Preventing and Managing Falls in the Elderly
Falls are a major health concern for older people and are the leading cause of unintentional injury in older Australians. As our population ages and the number of older people grows so too does the likelihood of falls-related injuries and hospitalisations.
A study of all hospital admissions from falls in 2019-2020 showed that people aged 65 or over made up 59% (AIHW, 2022). Falls are commonly due to tripping, slipping and stumbling. A fall can result in negative outcomes including death, loss of independence and autonomy, immobilisation, and depression (WHO 2007).
The psychological and functional consequences of falls can be severe whether or not an injury occurs. Reduced confidence, injury, pain, fear of falling, or “post-fall syndrome,” Over time, this can lead to the person reducing their activity and disengaging with their community, which further increases the risk of falling.
Most falls, however, can be prevented and a person’s risk of injury can be reduced. With motivation, healthy habits, and an awareness of how to reduce risk, we can play our part in preventing older people from having a fall.
So why do we fall more as we age?
1. Changes to the body
Our bodies change gradually and over many years as part of the normal ageing process, you may notice:
- Balance problems and feelings of unsteadiness when you walk
- Sarcopenia: age-related involuntary loss of muscle mass and strength
- Visual impairments
- Slower reaction times
- New health problems, such as incontinence or dementia
2. Environmental Factors
- Poor lighting
- Unsafe footwear, such as loose slippers or narrow heels
- Slippery surfaces
- Trip hazards like rugs, floor mats and electrical cords
- Steps and uneven surfaces
3. General Deconditioning
“Move it or lose it” as the old saying goes, if we don’t keep physically active and challenge our balance regularly our muscles will weaken and our balance can reduce over time, which increases the likelihood of having a fall. Nutrition also plays an important role in maintaining muscle mass and bone health not eating the right foods can lead to increase frailty in the older adult population which has been shown to increase the risk of falling (Clegg et al, 2013).
4. Medical risk factors:
Medical risk factors such as low or high blood pressure, postural hypotension, Parkinson’s disease, stroke, incontinence, diabetes, depression and dementia can all contribute to an increased likelihood of falls.
Physiotherapy and its role in preventing falls
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 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.
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.
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.
Australian Commission on Safety and Quality in Health Care (ACSQHC) 2009, Preventing falls and harm from falls in older people.
Australian Institute of Health and Welfare (AIHW), Injury in Australia: Falls, Web Article, June 16 2022 https://www.aihw.gov.au/reports/injury/falls
Clegg A, Young J, Iliffe S, Rikkert M O, Rockwood K. Frailty in elderly people. Lancet 2013; 381: 752-62.
Department of Health and Human Services, Victoria (Falls prevention)
Hewitt J., Goodall S., Clemson L., Henwood T., & Refshauge K. (2018) Progressive Resistance and Balance Training for Falls Prevention in Long-Term Residential Aged Care: A Cluster Randomized Trial of the Sunbeam Program. The Journal of Post-Acute and Long-Term Care Medicine 19(4) p361-369. DOI:https://doi.org/10.1016/j.jamda.2017.12.014
About the author
Pallavi Mathur is a Senior Physiotherapist at KEO care. Pallavi has over 10 years’ experience working as a Physiotherapist in India, Kuwait and Australia and has specialized in Cardiorespiratory Physiotherapy. Pallavi has developed skills in Musculoskeletal physiotherapy while working in Private practice settings.
Pallavi developed a strong passion to help the geriatric population in aged care settings. Her approach toward her clients is very goal oriented as she guides them through various physiotherapy interventions to reach their desired outcomes. She supports the KEO care team by mentoring and sharing her skills and knowledge to achieve the best outcomes for the clients.