropriate for the foot (e.g., heels)

• Wrong or incorrectly fitted mobility aid

• Not using mobility aid or other assistive equipment prescribed by Physiotherapist/Occupational Therapist

In the next chapters, we will look at eliminating or minimising these risk factors, so your falls risk decreases by a large extent.

Here is a diagram that sums up the risk factors of falling. Have a read and see if any could be putting you at risk of a fall.

Now we have identified the risk factors that could be putting you at risk of falling. It’s now time to start working on eliminating the risk factors to prevent falls.

We will cover all you can do to prevent falls, including exercise and more in the next section, PART 2: 10 STEPS TO PREVENT FALLS FOR GOOD

SOURCES

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