How to Prevent Falls in Older People. Part 3.
How Your Health and Fitness Impacts on Your Fall Risk.
Anybody can fall. Falls are not confined to older people but the fact is that as we get older, our bodies naturally begin to slow down a little bit and often our fitness levels decrease. Age alone does not necessarily make us unhealthy or unfit, after all plenty of eighty-year-olds run marathons but these are people that look after their health and fitness. In this section I'm going to show you some health and fitness issues that can increase your fall risk.
Before we look at those, I need to mention a couple of factors that you can't alter, but need to be aware of so that you can work with them. There are two factors that you can't alter:
Age - You cannot alter your chronological age (your age counted in years). In general, the older you are, the higher your risk of falling. However, it is thought that once you reach the age of around eighty, your fall risk levels off. This may be something to do with the 'Survival of the fittest' maxim.
Functional age is the age at which our bodies function. Therefore you could have a 75 year old person (chronological age) who has the fitness levels of an average fifty year old (functional age). It is actually the functional age that is more important in measuring fall risk but as this is difficult to assess, we usually use the chronological age. So for simplicity, the older you are, up to the age of around eighty, the higher your fall risk will be.
Gender - Females are more likely to fall than males. It's a part of ourselves that we cannot alter. Women tend to have a less stable stance than men due to differences in the anatomy of the pelvis and that can increase fall risk. It is also a fact that women are more likely to suffer from osteoporosis that weakens the bones. A sudden twisting movement in the hip can cause a weakened hip to break and cause a fall. Equally, if you do fall, osteoporosis will increase the chance of breaking a bone if you hit the floor.
It has also been suggested that one of the reasons that older women are more likely to fall is because they are more physically active, doing more housework, cleaning, shopping and the like, while men tend to sit more. I'm not sure how accurate this is but maybe there is a grain of truth in it.
Now for the things that you CAN alter.
Gait- This is the way that you move about on your legs. One of the first signs to watch out for as we get older, is when we become hesitant in our gait. That is to say that we need to take a second or two to get our balance when standing up. Be aware of this sign and make sure that you steady yourself every time you stand up. A sudden drop in blood pressure on standing can also make you feel light-headed and therefore less stable. If this happens to you, speak to your doctor about it, especially if you are taking any kind of medication for your blood pressure.
Transferring yourself from a bedside chair to a bed, or any other instance when you are going from one sitting position to another can also pose a hazard because not only are you having to maintain balance, but you have to rely on sufficient muscle strength to move safely. Be careful when doing this; it is one of the most common times that people fall.
If you are unsteady on your feet and need a walking aid to move around then take extra care. Make sure that your walking aid is in good condition, that it has sound ferrules and that the aid is actually suitable for you. Get your Occupational Therapist, Physiotherapist or Community Nurse to check this if you are unsure.
Medication - As we get older, we tend to take more medication for various health reasons. Some medications can increase your fall risk such as medications that alter your level of alertness and medications that control blood pressure. You need to mention to your doctor if you think that any medication may be making you feel less steady on your feet BUT NEVER STOP TAKING PRESCRIBED MEDICATION WITHOUT CONSULTING YOUR DOCTOR FIRST.
Another thing to remember is that some medications interact with each other, making their affects more pronounced. Your doctor will have taken this into consideration when prescribing them but often people take more medication than they need, so check with your doctor if you take multiple medications. Alcohol can also interact with some medications, so check this with your pharmacist if you drink alcohol. Remember that grapefruit juice can also make some medications more potent, so if you drink grapefruit juice, check with your pharmacist if there are likely to be any problems.
Sight and Hearing - Poor sight can obviously make you more likely to trip on an unseen hazard. Get your eyesight tested regularly, wear the right glasses and keep them clean. Poor hearing can also increase fall risk if you are unable to hear warnings of a hazard, such as somebody telling you to watch out for the lead of the vacuum cleaner or watch out for ice outside. Talk to your doctor if your hearing is not as sharp as think it should be.
History of Falling - If somebody has fallen once, it is a strong indicator that they may fall again. This is especially true if somebody has fallen inside their own house, as they would be very aware of all the hazards in the house and should be able to avoid them. If this has happened it is important to check every area for fall hazards and correct them where possible. Do the same in the garden and advise the person to be vigilant, especially when outside of their property.
Medical History - Falling is not a medical problem in itself, but some medical conditions can make falling more likely. Any medical conditions that may reduce muscle strength, alter gait or alter the level of alertness may play a part in increasing fall risk. Some examples of such medical conditions are: Diabetes, Epilepsy, Uncontrolled Blood Pressure and Stroke (although there are many others). If you have any medical condition which may influence your fall risk, talk to your doctor for advice.
Mobility - The more mobile you are, the more opportunity there is to fall if you are not fit and completely steady on your feet. Acknowledge the fact that you may not be as agile as you once were and take the necessary care when walking. If you use a walking aid, then this shows that you need some assistance with walking so make sure that the walking aid is in good condition (this can't be emphasised enough).
If your mobility is restricted then you may find that your reaction time is also compromised. This could mean that if you stumble then you may not be able to save yourself from falling in time. Use every aid that is available to you and take no risks.
You would imagine that somebody who is bed or chair bound would not have an increased fall risk but this isn't true. Somebody who is chair bound may forget that they are unable to walk safely and may try to get up and walk. This can have dangerous consequences. Likewise, somebody who is bed bound may roll out of bed accidentally. In these cases surveillance and emphasis on the importance in asking for help when wanting to move is very important. ON NO ACCOUNT TRY TO TIE SOMEBODY DOWN OR USE ANY OTHER RESTRAINT. Restraining devices can cause death and will almost certainly increase fall risk in the long term. More about this in the next instalment when we look at some important fall reduction measures.
This is an excerpt from my book 'Fall Prevention for Older People - A Survival Guide'. Now available from amazon.