Falls and Frailty

Falls and fall-related injuries are common and serious problems for older people. People aged 65 and above have the highest risk of falling with 30% of people older than 65 and 50% of people older than 80 falling once a year (source NICE clinical guideline 161, June 2013).

Despite this, falls are not an inevitable part of ageing. Children and athletes often fall, but the reason that such interest is taken in people over the age of 65 is that implications of a fall for this group are often very significant and can often result in the failure to recover to their previous level of health.  Frailty is related to the reduction in an individual’s function that develops as part of the ageing process.

Experts believe that the vast majority of falls could be prevented with some fairly modest changes to our lifestyle.  People at risk of falls are often reluctant to discuss it because they fear their independence may be taken away from them, its up you us to persuade them that the opposite is true: that by taking positive steps to prevent falls they will preserve their health and independence for longer.

Very Brief Intervention

Ask

OBSERVE if the person seems unsteady when walking or rising from a seating to a standing position

ASK - You seem a bit unsteady, which much be annoying, I hear that you can do something about that

OBSERVE if the person is shuffling or walking really slowly

ASK - Have you had a fall over the last 12 months or do you have a fear of falling?

  • A fear of falling is a common symptom in people who have had a fall even when person had not injured themselves, its increases the chance of further falls, because they are often unable to act rationally when about to fall, as panic kicks in.
  • Check if they informed their GP of the fall as they can often help by reviewing medication, supporting eye test etc

Do you spend quite a lot of time sitting down if you are worried about having a fall?

  • Sitting down for long periods can actually harm balance, body strength and mobility, which in turn makes a fall even more likely, its a vicious circle that damages confidence and independence.

Assist

Would you like some information on the benefits of keeping active and moving? 

  • The more active you can be the more you can offset the effects of ageing 
  • These activities are fantastic for maintaining balance and mobility
    • Gardening
    • Housework
    • Walking to the shops rather than driving 
    • Strengthening and balance fitness classes
    • When sitting, keep your back as straight as possible to avoid a stooped posture
    • When watching TV, roll your shoulders regularly and get up and walk about in ad breaks or between programmes

Would you like some information on the top five ways to avoid slips trips and falls?

  1. Badly fitting shoes - Our feet change shape with age and lose some feeling and flexibility, soles should be thin enough for you to feel the ground but have enough cushioning for shock-absorption and good tread for gripping
  2. Trailing clothes - Hems of trousers that are too long or loose belts or cords for dressing gowns
  3. 'Shuffly' walking - Its easy to get in the habit of not lifting your feet as high as you used to when walking but this increases your chance of tripping
  4. Worn out slippers - Its may be time to say goodbye to your old friends, frayed uppers and sloppy backs, Slippers should fasten and stay on and provide grip.
  5. Walking on socks/tights on hard floors - Don't do it, wear good slippers instead

Would you like some information on ways to try and fall proof your home?

Fall proof your home - 6 out of 10 falls happen in the home but a few simple changes can help

  • Lighting - Avoid trailing cables - Use a bedside lamp when getting up at night
  • Living areas - Check rugs have a non slip underlay, consider replaying or repairing frayed carpets - remove any clutter from hall, landing, stairs and doorways
  • Garden - Keep paths free of moss and leaves where possible - Repair cracks in paving
  • Kitchen/Bathroom - Rearrange cupboards so that frequently used items are in easy reach - Use a non slip matt in the shower/bath, consider installing grab rails in bathroom

Remember installing hand rails and non-slips mats might make you feel older but they can ensure that you are able to be more independent for longer and give you more freedom, not less.

Act

Self Care

There is a wealth of information and ways to prevent falls on the following websites

  • Saga - Discover ways to stay fit at https://www.saga.co.uk/magazine/health-wellbeing/wellbeing/falls-guide
  • Age Uk - Information on falls prevention, exercise classes and handyman services in some areas.  Call free on 0800 169 6565 or see https://www.ageuk.org.uk/information-advice/health-wellbeing/exercise/falls-prevention/
  • The effective assessment of an individual’s risk of a fall would be a multifactorial intervention considering falls history, visual impairment etc. This assessment would enable the referral of an individual to effective interventions targeted at specific risk factors
  • Your GP may carry out some simple tests to check your balance. They can also review any medicines you're taking, in case their side effects may increase your risk of falling. Your GP may also recommend:
    • having a sight test if you're having problems with your vision, even if you already wear glasses 
    • having an electrocardiogram (ECG) and checking your blood pressure while lying and standing
    • requesting a home hazard assessment, where a healthcare professional visits your home to identify potential hazards and offer
    • advice doing exercises to improve your strength and balance (try some exercises for older people)
  • NHS Choices - Find this leaflet and other resources at https://www.nhs.uk/live-well/bone-health/keep-your-bones-strong-over-65/ and https://www.nhs.uk/conditions/falls/