The risk of a fall unfortunately increases as we age, but they are not inevitable. We caught up with falls expert Ashley Martin from RoSPA to hear their insight on what makes falls so serious for older people, and what we can do to prevent them.
At Age UK Personal Alarms, we find that many of our customers are understandably worried about falls. In fact, one of the main reasons given for purchasing a personal alarm is to ensure help is at hand in case of a fall, and to regain confidence if one has already occurred.
We’ve been in touch with Ashley Martin, a public health expert at RoSPA (The Royal Society for the Prevention of Accidents) to help answer some of your questions around falls, and to share some invaluable advice about how to stay safe.
First things first, why are falls so common in older people?
Falls are so common in older adults because the risk of falling in the home increases with age. In fact, falls affect over a third of people over 65 years old and 40% of people over 80. The cause of a fall is often multi-factorial, involving both environmental hazards and an underlying medical condition.
A substantial number of falls are due to unspecified reasons and occur whilst moving about on one level, which may reflect instability associated with impaired general health. Good strength and balance is important for steadying oneself, so it’s understandable that as our strength and balance reduces naturally with age, we’re less steady on our feet.
Why are falls more serious for older citizens?
As bones become more brittle and skin becomes thinner the likelihood of a serious injury as a result of a fall increases. With a decline in muscle mass we are also less able to get up from a fall and so even if bones are not broken, the likelihood of lying on the floor for a long period of time leads to the risk of other problems such as hypothermia.
Hip fractures are a particular problem. Less than a third of patients who suffer a hip fracture return to the pre-facture levels of activity.
Some people see falls as an inevitable part of ageing, or just one of those things we have to accept. What do you think about that view?
Falls do not have to be inevitable! We can take action to maintain the strength and balance that will help to prevent falls. We can also take steps to make the home environment safer. Although there will always be some who fall, there is action we can take to prevent them.
That’s reassuring, are there any other common misconceptions about falls which you hear a lot?
Often we hear people say “Falls only affect older people” or “I’ll worry about that when I’m older” which could be a dangerous attitude to hold! Although the consequence of falls are often worse for older people, they can happen at any age. If someone has a series of falls it may be an indicator of other health problems or of a greater likelihood of falls in later life.
What’s more, evidence suggests that the more we do to maintain healthy lifestyles while we are younger, the better prepared our bodies will be to prevent falls in later life.
Let’s talk about what many worry about most; falling whilst alone at home. Do you have any practical advice for preventing falls in the home?
Falls can be brought on by a mixture of health and environmental factors, so it’s important to address both. In terms of what you can do at home there are a number of changes you could make to improve your safety.
Firstly, take a fresh look at your home and see if there are any tripping hazards, for example rugs, slippery floors, clutter on stairs and walkways, poor lighting, or highly patterned carpets that are causing a problem with visibility. Then figure out which of these potential hazards could be easily modified to be safer.
Having handrails on both sides of the stairs is a great home adaption that can make a significant difference. Whilst falls on the stairs are thankfully not as common as in other areas of the home, these falls can cause the most serious injuries. Similarly, grab rails can be fitted in bathrooms and any other places where you notice yourself struggling on occasion.
What about in the garden where conditions may vary day to day?
I would recommend firstly keeping surfaces and particularly paths in good repair, and being cautious of slippery paths or wet leaves in bad weather conditions.
As in the home, it could be worth considering installing grab rails on entrance steps or any other areas of the garden where you notice a mobility or stability issue. There’s really no shame in installing these, and it’s much better to do it at the first sign of instability rather than waiting until it is really needed.
Are there any areas of the home where falls are most common?
It seems to vary with age. For the 65-75 age range it tends to be where people are more active, for example in the living room or garden. However, for over 75s falls tend to happen more in the bedroom.
Falls on stairs are not the most numerous but, for obvious reasons, can be the most serious.
What kind of health problems can increase the risk of a fall?
Loss of strength, balance and gait, decline in vision and hearing, mental health problems and deficiencies in the diet are all contributory risk factors. Although prescription medicines are seldom the cause of falls, they may also be a major risk factor.
In addition to increasing the risk of a fall, these health factors can also increase the risk of injury resulting from a fall. Here are some examples of how certain health problems can cause accidents at home.
Type of Accident
Decrease in the blood supply
Fainting, leading to falls, contact burns, loss of Confidence
Decrease in sensation
Scalds in bath, superficial burns to legs, e.g. standing too close to fire, hypothermia, falls
Decrease in the skin or bone condition
Bruising, tearing or breaking of tissues may occur when moving around house, if rough edges or protrusions are present in the design
Decrease in strength
Loss of balance, leading to falls, dropping items, inability to lift or move items
What should you get regularly checked by your GP if you’re worried about falling?
