Falling for the fear of falling

The fear of falling in the over-65 age group is a major contributory factor for actual falls, according to the falls co-ordinator for Cork Falls Services, based at St Finbarr's Hospital in Cork.

Finola Cronin, a nurse, who has been working on the issues connected to falls for 10 years, says: “Fear of falling is a syndrome that happens after the first fall. The older person will decrease their activity levels. Then, their muscles get a little bit weakened and the person gets a bit fearful. After their second fall, people lose their nerve. The second or third fall can do damage. People often stop doing their normal everyday activities, whether it’s walking, going out to their day care centre or just stopping activities.”

Cronin discovered that older people attending A&E with a broken hip were often there for the third or fourth time. Before that, they might have suffered lacerations due to falling. “If somebody presents to us after a fall, the quicker we can get intervention, the more likely we are to prevent the second and more traumatic falls.”

It’s isn’t just elderly frail people with mobility problems that fall. One third of people over 65, often in good health, fall once a year. Simply getting older is a risk factor. But as Cronin points out, falling need not be an inevitable part of growing old. She stresses the need for education. “If people know why they fall, that’s the biggest thing. Most falls are just slips and trips. Our clinic (which has the expertise of two geriatricians, a nurse, a physiotherapist and an occupational therapist) will do a full risk assessment, going through every reason why a person might fall. We do a lot to reduce risk.”

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Ideally, after the first fall, people should talk to their health care professional. “The important thing is not to be embarrassed about it. A lot of people will ignore their first fall. We’d recommend that they talk to their GP or public health nurse. Or they can contact us. And there are plenty of clinics around the city.”

An older person who is on four or more types of medication is at a higher risk of falling. “People should have their medication reviewed every 12 months, particularly if they’ve had weight loss or a recent admission to hospital. If a person finds that a particular tablet makes them feel dizzy, they should definitely see their doctor. Some tablets, such as blood pressure medication, can cause dizziness or feeling faint. It’s important to discuss with your doctor what you’re on and why you’re on it. Your pharmacist can be a great resource as well.”

Drinking alcohol is not advisable, says Cronin, as it can increase the risk of falling. To lower risk factors, exercise “is probably the biggest thing a person can do. Once a person is assessed at the clinic, they can attend a physiotherapist-led programme, learning how to do exercises that will improve balance and strength. It’s all about balance and keeping active. About 30 minutes of exercise a day is recommended.”

If joining a Pilates, yoga or Tai Chi class, the important thing is to enjoy it. “The health benefits are not just about reducing your risk of falling. Exercise classes help your mental and social wellbeing. Meeting people your own age is important. It’s not about being old; it’s about being active.”

"I've had three falls in the last 12 months," says 82-year-old Nuala Murphy. "The first one was outside an entrance to my local shopping centre. My leg got caught in the ramp area that's there for wheelchairs. It didn't really make me nervous. But I had a fall in the bathroom that made me really nervous. I seem to have blacked out and it was thought that I may have passed a kidney stone. I don't ever lock the door in the bathroom. That's what saved me. My husband heard me hitting the wall. We have now put two bars on the side of the toilet. My third fall was the same as my first one, going into the supermarket. Those wheelchair ramps should be highlighted because you don't realise there's a dent in the footpath. I've stopped using that entrance and now I go in the main door of the supermarket.

“Falling makes you feel vulnerable for a while. I’m more careful now of where I’m walking and my husband is always with me. The doctor sent me to the falls clinic at St Finbarr’s after my third fall. They gave me physiotherapy and showed me how to do exercises which I’m still doing. Some of them were difficult but I got used to them. They involve standing next to the sink without putting your hands anywhere. Also, there’s raising one leg and there’s walking backward and forwards in a straight line. There’s lifting weights for the ankles.”

Under the falls service at St Finbarr’s Hospital, a “Better Bones, Better Balance” programme has been developed.

“Osteoporosis is one of the risk factors for falling. We go through a check list, recommending that people have a bone density scan. Activity, including weight bearing exercises and diet are huge when osteoporosis is present. It’s caused by the calcium being drawn out of your bones. The risk factors are smoking, drinking, steroid use and weight. And it can be hereditary.”

However, Cronin says that assessing people’s bone health and looking after it is “something we need to be doing a lot earlier in life”.

While the St Finbarr's Hospital Falls Risk Assessment Clinic is currently for the over-65s, "it would be great if, in the future, we could look at anyone who has had a fall".

WHAT HAPPENS AT A FALLS CLINIC ASSESSMENT
- Discuss your falls history
- Assess the way you walk, your mobility, balance and muscle strength
- Assess risk of osteoporosis and medication management
- Identify how you feel you carry out everyday task such as cooking and housework
- Discuss any problems you have with eyesight, bladder and nutrition
- Assess home hazards.