Falls in older people will become a big issue this winter unless we support people over 65 to be active in their homes and communities, according to Edel McDaid, physiotherapist at the Royal Hospital Donnybrook, Dublin.
McDaid says that health professionals need to reach out to older people in their homes help them keep physically and mentally well. “We have to balance the risk of asking older people to stay at home [to avoid catching Covid-19] with the risks of their loss of independence. Many older people have become prisoners of their sense of social responsibility during Covid,” says McDaid.
She says that older people are suffering the loss of day hospital services and active retirement association classes. “We need to develop low-risk activities and rehabilitation in their homes to prevent older people turning up in A&E departments due to falls over the winter months,” says McDaid.
Leaflets such as the Health Service Executive’s Let’s Get Moving Again (with eight daily exercises and a walking programme), family-supported walks in the community and protected times in supermarkets which are strictly adhered to are among the suggestions to help older people remain active in their communities.
Jodie Keating, the clinical nurse specialist in falls at Tallaght University Hospital (TUH) says that many older people became deconditioned during cocooning. "Some people now have a greater fear of falling because they haven't been moving as much. We need to find ways to integrate older people back into their communities and listen to their needs," she says.
In the Falls Assessment Clinic at TUH, Keating assesses patients’ gait and balance, bone health, medication, fluid intake, nutrition, blood pressure and circulation; and recommends hearing and sight tests. “Sometimes, they come here thinking they have a balance problem but discover their blood pressure isn’t right and they are dehydrated,” she explains. Keating also stresses the importance of home visits from community physiotherapists and occupational therapists to keep older people safe in their homes. Removing trip hazards such as loose mats and putting in grab rails in bathrooms and stair rails can improve safety hugely.
One in three people aged 65 and over falls every year and two-thirds of these individuals fall again within six months, according to most recent figures. Falls in older people can have life-changing consequences and older people are more likely to suffer serious injury, disability, psychological consequences and even death as a result of a fall.
Dr Paul McElwaine, consultant geriatrician at TUH says that it’s important that older people get their hearing and eyesight checked every couple of years as poor sight and/or hearing is a risk factor for falling. “We also recommend that people have their medication reviewed yearly as taking five or more medicines regularly increases the risk for a fall,” says Dr McElwaine. He says that patients are often not good at prompting GPs to do a medicines review and GPs themselves are slow to stop medications but there are a number of strong painkillers, anti-depressants, sedatives and cardiovascular medicines which increase the risk of falls in older people.
Strength and balance
Dr McElwaine also stresses the importance of strength and balancing exercises mentioning the Otago home-based strength and balance retraining programme led by physiotherapists as a good model. “Many older people have lost the social connection that group exercise classes bring but what you do at home counts as well,” he says. Tallaght University Hospital has just initiated an e-learning module in falls prevention for healthcare assistants and nurses.
As smartphone technologies develop, apps are now becoming available to allow people to self-assess their risk of falling. For example, a new smartphone app from UCD spin-off company Kinesis Health Technologies is currently available free on Google Play. "People can do a balance test using sensors and processing in the smartphone from which we calculate their risk of falling," explains Barry Greene from Kinesis Health Technologies. Those at low risk are then offered suggestions to maintain their balance while those at a higher risk are referred to private healthcare provider Spectrum Health for further assessment.
Greene says that the joint care programme at Spectrum Health (free for VHI customers) uses sensors on people’s shins to give feedback on how they are walking to more precisely assess their risk of falling. The technology (which uses software from a US company, Mathworks) has already been used by 34,000 people across nine countries, including 12,000 people in Irish private and public clinics.
“We see ourselves as working on falls prevention in the community so we aim to reach people before they have fallen and offer them strategies – including strength and balance exercises – to put in place so they don’t fall,” says Greene. He acknowledges that older people who are at a very high risk of falling will still need the full falls prevention assessment in places like Tallaght University Hospital.
“Those who are at a low or medium risk of falling will benefit most from our assessments and if we can reach them at an early stage, we can prevent up to 50 per cent of falls in this group of older people. It’s about empowering older people to take control of their own health,” says Greene.
Tips for older people to prevent falls
1) Eat regular hot meals and drink plenty of fluids to keep warm and give you energy to keep active.
2) Take exercise. Regular physical activity improves your balance and co-ordination. Even if you have a chronic illness such as heart disease, high blood pressure, diabetes or arthritis, you should exercise regularly. Wear loose comfortable clothes and well-fitted sturdy shoes when walking.
3) Ask your GP to review your medication. Some medicines or combination of medicines can make people faint or light-headed which could lead to a fall.
4) Have your vision and hearing checked. Poor vision can increase your chance of falling so it's important to have your eyesight checked regularly.
5) Eliminate trip hazards in your home. For example, keep floors clear of papers, wires, cords and loose-fitting rugs. Install handrails on stairs and grab rails in bathrooms and elsewhere. Wear a personal alarm.
(Adapted from the HSE Preventing Falls and Trips leaflet)