What are the appropriate actions to take when a patient is falling?

Key facts

• Nearly 1 in 3 older Australians have experienced a fall in the past 12 months.
• Falls usually happen because gradual changes to our bodies make walking difficult, or they can be caused by hazards in and around the home.
• Falls can cause hip fractures and other injuries that require lengthy hospital care and long-term effects.
• See your doctor for a check-up if you have ever fallen before, even if you weren’t injured as a result.

Anyone can have a fall, but falls are a major health concern for older people (those aged 65 and over).

Falls are the leading cause of unintentional injury in older Australians. As our population ages and the number of older people grows, the likelihood of more falls and fall-related hospitalisations increases.

Nearly 1 in 3 older Australians have experienced a fall in the past 12 months. Of these, 1 in 5 required hospitalisation.

Even when falls don’t cause an injury, they often trigger a loss of confidence in an older person and lead to an ongoing fear of falling. Over time, this can lead to the person limiting their movements and reducing their activity, 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 all play our part in preventing older people from having a fall.

Why might older people fall?

If someone falls, it’s not necessarily because they are not concentrating or they are clumsy. Reasons why older people might have a fall include:

Changes to the body

Our bodies change gradually and over many years as part of the normal ageing process. As you get older, you may notice:

• balance problems, such as feeling unsteady when you walk
• weaker muscles that, for example, make it harder to lift your feet when you walk
• poorer eyesight, meaning you don’t see quite as clearly, or have difficulty with sudden light changes or glare
• slower reaction times
• new health problems, such as incontinence (problems with urinating or with your bowels) or dementia

These changes can be due to normal ageing or they might be caused by an illness or condition. They can affect the way we move around — and sometimes they can cause us to fall.

Dangers in and around the home

Nearly 2 out of 3 falls happen in and around the home. Common household hazards include:

• poor lighting
• unsafe footwear, such as loose slippers or narrow heels
• slippery surfaces, such as wet or polished floors, or spills
• trip hazards like rugs, floor mats and electrical cords
• steps and uneven surfaces

Neglecting general health and wellbeing

Older people who don’t keep physically active or fit tend to have poorer balance and weaker muscles, which increases the likelihood of their having a fall. Not eating well and not drinking enough water can also make it difficult for them to be strong enough to move about safely.

What other risk factors are there for a fall?

Certain conditions increase the likelihood of a person falling. These include:

• A history of previous falls — If you have fallen more than once in the past 6 months, you are more likely to fall again.
• Low blood pressure — Older people with naturally low blood pressure may feel light-headed, dizzy or unsteady while moving.
• Postural (orthostatic) hypotension — With this condition, blood pressure drops when someone changes position, such as going from sitting to standing. Older people with postural hypotension — whether natural or due to a medication’s side effect — are at increased risk of having a fall.
• Incontinence — You may need to hurry to the toilet often, increasing the risk of a fall, particularly at night.
• Stroke, Parkinson’s disease and arthritis — These conditions change the way you move, and make it harder to react quickly and stop yourself if you stumble.
• Diabetes — Changes in blood sugar levels can make you feel faint. Diabetes can also affect your eyesight and reduce feeling in your feet and legs.
• Depression — Older people with depression may take a medicine that can increase their risk of falling
• Alzheimer’s disease and other dementia — Older persons with dementia can become less aware of their surroundings and less able to react quickly.

While osteoporosis — characterised by thin, weak bones — is not a risk factor for falls, if someone does fall, there’s a higher chance of their breaking or fracturing a bone.

When should I see my doctor?

Speak with your doctor if you’ve had a fall — even if you feel fine. Falls could signal any one of a range of health issues, including a new medical problem, a side effect of your medications, balance problems or muscle weakness . Your doctor can suggest ways to reduce your chance of falling in the future.

It’s also a good idea to see your doctor for regular check-ups. This helps to ensure any concerns you might have are addressed before they contribute to a more serious fall in the future.

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How are falls treated?

If you have had a fall, or you’re concerned about your risk of experiencing a fall, your doctor may suggest the following interventions.

Vitamin D and calcium supplements

Your doctor may suggest taking Vitamin D and calcium supplements. This will help to improve your bone health and reduce the likelihood that a fall will cause a fracture.

Medications review

Some medicines cause side effects such as drowsiness, confusion, unsteadiness or dizziness. Since these side effects can increase your risk of falling, your doctor or pharmacist can carry out a medication review to see if changes are needed.

Podiatry assessment

Ageing causes changes to the feet which can change the way we walk and our balance. If you have painful or swollen feet from walking, or get other symptoms like tingling or pins and needles, see a podiatrist for advice on ways to improve your circulation, decrease swelling and reduce pain in the legs and feet.

Eyesight assessments and cataract surgery

Early detection of any eye problems can stop them from getting worse. See your optometrist or doctor to get your eyes checked. If you struggle to see due to cataracts, surgery to remove these will help you reduce the likelihood of future falls and fractures.

Hip protectors

Older people are particularly vulnerable to hip fractures, the most common injury from a fall. Consider whether hip protectors might be suitable for you. These are placed inside special underwear and positioned over the hips to protect them in case of a fall. They reduce the likelihood of a broken hip, particularly for those who have osteoporosis or who fall frequently.

How can falls be prevented?

There are many practical ways to reduce the risk of falls occurring, including:

Lifestyle changes

• Keep physically active. Whatever your age, aim to do at least 30 minutes of activity, 5 times a week that will help make you stronger and improve your balance. Suitable activities include tai chi, dancing and group exercise programs.
• Eat healthily. Enjoy a wide variety of foods and drink, particularly during hot weather. Food supplements may help if you are very thin.
• Stand up slowly after you have been lying down or sitting to prevent posture-related dizziness.

Changes around the home

You can also reduce the risk of your falling by making positive changes to 3 types of potential hazard found in your home: lighting, slipping, and tripping.

Lighting

Good lighting around the house is important. Turn lights on when you walk around. Leave hallway lights on at night. You can reduce glare inside your house by using net curtains or blinds on your windows. These changes make it easy for your eyes to see where you are going and reduce the chances of a fall.

Slipping

Changing what you wear around the home and fixing dangerous surfaces can reduce the risk of slips occurring. Use non-slip mats in wet zones, such as the shower and bathroom. For larger rooms, it may be worth making the whole floor with non-slip material. Install hand rails or a seat in the shower or bath. Place non-skid tape on the edges of steps and stairs to make it easier to see. Remove moss, slime or fallen leaves from outdoor paths. Wearing properly fitted shoes that fit firmly to the foot can also help prevent slips.

Tripping

Even small things can be trip hazards. Keep any walkways clear of clutter, and tape down any electrical cords along skirting boards. Mark any small changes in floor level with contrasting colour so they’re clearly seen. Install a “draught excluder” on the bottom of doors instead of loose material that can be tripped over. Get rid of old mats and torn or stretched carpet..

Are there complications following a fall?

Falls can cause hip and thigh injuries both in men and women. They are the most common reason for hip fracture hospital admissions (9 in 10 cases). Other injuries that result from falls include head injuries, wrist fractures and other injuries.

Hip fractures also impose a heavy long-term burden as older people become less independent, more reliant on family members and carers, and have an increased chance of moving into an aged care facility.

After a fall, many older people become fearful of falling again and lose confidence in walking. You may start to do less physical activity. However, over time this reduced movement actually makes it more likely that you’ll have another fall because of poorer balance, weaker muscles and stiffer joints.

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