Introduction

Fall is one of the “Geriatric Giants” feared by the elderly. In these recent years it has been a hot topic commonly discussed as an important public health issue in our Malaysian ageing society. A big percentage of elderly patients admitted in the geriatric wards are commonly fall-related injuries.

Epidemiology

• Statistics showed that the increased rates of falling are closely associated with growing elderly and women are more at risk than men.
• Approximately 28-35% of people in their 65’s and beyond falling each year increasing to 32-42% for those who are over 70 years of age.
• Fall amongst the elderly is a big concerned because falls are costly maybe up to the Ministry of Health. The direct medical costs for the management of fall-related injuries maybe up to millions of ringgits.
• The total number of ageing population will be increasing dramatically in the next 5 years, and so will the economic burden.
• Another important consideration are injuries due to falls is the leading cause of mortality in older people aged over 75.

Identifiable Risk Factors for Falling

It is important to know the possible identifiable causes or factors that contributing to fall thus preventing it from happening. The etiology of falls is usually multi-factorial. We can summaries it as;

• Conditions that affect mobility or balance of the elderly such as arthritis of the knees or ankles which is the most common, stroke, Parkinson’s disease, Diabetes with neuropathy, and vestibular problems.

• Visual impairment or loss, associated with ageing.

• Confusion and cognitive impairment which may impair co-ordination.

• Vestibular impairment which can alter an older person’s sense of balance and space  perception, often causing dizziness.

• Urinary incontinence where the elderly in haste to the toilet will trip and fall.

• Polypharmacy especially drugs that cause hypotension, sleepiness or drowsiness.

• Other environmental hazards such as cluttering, lighting, slippery surface and also improper foot wears.

Practical Interventions :

• Physiotherapist would like to encourage mobility to be preserved as much as possible.

• It is evidenced by meta-analysis (Sherrington et all 2008) concluded that appropriate exercises are effective in reducing fall rates.

• The most effective and cost-effective fall prevention programs involves various activities and interventions.

The Action That The Elderly Can Take Is As Follows:

Carry out a systematic fall risk assessment with the help of your physiotherapist Home hazard assessment and environmental inspection includes :

• Stairs Safety
• Make sure stairs and steps are free from objects.  If the stairs are covered by carpet make sure they are not loose. Hand rails next to the steps are firmly secured.
• Steps must adequately be lit and switches are installed at the top and the bottom of the steps.
• Kitchen Safety
• Keep the kitchen utensils most often used the on the lower shelves at waist level.
• If you need to reach high objects, use a stable step stool, never use a chair.
• Assure the kitchen floor is clean and non-slippery.
• Bathroom Safety
• Use a rubber or non-slip mats in tubs and showers.
• Have grab bars installed where ever necessary, eg besides the toilet seat. Never use a towel bar for support. They are not strong enough to support your weight.
• Bedroom Safety
• Assure that all beddings and clothes are not thrown on the floor.
• Rooms and hallways are well-lit.  Place bed side lamp close by the bed for easy access to avoid over reaching and risk falling out of bed.
• Low bed is better than high bed.
• Keep items such as furnitures, books, magazines, boxes, blankets and other objects out of the walking path. Coil or tape all phones or electrical cords to avoid tripping.
• Other Factors
• Know your medications well. If you are taking medications that is lowering your blood pressure, ask your doctor the best time to take it. Be careful of medications that can make you drowsy.
• Have your vision examined and corrected annually.

Physiotherapist Role In The Prevention Of Falls

• Assessing your balance  
• Tests can be carried out to determine the status of balance such as Reach Test, Time Up and Go Test and many more.
• With the outcome results and critical analysis, the physiotherapist will plan and prescribe the appropriate program.
• Recommended Interventions
• Exercises includes components of balance exercises, functional strength activities (eg stairs, sit to stand) moderate intensity resistance training and endurance for general fitness.
• If poor balance is as a result of vestibular problems, physiotherapist will teach special exercises to correct or improve balance. Consult your physiotherapist on Vestibular Rehabilitation that is available in your hospital.
• Elderly suffering from stress incontinence or urgency which contribute to falls, also can be treated by your physiotherapist. You can gain benefits with special exercises to strengthen your pelvic floor and bladder training.
• Osteoarthritis of knee and ankle or muscular skeletal problems can be one of the cause of trips and falls due to pain and weakness. Consult your physiotherapist on pain management using electrotherapeutic modalities such as electrical, heat or ice or teaching strength, endurance, but also gait and mobility.

Education and information by the Physiotherapist
Awareness must be created among all elderly to prevent fall. You can consult your physiotherapist in your area for further assessment and explanation.

References

1. Exercise for falls prevention: putting evidence into practice, Richard Biss, Caulfield Community Rehabilitation Centre

2. Falls: assessment and prevention of falls in older people. NICE guidelines June 2013

3. Gillespie LD et al, Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2012; (9):CD007146.

4. Mayo Clinic A-Z health guide by Scott C. Leith M.D.

5. WHO Global Report on falls prevention in older age (2007)