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What is it about ?
Are you 65 or older, living at home, and having fallen 2 or more times in the past year, with or without injuries? You suffer from problems with your balance and walk ?
If so, you are more at risk of falling. In this case, preventing falls can help.
Indeed, the consequences of falls can be very diverse:
- skin lesions ;
- sprains;
- head injuries;
- fractures, for example of the hip, of wrist ;
- hospitalization, placement in a nursing home;
- fear of falling, so that:
- you avoid certain activities;
- you have less social contact;
- you have less confidence in yourself;
- your quality of life decreases.
To prevent falls, it is better to work as a team:
- different care providers (general practitioner, physiotherapist, occupational therapist, etc.) consult and collaborate;
- they talk to you, your family and the people who help you (your informal caregivers);
- they can assess your risk of falling, taking into account existing risk factors (see below) for :
- identify your possible specific needs;
- advise certain interventions to prevent falls;
- check whether these interventions have had a satisfactory effect.
Do the elderly fall often?
Out of 10 people over 65 who live at home, 2 to 4 fall at least once a year. Many of them even have repeated falls. In case of dementia, this figure is even higher.
What are the risk factors?
Usually there are several risk factors for falls. It is important to identify them. This will allow healthcare providers to offer an intervention suited to your situation.
Among the risk factors, we find:
- factors related to the state of health of the elderly;
- external factors.
Factors related to the state of health of the elderly
- Disorders of:
- the balance ;
- muscle strength;
- mobility.
- Fear of falling;
- Mental problem, eg confusion, mental decline;
- Vitamin D deficiency;
- Drop in blood pressure when the person stands up (orthostatic hypotension);
- Sight problem ;
- Pain ;
- Involuntary loss of urine (urinary incontinence);
- Risk behavior, for example rushing or carelessness when walking or moving.
External factors
- Some drugs:
- sedatives;
- sleeping tablets ;
- drugs for mental disorders.
- Take several drugs (polypharmacy);
- Social isolation ;
- Daily environment at risk:
- ground ;
- carpet ;
- poor lighting;
- unsuitable shoes.
What is a falls prevention program?
Effective fall prevention requires cooperation between different healthcare providers, you, your family and those who help you (your informal caregivers). The falls prevention program is targeted at:
- your risk of falling and the physical and psychological factors that play a role;
- a safe daily environment;
- sufficient physical activity;
- possible assistance devices.
Falls analysis
The Fall Prevention Team analyzes your risk of falling by:
- asking you questions, often using different questionnaires;
- doing a physical exam. For example, we observe your balance, how you walk and how you move;
- on your way to your home to see your daily surroundings.
By taking charge of these risks, the team tries to reduce your risk of falling.
What can your doctor do?
Your doctor’s main focus is on factors related to your condition that increase your risk for falls. He will direct you to the appropriate person on the falls prevention team for a specific assessment and / or intervention.
Checking your medications
The more medication you take, the higher your risk of falling. Your doctor can discuss with you whether it is necessary to adjust your treatment or to reduce the number of medicines. It is important that you take your medicine correctly and at the right time.
Blood pressure control
Sometimes you may have a drop in blood pressure when you stand up (orthostatic hypotension). It’s okay, but it can knock you down. Your doctor will advise you not to stand up too abruptly, but to stand up slowly and with something on.
Pain management
If you are in pain, you are more likely to fall. Your doctor will assess:
- the cause of your pain;
- how to treat these pains.
Eye exam
If you have eye problems and vision problems, your doctor will refer you to the ophthalmologist for an annual check-up.
It usually takes a while to get used to new spectacle lenses, especially if they are progressive lenses. So be careful, be careful not to fall.
In case of cataract, surgery, especially on the first eye, has a positive effect on your risk of falls.
Beware of psychological risk factors
If you have a psychological disorder, such as depression, your ability to assess things is reduced and your risk of falling is higher. Your doctor will try to give you the best possible support.
Physical activity
Exercise is helpful for everyone, but even more so if you have a high risk of falling.