Make sure you have your eyes tested regularly, as you may not notice a slow deterioration over time. Similarly, ask your GP to check your ears as they play a big part in coordinating balance. GPs and falls clinics may also check a patient’s gait and observe them walking.
If you are on four or more medications make sure you have a medicine use review with your doctor or pharmacist and check regularly whether you still need to be on the medicines you have been prescribed. People on multiple medications are far more likely to fall.
How can a fall damage someone’s mental wellbeing?
Loss of confidence is a significant outcome for many who have a fall. This in turn leads them to a more sedentary lifestyle and increases the risk of loneliness and isolation.
We recommend people talk to friends and family, their GP, or a support service [see bottom of page] about any concerns after a fall, to ensure the right measures are being put in place to reduce the risk of it happening again.
You’ve mentioned the importance of maintaining strength and balance to reduce the risk of falls. What are the best exercises that older people can do at home to improve in these areas?
Exercise such as walking might be good for general health but there is no evidence that it helps with strength and balance.
Strength and balance exercises are important and there’s lots that you can do easily at home. The NHS has some simple balance improving exercises listed on their website with easy to follow images and instructions. Some of these include side steps, walking toe to heel, and standing on one leg (with hands against a wall).
Try and practice these at least twice a week, or when you get a chance. You could challenge yourself to one exercise each time you are waiting for the kettle to boil!
What about outside the home, are there any useful classes which can help prevent falls?
Similarly, any exercises which improve strength and balance will be useful. Many people find that Yoga and Pilates are good for gently building strength and balance, without too much exertion or risk of injury.
It’s important to always check with your GP if you’re unsure about an activity, and mention any health conditions you may have to the class instructor.
When Falls happen
What should someone do immediately after falling?
The first thing is don’t panic. Stay calm and take a moment to listen to your body to see if you are hurt. If you feel you can get up, slowly help yourself up using nearby furniture to stabilise yourself. We recommend familiarising yourself with our video (see above) demonstrating how to get up safely after a fall.
You may wish to have a mobile phone or alarm on hand in case you need to call for assistance, allowing you to remain still until help arrives.
Is there a way of falling to reduce the chance of a serious injury?
Protecting the head is important and injuries quite often happen when people put their arms out to try and break the fall. However, this is not something that we have covered in detail because it is very difficult to think about how you are falling when it can happen so quickly.
Should someone visit their GP after a fall even if they were not injured?
They should notify their GP as it might be a symptom of something else, or the start of a problem with falls.
Is any sort of rehabilitation offered by the NHS after a fall? What does this involve?
It varies, but there are usually falls services for people with a history of falling and there may be some rehabilitation available from an Occupational Therapist or Physiotherapist. If people who have had falls are not referred into these services they should contact their GP to find out more.
Finally, we receive a lot of questions asking if a parent who has had a fall now needs full time care, does this have to be the case?
This is dependent on many factors: the nature of the injury, whether there is permanent disability, and the level of the patient’s ability to look after themselves. It is impossible to generalise but in general terms its people who have recurrent risk of falling (usually with multiple health issues) that need more care. A fall in itself is not an indicator of someone needing full time care.
There are many useful resources online for both help preventing falls, and regaining confidence after a fall. Here are a few that we recommend.
RoSPA – RoSPA have a collection of useful information about how to stay safe at home, and have been running their Stand Up, Stay Up campaign for over 2 years, educating businesses and individuals across the country on how to prevent falls in older people.
Age UK Personal Alarm service – If you are worried about the risk of falls at home you may find a personal alarm invaluable for the peace of mind it can bring. If you’re unsure feel free to arrange a no obligation demonstration with a representative who can answer any questions you may have.
Age UK – Age UK offers advice on preventing falls, and a guide to spotting hazards in your home. Age UK has a guide called Staying Steady – looking at falls and many factors to consider to help reduce your risk of having one. They also operate an advice line which can be called for any further advice and operate exercise classes at some of their local Age UK centres.
NHS – The NHS lists some useful and simple exercises that, if practiced regularly, can improve balance and subsequently reduce the risk of falls.
Move it or Lose it
– Similarly, Move it or Lose it also recommend some exercises which focus on improving strength and balance. They also run exercise classes across the country which are developed specifically to improve agility, flexibility, balance and strength in older adults.