Why is it important to be thinking about fall prevention?

You or someone you know maybe over the age of 65. More than one in three people in this group fall at least once a year. For elderly adults, a fall-related injury represents the single largest cause of hospital visits. Each year in NSW falls lead to roughly 27,000 hospitalisations and over 400 deaths. 

The injuries sustained from a fall can include things like hip fractures, joint dislocations and sprains. They can happen at home, in a nursing home, retirement village or specialist aged care facility. While falls are quite common ( especially for older adults) they are preventable.

The patients that we assist either in our clinics or on-site in their homes can be described as;

• Elderly with poor mobility and muscle weakness
• Usually, they are 70 years of age or older
• The fall they experience is mechanical in nature meaning they fall due to an external obstruction such as tripping over an uneven footpath
• Most falls are because there is usually an underlying biomechanical / balance issue 

When someone does fall it can result in many different injuries but commonly they are upper limbs as people try to brace the fall with their arms, so this can cause wrist sprains, rotator cuff irritation/tears, patella (knee cap) injuries (such as patella bone bruising). Typically patients will often present with acute pain in the injured area, bruising/swelling, difficulty moving the affected area, inability to perform everyday activities such as putting on clothes. 

What can cause an elderly adult to fall?

There is a range of factors that contribute to the risk of an adult falling. 

• Naturally, as you grow older changes happen to your body physically which makes movement a little more difficult than younger adult life as you may lack the same muscular strength.
• It is natural that over time each person loses muscle mass as they get older especially in the lower limb muscle groups.
• Changes to vision and sensation can also impact a person’s ability to balance. 
• There are also side effects from different forms or combinations of medications that can influence the potential risk of falling. 
• The environment that a person lives in may not be as safe as it seems. For example loose carpet, small changes in heights, steps with large drops, uneven tiles or even taps that are at heights that are hard to reach.
• There could be other underlying medical issues like Parkinson’s Disease
• Lengthy periods of inactivity and not exercising enough
• Wearing inadequate footwear like thongs

As a person’s body changes with age so does its ability to deal with different situations & typically the environment that we live in doesn’t change at the same rate. That is why so many elderly people eventually seek residence in an aged care facility or retirement village which have been specifically designed for this phase of a person’s life.

How can people prevent someone from falling?

There are three key areas to focus on to help someone reduce their chance of falling. This is applicable whether they live at home & receive in-home care, at an aged care facility or retirement village. The difference will be what assistance is available to them should a fall occur.

• Your strength, balance, and vision

Regular, targeted exercise is the most effective way to build and maintain strength as well as balance. The team at Switch can help assess and implement the right exercise program that can challenge, then improve, your level of strength and balance. 

The Switch team can help with treatment therapies that can include;

• • – balance exercises
  • – strengthening exercises
  • – teaching strategies to use when you feel unsteady or off-balance (ie how to regain your balance BEFORE you fall over and hurt yourself) 
  • – Referral to other services (eg occupational therapist) for installation of rails, handholds etc 
  •  physiotherapy guided treatments such as balance, strength training and treatment targeting biomechanical correction (specific to the person) 
  • – ensure walking environments are clear of clutter (at home) 
  • – adequate footwear selection 
  • – use of effective walking aids 

It is also recommended to get a regular check with an optometrist to measure any reduction in vision or determine if glasses should be worn. Maintaining clear vision can obviously help with judging distances between objects, maintaining balance or even grabbing hold of handrails or other movement devices when needed. Last, of all it may be important when needing to make a phone call to get help.

• What you are wearing

Shoes play an important role in fall risk. If the sole is worn out it may increase your chances of slipping and if your shoes are loose, they can potentially cause you to trip. The Switch team can make sure you are in the right pair of supportive shoes, our podiatrist can provide a full assessment of your shoes and also a biomechanical assessment to ensure there are no other issues with your feet and movement. One of our physiotherapists can also do a movement assessment to understand how your body moves when walking. Adjustments can be made to then correct any movement problems. Combined with wearing the right shoes this can help with balance and movement.

Let’s not forget it is important to be mindful of your pants, skirts or robes that are being worn. A garment that is a bit too long could get caught or pose a trip hazard as you walk. So these should be looked at as well.

• The environment around you

The other major factor we already mentioned in the environment – not just inside the home but around it & the places you frequent the most. The most basic element is to ensure you have adequate lighting in the home especially at night when going to the bathroom. This could even include small illuminated floor lights to make the pathway more visible at night.

Handrails can be installed if you feel unsteady in a bathroom, shower or even steps leading into or out of the home. In some cases, it may make sense to remove the steps and replace these with ramps with a handrail.

Flooring is also important to consider, for example, it‘s best to avoid using rugs or mats where you frequently walk as you can trip on the edges. It is also important to check for loose or carpet where it might be gathering or small patches which can also lead to trips. If the home has floorboards or tiling their surface may be too slippery to be safe & these should be looked at. Lastly the kitchen, bathroom and laundry are potential wet areas so the right floor safety should be assessed in these areas to reduce the chance of slipping on water pooling on the floor.

Walking pathways should all be assessed from the front to the rear of the home – each path has to be free from clutter and with enough space to accommodate a walking frame or wheelchair if need be. Even things like uneven surfaces like pavers, where concrete meets a step, a driveway edge to a footpath etc can all be reviewed.

Our team can also help assess the local areas you frequent like shops, local clubs etc to then assess your suitability for a walker or other mobility device so that you can maintain your independence.

How do our physio’s assess a patient to determine the appropriate therapy?

• History of falls, how many falls in the last year
• What walking aid do you use? (walking stick, walking frame, 4 wheeled walkers etc)
• Do you have any other medical issues? Including osteoporosis or iron deficiency? 
• Have you had any fractures/broken bones before? 
• How did you fall? (e.g. Did you trip over an object or did you lose balance when walking to the bathroom ?)
• How many falls have you had in the past? 
• Do you often feel unsteady on your feet? 
• Do you normally use a walking aid? If so, what? 
• Do you have any history of surgeries or relevant medical history? (to screen for potential risk factors for falls such as Parkinson’s Disease) 

Examples of patients we have helped with fall prevention assistance

Judith W, 80 YO

Had a fall when walking her dog; tripped over a bump in the footpath when her dog tried to run after another dog; ended up fracturing her right proximal shaft neck humerus (upper arm bone) as well as tearing apart of her rotator cuff

Treatment consisted of immobilisation of 6 weeks, mobility exercises for the surrounding joints, as well as manual therapy for pain relief. This was then followed by soft tissue and joint techniques to achieve a full range of motion in her shoulder. We then targeted the shoulder as well as surrounding muscles to build the strength back up so she could lift objects overhead as well as walk her dog without issues. We concurrently performed balance training to work on underlying balance issues. Judith is now pain-free and has reached her goals (lifting overhead, walking her dog and lifting shopping into car/out of the car.

Ruth Wilson, 82 year old, home visit patient. 

Extensive medical history including metastatic terminal stage breast cancer, Parkinson’s disease + right ankle fusion, left ankle fusion, chronic lower back pain, chronic shoulder rotator cuff tears on both shoulders. Mobilises with 4WW

Goals: 

1. increase mobility distance and improve independence
2. improve balance to reduce/prevent falls, improve confidence
3. improve strength and conditioning in lower limb
4. reduce pain in the lower back and (R) shoulder

With regular treatment at Switch Physiotherapy each week for the past year, Ruth has gone from walking to the end of the street to now walking 2km at a time consistently. She has improved her balance and is much steadier on her feet. She is now receiving compliments about how “she is moving extremely well for an 82-year-old and looking fit!”