Depending on your possibilities and preferences, your doctor will give you general advice on physical activity. For example :
- be active at home;
- get at least 30 minutes of moderate-intensity exercise per day, including at least 10 minutes at a stretch. You can walk, cycle, … Moderate intensity exercise is exercise that still allows you to talk. Walking 8,000 steps a day is a good goal;
- if you want to do more intensive exercises, it is better to do 20 minutes, 3 times a week;
- do weekly exercises that strengthen your muscles and balance, especially if you are afraid of falling.
Your doctor will prescribe a specific exercise program generally under the supervision of a physiotherapist:
- in groups or individually;
- in order to :
- maintain and / or improve your mobility;
- train your balance, strength, flexibility and endurance and to cope with possible walking difficulties.
Environment and safety
It is important that your daily environment is safer. To do this, your doctor may refer you to a physiotherapist or occupational therapist (to see further).
What can your physiotherapist do?
In order to reduce the risk of falling, the help of a physiotherapist is often recommended.
Information and advice
After evaluation, your physiotherapist will give you
- Informations about
- your risk of falling;
- factors that increase your risk for falls;
- walking aids (cane, walker or gadot, etc.);
- fall protection devices (bars to lean on, etc.);
- alarm systems.
- advices :
- do exercises;
- to move ;
- how to get back on your feet after a fall.
He can also refer you to an occupational therapist for this.
Exercises
Your physiotherapist
- will motivate you to get enough exercise. Indeed, physical activity reduces the number of falls and the need for medical intervention;
- will give you information or advice on specific exercise programs, adapted to your situation, such as tai chi or a hiking club for example.
- implement a specific exercise program that decreases the risk of falls. These are exercises to integrate into your daily activities and that you can do at home, for example:
- balance exercises;
- exercises to strengthen your muscles;
- exercises to be more flexible and more mobile;
- exercises that promote your endurance, reaction speed and your physical condition.
The exercise program takes into account:
- your request for assistance;
- your physical abilities;
- a safe exercise environment.
What can your occupational therapist do?
Preventing falls lowers the risk of falling, but it can still be a risk. Sometimes you can just be afraid of falling. The occupational therapist can help you perform your daily activities as well as possible, taking into account your risk of falling.
The occupational therapist can:
- assess your daily environment;
- give you advice:
- a safer daily environment, e.g. avoiding steps, rugs, slippery floors, etc.
- appropriate footwear:
- heel less than 2.5 cm;
- as large a bearing surface between the sole and the sole of the foot as possible;
- no non-slip soles unless the floors in your home are slippery.
- walking aids:
- cane;
- platform;
- walker,…. .
- home help equipment:
- handles and handrails in the house and in the shower;
- WC booster, ….
- discuss with you the usefulness of a:
- alarm system.
- Such an alarm detects a fall and immediately alerts someone so that we can help you.
- hip protector
- A hip protector is padding that decreases the risk of fracture if worn correctly.
- alarm system.
Want to know more?
- Prevent Falls and Injuries Here Where to find on this page of Saint-Luc University Clinics (UCLouvain)
- Falls prevention – Ottawa Public Health
Sources
Main sources
- Belgian clinical practice guide ‘The prevention of falls in the elderly living at home’ (28.09.2018) – ebpracticenet
- DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 -. Record No. T115430, Falls in Older Adults; [updated 2018 Dec 05, cited 06.2021]. Available from https://www-dynamed-com.gateway2.cdlh.be/topics/dmp~AN~T115430. Registration and login required.
- www.valpreventie.be
- valpreventie-ouderen.nl
- www.veiligheid.nl/valpreventie
Other sources
- Effectiveness of a multifactorial intervention, exercise program and vitamin D supplement as a fall prevention strategy in older people living at home? (03.15.2021) – Minerva
- Consensus meeting ‘Use of calcium and vitamin D’ (05.2015) – INAMI – National Institute for Sickness and Invalidity Insurance
- Recommendations to patients ‘The role of vitamin D and calcium in the prevention of osteoporosis and fractures’ (25.11.2016) – INAMI – National Institute for Sickness and Disability Insurance
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