Preventing and Managing Falls in the Elderly

Physiotherapy is a very diverse profession that identifies human movement as key to the health and well-being of patients. They promote preventive healthcare and have expertise not only in treating joint/spinal problems but can address posture, balance and gait-related discrepancies.

Physiotherapists can also help reduce the number of falls in the elderly. Physiotherapy-led specific exercise programs have been proven to reduce falls amongst older people by 55% (Hewitt et al, 2018).

Prevention of falls should be individualised, based on the outcomes of a comprehensive assessment. Physiotherapy intervention to prevent falls and reduce injury is always a multipronged approach and may include any or all of the following;

Exercise program

Exercise programs are individualised to the physical capabilities and health profile of the person. Exercise is prescribed, supervised and evaluated by Physiotherapists.

Exercise programs that challenge balance training are the most effective in preventing falls.

Prescribing equipment and reviewing transfers

The prescription of appropriate mobility aids to improve mobility and safety. Physiotherapists also assess a person’s transfers and mobility and will make recommendations to ensure safety. This is the key to injury minimisation.

Falls surveillance

Identifying and regularly checking residents in aged care or home who have a high risk of falling, particularly residents with dementia is important. The use of fall alarm devices (personal or pressure sensors, motion sensors, out-of-bed sensors, and video surveillance) should be encouraged.

Medication review and minimisation

All medications should be reviewed regularly by a GP and minimised (where appropriate), particularly high-risk medicines: – sedatives and hypnotics; neuroleptics and antipsychotics; antidepressants; benzodiazepines and nonsteroidal anti-inflammatory drugs.

Footwear

Any identified foot problems should be treated and correctly fitted footwear worn.

Safe footwear characteristics include: – thin and firm soles to improve foot position sense; a tread sole may further prevent slips on slippery surfaces – a low, square heel with a supporting collar to improve stability.

Environmental review and modification

Environmental reviews should be conducted regularly, and modifications made accordingly. Things to consider:

• Adequate lighting, especially between the bed and the bathroom or toilet at night and near any internal steps.
• Repair or replace carpets with worn areas, holes or long threads.
• Placement of mats and rugs: Is the rug necessary or is it a tripping hazard? Consider utilising adhesive strips to secure the rug or mat to the floor.
• Reliable and sturdy furniture: Ensure bed/seats are an appropriate height to stand from.
• Wipe up spills immediately.
• Consider home modifications such as installing grab rails in the bathroom. An occupational therapist referral may be appropriate.

Observing for cognitive changes

Addressing all reversible causes of progressive cognitive decline is the key. Older people with an acute change in cognitive function should be assessed for delirium and the underlying cause of this change. Responsive behaviours should be investigated, and reversible causes of these behaviours (for example, delirium) should be treated. It is important to respond to the person’s behaviour and understand the cause, rather than attempting to control it.

After a fall, many elderly people become fearful of falling again and lose confidence in walking. As mentioned above withdrawal from physical activity including walking can lead to an increased risk of falling. Exercise plays a key role in not only preventing falls but also improving and maintaining independence and increasing participation in life (Hewitt et al, 2022). As “exercise specialists” physiotherapists are best placed to support the older population reduce falls and falls-related injuries.