Introduction

Fall is defined as an event when a person is unintentionally falling to the ground or lower level usually the floor other than the consequence of sustaining a violent blow, loss of consciousness or sudden onset of paralysis due to stroke or seizure.

Falls are common among the older persons. Studies reported that 30 to 40% of older persons aged 65 years old and above in the community had one or more falls in the previous 12 months. A fifth sustained injury due to their falls. About 40% to 50% of residents of institutions fall each year. In a study done in the primary care clinic in Malaysia, the prevalence of falls among the older persons was around 47%.

It is important for the caregivers to know what to do when they see someone else fall. The proper reaction to a fall can help to decrease its physical and psychological consequences and enable the elderly regain their confidence more quickly and to continue to be as independent as possible.

Unwanted consequences of falls

• Falls related injury e.g. fracture (5%) and other serious injuries (15%)
• Prolonged post fall immobility can lead to:
  • Muscle atrophy
  • Joints contracture
  • Pressure sores
  • Dehydration
  • Pneumonia
  • Deep vein thrombosis
  • Orthostatic hypotension
  • Osteoporosis
• Secondary injuries due to post fall immobility and half of older people cannot get up again after the fall with increase dependency
• Psychological effect leading to loss of confidence, fear of falling, anxiety and depression
• Admission to institutional care
• Major cause of disability and death in elderly

Why is it important for the caregivers to know what to do if the older persons fall?

• Fall is very common among older persons they care for.
• As the person’s age, both the number of falls and the likelihood of injury will increase.
• So, it is very important for the caregivers to know what to do if the patients fall.
• The proper reaction to a fall can make the difference to minimize the physical and psychological consequences on the older person.
• It also enables the patients they care for to regain their confidence more quickly and to continue to be as independent as possible.

What should the caregivers do if they witness a fall?

In order to minimize the unwanted consequences of falls, the caregivers should try to take the following steps, depending on the condition of the older person after a fall.

If the caregivers see the older persons fall, resist the urge to get the person up immediately. First of all, check for the patients’ condition i.e.

• Is the older person conscious or unconscious?
• Does the person appears to be injured or has sustained fracture?
• Reassure the older person.

If the older person cannot get up, the caregivers can follow the steps below:

• Call for help immediately
• Apply first aid if the caregivers are able to do so
• Try to help the older person to find a comfortable position which does not hurt
• Keep him or her warm by using clothing or blanket.

If the individual appears able to get up, follow the steps below with care:

• Bring a stable chair close by the patient, help him/ her to turn onto the side and bend the upper leg and help the patient into a semi-seated position.
• Placing the caregivers behind the older person and apply a firm grip on the hips, then help the person to a kneeling position with both hands on the chair.
• By holding on to the chair, the older person should then place the stronger leg in front. The caregivers may help by guiding his or her leg.
• By applying a firm grip on the hips, help the older person to stand, then turn and sit on the chair.

The caregivers should encourage the older persons to practice these steps frequently so that they are more prepared in case they fall again subsequently.

When should the caregivers bring the older persons to consult a doctor for further assessment?

The caregivers should never underestimate the seriousness of a fall even if it appears no harm was done to the older persons initially.

Reasons to bring the older persons to consult a doctor include:

• Loss of consciousness may be transient, just before or after the fall
• Any injuries
• Any strong or persistent pain
• Dizziness or a headache
• Nausea or vomiting
• Any weakness
• Any vision problems

The above symptoms may appear any time after a fall. It is important for the caregivers to inform the doctor about the situation of fall so that the doctor can then assess and determine if the fall is linked to an illness, prescribed medication, over-the-counter drugs or other factors.

How can the caregivers help the older persons to prevent further fall?

• To ensure safe environment
  Caregivers should check the surroundings to find out if there are any fall hazards and simple modifications can be applied to prevent further falls e.g. install grab bars in the bathroom, non-slip rugs and handrail on both sides of stairs.
• To wear appropriate footwear
  The caregivers should make sure that the older persons are wearing a suitable footwear to reduce the risk of further falling. The suitable shoes should have non-slippery soles, heels of reasonable height, and are wide enough to prevent any twisting of the foot.
• Help the older persons to plan how to get help if they have another fall and share the plan with their family members and neighbors
  Caregivers should consider getting an emergency call device or a cordless phone close at hand for the older person, ask a friend or a family member to phone the older persons at regular intervals, give their home keys to someone they trust who could use them in an emergency. In short, caregivers should think about what the older persons can do to get help if they have another fall.

Conclusion

Falls could lead to significant morbidity and mortality in elderly, as well as affect the quality of life of the older persons. As we age, both the number of falls and the likelihood of injury will increase. Therefore, it is very important for the caregivers to know what to do if the older persons fall. The proper reaction to a fall by the caregivers can minimize the physical and psychological consequences of fall and enables the elderly to regain their confidence more quickly and to continue to be as independent as possible.

References

1. The prevention of falls in later life. (1987). A report of the Kellogg  International Work Group on the Prevention of Falls by the   Elderly. Dan Med Bull, 34 (4), 1-24.
2. Centers  for Disease Control and Prevention (CDC). (2008). Self-reported  falls  and falls at home among person more or equal 65 years- United States,2006. MMWR Morb Mortal Wkly, 57, 225
3. Sazlina SG, Krishnan R, Samsul AS, Zaiton A , Visvanathan R.  (2008). Prevalence of falls among older people attending a primary care  clinic in Kuala Lumpur Malaysia.  Malaysian Journal of Community  Health, 14(1), 11-15.
4. Ayse O, Hulya D, Nihal G, Mehtap O, Didem K. (2005). The relationship between risk factors for falling and the quality of life in older  adults. BMC Public Health, 5, 90 doi:10.1186/1471-2458
5. Public Health Agency of Canada. If you fall or witness a fall, do you know what to do? (Date modified : 05-07-2011) (http://www.phac-aspc.gc.ca/seniors-aines/publications/ public/injury-blessure/falls-chutes/index-eng.php)(Accessed on 12 August 2015)